Oncologic treatment Case 2 Lobular carcinoma in situ
Authors: Sarah Gierahn Nielsen, med. student & Hanne Melgaard Nielsen, MD
Step 1: Patophysiology
Lobular carcinoma in situ (LCIS) is a non-invasive lesion , where abnormal cells develop in the milk glands, known as lobules. .
- In Denmark, LCIS is considered a precursor for developing invasive lobular carcinoma later on.
- There are no clinical features – only 40% of the cases are associated with microcalcifications. In most cases it is an incidental finding in a biopsy for some other mass producing lesion such as a fibroadenoma.
- In Denmark, more than 90% are diagnosed in premenopausal women, and the mean age are 45 years.
- Studies shown that it is often multicentric (70%) and frequently bilateral (22%-60%) 
Step 2: Predictive factors
To distinguish whether possible predictive factors exists for developing invasive lobular carcinoma, the registration of the following is of uttermost importance
- Genetic predisposition
- Age at first-time birth
- Age at menarche
- Previously biopsies with/without ALH/LCIS
- Hormone replacement therapy
Step 3: Excisional biopsy
Recommended treatment in Denmark according to Danish Breast Cancer Group (DBCG) if the excisional biopsy shows lobular carcinoma
- Clinical control scans every second year
- Participation in clinical trials with anti-estrogen treatment
- Bilateral mastectomy under certain circumstances – (eg. patients wish or patients with other predictive factors)
Step 4: Core needle biopsy
Recommended treatment in Denmark according to Danish Breast Cancer Group (DBCG) if the core needle biopsy shows lobular carcinoma
- If the mammography and ultrasound is normal (eg. without any suspicious abnormality), treatment is as according to treatment mentioned above.
- If the mammography and ultrasound is positive (eg. with any suspicious abnormality) an excisional biopsy will determine any further treatment.
Illustrators: Caroline Lilja, med. student