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Other Guidelines
The management of lobular carcinoma in situ (LCIS). Is LCIS
the same as ductal carcinoma in situ (DCIS)?
1. Radiology
Since most LCIS do not present as a mass nor contain
microcalcification, mammography and ultrasound do not appear to have a role in
prospectively diagnosing LCIS. LCIS may be associated with contrast enhancement
in magnetic resonance imaging (MRI) and may therefore be visible, but this is
usuallymasked by enhancement secondary to concomitant fibrocystic change, hence
reliable diagnosis may not be possible even with MRI. However, PLCIS, which
more often show microcalcification will be picked up because of similarities in
presentation with DCIS
[25]
[26].
Radiology, however,may have a role in subsequent surveillance of
patients following a diagnosis of LCIS, either to identify other preinvasive
lesions such as DCIS or the invasive carcinoma that the patient would be at
risk of. In particular, this may be important in high-risk women with a
positive family history of breast cancer.
Although there are no data available on systematic randomised
clinical trials regarding the efficacy of radiologic follow-up in women
diagnosed with LCIS, and although we do not know whether it will improve
outcome of women who develop invasive breast cancer, it seems reasonable to
suggest at least the same degree of surveillance as is recommended in women at
average risk. Accordingly, women who are diagnosed with LCIS should undergo
annual two-view mammography of the affected and of the contralateral breast; in
women with dense breasts (defined as mammograms rated as ACR II or higher)
additional screening breast ultrasound should be considered. Whether or not
women diagnosed with LCIS should undergo MRI for intensified surveillance as
has been recently recommended in women with a genetically increased risk, is
subject to current European clinical trials (e.g. MARIBS)
[56].
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