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Lobular Carcinoma of the Breast in Situ: Are We Too Radical in Its Treatment?

Lobular Carcinoma of the Breast in Situ: Are We Too Radical in Its Treatment? Abstract Twenty-four patients (average age, 46 years) with 29 instances of lobular carcinoma in situ of the breast have been treated from 1952 to 1971 at the Henry Ford Hospital (incidence, 1%). Six patients had bilateral lesions, one synchronous and 5 metachronous. The initial complaint in 23 of 24 patients was a mass in the breast. Diagnosis was based on permanent histologic section as mammography and frozen section analysis were inconclusive. Treatment consisted of radical mastectomy in six, modified radical mastectomy in five, and simple mastectomy in 20. All lymph nodes recovered showed no metastatic disease. All patients are alive and well with no evidence of disease. Based on our experience, we recommend a simple mastectomy for treatment of lobular carcinoma in situ with contralateral biopsy examination in those instances when clinical or roentgenographic evidence suggests a pathologic process. References 1. Foote FW Jr, Stewart FW: Lobular carcinoma in situ . Am J Pathol 17:491-496, 1941. 2. Muir R: Evolution of carcinoma of the mamma . J Pathol Bacteriol 52:155-172, 1941.Crossref 3. Ewing J: Neoplastic Disease . Philadelphia, WB Saunders Co, 1919, p 473. 4. Benfield JR, Fingerhut AG, Warner NE: A multidiscipline view of lobular breast carcinoma . Am Surg 176:115-116, 1972. 5. Newman W: In situ lobular carcinoma of the breast . Ann Surg 157:591-599, 1963.Crossref 6. Shorey WD: Carcinoma in situ of the breast . Surg Clin North Am 51:175-182, 1971. 7. Warner NE: Lobular carcinoma of the breast . Cancer 23:840-846, 1969.Crossref 8. Giordano JM, Klopp CT: Lobular carcinoma in situ: Incidence and treatment . Cancer 31:105-109, 1973.Crossref 9. Wheeler JE, Enterline HT, Roseman JM, et al: Lobular carcinoma in situ of the breast: Long-term follow-up . Cancer 34:554-563, 1974.Crossref 10. Antonius JI, Jones HW: The significance of certain types of epithelial proliferation occurring in the female mammary gland . Bull Mason Clin 17:17-26, 1963. 11. Urban JA: Bilaterality of cancer of the breast . Cancer 20:1867-1870, 1967.Crossref 12. Lambird PA, Shelley WM: The spatial distribution of lobular in situ mammary carcinoma . JAMA 210:689-693, 1969.Crossref 13. Farrow JH: Current concepts in the detection and treatment of the earliest of the early breast cancers . Cancer 25:468-477, 1970.Crossref 14. Gershon C Jr, Berger SM, Curcio BM: Breast cancer with macrocalcifications: Diagnostic difficulties . Radiology 87:613-622, 1966.Crossref 15. Hutter RVP, Snyder RE, Lucas JC, et al: Clinical and pathologic correlation with mammographic findings in lobular carcinoma in situ . Cancer 23:826-839, 1969.Crossref 16. Snyder RE: Mammography and lobular carcinoma in situ . Surg Gynecol Obstet 122:255-260, 1966. 17. Benfield JR, Jacobson M, Warner NE: In situ lobular carcinoma of the breast . Arch Surg 91:130-135, 1965.Crossref 18. Frable WS: Lobular carcinoma in situ: An uncommon form of mammary cancer . Va Med Mon 98:559-561, 1972. 19. Farrow JH: Clinical considerations and treatment of in situ lobular breast cancer . Am J Roentgenol Radium Ther Nucl Med 102:652-656, 1968.Crossref 20. Foote FW Jr, Stewart FW: A histologic classification of carcinoma of the breast . Surgery 19:74-99, 1946. 21. Godwin JT: Chronology of lobular carcinoma of the breast Cancer 5:259-266, 1952.Crossref 22. Haagensen CD: Diseases of the Breast . Philadelphia, WB Saunders Co, 1971, p 503. 23. Barnes JP: Bilateral lobular carcinoma in situ of the breast . Tex State J Med 55:581-584, 1959. 24. Moertel CG, Dockerty MB, Baggenstoss AH: Multiple primary malignant neoplasms . Cancer 14:238-248, 1961.Crossref 25. Newman W: Lobular carcinoma of the female breast . Ann Surg 164:305-314, 1966.Crossref 26. Qualheim RE, Gall EA: Breast carcinoma with multiple sites of origin . Cancer 10:460-468, 1957.Crossref 27. Leis HP Jr, Mersheimer WL, Black MM, et al: The second breast . NY State J Med 65:2460-2468, 1965. 28. Lewison EF, Finney GG Jr: Lobular carcinoma in situ of the breast . Surg Gynecol Obstet 126:1280-1286, 1968. 29. Lewison EF: Lobular carcinoma in situ of the breast: The feminine mystique . Milit Med 129:115-123, 1964. 30. McDivitt RW, Hutter RVP, Foote FW Jr, et al: In situ lobular carcinoma . JAMA 201:82-86, 1967.Crossref 31. Hutter RVP, Foote FW Jr: Lobular carcinoma in situ: Long-term follow-up . Cancer 24:1081-1085, 1969.Crossref 32. Hutter RVP, Foote FW Jr, Farrow JH: In situ lobular carcinoma of the female breast: 1939-1968 , in Breast Cancer Early and Late . Chicago, Year Book Medical Publishers Inc, 1970, p 201. 33. Donegan WL, Perez-Mesa CM: Lobular carcinoma: An indication for elective biopsy of the second breast . Ann Surg 176:178-187, 1972.Crossref 34. Roscher AA: Mammary carcinoma in situ . Int Surg 54:71-74, 1970. 35. Benfield JR, Fingerhut AG, Warner NE: Lobular carcinoma of the breast, 1969: A therapeutic proposal . Arch Surg 99:129-131, 1969.Crossref 36. Fechner RE: Infiltrating lobular carcinoma without lobular carcinoma in situ . Cancer 29:1539-1545, 1972.Crossref 37. Graber LD: Lobular carcinoma in situ . Wis Med J 72:229-232, 1973. 38. Haagensen CD: Lobular carcinoma of the breast . Clin Obstet Gynecol 5:1093-1101, 1962.Crossref 39. Herrmann JB: Treatment of in situ mammary carcinoma . Int Surg 57:127-129, 1972. 40. Macaulay RAA, Mitchinson MJ: Lobular carcinoma in situ of the breast . Br J Surg 60:527-529, 1973.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Lobular Carcinoma of the Breast in Situ: Are We Too Radical in Its Treatment?

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Publisher
American Medical Association
Copyright
Copyright © 1975 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1975.01360110083015
Publisher site
See Article on Publisher Site

Abstract

Abstract Twenty-four patients (average age, 46 years) with 29 instances of lobular carcinoma in situ of the breast have been treated from 1952 to 1971 at the Henry Ford Hospital (incidence, 1%). Six patients had bilateral lesions, one synchronous and 5 metachronous. The initial complaint in 23 of 24 patients was a mass in the breast. Diagnosis was based on permanent histologic section as mammography and frozen section analysis were inconclusive. Treatment consisted of radical mastectomy in six, modified radical mastectomy in five, and simple mastectomy in 20. All lymph nodes recovered showed no metastatic disease. All patients are alive and well with no evidence of disease. Based on our experience, we recommend a simple mastectomy for treatment of lobular carcinoma in situ with contralateral biopsy examination in those instances when clinical or roentgenographic evidence suggests a pathologic process. References 1. Foote FW Jr, Stewart FW: Lobular carcinoma in situ . Am J Pathol 17:491-496, 1941. 2. Muir R: Evolution of carcinoma of the mamma . J Pathol Bacteriol 52:155-172, 1941.Crossref 3. Ewing J: Neoplastic Disease . Philadelphia, WB Saunders Co, 1919, p 473. 4. Benfield JR, Fingerhut AG, Warner NE: A multidiscipline view of lobular breast carcinoma . Am Surg 176:115-116, 1972. 5. Newman W: In situ lobular carcinoma of the breast . Ann Surg 157:591-599, 1963.Crossref 6. Shorey WD: Carcinoma in situ of the breast . Surg Clin North Am 51:175-182, 1971. 7. Warner NE: Lobular carcinoma of the breast . Cancer 23:840-846, 1969.Crossref 8. Giordano JM, Klopp CT: Lobular carcinoma in situ: Incidence and treatment . Cancer 31:105-109, 1973.Crossref 9. Wheeler JE, Enterline HT, Roseman JM, et al: Lobular carcinoma in situ of the breast: Long-term follow-up . Cancer 34:554-563, 1974.Crossref 10. Antonius JI, Jones HW: The significance of certain types of epithelial proliferation occurring in the female mammary gland . Bull Mason Clin 17:17-26, 1963. 11. Urban JA: Bilaterality of cancer of the breast . Cancer 20:1867-1870, 1967.Crossref 12. Lambird PA, Shelley WM: The spatial distribution of lobular in situ mammary carcinoma . JAMA 210:689-693, 1969.Crossref 13. Farrow JH: Current concepts in the detection and treatment of the earliest of the early breast cancers . Cancer 25:468-477, 1970.Crossref 14. Gershon C Jr, Berger SM, Curcio BM: Breast cancer with macrocalcifications: Diagnostic difficulties . Radiology 87:613-622, 1966.Crossref 15. Hutter RVP, Snyder RE, Lucas JC, et al: Clinical and pathologic correlation with mammographic findings in lobular carcinoma in situ . Cancer 23:826-839, 1969.Crossref 16. Snyder RE: Mammography and lobular carcinoma in situ . Surg Gynecol Obstet 122:255-260, 1966. 17. Benfield JR, Jacobson M, Warner NE: In situ lobular carcinoma of the breast . Arch Surg 91:130-135, 1965.Crossref 18. Frable WS: Lobular carcinoma in situ: An uncommon form of mammary cancer . Va Med Mon 98:559-561, 1972. 19. Farrow JH: Clinical considerations and treatment of in situ lobular breast cancer . Am J Roentgenol Radium Ther Nucl Med 102:652-656, 1968.Crossref 20. Foote FW Jr, Stewart FW: A histologic classification of carcinoma of the breast . Surgery 19:74-99, 1946. 21. Godwin JT: Chronology of lobular carcinoma of the breast Cancer 5:259-266, 1952.Crossref 22. Haagensen CD: Diseases of the Breast . Philadelphia, WB Saunders Co, 1971, p 503. 23. Barnes JP: Bilateral lobular carcinoma in situ of the breast . Tex State J Med 55:581-584, 1959. 24. Moertel CG, Dockerty MB, Baggenstoss AH: Multiple primary malignant neoplasms . Cancer 14:238-248, 1961.Crossref 25. Newman W: Lobular carcinoma of the female breast . Ann Surg 164:305-314, 1966.Crossref 26. Qualheim RE, Gall EA: Breast carcinoma with multiple sites of origin . Cancer 10:460-468, 1957.Crossref 27. Leis HP Jr, Mersheimer WL, Black MM, et al: The second breast . NY State J Med 65:2460-2468, 1965. 28. Lewison EF, Finney GG Jr: Lobular carcinoma in situ of the breast . Surg Gynecol Obstet 126:1280-1286, 1968. 29. Lewison EF: Lobular carcinoma in situ of the breast: The feminine mystique . Milit Med 129:115-123, 1964. 30. McDivitt RW, Hutter RVP, Foote FW Jr, et al: In situ lobular carcinoma . JAMA 201:82-86, 1967.Crossref 31. Hutter RVP, Foote FW Jr: Lobular carcinoma in situ: Long-term follow-up . Cancer 24:1081-1085, 1969.Crossref 32. Hutter RVP, Foote FW Jr, Farrow JH: In situ lobular carcinoma of the female breast: 1939-1968 , in Breast Cancer Early and Late . Chicago, Year Book Medical Publishers Inc, 1970, p 201. 33. Donegan WL, Perez-Mesa CM: Lobular carcinoma: An indication for elective biopsy of the second breast . Ann Surg 176:178-187, 1972.Crossref 34. Roscher AA: Mammary carcinoma in situ . Int Surg 54:71-74, 1970. 35. Benfield JR, Fingerhut AG, Warner NE: Lobular carcinoma of the breast, 1969: A therapeutic proposal . Arch Surg 99:129-131, 1969.Crossref 36. Fechner RE: Infiltrating lobular carcinoma without lobular carcinoma in situ . Cancer 29:1539-1545, 1972.Crossref 37. Graber LD: Lobular carcinoma in situ . Wis Med J 72:229-232, 1973. 38. Haagensen CD: Lobular carcinoma of the breast . Clin Obstet Gynecol 5:1093-1101, 1962.Crossref 39. Herrmann JB: Treatment of in situ mammary carcinoma . Int Surg 57:127-129, 1972. 40. Macaulay RAA, Mitchinson MJ: Lobular carcinoma in situ of the breast . Br J Surg 60:527-529, 1973.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1975

References