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Hagen-Ansert, S. L. (2018). Textbook of Diagnostic Sonography (Eighth). Elsevier.

Lobular carcinoma in situ (LCIS). (2024, June 25). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21791-lobular-carcinoma-in-situ-lcis

Limaiem, F., Khan, M., & Lotfollahzadeh, S. (2023, June 3). Lobular breast carcinoma. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK554578/

Case: Lobular Carcinoma in situ (LCIS). (n.d.). UCLA Health. https://www.uclahealth.org/departments/radiology/education/breast-imaging-teaching-resources/cases/case-lcis

Lobular carcinoma in situ (LCIS) - Diagnosis & treatment - Mayo Clinic. (2022, May 18). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/lobular-carcinoma-in-situ/diagnosis-treatment/drc-20374535

Lobular carcinoma in situ. (2022, June 15). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/breast-cancer/lobular-carcinoma-in-situ

Lobular carcinoma in situ | LCIS. (n.d.). American Cancer Society. https://www.cancer.org/cancer/types/breast-cancer/non-cancerous-breast-conditions/lobular-carcinoma-in-situ.html

Wen, H. Y., & Brogi, E. (2018). Lobular carcinoma in situ. Surgical Pathology Clinics, 11(1), 123–145. https://doi.org/10.1016/j.path.2017.09.009

Yee, K. M. (2012, January 30). LCIS lesions found on biopsy should be removed. AuntMinnie. https://www.auntminnie.com/clinical-news/womens-imaging/breast/article/15601668/lcis-lesions-found-on-biopsy-should-be-removed

Below are individual links to all sources used and listed above, minus a link to our Textbook of Diagnostic Sonography.

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Textbook of Diagnostic Sonography

EIGHTH EDITION VOLUME ONE AND VOLUME TWO

Sandra L. Hagen-Ansert, MS, RDMS, RDCS, FASE, FSDMS

Cardiology Department, Manager, Echo Labs, Scripps Clinic & Hospitals—La Jolla, California

Elsevier

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LCIS stands for “lobular carcinoma in situ,” which is a condition that increases breast cancer risk. Learn more here.

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Lobular Breast Carcinoma - StatPearls - NCBI Bookshelf

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Invasive lobular carcinoma is the second most common histologic form of breast cancer, representing 5% to 15% of all invasive breast cancers.[1] It is composed of non-cohesive cells individually dispersed or organized in a single-file linear pattern in a fibrous stroma. Invasive lobular carcinoma is usually associated with lobular carcinoma in situ. It is now recognized as a biologically distinct disease from the more common invasive ductal carcinoma, with unique molecular pathogenesis and consequential implications on diagnosis and treatment. An understanding of these differences is crucial to tailor management strategies.[2]

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This video did a great job of breaking down the different classifications!

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Classic LCIS usually is a microscopic incidental finding in a breast needle core biopsy or surgical excision specimen targeting another lesion.

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By: Amy Zhang, MD and Reza Fardanesh, MD

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LCIS may appear as oval, hypoechoic masses with circumscribed or microlobulated margins, posterior enhancement is common.

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Lobular carcinoma in situ(LCIS) is a rare form of mammary cancer originating in lobules and terminal ducts.

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LCIS arises in the epithelium in the blunt ducts of the mammary lobules; it is more commonly found in younger women of reproductive age and is often multifocal and bilateral (Hagen-Ansert 2004)

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Lobular Carcinoma in Situ (LCIS) is a risk factor and a nonobligate precursor of breast carcinoma. The relative risk of invasive carcinoma after classic LCIS diagnosis is approximately 9 to 10 times that of the general population.(Wen, Brogi 2017)

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Although lobular carcinoma contains the word “carcinoma” (another term for cancer), it is actually not a form of breast cancer.

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LCIS is a treatable condition and the outlook is excellent for those who are diagnosed with it.

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Lobular carcinoma in situ does not usually cause any symptoms.

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LCIS may be diagnosed with a biopsy. A close look at the LCIS cells by the pathologist can help your doctor decide on the next steps in management.

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(Mayo Clinic 2022)

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LCIS | Does LCIS lead to diagnosis of breast cancer?

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Sometimes, the needle biopsy itself is sufficient. In some cases, a slightly larger sample of the breast tissue is needed to more definitively rule out breast cancer, and a surgical breast biopsy is performed.(Camp)

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Monitoring and observation may be all that is needed. It simply means that they have identified that you may be at higher risk for developing breast cancer in the future.

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Breast surgery might be an option if you have other risk factors for breast cancer, such as a BRCA gene mutation or other hereditary factor. Treatment can include a preemptive mastectomy.(Camp)

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While it doesn’t happen often, lobular carcinoma in situ may develop into ductal carcinoma in situ (DCIS) or lobular breast cancer. Studies show that 1 in 10 people with LCIS develop DCIS or lobular breast cancer.(Cleveland Clinic 2024)

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A lower frequency of axillary nodal metastasis in invasive lobular carcinoma than in invasive carcinoma of no special type has been reported in some series, the difference ranging from 3% to 10%.(Limaiem; Khan; Lotfollahzadeh 2023)

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MRI is useful in estimating the extent of invasive lobular carcinoma since it determines tumor margins, size, and multifocality more accurately than ultrasound and mammography.

The preoperative MRI is more effective in the detection of contralateral breast cancer in an early stage with positive hormone receptors in older women at high risk of breast cancer.

The most frequent manifestation of invasive lobular carcinoma is an enhancing solitary nodule with spiculated or ill-defined margins.

Significant correlations between histology and MRI enhancement patterns have been demonstrated. Classic invasive lobular carcinomas with tumor cells streaming along septa are visualized at MRI as enhancing septa without a dominant tumor focus.(Limaiem; Khan; Lotfollahzadeh 2023)

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Lobular carcinoma often metastasizes to the ovary, gastrointestinal tract, uterus, serosal cavities, meninges, or bone than to the regional lymph nodes or lungs.(Limaiem; Khan; Lotfollahzadeh 2023)

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Metastases of invasive lobular carcinoma differ from those of invasive carcinoma of no special type. A higher frequency of tumor extension to the bone, gastrointestinal tract, uterus, meninges, ovary, and diffuse serosal involvement is observed in invasive lobular carcinoma, while the extension to the lung is more frequent in invasive carcinoma of no special type.(Limaiem; Khan; Lotfollahzadeh 2023)

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Focal nonmass enhancement at site of biopsy-proven LCIS.

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Ultrasound image (left) reveals subtle, hypoechoic, ovoid-shaped, 2-cm mass (arrow) containing numerous echogenic foci. Ultrasound-guided needle core biopsy image (right) reveals LCIS. At open surgical biopsy, diagnosis of infiltrating lobular carcinoma was made.(Yee 2012)

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The different presentations of invasive lobular carcinoma on ultrasonography are:

A hypoechoic mass with irregular or indistinct margins and posterior acoustic shadowing (60%)

Shadowing with no appearance of a mass (15 to 18%)

Well-circumscribed mass lesions (9 to 13%)

Ultrasonographically invisible (approximately 10%)

(Limaiem; Khan; Lotfollahzadeh 2023)

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Molecular studies have been instrumental in highlighting the role of E-cadherin inactivation in the development of lobular lesions and in supporting the notion that lobular carcinoma in situ and atypical lobular hyperplasia are, nonobligate precursors for the development of invasive cancer, rather than being simply risk indicators for invasive disease.(Limaiem; Khan; Lotfollahzadeh 2023)

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It is difficult to estimate the actual incidence of LCIS.

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57-year-old woman with invasive lobular carcinoma presenting as newly palpable mass. Sonogram shows oval, circumscribed mass (solid arrows) that is isoechoic to adjacent fat (dashed arrow).(AJR 2013)

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62-year-old woman with invasive lobular carcinoma presenting as palpable mass. Sonogram shows irregular, hyperechoic mass (> 90% echogenic) with indistinct margins (arrows).(AJR 2013)

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48-year-old woman with invasive lobular carcinoma presenting as palpable left breast abnormality and architectural distortion on diagnostic mammogram. Sonogram shows ill-defined area of shadowing without discrete mass (arrows).(AJR 2013)

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56-year-old woman with invasive lobular carcinoma presenting as palpable mass.

Photomicrograph (H and E, ×400) of histologic section from excisional biopsy shows invasive lobular carcinoma as small cells with dark-staining small nuclei growing in single file (arrow).(AJR 2013)

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77-year-old woman with invasive lobular carcinoma presenting as mass on screening mammogram. Sonogram shows irregular, hypoechoic mass (arrows).(AJR 2013)

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I found this video interesting!

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Histopathology Breast--Lobular carcinoma in situ

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Since there are no signs or symptoms, I wanted to include this video that does a good job of explaining LCIS in an easy to understand way!

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A cool look into breast imaging with MRI!

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Lobular carcinoma in situ: Marker for breast cancer risk-Lobular carcinoma in situ (LCIS) - Diagnosis & treatment - Mayo Clinic

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If a breast biopsy reveals you have LCIS, your risk of breast cancer is increased. Learn how you can reduce your risk through medications and other strategies.

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With careful monitoring with an experienced doctor, patients with lobular carcinoma in situ have the best chance to stay healthy and cancer free.(Camp)

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Although lobular carcinoma in situ contains the word “carcinoma” (another name for cancer), it is actually not a form of breast cancer. LCIS is a risk factor, however, for developing breast cancer in the future.

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Lobular carcinoma in situ means abnormal cells are in the breast. LCIS is not cancer but can signal a higher risk of breast cancer. Learn more here.

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This image says there was a problem providing the content but once you click on it, it takes you to the source I cited in this presentation.

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LCIS lesions found on biopsy should be removed

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Lobular carcinoma in situ (LCIS) is a relatively rare high risk marker for breast cancer, but LCIS lesions found on core needle biopsy should be removed, according to a new study published in the February issue of the American Journal of Roentgenology.

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Another option for treating LCIS is preventive (prophylactic) mastectomy. This surgery removes both breasts — not just the breast affected with LCIS — to reduce your risk of developing invasive breast cancer. To obtain the best possible protective benefit from this surgery, both breasts are removed, because LCISincreases your risk of developing breast cancer in either breast. This may be an option if you have additional risk factors for breast cancer, such as an inherited gene mutation that increases your risk, or a very strong family history of the disease.(Mayo Clinic 2022)