Pleomorphic lobular carcinoma in situ of the breast: Can the evidence guide practice?

Table 3 Summary of guidelines for the management of in situ breast disease

Guideline source	Recommendation-PLCIS	Recommendation-CLCIS	Recommendation-DCIS
ABS, 2009[16] (United Kingdom)	PLCIS not mentioned	Should consider diagnostic biopsy Clear margins not required Post-op surveillance is appropriate (No adjuvant treatment mentioned) (No lymph node surgery required)	Resection with clear margins (> 1 mm) required (WLE or Mx) Intra-op radiography should be used for all DCIS as majority impalpable Lymph node surgery not usually required but may be considered in high risk cases
NCCN, 2013[20] (United States)	“Consider excision with negative margins”	Diagnostic biopsy Risk reducing treatment discussion with patient (options: risk reducing surgery, hormone therapy, no further treatment) Surveillance indicated	Consider MRI WLE or Mx Margin controversial but certainly > 1 mm SLNB usually not required but may be considered in high risk cases Consider RTx
ESMO, 2013[29] (pan-European)	“May behave similarly to DCIS and should be treated accordingly”	Risk factor for future development of invasive cancer and does not require active treatment	Resection with clear margin (≥ 2 mm) required (WLE or Mx) SLNB usually not required but may be considered in high risk cases
NBOCC, 2003[27] (Australia)	PLCIS not mentioned	Consider surgical biopsy Surveillance ≥ 15 yr No role for clear margin excision established	Clear margin excision Usually adjuvant RTx Consider hormone therapy
NHSBSP “In situ lobular neoplasia: overview and recommendations” [pending publication][17] (United Kingdom)	Should be classified B5a (as with DCIS) and excised with negative margins	Merits MDT discussion and usually diagnostic biopsy

ABS: Association of Breast Surgery; NCCN: National Comprehensive Cancer Network; ESMO: European Society of Medical Oncology; NBOCC: National Breast and Ovarian Cancer Care; NHSBSP: National Health Service Breast Screening Programme. PLCIS: Pleomorphic lobular carcinoma in situ; DCIS: Ductal carcinoma in situ.