Clinical management and oncologic outcomes of pure pleomorphic and florid lobular carcinoma in situ of the breast: Results from a large single institution experience

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-04-05 DOI:10.1016/j.ejso.2025.110021

M. Ferrucci , D. Passeri , F. Milardi , A. Marchet , P. Del Bianco , R. Cappellesso , A.P. Dei Tos

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Abstract

Introduction

Pure pleomorphic (PLCIS) and florid (FLCIS) lobular carcinoma in situ, without concurrent invasive carcinoma (IC) or ductal carcinoma in situ (DCIS), are rare. We collected the largest and most comprehensive single-institution cohort to analyze oncological outcomes and management strategies.

Methods

Consecutive patients diagnosed with pure PLCIS and/or FLCIS and treated at our institution between 2012 and 2021 were identified. Clinical, radiological, and pathological characteristics, along with recurrence risk, were analyzed.

Results

A total of 303 patients were diagnosed with PLCIS and/or FLCIS on surgical specimens. Among them, 144 PLCIS and 116 FLCIS cases were associated with IC or DCIS, leaving 43 (14.2 %) pure P-/FLCIS cases (20 PLCIS, 17 FLCIS, and six mixed cases).

Pure P-/FLCIS diagnosed on core-biopsy had a 31.3 % upgrade ratio on surgical specimens to IC (86.7 %) or DCIS (13.3 %).

Median lesion size was 15 mm. Mastectomy was performed in four cases, while 90.7 % underwent wide local excision, with 14 % positive margin rate. Sentinel lymph node biopsy was performed in four cases, with no positive nodes. No adjuvant treatment was administered, as per multidisciplinary decision.

After a median follow-up of 53 months, local recurrence (LR) occurred in 14 % of cases.

Margin involvement strongly predicted LR, which was higher in patients with final positive margins (5/6, 83.3 % vs. 0/31, 0 % in patients with clear margins, p < 0.001).

Conclusions

The 31.3 % upgrade ratio from pure P-/FLCIS to IC/DCIS recommends surgical excision. Axillary surgery should be omitted. Positive margins are strongly associated with LR. Surgery with negative margins is the mainstay of treatment. Larger multicentric studies are needed.

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纯多形性和花型乳腺原位小叶癌的临床处理和肿瘤预后：来自大型单一机构经验的结果

单纯的多形性（PLCIS）和花型（FLCIS）小叶原位癌，无并发浸润性癌（IC）或导管原位癌（DCIS）是罕见的。我们收集了最大和最全面的单机构队列来分析肿瘤预后和管理策略。方法选取2012年至2021年间在我院连续治疗的纯PLCIS和/或FLCIS患者。分析临床、影像学、病理特征及复发风险。结果303例患者在手术标本上被诊断为PLCIS和/或FLCIS。其中，144例PLCIS和116例FLCIS合并IC或DCIS， 43例（14.2%）为纯P-/FLCIS（20例PLCIS， 17例FLCIS， 6例混合）。经核心活检诊断为纯P-/FLCIS的手术标本升级率为31.3%，为IC（86.7%）或DCIS（13.3%）。中位病灶大小为15mm。4例行乳房切除术，90.7%行广泛性局部切除，阳性切缘率14%。前哨淋巴结活检4例，未见阳性淋巴结。根据多学科决定，未给予辅助治疗。中位随访53个月后，14%的病例出现局部复发（LR）。切缘受累强烈预测LR，最终切缘阳性患者的LR更高(5/ 6,83.3% vs.切缘清晰患者的0/ 31.0%,p <；0.001)。结论单纯P-/FLCIS到IC/DCIS的升级率为31.3%，建议行手术切除。应避免腋窝手术。正边际与LR密切相关。阴性切缘手术是治疗的主要方法。需要更大规模的多中心研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.