Accepted Manuscript Synchronous Lobular Carcinoma In Situ And Invasive Lobular Cancer: Marker or Precursor For Invasive Lobular Carcinoma A.S. Wallace, MD D. Xiang, MD L. Hockman, BS M. Arya, MD J. Jeffress, MS Z. Wang, MA P.S. Dale, MD PII:
S0748-7983(14)00422-3
DOI:
10.1016/j.ejso.2014.04.007
Reference:
YEJSO 3820
To appear in:
European Journal of Surgical Oncology
Received Date: 19 November 2013 Revised Date:
1 April 2014
Accepted Date: 11 April 2014
Please cite this article as: Wallace AS, Xiang D, Hockman L, Arya M, Jeffress J, Wang Z, Dale PS, Synchronous Lobular Carcinoma In Situ And Invasive Lobular Cancer: Marker or Precursor For Invasive Lobular Carcinoma, European Journal of Surgical Oncology (2014), doi: 10.1016/j.ejso.2014.04.007. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Title page Synchronous Lobular Carcinoma In Situ And Invasive Lobular Cancer: Marker or Precursor For Invasive Lobular Carcinoma
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Statement about content of paper: Little is reported about the incidence of lobular carcinoma in situ (LCIS) in specimens of invasive lobular cancer (ILC). We report a large coexistence of ILC with LCIS in a 10 year cohort of women.
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A.S. Wallace, MD 1 D. Xiang, MD 2 L. Hockman, BS 1 M. Arya, MD 2 J. Jeffress, MS 1 Z. Wang, MA 3 P.S. Dale, MD 4
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1. University of Missouri Hospitals and Clinics University of Missouri School of Medicine 1 Hospital Drive, MC520, DC116.94 Columbia, MO
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2. University of Missouri Hospitals and Clinics Division of Hematology Oncology 1 Hospital Drive, MC520, DC116.94 Columbia, MO
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3. University of Missouri Hospitals and Clinics Division of Hematology Oncology 1 Hospital Drive, MC520, DC116.94 Columbia, MO 4. Corresponding Author: P.S. Dale, MD University of Missouri Hospitals and Clinics 1 Hospital Drive, MC520, DC116.94 Columbia, MO Fax: 573-884-6054 Number: 573-882-8454
[email protected] Conflict of Interest: No authors have financial conflicts of interest.
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Abstract
AIM:
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Lobular carcinoma in situ (LCIS) is a known risk factor for invasive breast carcinoma, but there is increasing data indicating a possible precursor relationship. This study investigates the
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incidence of lobular carcinoma in situ that occurs with invasive lobular carcinoma (ILC).
METHODS:
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Women diagnosed with ILC or LCIS from 2000-2010 were retrospectively identified and reviewed after institutional review board approval. This group was divided into two cohorts: ILC alone, and LCIS and ILC (ILC/LCIS). Patient demographics, disease characteristics, and
RESULTS:
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treatment modalities were captured. P 2 cm in comparison to IDC. Despite this higher T stage, prognosis
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was better for ILC than the IDC cohort. [26] In the prior mentioned SEER analysis, Chuba et al. found that IBC diagnosed after LCIS was more likely to be smaller than primary IBC. [8] Hence, we postulated that our findings of smaller tumor size in ILC/LCIS was simply an earlier manifestation of invasive lobular disease. Despite the similar age at diagnosis, duration of follow-up, and overall recurrence rates between our two cohorts, patients were more likely to be
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dead at time of analysis with ILC than with the more indolent ILC/LCIS. If ILC/LCIS lesions were simply diagnosed earlier than their ILC counterparts, it is not unreasonable to assume
Weakness
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worse survival would be due to the more advanced nature of the disease.
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Although pathology specimens were reviewed by experienced pathologists at our institution, no centralized review was performed. It is possible that some cases may be changed today given the evolving diagnostic criteria of lobular disease, and understanding about the role of LCIS as a precursor and prognostic factor rather than a form of breast cancer. Also, given our short followup, we may not have provided enough time for detection of contralateral breast recurrences that are typically reported in studies with follow-up of 10 to 20 years. In the previously mentioned
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review of National Surgical Adjuvant Breast and Bowel Project (NSABP) patients, Fisher et al. found contralateral cancer recurrences occurred later than ipsilateral recurrences, with 70% identified after five years in comparison to 44% in ipsilateral breast. [27] Despite these
with pre-invasive and invasive lobular disease.
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Conclusion:
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weaknesses, this study adds valuable information regarding disease characteristics for patients
The presence of a pre-invasive disease may present precursor lesions to invasive carcinoma. The
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incidence of lobular carcinoma in situ in proximity to specimens of invasive lobular disease was high in our 10 year cohort of patients (47%). These findings are hypothesis generating, and
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further research is necessary to identify the relationship between in situ and invasive disease.
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Table 1: Treatment and Surgical Pathology Characteristics by Histology ILC/LCIS (n=37) (41%) (32%) (22%) (5%)
0.54
(38%) (48%) (11%) (3%)
0.19
12 21 4
(32%) (57%) (11%)
0.33
17 18 2
(46%) (49%) (5%)
0.26
21 13 3
(57%) (35%) (8%)
0.80
15 (5-85)
--
0.03
14 19 1 3
(38%) (51%) (3%) (8%)
0.11
24 5 3 5
(65%) (13.5%) (8%) (13.5%)
0.75
14 18 4 1
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15 12 8 2
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AJCC Stage 1 11 (25%) 2 19 (43%) 3 11 (25%) 4 1 (2%) Other 2 (5%) Method of Initial Diagnosis Clinical Exam 23 (52%) Mammogram 17 (39%) Ultrasound 4 (9%) MRI Surgical Diagnosis Excisional 8 (18%) Core 31 (71%) Unknown or other 5 (11%) Surgical Extent Mastectomy 28 (64%) Less than Mastectomy 15 (34%) Biopsy 1 (2%) Lymph Node Evaluation Negative 22 (50%) Positive 17 (39%) Unknown 5 (11%) Tumor Size Largest Diameter(mm) 35 -(range) (n= 74) ( 1-110) Nuclear Grade Grade 1 16 (36%) Grade 2 14 (32%) Grade 3 4 (9%) Unknown 10 (23%) Margins Negative 29 (66%) Close (