A 55-year-old woman undergoes wide local excision for a 2.2 cm ER-positive, HER2-negative invasive lobular carcinoma. Final histology reveals lobular carcinoma in situ (LCIS) at the surgical margin. What is the most appropriate management?

• A Re-excision to clear all LCIS at margins
• B Mastectomy due to diffuse LCIS
• C Chest wall radiation to sterilize the margin
• D No further surgery; LCIS at margins does not mandate re-excision ✓

Explanation

Current consensus guidelines (SSO-ASTRO-ASCO) state that LCIS at surgical margins after breast-conserving surgery does not mandate re-excision, unlike invasive carcinoma or DCIS. LCIS is considered a risk factor and marker of increased bilateral breast cancer risk rather than a true precursor requiring clear margins. The clinical management is focused on surveillance, chemoprevention (tamoxifen or aromatase inhibitor), and shared decision-making, not margin re-excision.

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

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Written and medically reviewed by the StethoPrep medical team.