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Breast
Histopathologic Diagnoses
Risk Lesions
Lobular Carcinoma In Situ, Classic
Lobular Carcinoma In Situ, Classic
Katie M. Davis, DO; Wendie A. Berg, MD, PhD, FACR, FSBI; Marion E. Scoggins, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Lobular carcinoma in situ (LCIS)

            • Definitions

              • Classic LCIS: Proliferation of neoplastic cells that fill and expand > 50% of acini in terminal duct lobular units (TDLUs)
                • Nuclear grade 1 or 2
                • Loss of E-cadherin and (+) cytoplasmic staining for p120 catenin
                • Pagetoid spread of monomorphic LCIS cells beneath epithelial layer common
              • Pleomorphic LCIS: Nuclear grade 3 variant of LCIS
              • Florid LCIS: Architectural variant of LCIS with massive distention of lobule(s); duct extension, and (often) central necrosis; mimics solid-type DCIS but E-cadherin (-); can be classic or pleomorphic
              • Risk factor and nonobligate precursor for development of invasive cancer (8-10x risk)
              • Atypical lobular hyperplasia (ALH): Proliferation of neoplastic cells indistinguishable from LCIS, but of lesser extent, filling < 50% acini in TDLUs without distention
              • Lobular neoplasia (LN): Morphologic spectrum including ALH and classic LCIS
                • Some literature uses LN as synonymous with LCIS
              • WHO classification of lobular intraepithelial lesion (LIN): LIN1 = ALH; LIN2 = LCIS; LIN3 = LCIS variants (pleomorphic, florid)

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Image-Guided Biopsy

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Marmor S et al: Trends in lobular carcinoma in situ management: endocrine therapy use in California and New Jersey. Cancer Causes Control. ePub, 2019
                                          2. Donaldson AR et al: Breast cancer risk associated with atypical hyperplasia and lobular carcinoma in situ initially diagnosed on core-needle biopsy. Cancer. 124(3):459-465, 2018
                                          3. Linsk A et al: Surgical upgrade rate of breast atypia to malignancy: an academic center's experience and validation of a predictive model. Breast J. 24(2):115-119, 2018
                                          4. Masannat YA et al: Pleomorphic LCIS what do we know? A UK multicenter audit of pleomorphic lobular carcinoma in situ. Breast. 38:120-124, 2018
                                          5. Schmidt H et al: Observation versus excision of lobular neoplasia on core needle biopsy of the breast. Breast Cancer Res Treat. 168(3):649-654, 2018
                                          6. Singh K et al: Evaluating agreement, histological features, and relevance of separating pleomorphic and florid lobular carcinoma in situ subtypes. Hum Pathol. 78:163-170, 2018
                                          7. Speer ME et al: High risk breast lesions identified on MRI-Guided vacuum assisted needle biopsy: outcome of surgical excision and imaging follow-up. Br J Radiol. 20180300, 2018
                                          8. Wen HY et al: Lobular carcinoma in situ. Surg Pathol Clin. 11(1):123-145, 2018
                                          9. Ferré R et al: Sonographic Appearance of Lesions Diagnosed as Lobular Neoplasia at Sonographically Guided Biopsies. AJR Am J Roentgenol. 208(3):669-675, 2017
                                          10. Mao K et al: Risk of second breast cancers after lobular carcinoma in situ according to hormone receptor status. PLoS One. 12(5):e0176417, 2017
                                          11. Mullooly M et al: Epidemiologic Risk Factors for In Situ and Invasive Breast Cancers Among Postmenopausal Women in the National Institutes of Health-AARP Diet and Health Study. Am J Epidemiol. 186(12):1329-1340, 2017
                                          12. Trivedi MS et al: Chemoprevention Uptake among Women with Atypical Hyperplasia and Lobular and Ductal Carcinoma In Situ. Cancer Prev Res (Phila). 10(8):434-441, 2017
                                          13. Clauser P et al: Management of atypical lobular hyperplasia, atypical ductal hyperplasia, and lobular carcinoma in situ. Expert Rev Anticancer Ther. 16(3):335-46, 2016
                                          14. Fives C et al: When pathological and radiological correlation is achieved, excision of fibroadenoma with lobular neoplasia on core biopsy is not warranted. Breast. 30:125-129, 2016
                                          15. Maxwell AJ et al: The radiological features, diagnosis and management of screen-detected lobular neoplasia of the breast: Findings from the Sloane Project. Breast. 27:109-15, 2016
                                          16. Mooney KL et al: Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review. Mod Pathol. 29(12):1471-1484, 2016
                                          17. Murray M: Pathologic High-risk Lesions, Diagnosis and Management. Clin Obstet Gynecol. 59(4):727-732, 2016
                                          18. Nakhlis F et al: Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In-situ in Patients with Lobular Neoplasia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 020). Ann Surg Oncol. 23(3):722-8, 2016
                                          19. Rageth CJ et al: First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 159(2):203-13, 2016
                                          20. Renshaw AA et al: Long term clinical follow-up of atypical ductal hyperplasia and lobular carcinoma in situ in breast core needle biopsies. Pathology. 48(1):25-9, 2016
                                          21. Chang Sen LQ et al: Core Breast Biopsies Showing Lobular Carcinoma In Situ Should Be Excised and Surveillance Is Reasonable for Atypical Lobular Hyperplasia. AJR Am J Roentgenol. 207(5):1132-1145, 2016
                                          22. McCart Reed AE et al: Invasive lobular carcinoma of the breast: morphology, biomarkers and 'omics. Breast Cancer Res. 17:12, 2015
                                          23. McEvoy MP et al: Breast Cancer Risk and Follow-up Recommendations for Young Women Diagnosed with Atypical Hyperplasia and Lobular Carcinoma In Situ (LCIS). Ann Surg Oncol. 22(10):3346-9, 2015
                                          24. Schwartz T et al: Screening breast magnetic resonance imaging in women with atypia or lobular carcinoma in situ. J Surg Res. 193(2):519-22, 2015
                                          25. Middleton LP et al: Most lobular carcinoma in situ and atypical lobular hyperplasia diagnosed on core needle biopsy can be managed clinically with radiologic follow-up in a multidisciplinary setting. Cancer Med. 3(3):492-9, 2014
                                          26. Chaudhary S et al: Classic lobular neoplasia on core biopsy: a clinical and radio-pathologic correlation study with follow-up excision biopsy. Mod Pathol. 26(6):762-71, 2013
                                          27. Scoggins M et al: Lobular carcinoma in situ of the breast: clinical, radiological, and pathological correlation. Acad Radiol. 20(4):463-70, 2013
                                          28. Ibrahim N et al: Surgical outcome of biopsy-proven lobular neoplasia: is there any difference between lobular carcinoma in situ and atypical lobular hyperplasia? AJR Am J Roentgenol. 198(2):288-91, 2012
                                          29. Linda A et al: Nonsurgical management of high-risk lesions diagnosed at core needle biopsy: can malignancy be ruled out safely with breast MRI? AJR Am J Roentgenol. 198(2):272-80, 2012
                                          30. Londero V et al: High-risk breast lesions at imaging-guided needle biopsy: usefulness of MRI for treatment decision. AJR Am J Roentgenol. 199(2):W240-50, 2012
                                          31. Rendi MH et al: Lobular in-situ neoplasia on breast core needle biopsy: imaging indication and pathologic extent can identify which patients require excisional biopsy. Ann Surg Oncol. 19(3):914-21, 2012
                                          32. Zhao C et al: Pathologic findings of follow-up surgical excision for lobular neoplasia on breast core biopsy performed for calcification. Am J Clin Pathol. 138(1):72-8, 2012
                                          33. Friedlander LC et al: Results of MR imaging screening for breast cancer in high-risk patients with lobular carcinoma in situ. Radiology. 261(2):421-7, 2011
                                          34. Sung JS et al: Screening breast MR imaging in women with a history of lobular carcinoma in situ. Radiology. 261(2):414-20, 2011
                                          35. Ansquer Y et al: Risk of invasive breast cancer after lobular intra-epithelial neoplasia: review of the literature. Eur J Surg Oncol. 36(7):604-9, 2010
                                          36. Bevers TB et al: NCCN clinical practice guidelines in oncology: breast cancer screening and diagnosis. J Natl Compr Canc Netw. 2009 Nov;7(10):1060-96. Review. Erratum in: J Natl Compr Canc Netw. 8(2):xxxvii, 2010
                                          37. Gao F et al: Clinical importance of histologic grading of lobular carcinoma in situ in breast core needle biopsy specimens: current issues and controversies. Am J Clin Pathol. 133(5):767-71, 2010
                                          38. Pediconi F et al: Role of breast MR imaging for predicting malignancy of histologically borderline lesions diagnosed at core needle biopsy: prospective evaluation. Radiology. 257(3):653-61, 2010
                                          39. Sullivan ME et al: Lobular carcinoma in situ variants in breast cores: potential for misdiagnosis, upgrade rates at surgical excision, and practical implications. Arch Pathol Lab Med. 134(7):1024-8, 2010
                                          40. Ho BC et al: Lobular neoplasia of the breast: 68 years on. Pathology. 41(1):28-35, 2009
                                          41. Brem RF et al: Lobular neoplasia at percutaneous breast biopsy: variables associated with carcinoma at surgical excision. AJR Am J Roentgenol. 190(3):637-41, 2008
                                          42. Hwang H et al: Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens: routine excision is not necessary. Mod Pathol. 21(10):1208-16, 2008
                                          43. Linda A et al: Borderline breast lesions diagnosed at core needle biopsy: can magnetic resonance mammography rule out associated malignancy? Preliminary results based on 79 surgically excised lesions. Breast. 17(2):125-31, 2008
                                          44. Londero V et al: Lobular neoplasia: core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features. Breast. 17(6):623-30, 2008
                                          45. Sohn VY et al: Lobular neoplasia: is surgical excision warranted? Am Surg. 74(2):172-7, 2008
                                          46. Port ER et al: Results of MRI screening for breast cancer in high-risk patients with LCIS and atypical hyperplasia. Ann Surg Oncol. 14(3):1051-7, 2007
                                          47. Saslow D et al: American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007 Mar-Apr;57(2):75-89. Erratum in: CA Cancer J Clin. 57(3):185, 2007
                                          48. Anderson BO et al: Evolving concepts in the management of lobular neoplasia. J Natl Compr Canc Netw. 4(5):511-22, 2006
                                          49. Bevers TB et al: Breast cancer screening and diagnosis. J Natl Compr Canc Netw. 4(5):480-508, 2006
                                          50. Mahoney MC et al: Lobular neoplasia at 11-gauge vacuum-assisted stereotactic biopsy: correlation with surgical excisional biopsy and mammographic follow-up. AJR Am J Roentgenol. 187(4):949-54, 2006
                                          51. Bassett LW et al: Breast core needle biopsy: imaging-pathology assessment of results. Breast Imaging: RSNA Categorical Course in Diagnostic Radiology. 55-65, 2005
                                          52. Garreau JR et al: Risk counseling and management in patients with lobular carcinoma in situ. Am J Surg. 189(5):610-4; discussion 614-5, 2005
                                          53. Arpino G et al: Lobular neoplasia on core-needle biopsy--clinical significance. Cancer. 101(2):242-50, 2004
                                          54. Berg WA: Image-guided breast biopsy and management of high-risk lesions. Radiol Clin North Am. 42(5):935-46, vii, 2004
                                          55. Foster MC et al: Lobular carcinoma in situ or atypical lobular hyperplasia at core-needle biopsy: is excisional biopsy necessary? Radiology. 231(3):813-9, 2004
                                          56. Selinko VL et al: Role of sonography in diagnosing and staging invasive lobular carcinoma. J Clin Ultrasound. 32(7):323-32, 2004
                                          57. Liberman L et al: Ductal enhancement on MR imaging of the breast. AJR Am J Roentgenol. 181(2):519-25, 2003
                                          58. Middleton LP et al: Lobular carcinoma in situ diagnosed by core needle biopsy: when should it be excised? Mod Pathol. 16(2):120-9, 2003
                                          59. Page DL et al: Atypical lobular hyperplasia as a unilateral predictor of breast cancer risk: a retrospective cohort study. Lancet. 361(9352):125-9, 2003
                                          60. Li CI et al: Changing incidence of lobular carcinoma in situ of the breast. Breast Cancer Res Treat. 75(3):259-68, 2002
                                          61. Berg WA et al: Atypical lobular hyperplasia or lobular carcinoma in situ at core-needle breast biopsy. Radiology. 218(2):503-9, 2001
                                          62. Georgian-Smith D et al: Calcifications of lobular carcinoma in situ of the breast: radiologic-pathologic correlation. AJR Am J Roentgenol. 176(5):1255-9, 2001
                                          63. Rosen PP: Chapter 33. In Rosen's Breast Pathology. Philadelphia, Lippincott Williams & Wilkins. 581-610, 2001
                                          64. Fisher B et al: Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 90(18):1371-88, 1998
                                          65. Page DL et al: Lobular neoplasia of the breast: higher risk for subsequent invasive cancer predicted by more extensive disease. Hum Pathol. 22(12):1232-9, 1991
                                          66. Foote FW et al: Lobular carcinoma in situ: A rare form of mammary cancer. Am J Pathol. 17(4):491-496, 1941
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Lobular carcinoma in situ (LCIS)

                                                    • Definitions

                                                      • Classic LCIS: Proliferation of neoplastic cells that fill and expand > 50% of acini in terminal duct lobular units (TDLUs)
                                                        • Nuclear grade 1 or 2
                                                        • Loss of E-cadherin and (+) cytoplasmic staining for p120 catenin
                                                        • Pagetoid spread of monomorphic LCIS cells beneath epithelial layer common
                                                      • Pleomorphic LCIS: Nuclear grade 3 variant of LCIS
                                                      • Florid LCIS: Architectural variant of LCIS with massive distention of lobule(s); duct extension, and (often) central necrosis; mimics solid-type DCIS but E-cadherin (-); can be classic or pleomorphic
                                                      • Risk factor and nonobligate precursor for development of invasive cancer (8-10x risk)
                                                      • Atypical lobular hyperplasia (ALH): Proliferation of neoplastic cells indistinguishable from LCIS, but of lesser extent, filling < 50% acini in TDLUs without distention
                                                      • Lobular neoplasia (LN): Morphologic spectrum including ALH and classic LCIS
                                                        • Some literature uses LN as synonymous with LCIS
                                                      • WHO classification of lobular intraepithelial lesion (LIN): LIN1 = ALH; LIN2 = LCIS; LIN3 = LCIS variants (pleomorphic, florid)

                                                    IMAGING

                                                    • General Features

                                                      • Mammographic Findings

                                                        • Ultrasonographic Findings

                                                          • MR Findings

                                                            • Image-Guided Biopsy

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Marmor S et al: Trends in lobular carcinoma in situ management: endocrine therapy use in California and New Jersey. Cancer Causes Control. ePub, 2019
                                                                                  2. Donaldson AR et al: Breast cancer risk associated with atypical hyperplasia and lobular carcinoma in situ initially diagnosed on core-needle biopsy. Cancer. 124(3):459-465, 2018
                                                                                  3. Linsk A et al: Surgical upgrade rate of breast atypia to malignancy: an academic center's experience and validation of a predictive model. Breast J. 24(2):115-119, 2018
                                                                                  4. Masannat YA et al: Pleomorphic LCIS what do we know? A UK multicenter audit of pleomorphic lobular carcinoma in situ. Breast. 38:120-124, 2018
                                                                                  5. Schmidt H et al: Observation versus excision of lobular neoplasia on core needle biopsy of the breast. Breast Cancer Res Treat. 168(3):649-654, 2018
                                                                                  6. Singh K et al: Evaluating agreement, histological features, and relevance of separating pleomorphic and florid lobular carcinoma in situ subtypes. Hum Pathol. 78:163-170, 2018
                                                                                  7. Speer ME et al: High risk breast lesions identified on MRI-Guided vacuum assisted needle biopsy: outcome of surgical excision and imaging follow-up. Br J Radiol. 20180300, 2018
                                                                                  8. Wen HY et al: Lobular carcinoma in situ. Surg Pathol Clin. 11(1):123-145, 2018
                                                                                  9. Ferré R et al: Sonographic Appearance of Lesions Diagnosed as Lobular Neoplasia at Sonographically Guided Biopsies. AJR Am J Roentgenol. 208(3):669-675, 2017
                                                                                  10. Mao K et al: Risk of second breast cancers after lobular carcinoma in situ according to hormone receptor status. PLoS One. 12(5):e0176417, 2017
                                                                                  11. Mullooly M et al: Epidemiologic Risk Factors for In Situ and Invasive Breast Cancers Among Postmenopausal Women in the National Institutes of Health-AARP Diet and Health Study. Am J Epidemiol. 186(12):1329-1340, 2017
                                                                                  12. Trivedi MS et al: Chemoprevention Uptake among Women with Atypical Hyperplasia and Lobular and Ductal Carcinoma In Situ. Cancer Prev Res (Phila). 10(8):434-441, 2017
                                                                                  13. Clauser P et al: Management of atypical lobular hyperplasia, atypical ductal hyperplasia, and lobular carcinoma in situ. Expert Rev Anticancer Ther. 16(3):335-46, 2016
                                                                                  14. Fives C et al: When pathological and radiological correlation is achieved, excision of fibroadenoma with lobular neoplasia on core biopsy is not warranted. Breast. 30:125-129, 2016
                                                                                  15. Maxwell AJ et al: The radiological features, diagnosis and management of screen-detected lobular neoplasia of the breast: Findings from the Sloane Project. Breast. 27:109-15, 2016
                                                                                  16. Mooney KL et al: Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review. Mod Pathol. 29(12):1471-1484, 2016
                                                                                  17. Murray M: Pathologic High-risk Lesions, Diagnosis and Management. Clin Obstet Gynecol. 59(4):727-732, 2016
                                                                                  18. Nakhlis F et al: Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In-situ in Patients with Lobular Neoplasia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 020). Ann Surg Oncol. 23(3):722-8, 2016
                                                                                  19. Rageth CJ et al: First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 159(2):203-13, 2016
                                                                                  20. Renshaw AA et al: Long term clinical follow-up of atypical ductal hyperplasia and lobular carcinoma in situ in breast core needle biopsies. Pathology. 48(1):25-9, 2016
                                                                                  21. Chang Sen LQ et al: Core Breast Biopsies Showing Lobular Carcinoma In Situ Should Be Excised and Surveillance Is Reasonable for Atypical Lobular Hyperplasia. AJR Am J Roentgenol. 207(5):1132-1145, 2016
                                                                                  22. McCart Reed AE et al: Invasive lobular carcinoma of the breast: morphology, biomarkers and 'omics. Breast Cancer Res. 17:12, 2015
                                                                                  23. McEvoy MP et al: Breast Cancer Risk and Follow-up Recommendations for Young Women Diagnosed with Atypical Hyperplasia and Lobular Carcinoma In Situ (LCIS). Ann Surg Oncol. 22(10):3346-9, 2015
                                                                                  24. Schwartz T et al: Screening breast magnetic resonance imaging in women with atypia or lobular carcinoma in situ. J Surg Res. 193(2):519-22, 2015
                                                                                  25. Middleton LP et al: Most lobular carcinoma in situ and atypical lobular hyperplasia diagnosed on core needle biopsy can be managed clinically with radiologic follow-up in a multidisciplinary setting. Cancer Med. 3(3):492-9, 2014
                                                                                  26. Chaudhary S et al: Classic lobular neoplasia on core biopsy: a clinical and radio-pathologic correlation study with follow-up excision biopsy. Mod Pathol. 26(6):762-71, 2013
                                                                                  27. Scoggins M et al: Lobular carcinoma in situ of the breast: clinical, radiological, and pathological correlation. Acad Radiol. 20(4):463-70, 2013
                                                                                  28. Ibrahim N et al: Surgical outcome of biopsy-proven lobular neoplasia: is there any difference between lobular carcinoma in situ and atypical lobular hyperplasia? AJR Am J Roentgenol. 198(2):288-91, 2012
                                                                                  29. Linda A et al: Nonsurgical management of high-risk lesions diagnosed at core needle biopsy: can malignancy be ruled out safely with breast MRI? AJR Am J Roentgenol. 198(2):272-80, 2012
                                                                                  30. Londero V et al: High-risk breast lesions at imaging-guided needle biopsy: usefulness of MRI for treatment decision. AJR Am J Roentgenol. 199(2):W240-50, 2012
                                                                                  31. Rendi MH et al: Lobular in-situ neoplasia on breast core needle biopsy: imaging indication and pathologic extent can identify which patients require excisional biopsy. Ann Surg Oncol. 19(3):914-21, 2012
                                                                                  32. Zhao C et al: Pathologic findings of follow-up surgical excision for lobular neoplasia on breast core biopsy performed for calcification. Am J Clin Pathol. 138(1):72-8, 2012
                                                                                  33. Friedlander LC et al: Results of MR imaging screening for breast cancer in high-risk patients with lobular carcinoma in situ. Radiology. 261(2):421-7, 2011
                                                                                  34. Sung JS et al: Screening breast MR imaging in women with a history of lobular carcinoma in situ. Radiology. 261(2):414-20, 2011
                                                                                  35. Ansquer Y et al: Risk of invasive breast cancer after lobular intra-epithelial neoplasia: review of the literature. Eur J Surg Oncol. 36(7):604-9, 2010
                                                                                  36. Bevers TB et al: NCCN clinical practice guidelines in oncology: breast cancer screening and diagnosis. J Natl Compr Canc Netw. 2009 Nov;7(10):1060-96. Review. Erratum in: J Natl Compr Canc Netw. 8(2):xxxvii, 2010
                                                                                  37. Gao F et al: Clinical importance of histologic grading of lobular carcinoma in situ in breast core needle biopsy specimens: current issues and controversies. Am J Clin Pathol. 133(5):767-71, 2010
                                                                                  38. Pediconi F et al: Role of breast MR imaging for predicting malignancy of histologically borderline lesions diagnosed at core needle biopsy: prospective evaluation. Radiology. 257(3):653-61, 2010
                                                                                  39. Sullivan ME et al: Lobular carcinoma in situ variants in breast cores: potential for misdiagnosis, upgrade rates at surgical excision, and practical implications. Arch Pathol Lab Med. 134(7):1024-8, 2010
                                                                                  40. Ho BC et al: Lobular neoplasia of the breast: 68 years on. Pathology. 41(1):28-35, 2009
                                                                                  41. Brem RF et al: Lobular neoplasia at percutaneous breast biopsy: variables associated with carcinoma at surgical excision. AJR Am J Roentgenol. 190(3):637-41, 2008
                                                                                  42. Hwang H et al: Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens: routine excision is not necessary. Mod Pathol. 21(10):1208-16, 2008
                                                                                  43. Linda A et al: Borderline breast lesions diagnosed at core needle biopsy: can magnetic resonance mammography rule out associated malignancy? Preliminary results based on 79 surgically excised lesions. Breast. 17(2):125-31, 2008
                                                                                  44. Londero V et al: Lobular neoplasia: core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features. Breast. 17(6):623-30, 2008
                                                                                  45. Sohn VY et al: Lobular neoplasia: is surgical excision warranted? Am Surg. 74(2):172-7, 2008
                                                                                  46. Port ER et al: Results of MRI screening for breast cancer in high-risk patients with LCIS and atypical hyperplasia. Ann Surg Oncol. 14(3):1051-7, 2007
                                                                                  47. Saslow D et al: American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007 Mar-Apr;57(2):75-89. Erratum in: CA Cancer J Clin. 57(3):185, 2007
                                                                                  48. Anderson BO et al: Evolving concepts in the management of lobular neoplasia. J Natl Compr Canc Netw. 4(5):511-22, 2006
                                                                                  49. Bevers TB et al: Breast cancer screening and diagnosis. J Natl Compr Canc Netw. 4(5):480-508, 2006
                                                                                  50. Mahoney MC et al: Lobular neoplasia at 11-gauge vacuum-assisted stereotactic biopsy: correlation with surgical excisional biopsy and mammographic follow-up. AJR Am J Roentgenol. 187(4):949-54, 2006
                                                                                  51. Bassett LW et al: Breast core needle biopsy: imaging-pathology assessment of results. Breast Imaging: RSNA Categorical Course in Diagnostic Radiology. 55-65, 2005
                                                                                  52. Garreau JR et al: Risk counseling and management in patients with lobular carcinoma in situ. Am J Surg. 189(5):610-4; discussion 614-5, 2005
                                                                                  53. Arpino G et al: Lobular neoplasia on core-needle biopsy--clinical significance. Cancer. 101(2):242-50, 2004
                                                                                  54. Berg WA: Image-guided breast biopsy and management of high-risk lesions. Radiol Clin North Am. 42(5):935-46, vii, 2004
                                                                                  55. Foster MC et al: Lobular carcinoma in situ or atypical lobular hyperplasia at core-needle biopsy: is excisional biopsy necessary? Radiology. 231(3):813-9, 2004
                                                                                  56. Selinko VL et al: Role of sonography in diagnosing and staging invasive lobular carcinoma. J Clin Ultrasound. 32(7):323-32, 2004
                                                                                  57. Liberman L et al: Ductal enhancement on MR imaging of the breast. AJR Am J Roentgenol. 181(2):519-25, 2003
                                                                                  58. Middleton LP et al: Lobular carcinoma in situ diagnosed by core needle biopsy: when should it be excised? Mod Pathol. 16(2):120-9, 2003
                                                                                  59. Page DL et al: Atypical lobular hyperplasia as a unilateral predictor of breast cancer risk: a retrospective cohort study. Lancet. 361(9352):125-9, 2003
                                                                                  60. Li CI et al: Changing incidence of lobular carcinoma in situ of the breast. Breast Cancer Res Treat. 75(3):259-68, 2002
                                                                                  61. Berg WA et al: Atypical lobular hyperplasia or lobular carcinoma in situ at core-needle breast biopsy. Radiology. 218(2):503-9, 2001
                                                                                  62. Georgian-Smith D et al: Calcifications of lobular carcinoma in situ of the breast: radiologic-pathologic correlation. AJR Am J Roentgenol. 176(5):1255-9, 2001
                                                                                  63. Rosen PP: Chapter 33. In Rosen's Breast Pathology. Philadelphia, Lippincott Williams & Wilkins. 581-610, 2001
                                                                                  64. Fisher B et al: Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 90(18):1371-88, 1998
                                                                                  65. Page DL et al: Lobular neoplasia of the breast: higher risk for subsequent invasive cancer predicted by more extensive disease. Hum Pathol. 22(12):1232-9, 1991
                                                                                  66. Foote FW et al: Lobular carcinoma in situ: A rare form of mammary cancer. Am J Pathol. 17(4):491-496, 1941
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