Concurrent lobular neoplasia increases the risk of ipsilateral breast cancer recurrence in patients with ductal carcinoma in situ treated with breast‐conserving therapy

Abstract

BACKGROUND:Multiple clinicopathologic factors have been analyzed for their association with an increased risk of ipsilateral breast tumor recurrence (IBTR) after women receive breast‐conserving treatment (BCT) for ductal carcinoma in situ (DCIS). The reported incidence of proliferative lesions, such as atypical ductal hyperplasia (ADH), columnar cell changes (CCC), and lobular neoplasia associated with breast cancer, has been as high as 23%; however, the relevance of these lesions on the natural history of DCIS and the risk of IBTR remains unknown.METHODS:Two hundred ninety‐four patients with DCIS who received BCT between 1991 and 1995 were identified from the authors' institutional database. Slides were reviewed by a dedicated breast pathologist with particular attention to the presence of lobular neoplasia, ADH, and CCC. The actuarial 5‐, 10‐, and 15‐year IBTR rates were calculated using the Kaplan‐Meier method and were compared using the log‐rank test.RESULTS:Concurrent lobular neoplasia was present in 41 of 294 patients (14%), ADH was present in 37 of 294 patients (13%), and CCC was present in 71 of 294 patients (24%). The median follow‐up was 11 years. IBTR occurred in 40 of 227 patients without lobular neoplasia (18%) versus 15 of 41 patients with lobular neoplasia (37%; P=.005; hazard ratio [HR], 2.49). The 5‐, 10‐, and 15‐year cumulative incidence rates of IBTR were twice as high in women who had DCIS and lobular neoplasia compared with women who had DCIS alone (P=.002). Concomitant ADH (HR, 1.53) and CCC (HR, 1.24) were not associated significantly with IBTR (P=.20 and P=.44, respectively).CONCLUSIONS:Concurrent lobular neoplasia is associated with a significantly higher risk of IBTR in women with DCIS who received BCT. Women with coexisting DCIS and lobular neoplasia who receive BCT should consider using additional risk‐reducing strategies. Cancer 2009. © 2009 American Cancer Society.

Risk factors for non-invasive and invasive local recurrence in patients with ductal carcinoma in situ

“…A few prior studies have assessed the presence of concomitant precursor lesions (such as atypical hyperplasia or lobular neoplasia) and LR risk [32, 33]. Rudloff et al [32] demonstrated that lobular neoplasia in the presence of DCIS was associated with an almost three-fold increase in the risk of LR.…”

“…Rudloff et al [32] demonstrated that lobular neoplasia in the presence of DCIS was associated with an almost three-fold increase in the risk of LR. We also found that women in whom lobular neoplasia co-existed with DCIS had a two-fold increase in their risk of LR compared to those without concurrent lobular neoplasia.…”

Lobular Carcinoma, Not Only a Classic

“…Some investigators have reported that finding LCIS does not have an impact on the recurrence rate of patients with stage I-II carcinoma managed conservatively (35), however, two separate groups observed higher recurrence rate in patients with LCIS (36,37). Similarly, some investigators have concluded that LCIS does not affect the recurrence rate of DCIS managed conservatively, but we and others have found a twofold increase in the rate of local recurrence (38,39).…”

Memorial Sloan-Kettering Cancer Center: Two Decades of Experience with Ductal Carcinoma In Situ of the Breast

“…Rudloff et al sought to determine whether the associated histologic findings of columnar cell changes, atypical ductal hyperplasia, or lobular neoplasia affected IBTR rates in patients who underwent BCS for DCIS [30]. They state that “the presence of concurrent proliferative lesions associated with in situ or infiltrating breast carcinoma may reflect underlying gene perturbations of cancer-related pathways in the uninvolved ductal epithelium, which could be markers of disease risk, occult disease, or, also, the tissue response to an existing tumor.” This study included 294 patients with DCIS treated with wide local excision, with or without radiotherapy, between 1991 and 1995, and included re-review of all available pathology slides.…”