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World J Clin Oncol. Aug 10, 2014; 5(3): 546-553
Published online Aug 10, 2014. doi: 10.5306/wjco.v5.i3.546
Pleomorphic lobular carcinoma in situ of the breast: Can the evidence guide practice?
Andrew Pieri, James Harvey, Nigel Bundred
Andrew Pieri, Wansbeck General Hospital, Northumbria, NE63 9JJ, United Kingdom
James Harvey, Nigel Bundred, Nightingale Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, M23 9LT, United Kingdom
Author contributions: Pieri A, Harvey J and Bundred N designed the review; Pieri A performed the systematic search; Pieri A and Harvey J assessed the quality of the studies; Pieri A analysed the data from the included studies; Pieri A, Harvey J and Bundred N wrote the paper.
Correspondence to: Nigel Bundred, MD, FRCS, Professor of Surgical Oncology, Nightingale Centre, University Hospital of South Manchester, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, United Kingdom. nigel.j.bundred@manchester.ac.uk
Telephone: +44-161-2915859 Fax: +44-161-2915860
Received: February 22, 2014
Revised: April 20, 2014
Accepted: June 10, 2014
Published online: August 10, 2014
Processing time: 159 Days and 23.1 Hours
Abstract

The clinical significance of pleomorphic lobular carcinoma in situ (PLCIS) is a subject of controversy. As a consequence, there is a risk of providing inconsistent management to patients presenting with PLCIS. This review aims to establish whether the current guidelines for the management of PLCIS are consistent with current evidence. A systematic electronic search was performed to identify all English language articles regarding PLCIS management. The data was analysed, specifically looking at: incidence of concurrent disease, recurrence rates, long-term prognosis and PLCIS management. A search was also performed for PLCIS management guidelines for the United Kingdom, United States, Canada, Australia, Germany and pan-European. The results of the evidence analyses were compared to the guidelines in order to establish whether the recommended management is consistent with the published evidence. Nine studies (level 3-4 evidence), involving a total of 176 patients and five management guidelines (from United Kingdom, United States, Australia and pan-European) were included in the review. From the evidence, 46 of 93 (49%) patients were found to have PLCIS with concurrent invasive disease on excision specimen analysis. Regarding recurrence rates, 11 of 117 (9.4%) patients developed a recurrence of PLCIS. There were no instances of invasive disease or ductal carcinoma in situ (DCIS) on recurrence histology. There were no studies assessing long-term outcomes in PLCIS cases. With regards to the management guidelines, the Association of Breast Surgery (United Kingdom) and the National Breast and Ovarian Cancer Care (Australia) do not mention PLCIS. The National Comprehensive Cancer Network (United States) suggest considering excision of PLCIS with negative margins. The NHS Breast Screening Programme (United Kingdom) and the European Society of Medical Oncology (pan-European) recommend PLCIS should be treated as with DCIS. We conclude that high quality evidence to inform guidance is lacking, thus recommendations are relatively vague. However, based on the available evidence, it would seem prudent to treat PLCIS in a similar manner to DCIS.

Keywords: Pleomorphic lobular carcinoma in situ; Breast cancer; Breast carcinoma; Carcinoma in situ; Guideline; Excision margin; Recurrence rate

Core tip: Pleomorphic lobular carcinoma in situ (PLCIS) is a breast lesion, the clinical significance of which is a subject of controversy. To date, this systematic review is the largest pooled series of clinical data regarding PLCIS. We aimed to establish whether current guidelines for management are consistent with the evidence. The results demonstrate a lack of high quality data and guidelines for management are variable. Analysis revealed a high incidence of concurrent invasive disease with PLCIS (49%) and following excision, a recurrence rate of 9.4%. We conclude that it would seem prudent to manage PLCIS as with ductal carcinoma in situ, although there is a dire need for long-term outcome studies.