The primary aim of this study was to determine the upgrade rates of variant lobular carcinoma in situ (V-LCIS, ie, combined florid [F-LCIS] and pleomorphic [P-LCIS]) compared with classic LCIS (C-LCIS) when diagnosed on core needle biopsy (CNB). The secondary goal was to determine the rate of progression/development of invasive carcinoma on long-term follow-up after primary excision. After institutional review board approval, our institutional pathology database was searched for patients with “pure” LCIS diagnosed on CNB who underwent subsequent excision. Radiologic findings were reviewed, radiologic–pathologic (rad-path) correlation was performed, and follow-up patient outcome data were obtained. One hundred twenty cases of LCIS were identified on CNB (C-LCIS = 97, F-LCIS = 18, and P-LCIS = 5). Overall upgrade rates after excision for C-LCIS, F-LCIS, and P-LCIS were 14% (14/97), 44% (8/18), and 40% (2/5), respectively. Of the total cases, 79 (66%) were deemed rad-path concordant. Of these, the upgrade rate after excision for C-LCIS, F-LCIS, and P-LCIS was 7.5% (5 of 66), 40% (4 of 10), and 0% (0 of 3), respectively. The overall upgrade rate for V-LCIS was higher than for C-LCIS ( = .004), even for the cases deemed rad-path concordant ( value: .036). Most upgraded cases (23 of 24) showed pT1a disease or lower. With an average follow-up of 83 months, invasive carcinoma in the ipsilateral breast was identified in 8/120 (7%) cases. Six patients had died: 2 of (contralateral) breast cancer and 4 of other causes. Because of a high upgrade rate, V-LCIS diagnosed on CNB should always be excised. The upgrade rate for C-LCIS (even when rad-path concordant) is higher than reported in many other studies. Rad-path concordance read, surgical consultation, and individualized decision making are recommended for C-LCIS cases. The risk of developing invasive carcinoma after LCIS diagnosis is small (7% with ∼7-year follow-up), but active surveillance is required to diagnose early-stage disease.

中文翻译：

---

与核心针活检诊断的经典原位小叶癌相比，变异型原位小叶癌的升级率：一项 10 年单一机构回顾性研究

本研究的主要目的是确定变异型小叶原位癌（V-LCIS，即结合华丽 [F-LCIS] 和多形性 [P-LCIS]）与经典 LCIS (C-LCIS) 的升级率经粗针活检（CNB）确诊。第二个目标是确定初次切除后长期随访中浸润性癌的进展/发展率。经过机构审查委员会批准后，我们​​的机构病理学数据库中搜索了在 CNB 上诊断为“纯”LCIS 并随后接受切除的患者。审查放射学结果，进行放射学-病理学（rad-path）相关性，并获得后续患者结果数据。 CNB 发现了 120 例 LCIS 病例（C-LCIS = 97，F-LCIS = 18，P-LCIS = 5）。 C-LCIS、F-LCIS 和 P-LCIS 切除后的总体升级率分别为 14% (14/97)、44% (8/18) 和 40% (2/5)。在所有病例中，79 例 (66%) 被认为是 rad 路径一致的。其中，C-LCIS、F-LCIS 和 P-LCIS 切除后的升级率分别为 7.5%（66 例中的 5 例）、40%（10 例中的​​ 4 例）和 0%（3 例中的 0 例）。 V-LCIS 的总体升级率高于 C-LCIS (= .004)，即使对于被视为 rad 路径一致的情况（值：.036）也是如此。大多数升级病例（24 例中有 23 例）显示 pT1a 疾病或更低。平均随访 83 个月，8/120 (7%) 例发现同侧乳腺浸润性癌。六名患者死亡：2 名死于（对侧）乳腺癌，4 名死于其他原因。由于升级率较高，CNB 诊断出的 V-LCIS 应始终切除。 C-LCIS 的升级率（即使在 rad 路径一致时）比许多其他研究中报告的要高。对于 C-LCIS 病例，建议进行 Rad-path 一致性阅读、手术咨询和个体化决策。 LCIS 诊断后发展为浸润性癌的风险很小（约 7 年随访时为 7%），但需要积极监测才能诊断早期疾病。