Manuel A. Torres-Salichs MD,FACS Surgical Oncology, Breast Surgeon

Edileidis Tarrio, ARNP-BC, OCN





Lobular Carcinoma In Situ (LCIS)

LCIS: LCIS is a pathologic entity that continues to cause great anxiety and confusion to both patients and the medical community. LCIS contains foci of neoplastic (abnormal) cells similar to invasive lobular carcinoma with the exception of being confined within the breast lobule. LCIS has mainly been considered a risk factor, but not as a precursor to invasive breast cancer. LCIS is not a breast cancer. Nevertheless, some authors suggest that LCIS could be an indolent precursor. A diagnosis of LCIS is associated with a higher risk of developing breast cancer in both the affected breast and contralateral side in the future. Approximately 66% of the subsequent breast cancers are located in the affected breast. The majority of breast cancers are ductal in origin (50%). Invasive lobular carcinoma occurs at a higher frequency (23%) than in the general population (6.5%).

LCIS does not cause changes in either imaging studies or physical examination. It is usually an incidental finding in breast biopsies performed for other reasons. Controversy still exists regarding the surgical management of LCIS diagnosed by needle core biopsy. In the presence of an abnormality such as a palpable mass, mammographic density, microcalcifications or sonographic abnormality an open excisional biopsy is recommended to rule out an underlying cancer. In the absence of abnormal imaging findings further management regarding the need of an open biopsy should be discussed with the breast surgeon. An open biopsy is still a strong consideration because LCIS usually does not cause changes in either imaging or physical examination and additional disease must be ruled out.

LCIS.This image demonstrates a breast lobule with cancer cells confined within the lobule. LCIS is considered a risk factor to develop breast cancer. The patients with LCIS are given the option of chemoprevention to decrease the possibility of developing a breast cancer.


Close observation with a baseline breast MRI, clinical breast exam and breast imaging every 6 months
Chemoprevention with tamoxifen or raloxifene (high risk post menopausal women only)
Bilateral prophylactic mastectomy. The role of prophylactic mastectomy is debatable as only 15 to 20% of patients who elect to observe will eventually develop breast cancer. These cancers are likely to be detected at an early stage and are potentially curable when they are diagnosed

Atypical Hyperplasia

Atypical Ductal Hyperplasia (ADH) and Atypical Lobular Hyperplasia (ALH)

ADH and ALH: Atypical hyperplasia is a high-risk breast lesion that can lead to breast cancer during lifetime. It is considered precancerous. It is defined as a growth of abnormal cells within the ductal system or lobules of the breast. These lesions usually do not have clinical or specific radiographic manifestations.


Clinically, patients with a core biopsy identifying atypical hyperplasia, either ADH or ALH, should undergo an excisional biopsy. Examination of additional tissue is important as the pathologic analysis of the same specimen may vary between pathologists. In some studies, cancer has been found in a significant number of the biopsy specimens. Margins of resection do not appear important as long as malignancy has been properly ruled out.

The patients with a diagnosis of atypical hyperplasia should be evaluated for chemoprevention. Multiple studies have evaluated tamoxifen as a prevention of breast cancer in high-risk individuals. Using the Gail Risk Analysis Model, tamoxifen has been used in patients who have a 5-year risk of developing breast cancer equal to or greater than 1.66%. Studies have shown a 50% reduction in both invasive cancer and carcinoma in situ. There was also a significant reduction in patients with a diagnosis of atypical hyperplasia. Raloxifene has also been used as a chemo-preventive agent showing good results in postmenopausal high-risk patients.

Hyperplasia Without Atypia

In cases of hyperplasia without atypia, a slight increased risk of breast cancer has been demonstrated in several studies. The relative risk with moderate or florid hyperplasia ranges from 1.5 to 2.0. The need of chemoprevention has not been supported by studies. Surgical excision is not indicated unless there is concern of additional disease.