A 44-year-old woman undergoes core biopsy of an area of architectural distortion. Histology shows classic lobular carcinoma in situ involving the terminal duct lobular units, with E-cadherin loss. No invasion is seen. The most appropriate management is:

• A Wide local excision to clear margins, as LCIS is an obligate precursor
• B Simple mastectomy because ipsilateral recurrence risk approaches 30%
• C Radiotherapy to the breast alone
• D No further surgery; treat as a risk marker with surveillance and consider endocrine chemoprevention ✓

Explanation

Classic LCIS is usually an incidental finding and behaves as a marker of increased risk of future breast cancer in either breast rather than as a direct precursor demanding excision. Management is close surveillance with consideration of tamoxifen or raloxifene chemoprevention. Pleomorphic LCIS with central necrosis may warrant excision, but classic LCIS found on core biopsy does not require margin-negative surgery. Radiotherapy alone has no role, and mastectomy is reserved for exceptional circumstances.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.