A 50-year-old woman undergoes core biopsy of an area of architectural distortion seen on screening mammography. Histology shows a classic lobular neoplasia pattern with loss of E-cadherin expression involving the terminal duct lobular units, with no invasive component. There is no family history. What is the correct management?

• A Wide local excision with radiotherapy to the affected breast
• B No further surgery; consider chemoprevention with tamoxifen and enhanced surveillance of both breasts ✓
• C Simple mastectomy because of high ipsilateral recurrence risk
• D Sentinel lymph node biopsy followed by annual MRI of the ipsilateral breast only

Explanation

Lobular carcinoma in situ is a marker of increased risk of subsequent invasive carcinoma in either breast rather than an obligate precursor demanding local treatment, so excision, mastectomy, and nodal sampling have no role once invasion is excluded. Management consists of surveillance of both breasts, with tamoxifen offered for risk reduction in appropriate women. The E-cadherin loss explains the discohesive histology and also underlies invasive lobular carcinoma, but it does not change the non-operative approach to LCIS itself.

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

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Written and medically reviewed by the StethoPrep medical team.