A 38-year-old woman presents with a breast lump. Core biopsy shows lobular carcinoma in situ (LCIS). What is the MOST appropriate management?

• A Wide local excision with clear margins
• B Mastectomy as LCIS is a high-grade malignancy
• C Axillary sentinel node biopsy to stage the disease
• D Surveillance and risk-reduction counselling; excision only for pleomorphic variant ✓

Explanation

Classical LCIS is a risk indicator, not a direct precursor requiring excision — it indicates a 7-12-fold increased lifetime risk for invasive cancer in either breast. Management involves surveillance, and risk-reduction options (chemoprevention with tamoxifen or raloxifene, or risk-reducing surgery for selected high-risk patients). Pleomorphic LCIS behaves more aggressively and warrants excision with clear margins. Axillary staging is not required for LCIS.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.