| One of the more confusing areas in breast | | | | mastectomy with a diagnosis of DCIS, be sure |
| pathology for patients is the difference between | | | | that the pathology report includes the following: |
| ductal carcinoma in situ and lobular carcinoma in | | | | the size of the DCIS, the grade, the presence or |
| situ (DCIS vs. LCIS). DCIS arises in the larger | | | | absence of necrosis, and the distance the DCIS is |
| ducts of the breast and LCIS arises within the | | | | from the surgical margins. All of these factors |
| lobules of the breast. However, the ducts and | | | | influence what type of treatment you should |
| lobules are connected which means that DCIS | | | | receive next. Possible therapies include one or |
| may travel into the lobules and LCIS may travel | | | | more of the following: additional surgery, radiation |
| up the ducts. For this reason, pathologists rely on | | | | therapy, or endocrine therapy. |
| the type of cells and pattern of growth to | | | | Lobular Carcinoma In Situ (LCIS) |
| determine the diagnosis of DCIS vs. LCIS. Only a | | | | Lobular carcinoma in situ (LCIS) refers to a |
| pathologist can make this distinction. In some | | | | neoplastic proliferation of cells that fill up the |
| cases, both DCIS and LCIS are present in the | | | | lobules in your breast and may extend into the |
| same biopsy. | | | | duct system. |
| DCIS and LCIS both increase a patient's relative | | | | Unlike DCIS, LCIS is generally not graded by most |
| risk for developing invasive breast cancer and | | | | pathologists. An exception is a recently described |
| that risk applies to both breasts. However, DCIS | | | | entity called "pleomorphic LCIS." Pleomorphic LCIS |
| is also thought to be a "precursor" to invasive | | | | refers to an in situ carcinoma with the |
| carcinoma based upon numerous research studies. | | | | characteristic features of LCIS, plus more atypical |
| This is why your surgeon tries to remove all | | | | cells and often necrosis (dead cells). Pleomorphic |
| areas of DCIS from your breast and why many | | | | LCIS can be difficult to distinguish from DCIS in |
| patients subsequently receive radiation therapy to | | | | many cases, but a special stain called e-cadherin |
| that breast. | | | | can be used to help your pathologist make the |
| LCIS, on the other hand, has not traditionally been | | | | distinction. |
| considered to be a "precursor" to invasive | | | | Treatment of LCIS vs. Pleomorphic LCIS |
| carcinoma, therefore complete removal of LCIS | | | | If you have a diagnosis of LCIS on a core needle |
| and radiation therapy is not required. There is | | | | biopsy, generally your surgeon will want to |
| emerging data that may change this way of | | | | perform surgery to excise the area of concern, |
| thinking, but the current standard of care is to | | | | although this is somewhat controversial in the |
| treat LCIS and DCIS differently. One exception to | | | | medical literature. If you have a diagnosis of only |
| this may be pleomorphic LCIS which will be | | | | LCIS on your lumpectomy/partial mastectomy, |
| discussed later. | | | | there is no need to worry about clear margins |
| Ductal Carcinoma In Situ (DCIS) | | | | and radiation therapy is not the standard of |
| DCIS is a complex diagnosis. If you are diagnosed, | | | | treatment. Unlike classic LCIS, there is no |
| it's important to know what grade of DCIS your | | | | uniformly accepted standard treatment for |
| pathologist has assigned (low, intermediate, or | | | | pleomorphic LCIS, although many medical teams |
| high), and whether or not necrosis (dead cells) are | | | | choose to treat it like DCIS. |
| present. | | | | Once you have a diagnosis of LCIS, because you |
| If you have a diagnosis of DCIS on a core needle | | | | are now at increased risk for developing invasive |
| biopsy, you need to have a surgical procedure to | | | | carcinoma, your medical team may recommend |
| try and remove all of the DCIS with adequate | | | | endocrine therapy. |
| margins. If you have had a lumpectomy/partial | | | | |