Lobular Carcinoma in Situ During Preoperative Biopsy and the Rate of Upgrade

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This study aimed to evaluate the rate of upgrade of LCIS on preoperative biopsy to DCIS or invasive carcinoma. Methods: Data of 55 patients with LCIS on preoperative biopsy were analyzed. All patients underwent surgery between 1991 and 2016 at Severance Hospital in Seoul, Korea. We analyzed the rate of upgrade of preoperative LCIS to DCIS or invasive cancer in the final pathology. The clinicopathologic features related to the upgrade were evaluated. Results: The rate of upgrade of LCIS to DCIS or invasive carcinoma was 16.4% (9/55). In multivariate analysis, microcalcification and progesterone receptor expression were significantly associated with the upgrade of LCIS ( P = 0.023 and 0.044, respectively). Conclusions: The current study showed a relatively high rate of upgrade of LCIS on preoperative biopsy to DCIS or invasive cancer. The presence of microcalcification and progesterone receptor expression may be potential predictors of upgradation of LCIS on preoperative biopsy. Surgical excision of the LCIS during preoperative biopsy could be a management option to identify the concealed malignancy. Cancer Biology Breast carcinoma in situ breast neoplasm core needle biopsy lobular carcinoma in situ surgical diagnostic technics Figures Figure 1 Figure 2 Figure 3 Background Traditionally, an excision is recommended for patients with lobular carcinoma in situ (LCIS) diagnosed on core needle biopsy [ 1 ]. However, the management of LCIS has been controversial, and some authors advocate observation rather than surgical excision [ 2 , 3 ]. LCIS was excluded from the malignant category in the 8th American Joint Committee on Cancer (AJCC) staging system for breast cancer [ 4 ]. The National Comprehensive Cancer Network (NCCN) guidelines® recommend active surveillance, surgical excision, and/or other interventions such as counseling for lifestyle modification, medication, or surgery for reducing the risk of breast cancer in patients with LCIS diagnosed on core needle biopsy [ 1 ]. Surgical excision should be considered only in patients with pleomorphic LCIS or lesions that are non-concordant with imaging findings [ 1 ]. Patients with classic LCIS and those with lesions that are concordant with imaging findings can be followed up with close observation [ 1 ]. Across the literature, the upgrade rates of LCIS on core needle biopsy to invasive carcinoma or ductal carcinoma in situ (DCIS) at surgical excision have been reported from 0–50% [ 5 ]. Previous studies have shown that the upgrade rate varies, and there is still no consensus about surgical treatment or observation in cases of LCIS [ 5 ]. In this study, we analyzed the upgrade rate and risk factors associated with the upgrade of LCIS diagnosed at preoperative biopsy and performed surgical excision in a single institution. Methods We reviewed electronic medical records (EMR) and data from the Breast Cancer Registry database of Severance Hospital, Yonsei University Health System, and conducted a retrospective study. The computerized medical database included information about the clinical, radiological, and pathological characteristics of patients; treatment methods; preoperative and postoperative pathologic findings; preoperative findings on physical examination, mammography, and ultrasonography; recurrence and mortality; and follow-up data, as previously described [ 6 ]. This study was approved by the Institutional Review Board of Severance Hospital, Yonsei University Health System (4-2020-0716). We reviewed the data of 80 patients who underwent breast surgery for LCIS at Severance Hospital between January 1991 and December 2016 using EMRs and data from the database. We excluded patients diagnosed with invasive cancer at preoperative biopsy ( n = 6) and non-LCIS at preoperative biopsy ( n = 18); we also excluded one case involving unavailable data. Finally, 55 cases of LCIS diagnosed at preoperative biopsy were enrolled in the study (Fig. 1 ). The patients underwent breast-conserving surgery or mastectomy, according to the patients’ and surgeons' preferences based on the tumor size, location, and multiplicity of tumors. After surgery, some patients who underwent breast-conserving surgery received adjuvant radiotherapy according to the multidisciplinary team approach. Patient characteristics such as age, clinical findings, preoperative biopsy methods, pathological findings, and treatment methods were reviewed. A preoperative physical examination was performed by experienced surgeons, and a palpable mass was described in the medical database with or without information about the location or size of the lesion. Preoperative imaging evaluations including mammography, ultrasonography, and magnetic resonance imaging (MRI) were performed. The initial reports of preoperative imaging studies were reviewed for their correlation with the final pathology. Final pathology records were reviewed to analyze histopathological variables including tumor size, hormone receptor status, E-cadherin expression, pleomorphism, and comedo necrosis. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (HER) 2/neu expression were evaluated on formalin-fixed, paraffin-embedded whole sections of the surgically resected breast specimens using immunohistochemistry (IHC). The cutoff value for ER and PR positivity was > 1% staining on IHC. Pleomorphism and comedo necrosis were reviewed by an experienced breast pathologist, JSK, and categorized as either absent or present. Statistical analysis Categorical variables were analyzed using the chi-square test or Fisher's exact test. Continuous variables were analyzed using the Student's t-test or Mann-Whitney U test. Univariate and multivariate analyses for calculating the odds ratios of significant risk factors for the upgrade of preoperative LCIS were performed using binary logistic regression. Multivariate analysis was adjusted for age, microcalcification on mammography, and PR status as covariates. Risk factors were selected using backward stepwise regression based on the probability of the likelihood ratio. A P < 0.05 was considered significant; all tests were two-sided. Statistical analyses were conducted using a commercially available statistical software SPSS Statistics 25 (IBM Corp., Armonk, NY, USA). Results Overall, 55 cases of preoperative LCIS were identified. They were classified into two different groups based on the final pathology: 9 cases of postoperative DCIS or invasive carcinoma in the upgrade group and 46 cases of postoperative LCIS in the non-upgrade group (Fig. 1 ). The upgrade rate of preoperative LCIS to DCIS or invasive carcinoma was 16.4% (9/55) (Fig. 2 a). Clinicopathologic features were compared between the upgrade group and the non-upgrade group (Table 1 ). There was no significant difference between the two groups in terms of age; physical examination findings; ultrasonographic findings; Breast Imaging-Reporting and Data System (BI-RADS) category; MRI findings; biopsy methods; surgical methods; tumor site; tumor size; and the status of ER, PR, HER-2, and E-cadherin expression at baseline. Microcalcification on mammography was seen in 41.3% (19/46) of patients in the non-upgrade group and in 77.8% (7/9) of patients in the upgrade group, which indicated a marginally significant difference ( P = 0.05). In the multivariate analysis, microcalcification on mammography and PR positivity were significantly associated with the risk of upgrade of preoperative LCIS (Odds ratio [OR] = 14.155; P = 0.023 and OR = 10.621; P = 0.044) (Table 2 ). Table 1 Comparison of clinicopathologic features between the upgrade group and non-upgrade group Preoperative LCIS ( n = 55) P value Upgrade group Non-upgrade group ( n = 9, 16.4%) number (%) ( n = 46, 83.6%) number (%) Age (years) 0.467 ≤50 4 (44.4%) 28 (60.9%) >50 5 (55.6%) 18 (39.1%) Physical exam > 0.999 Non-palpable 7 (77.8%) 36 (78.3%) Palpable 2 (22.2%) 10 (21.7%) Microcalcification on mammography 0.050 Negative 1 (11.1%) 24 (52.2%) Positive 7 (77.8%) 19 (41.3%) Unknown 1 (11.1%) 3 (6.5%) USG mass > 0.999 Negative 6 (66.7%) 28 (63.6%) Positive 3 (33.3%) 16 (36.4%) BI-RADS category 0.767 Category 4 8 (88.9%) 34 (73.9%) Category 5 0 (0%) 2 (4.3%) Others (category 2,3,6) 1 (11.1%) 10 (21.7%) MRI enhancement 0.649 Negative 1 (16.7%) 12 (32.4%) Positive 5 (83.3%) 25 (67.6%) Biopsy methods > 0.999 Core needle biopsy 5 (55.6%) 31 (67.4%) Vacuum assisted biopsy 4 (44.4%) 12 (26.1%) Excisional biopsy 0 (0%) 3 (6.5%) Surgery type > 0.999 Partial mastectomy 7 (77.8%) 36 (78.3%) Total mastectomy 2 (22.2%) 10 (21.7%) Tumor site 0.475 Left 6 (66.7%) 23 (50.0%) Right 3 (33.3%) 23 (50.0%) Tumor size > 0.999 ≤ 2 cm 7 (77.8%) 30 (75.0%) > 2 cm 2 (22.2%) 10 (25.0%) ER > 0.999 Negative 0 (0%) 1 (2.3%) Positive 9 (100.0%) 42 (97.7%) PR 0.241 Negative 1 (11.1%) 16 (38.1%) Positive 8 (88.9%) 26 (61.9%) HER-2 0.796 0 ~ 1+ 5 (55.6%) 21 (45.7%) 2+ 2 (22.2%) 17 (37.0%) 3+ 2 (22.2%) 4 (8.7%) E-cadherin expression 0.327 Negative 9 (100.0%) 38 (82.6%) Positive* 0 (0%) 1 (2.2%) Not done 0 (0%) 7 (15.2%) * Weak positive BI-RADS Breast Imaging-Reporting and Data System, ER estrogen receptor, HER human epidermal growth factor receptor, LCIS lobular carcinoma in situ, MRI magnetic resonance imaging, PR progesterone receptor, USG ultrasonography Table 2 Univariate and multivariate analysis for the upgradation of preoperative LCIS ( n = 55) Clinicopathologic factors Univariate analysis Multivariate analysis OR (95% CI) P value OR (95% CI) P value Age (≤ 50 years vs. >50 years) 1.944 (0.460–8.223) 0.366 - Microcalcification on MMG (negative vs. positive) 8.842 (1.000-78.221) 0.050 14.155 (1.448-138.394) 0.023 PR (negative vs. positive) 4.923 (0.562–43.123) 0.150 10.621 (1.069-105.559) 0.044 MMG mammography, PR progesterone receptor Pleomorphism of LCIS was analyzed by preoperative biopsy (Table 3 ). The rates of pleomorphic LCIS and comedo necrosis were 19.5% and 17.1%, respectively. Based on preoperative biopsy findings, there were no cases of pleomorphic LCIS in the upgrade group, whereas there were 8 cases of pleomorphic LCIS in the non-upgrade group. There were only 7 cases of comedo necrosis in the non-upgrade group. There were no significant differences between the two groups in terms of pleomorphism and comedo necrosis ( P = 0.318 and 0.310, respectively). Table 3 Pleomorphic subtypes and comedo necrosis in the upgrade and non-upgrade groups Preoperative LCIS ( n = 55)* Upgrade group ( n = 9) number (%) Non-upgrade group ( n = 46) number (%) P value Preop - Pleomorphic type 0.318 No 8 (100%) 25 (75.8%) Yes 0 8 (24.2%) Preop – comedo necrosis 0.310 No 8 (100%) 26 (78.8%) Yes 0 7 (21.2%) * Missing data were excluded from the analysis (preop-pleomorphic n = 14, preop-comedo necrosis n = 14) Discussion The current study demonstrated that the upgrade rate of preoperative LCIS was 16.4%. A relatively significant proportion of the patients with preoperative LCIS had hidden invasive cancer that might be missed if only core needle biopsy is used as a definitive diagnostic tool. A previous study reported an 8.4–9.3% rate of upgrade for LCIS, which was considerably higher than the acceptable target for surveillance, and the authors suggested excision of preoperative LCIS confirmed by a core needle biopsy [ 5 ]. Li et al. suggested that LCIS might be a precursor of invasive carcinoma, and localized treatment for LCIS is warranted [ 7 ]. Cheng et al. also suggested that lumpectomy is the most appropriate management for LCIS [ 8 ]. In this study, all upgrade groups were diagnosed by core needle or vacuum assisted biopsy, not by excisional biopsy (Fig. 2 b). This result suggested that excision could be considered in case of LCIS for reliable tissue confirmation. Nevertheless, there is controversy about the treatment of LCIS diagnosed on core needle biopsy, because of the varying upgrade rates mentioned in the literature (Table 4 ). Schmidt et al. reported that the true upgrade rate of LCIS was 4% on excluding pleomorphic LCIS and image-discordant lesions [ 9 ]. They suggested that surgery for classic LCIS is unnecessary, and careful radio-pathological correlation during initial biopsy is critical. Wen and Brogi suggested that classic LCIS on core needle biopsy with concordant imaging does not require surgical resection [ 10 ]. However, our study showed a relatively high rate of upgrade of LCIS, regardless of the presence of pleomorphism. There was no association between the upgrade rate and presence of pleomorphic LCIS or comedo necrosis in this study. Even though the pathologic slides of all cases of LCIS were reviewed by a specialized pathologist, no pleomorphism or comedo necrosis was detected in the upgrade group. Pleomorphic LCIS is considered to be an aggressive type of LCIS associated with high-grade DCIS and invasive cancer [ 11 , 12 ]. In the previous studies, the upgrade rates of pleomorphic LCIS were relatively high, at 20–100% [ 9 , 13 , 14 ]. Hence, the NCCN guidelines recommend surgical excision for pleomorphic LCIS [ 1 ]. The difference in the upgrade rate of pleomorphic LCIS between the previous and current study might be due to the small sample size of each study and inter-observer variability in the pathological evaluations. Table 4 Upgrade rates of lobular neoplasia or LCIS during the recent 5 years Authors Years Pathology N Upgrade rate Features Benjamin C. Calhoun [ 12 ] 2016 LN 76 13% Included pLCIS as an upgraded pathology Thaer Khoury [ 13 ] 2016 LN LCIS 63 34 24% 32% 67% (pLCIS) MRI-guided core biopsy Schmidt H [ 9 ] 2018 LN 115 11% (all LN) 4% (except pLCIS and discordant lesions) Observation vs. excision Desai AA [ 14 ] 2018 pLCIS 15 20% Iskender Sinan Genco [ 18 ] 2019 LN cLCIS 287 115 3.8% 7% Classic LN diagnosed on breast core needle biopsy Holbrook AI [ 19 ] 2019 LN 66 7.6% Nakhlis F [ 20 ] 2019 NC-LCIS 76 36% Supporting routine excision LCIS lobular carcinoma in situ, LN lobular neoplasia, NC-LCIS non-classic lobular carcinoma in situ, pLCIS pleomorphic lobular carcinoma in situ The definition of concordant images and pathologic results is variable [ 15 ]. Youk et al. summarized five categories of radio-pathological correlation in a sonography-guided core needle biopsy of a breast lesion: concordant malignancy, discordant malignancy, concordant benign, discordant benign, and borderline or high-risk [ 15 ]. Before the AJCC system 8th edition was published, LCIS was considered a malignant lesion; thus, when core needle biopsy for a BI-RADS category 4a lesion reveals classic LCIS, it could be considered either as discordant benign or borderline. When the radio-pathological correlation is borderline, a multidisciplinary approach or surgical excision to identify the hidden malignancy could be adopted. However, after the AJCC system 8th edition was published, when core needle biopsy for a category 4a lesion revealed classic LCIS, it was considered as concordant benign and not borderline or high-risk. In such cases, surgical excision should not be routinely recommended according to the NCCN guidelines. Since most previous studies used data obtained before the AJCC system 8th edition was published, the definition of the radio-pathological correlation for classic LCIS was considered to be either discordant benign or borderline. When we reviewed a previous study, the exact definition of the radio-pathological correlation was not specified [ 16 , 17 ]. Since the general recommendation of close follow-up for classic LCIS is based on ambiguous or arbitrary definition of the radio-pathological correlation for classic LCIS, it is difficult to routinely follow the revised guidelines for classic LCIS. A more detailed definition of the radio-pathological correlation for LCIS should be developed to avoid miscommunication among physicians, radiologists, pathologists, and surgeons. The current study found that microcalcification on mammography and the expression of PR were significant in predicting the likelihood of upgrade of LCIS. A previous study reported a similar association between the upgrade rate of LCIS and mammographic calcification [ 5 ]. This result was similar to that observed in our study. Therefore, when cases of LCIS diagnosed on preoperative biopsy involve mammographic microcalcification and PR positivity, hidden invasive cancer or DCIS might be discovered after surgical excision (Fig. 3 ). There were some limitations to this study. First, we analyzed a small number of cases. Few cases of preoperative LCIS were evaluated for calculating the upgrade rate. Second, when we reviewed the pathologic data, including data on pleomorphism, there were some missing data that might have affected the accuracy of the analysis. In the future, more large-scale, long-term research on LCIS is necessary. Finally, our research has the limitations of a retrospective study. Nevertheless, the current study has valuable implications for clinical practice. Our study focused only on LCIS and not on lobular neoplasia or atypical lobular hyperplasia. We found that the ambiguity in the definition of radio-pathological correlation in the previous studies might have weakened the evidence of the current guidelines. In the current study, multivariate analysis found two significant predictors of the upgrade of preoperative LCIS. Conclusions This study showed a relatively high rate of upgrade to DCIS or invasive cancer in cases of preoperative LCIS. The presence of microcalcification on mammography and PRs can be potential predictors of upgrade. Surgical excision of LCIS during core needle biopsy could be considered as a management option to identify a hidden malignancy. Abbreviations AJCC: American Joint Committee on Cancer BI-RADS: Breast Imaging-Reporting and Data System DCIS: Ductal carcinoma in situ EMR: Electronic medical records ER: Estrogen receptor HER: Human epidermal growth factor receptor IHC: Immunohistochemistry LCIS: Lobular carcinoma in situ MRI: Magnetic resonance imaging NCCN: National Comprehensive Cancer Network OR: Odds ratio PR: Progesterone receptor Declarations Ethics approval This retrospective chart review study was approved by the Institutional Review Board of Severance Hospital, Yonsei University Health System (4-2020-0716). Consent to participate Not applicable Consent to publication Not applicable Availability of data and material The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests All authors have no conflict of interest. Funding No funding was received for this study. Author Contributions HSP conceived and designed the study. HSP, JL, GYK and HML analyzed and interpreted data, wrote the paper with input from all authors. JSK contributed to the interpretation of the pathology. All authors contributed to revise the article and approved the submitted version. Acknowledgments No funding was received for this study. References Bergman MA, Kumar R: NCCN Clinical Practive Guidelines in Oncology ( NCCN Guidelines® ) Breast Cancer Screening and Diagnosis . 2019, 1 . 2019 . Middleton LP, Grant S, Stephens T, Stelling CB, Sneige N, Sahin AA: Lobular carcinoma in situ diagnosed by core needle biopsy: when should it be excised? Modern pathology: an official journal of the United States and Canadian Academy of Pathology, Inc 2003, 16 (2):120–129. Shah-Khan MG, Geiger XJ, Reynolds C, Jakub JW, Deperi ER, Glazebrook KN: Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy . 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Cheng P, Huang Q, Shou J, Hu G, Han M, Huang J: Treatment and survival outcomes of lobular carcinoma in situ of the breast: a SEER population based study . Oncotarget 2017, 8 (61):103047–103054. Schmidt H, Arditi B, Wooster M, Weltz C, Margolies L, Bleiweiss I, Port E, Jaffer S: Observation versus excision of lobular neoplasia on core needle biopsy of the breast . Breast Cancer Res Treat 2018, 168 (3):649–654. Wen HY, Brogi E: Lobular Carcinoma In Situ . Surg Pathol Clin 2018, 11 (1):123–145. Foschini MP, Miglio R, Fiore R, Baldovini C, Castellano I, Callagy G, Bianchi S, Kaya H, Amendoeira I, Querzoli P et al : Pre - operative management of Pleomorphic and florid lobular carcinoma in situ of the breast : Report of a large multi - institutional series and review of the literature . European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 2019, 45 (12):2279–2286. 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Cangiarella J, Guth A, Axelrod D, Darvishian F, Singh B, Simsir A, Roses D, Mercado C: Is surgical excision necessary for the management of atypical lobular hyperplasia and lobular carcinoma in situ diagnosed on core needle biopsy?: a report of 38 cases and review of the literature . Archives of pathology & laboratory medicine 2008, 132 (6):979–983. Bowman K, Munoz A, Mahvi DM, Breslin TM: Lobular neoplasia diagnosed at core biopsy does not mandate surgical excision . The Journal of surgical research 2007, 142 (2):275–280. Genco IS, Tugertimur B, Chang Q, Cassell L, Hajiyeva S: Outcomes of classic lobular neoplasia diagnosed on breast core needle biopsy: a retrospective multi-center study . Virchows Arch 2020, 476 (2):209–217. Holbrook AI, Hanley K, Jeffers C, Kang J, Cohen MA: Triaging Atypical Lobular Hyperplasia and Lobular Carcinoma In Situ on Percutaneous Core Biopsy to Surgery or Observation : Assiduous Radiologic - Pathologic Correlation Works , Quantitating Extent of Disease Does Not . Arch Pathol Lab Med 2019, 143 (5):621–627. Nakhlis F, Harrison BT, Giess CS, Lester SC, Hughes KS, Coopey SB, King TA: Evaluating the Rate of Upgrade to Invasive Breast Cancer and/or Ductal Carcinoma In Situ Following a Core Biopsy Diagnosis of Non-classic Lobular Carcinoma In Situ . Ann Surg Oncol 2019, 26 (1):55–61. Additional Declarations No competing interests reported. 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Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-711303","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":40667576,"identity":"ee76aeaa-dec8-4d7d-85b3-dd39539a9732","order_by":0,"name":"Jeea Lee","email":"","orcid":"","institution":"Yonsei University College of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jeea","middleName":"","lastName":"Lee","suffix":""},{"id":40667577,"identity":"b4200f09-e37c-477d-9080-19bebcee408a","order_by":1,"name":"Ga Yoon Ku","email":"","orcid":"","institution":"Yonsei University College of 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Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Seung","middleName":"Il","lastName":"Kim","suffix":""},{"id":40667590,"identity":"f64d2537-f586-4143-a42c-289cd185ab8b","order_by":8,"name":"Byeong-Woo Park","email":"","orcid":"","institution":"Yonsei University College of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Byeong-Woo","middleName":"","lastName":"Park","suffix":""}],"badges":[],"createdAt":"2021-07-12 15:29:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-711303/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-711303/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.4143/crt.2021.864","type":"published","date":"2021-12-21T06:37:43+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":11720543,"identity":"8bb4fae4-47e8-4301-a05e-34263b3ffb4c","added_by":"auto","created_at":"2021-07-22 18:20:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":203069,"visible":true,"origin":"","legend":"Schema of the study design to analyze the upgrade rate of preoperative LCIS","description":"","filename":"Onlinefigure1upgradefinal.png","url":"https://assets-eu.researchsquare.com/files/rs-711303/v1/fbd37a1797d1998328c4e767.png"},{"id":11720544,"identity":"4be36789-a084-410a-bc9a-ad2a62ad8f23","added_by":"auto","created_at":"2021-07-22 18:20:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":135600,"visible":true,"origin":"","legend":"The rate of upgrade of preoperative LCIS (n = 55)\n(a) The rate of upgrade of preoperative LCIS\n(b) The rate of upgrade of preoperative LCIS according to the methods of preoperative biopsy\nBx biopsy, CNB core needle biopsy, LCIS lobular carcinoma in situ, VAB vacuum assisted-biopsy","description":"","filename":"Onlinefigure2upgradeab1200final.png","url":"https://assets-eu.researchsquare.com/files/rs-711303/v1/337427f44f43d1da444b2c53.png"},{"id":11720545,"identity":"33ac59fc-a5e2-42b6-a5cd-3190088fc025","added_by":"auto","created_at":"2021-07-22 18:20:18","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":598127,"visible":true,"origin":"","legend":"A case of the upgrade group with definite microcalcification on mammography without USG and MRI findings and the PR positivity\n(a) Increased extent and amount of grouped microcalcification in lower central portion of the left breast on mammography\n(b) Multiple probable benign enhancement without localized suspicious enhancements in both breasts on MRI\n(c) Increased benign looking lesions in the both breasts on USG\nLCIS lobular carcinoma in situ, MRI magnetic resonance imaging, PR progesterone receptor, USG ultrasonography","description":"","filename":"Onlinefigure3upgradeLCIScalcificationcaseimage.png","url":"https://assets-eu.researchsquare.com/files/rs-711303/v1/a5bb21df6533f44ca4e92014.png"},{"id":16857967,"identity":"0c903fa1-ba89-4e1a-81fb-5f65e85460e0","added_by":"auto","created_at":"2021-12-30 06:37:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1371265,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-711303/v1/ce0bc2a8-ac36-4119-a418-28dbde024a09.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eLobular Carcinoma in Situ During Preoperative Biopsy and the Rate of Upgrade\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eTraditionally, an excision is recommended for patients with lobular carcinoma in situ (LCIS) diagnosed on core needle biopsy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, the management of LCIS has been controversial, and some authors advocate observation rather than surgical excision [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLCIS was excluded from the malignant category in the 8th American Joint Committee on Cancer (AJCC) staging system for breast cancer [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The National Comprehensive Cancer Network (NCCN) guidelines\u0026reg; recommend active surveillance, surgical excision, and/or other interventions such as counseling for lifestyle modification, medication, or surgery for reducing the risk of breast cancer in patients with LCIS diagnosed on core needle biopsy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Surgical excision should be considered only in patients with pleomorphic LCIS or lesions that are non-concordant with imaging findings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Patients with classic LCIS and those with lesions that are concordant with imaging findings can be followed up with close observation [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAcross the literature, the upgrade rates of LCIS on core needle biopsy to invasive carcinoma or ductal carcinoma in situ (DCIS) at surgical excision have been reported from 0\u0026ndash;50% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Previous studies have shown that the upgrade rate varies, and there is still no consensus about surgical treatment or observation in cases of LCIS [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, we analyzed the upgrade rate and risk factors associated with the upgrade of LCIS diagnosed at preoperative biopsy and performed surgical excision in a single institution.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e We reviewed electronic medical records (EMR) and data from the Breast Cancer Registry database of Severance Hospital, Yonsei University Health System, and conducted a retrospective study. The computerized medical database included information about the clinical, radiological, and pathological characteristics of patients; treatment methods; preoperative and postoperative pathologic findings; preoperative findings on physical examination, mammography, and ultrasonography; recurrence and mortality; and follow-up data, as previously described [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This study was approved by the Institutional Review Board of Severance Hospital, Yonsei University Health System (4-2020-0716).\u003c/p\u003e \u003cp\u003eWe reviewed the data of 80 patients who underwent breast surgery for LCIS at Severance Hospital between January 1991 and December 2016 using EMRs and data from the database. We excluded patients diagnosed with invasive cancer at preoperative biopsy (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6) and non-LCIS at preoperative biopsy (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;18); we also excluded one case involving unavailable data. Finally, 55 cases of LCIS diagnosed at preoperative biopsy were enrolled in the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe patients underwent breast-conserving surgery or mastectomy, according to the patients\u0026rsquo; and surgeons' preferences based on the tumor size, location, and multiplicity of tumors. After surgery, some patients who underwent breast-conserving surgery received adjuvant radiotherapy according to the multidisciplinary team approach.\u003c/p\u003e \u003cp\u003ePatient characteristics such as age, clinical findings, preoperative biopsy methods, pathological findings, and treatment methods were reviewed. A preoperative physical examination was performed by experienced surgeons, and a palpable mass was described in the medical database with or without information about the location or size of the lesion. Preoperative imaging evaluations including mammography, ultrasonography, and magnetic resonance imaging (MRI) were performed. The initial reports of preoperative imaging studies were reviewed for their correlation with the final pathology.\u003c/p\u003e \u003cp\u003eFinal pathology records were reviewed to analyze histopathological variables including tumor size, hormone receptor status, E-cadherin expression, pleomorphism, and comedo necrosis. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (HER) 2/neu expression were evaluated on formalin-fixed, paraffin-embedded whole sections of the surgically resected breast specimens using immunohistochemistry (IHC). The cutoff value for ER and PR positivity was \u0026gt;\u0026thinsp;1% staining on IHC. Pleomorphism and comedo necrosis were reviewed by an experienced breast pathologist, JSK, and categorized as either absent or present.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eCategorical variables were analyzed using the chi-square test or Fisher's exact test. Continuous variables were analyzed using the Student's t-test or Mann-Whitney U test. Univariate and multivariate analyses for calculating the odds ratios of significant risk factors for the upgrade of preoperative LCIS were performed using binary logistic regression. Multivariate analysis was adjusted for age, microcalcification on mammography, and PR status as covariates. Risk factors were selected using backward stepwise regression based on the probability of the likelihood ratio. A \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant; all tests were two-sided. Statistical analyses were conducted using a commercially available statistical software SPSS Statistics 25 (IBM Corp., Armonk, NY, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOverall, 55 cases of preoperative LCIS were identified. They were classified into two different groups based on the final pathology: 9 cases of postoperative DCIS or invasive carcinoma in the upgrade group and 46 cases of postoperative LCIS in the non-upgrade group (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The upgrade rate of preoperative LCIS to DCIS or invasive carcinoma was 16.4% (9/55) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eClinicopathologic features were compared between the upgrade group and the non-upgrade group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). There was no significant difference between the two groups in terms of age; physical examination findings; ultrasonographic findings; Breast Imaging-Reporting and Data System (BI-RADS) category; MRI findings; biopsy methods; surgical methods; tumor site; tumor size; and the status of ER, PR, HER-2, and E-cadherin expression at baseline. Microcalcification on mammography was seen in 41.3% (19/46) of patients in the non-upgrade group and in 77.8% (7/9) of patients in the upgrade group, which indicated a marginally significant difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05). In the multivariate analysis, microcalcification on mammography and PR positivity were significantly associated with the risk of upgrade of preoperative LCIS (Odds ratio [OR]\u0026thinsp;=\u0026thinsp;14.155; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023 and OR\u0026thinsp;=\u0026thinsp;10.621; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of clinicopathologic features between the upgrade group and non-upgrade group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePreoperative LCIS (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003cp\u003evalue\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpgrade group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-upgrade group\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;9, 16.4%)\u003c/p\u003e \u003cp\u003enumber (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;46, 83.6%)\u003c/p\u003e \u003cp\u003enumber (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (60.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (55.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (39.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical exam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-palpable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (78.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePalpable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMicrocalcification on mammography\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (52.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (41.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUSG mass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (63.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBI-RADS category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (88.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (73.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers (category 2,3,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRI enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.649\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (32.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (67.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiopsy methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCore needle biopsy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (55.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (67.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVacuum assisted biopsy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (26.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcisional biopsy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartial mastectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (78.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal mastectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.475\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;2 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 2 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (97.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.241\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (88.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (61.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHER-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.796\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026thinsp;~\u0026thinsp;1+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (55.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (45.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (37.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE-cadherin expression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.327\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (82.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot done\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e* Weak positive\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eBI-RADS\u003c/em\u003e Breast Imaging-Reporting and Data System, \u003cem\u003eER\u003c/em\u003e estrogen receptor, \u003cem\u003eHER\u003c/em\u003e human epidermal growth factor receptor, \u003cem\u003eLCIS\u003c/em\u003e lobular carcinoma in situ, \u003cem\u003eMRI\u003c/em\u003e magnetic resonance imaging, \u003cem\u003ePR\u003c/em\u003e progesterone receptor, \u003cem\u003eUSG\u003c/em\u003e ultrasonography\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate analysis for the upgradation of preoperative LCIS (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;55)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClinicopathologic\u003c/p\u003e \u003cp\u003efactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e(\u0026le;\u0026thinsp;50 years vs. \u0026gt;50 years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.944\u003c/p\u003e \u003cp\u003e(0.460\u0026ndash;8.223)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMicrocalcification on MMG\u003c/p\u003e \u003cp\u003e(negative vs. positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.842\u003c/p\u003e \u003cp\u003e(1.000-78.221)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.155\u003c/p\u003e \u003cp\u003e(1.448-138.394)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePR\u003c/p\u003e \u003cp\u003e(negative vs. positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.923\u003c/p\u003e \u003cp\u003e(0.562\u0026ndash;43.123)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.621\u003c/p\u003e \u003cp\u003e(1.069-105.559)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMMG\u003c/em\u003e mammography, \u003cem\u003ePR\u003c/em\u003e progesterone receptor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePleomorphism of LCIS was analyzed by preoperative biopsy (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The rates of pleomorphic LCIS and comedo necrosis were 19.5% and 17.1%, respectively. Based on preoperative biopsy findings, there were no cases of pleomorphic LCIS in the upgrade group, whereas there were 8 cases of pleomorphic LCIS in the non-upgrade group. There were only 7 cases of comedo necrosis in the non-upgrade group. There were no significant differences between the two groups in terms of pleomorphism and comedo necrosis (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.318 and 0.310, respectively).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePleomorphic subtypes and comedo necrosis in the upgrade and non-upgrade groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePreoperative LCIS (\u003cem\u003en =\u003c/em\u003e 55)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUpgrade group\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;9)\u003c/p\u003e \u003cp\u003enumber (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-upgrade group\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;46)\u003c/p\u003e \u003cp\u003enumber (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003cp\u003evalue\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreop - Pleomorphic type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (75.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreop \u0026ndash; comedo necrosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.310\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (78.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (21.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* Missing data were excluded from the analysis (preop-pleomorphic \u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;14, preop-comedo necrosis \u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;14)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study demonstrated that the upgrade rate of preoperative LCIS was 16.4%. A relatively significant proportion of the patients with preoperative LCIS had hidden invasive cancer that might be missed if only core needle biopsy is used as a definitive diagnostic tool. A previous study reported an 8.4\u0026ndash;9.3% rate of upgrade for LCIS, which was considerably higher than the acceptable target for surveillance, and the authors suggested excision of preoperative LCIS confirmed by a core needle biopsy [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Li et al. suggested that LCIS might be a precursor of invasive carcinoma, and localized treatment for LCIS is warranted [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Cheng et al. also suggested that lumpectomy is the most appropriate management for LCIS [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In this study, all upgrade groups were diagnosed by core needle or vacuum assisted biopsy, not by excisional biopsy (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb). This result suggested that excision could be considered in case of LCIS for reliable tissue confirmation.\u003c/p\u003e \u003cp\u003eNevertheless, there is controversy about the treatment of LCIS diagnosed on core needle biopsy, because of the varying upgrade rates mentioned in the literature (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Schmidt et al. reported that the true upgrade rate of LCIS was 4% on excluding pleomorphic LCIS and image-discordant lesions [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. They suggested that surgery for classic LCIS is unnecessary, and careful radio-pathological correlation during initial biopsy is critical. Wen and Brogi suggested that classic LCIS on core needle biopsy with concordant imaging does not require surgical resection [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, our study showed a relatively high rate of upgrade of LCIS, regardless of the presence of pleomorphism. There was no association between the upgrade rate and presence of pleomorphic LCIS or comedo necrosis in this study. Even though the pathologic slides of all cases of LCIS were reviewed by a specialized pathologist, no pleomorphism or comedo necrosis was detected in the upgrade group. Pleomorphic LCIS is considered to be an aggressive type of LCIS associated with high-grade DCIS and invasive cancer [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In the previous studies, the upgrade rates of pleomorphic LCIS were relatively high, at 20\u0026ndash;100% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Hence, the NCCN guidelines recommend surgical excision for pleomorphic LCIS [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The difference in the upgrade rate of pleomorphic LCIS between the previous and current study might be due to the small sample size of each study and inter-observer variability in the pathological evaluations.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUpgrade rates of lobular neoplasia or LCIS during the recent 5 years\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYears\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePathology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUpgrade rate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFeatures\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenjamin C.\u003c/p\u003e \u003cp\u003eCalhoun [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIncluded pLCIS as an upgraded pathology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThaer Khoury [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLN\u003c/p\u003e \u003cp\u003eLCIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63\u003c/p\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24%\u003c/p\u003e \u003cp\u003e32%\u003c/p\u003e \u003cp\u003e67% (pLCIS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMRI-guided core biopsy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchmidt H [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11% (all LN)\u003c/p\u003e \u003cp\u003e4% (except pLCIS and discordant\u003c/p\u003e \u003cp\u003elesions)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eObservation vs. excision\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDesai AA [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epLCIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIskender Sinan Genco [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLN\u003c/p\u003e \u003cp\u003ecLCIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e287\u003c/p\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.8%\u003c/p\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eClassic LN diagnosed on breast core needle biopsy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHolbrook AI [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNakhlis F [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNC-LCIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSupporting routine excision\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eLCIS\u003c/em\u003e lobular carcinoma in situ, \u003cem\u003eLN lobular neoplasia, NC-LCIS non-classic lobular carcinoma in situ, pLCIS\u003c/em\u003e pleomorphic lobular carcinoma in situ\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe definition of concordant images and pathologic results is variable [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Youk et al. summarized five categories of radio-pathological correlation in a sonography-guided core needle biopsy of a breast lesion: concordant malignancy, discordant malignancy, concordant benign, discordant benign, and borderline or high-risk [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Before the AJCC system 8th edition was published, LCIS was considered a malignant lesion; thus, when core needle biopsy for a BI-RADS category 4a lesion reveals classic LCIS, it could be considered either as discordant benign or borderline. When the radio-pathological correlation is borderline, a multidisciplinary approach or surgical excision to identify the hidden malignancy could be adopted. However, after the AJCC system 8th edition was published, when core needle biopsy for a category 4a lesion revealed classic LCIS, it was considered as concordant benign and not borderline or high-risk. In such cases, surgical excision should not be routinely recommended according to the NCCN guidelines. Since most previous studies used data obtained before the AJCC system 8th edition was published, the definition of the radio-pathological correlation for classic LCIS was considered to be either discordant benign or borderline. When we reviewed a previous study, the exact definition of the radio-pathological correlation was not specified [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Since the general recommendation of close follow-up for classic LCIS is based on ambiguous or arbitrary definition of the radio-pathological correlation for classic LCIS, it is difficult to routinely follow the revised guidelines for classic LCIS. A more detailed definition of the radio-pathological correlation for LCIS should be developed to avoid miscommunication among physicians, radiologists, pathologists, and surgeons.\u003c/p\u003e \u003cp\u003eThe current study found that microcalcification on mammography and the expression of PR were significant in predicting the likelihood of upgrade of LCIS. A previous study reported a similar association between the upgrade rate of LCIS and mammographic calcification [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This result was similar to that observed in our study. Therefore, when cases of LCIS diagnosed on preoperative biopsy involve mammographic microcalcification and PR positivity, hidden invasive cancer or DCIS might be discovered after surgical excision (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThere were some limitations to this study. First, we analyzed a small number of cases. Few cases of preoperative LCIS were evaluated for calculating the upgrade rate. Second, when we reviewed the pathologic data, including data on pleomorphism, there were some missing data that might have affected the accuracy of the analysis. In the future, more large-scale, long-term research on LCIS is necessary. Finally, our research has the limitations of a retrospective study. Nevertheless, the current study has valuable implications for clinical practice. Our study focused only on LCIS and not on lobular neoplasia or atypical lobular hyperplasia. We found that the ambiguity in the definition of radio-pathological correlation in the previous studies might have weakened the evidence of the current guidelines. In the current study, multivariate analysis found two significant predictors of the upgrade of preoperative LCIS.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study showed a relatively high rate of upgrade to DCIS or invasive cancer in cases of preoperative LCIS. The presence of microcalcification on mammography and PRs can be potential predictors of upgrade. Surgical excision of LCIS during core needle biopsy could be considered as a management option to identify a hidden malignancy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAJCC: American Joint Committee on Cancer\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBI-RADS: Breast Imaging-Reporting and Data System\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDCIS: Ductal carcinoma in situ\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEMR: Electronic medical records\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eER: Estrogen receptor\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHER: Human epidermal growth factor receptor\u003c/p\u003e\n\u003cp\u003eIHC: Immunohistochemistry\u003c/p\u003e\n\u003cp\u003eLCIS: Lobular carcinoma in situ\u003c/p\u003e\n\u003cp\u003eMRI: Magnetic resonance imaging\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNCCN: National Comprehensive Cancer Network\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOR: Odds ratio\u003c/p\u003e\n\u003cp\u003ePR: Progesterone receptor\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective chart review study was approved by the Institutional Review Board of Severance Hospital, Yonsei University Health System (4-2020-0716).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHSP conceived and designed the study. HSP, JL, GYK and HML analyzed and interpreted data, wrote the paper with input from all authors. JSK contributed to the interpretation of the pathology. All authors contributed to revise the article and approved the submitted version.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBergman MA, Kumar R: \u003cb\u003eNCCN Clinical Practive Guidelines in Oncology\u003c/b\u003e (\u003cb\u003eNCCN Guidelines\u0026reg;\u003c/b\u003e) \u003cb\u003eBreast Cancer Screening and Diagnosis\u003c/b\u003e. 2019, \u003cb\u003e1\u003c/b\u003e. \u003cb\u003e2019\u003c/b\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiddleton LP, Grant S, Stephens T, Stelling CB, Sneige N, Sahin AA: \u003cb\u003eLobular carcinoma in situ diagnosed by core needle biopsy: when should it be excised?\u003c/b\u003e \u003cem\u003eModern pathology: an official journal of the United States and Canadian Academy of 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literature\u003c/b\u003e. \u003cem\u003eHistopathology\u003c/em\u003e 2016, \u003cb\u003e68\u003c/b\u003e(1):138\u0026ndash;151.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhoury T, Kumar PR, Li Z, Karabakhtsian RG, Sanati S, Chen X, Wang D, Liu S, Reig B: \u003cb\u003eLobular neoplasia detected in MRI-guided core biopsy carries a high risk for upgrade: a study of 63 cases from four different institutions\u003c/b\u003e. \u003cem\u003eModern Pathology\u003c/em\u003e 2016, \u003cb\u003e29\u003c/b\u003e(1):25\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDesai AA, Jimenez RE, Hoskin TL, Day CN, Boughey JC, Hieken TJ: \u003cb\u003eTreatment Outcomes for Pleomorphic Lobular Carcinoma In Situ of the Breast\u003c/b\u003e. \u003cem\u003eAnnals of surgical oncology\u003c/em\u003e 2018, \u003cb\u003e25\u003c/b\u003e(10):3064\u0026ndash;3068.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYouk JH, Kim E-K, Kim MJ, Ko KH, Kwak JY, Son EJ, Choi J, Kang HY: \u003cb\u003eConcordant or discordant? Imaging-pathology correlation in a sonography-guided core needle biopsy of a breast lesion\u003c/b\u003e. \u003cem\u003eKorean J Radiol\u003c/em\u003e 2011, \u003cb\u003e12\u003c/b\u003e(2):232\u0026ndash;240.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCangiarella J, Guth A, Axelrod D, Darvishian F, Singh B, Simsir A, Roses D, Mercado C: \u003cb\u003eIs surgical excision necessary for the management of atypical lobular hyperplasia and lobular carcinoma in situ diagnosed on core needle biopsy?: a report of 38 cases and review of the literature\u003c/b\u003e. \u003cem\u003eArchives of pathology \u0026amp; laboratory medicine\u003c/em\u003e 2008, \u003cb\u003e132\u003c/b\u003e(6):979\u0026ndash;983.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBowman K, Munoz A, Mahvi DM, Breslin TM: \u003cb\u003eLobular neoplasia diagnosed at core biopsy does not mandate surgical excision\u003c/b\u003e. \u003cem\u003eThe Journal of surgical research\u003c/em\u003e 2007, \u003cb\u003e142\u003c/b\u003e(2):275\u0026ndash;280.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGenco IS, Tugertimur B, Chang Q, Cassell L, Hajiyeva S: \u003cb\u003eOutcomes of classic lobular neoplasia diagnosed on breast core needle biopsy: a retrospective multi-center study\u003c/b\u003e. \u003cem\u003eVirchows Arch\u003c/em\u003e 2020, \u003cb\u003e476\u003c/b\u003e(2):209\u0026ndash;217.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolbrook AI, Hanley K, Jeffers C, Kang J, Cohen MA: \u003cb\u003eTriaging Atypical Lobular Hyperplasia and Lobular Carcinoma In Situ on Percutaneous Core Biopsy to Surgery or Observation\u003c/b\u003e: \u003cb\u003eAssiduous Radiologic\u003c/b\u003e-\u003cb\u003ePathologic Correlation Works\u003c/b\u003e, \u003cb\u003eQuantitating Extent of Disease Does Not\u003c/b\u003e. \u003cem\u003eArch Pathol Lab Med\u003c/em\u003e 2019, \u003cb\u003e143\u003c/b\u003e(5):621\u0026ndash;627.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakhlis F, Harrison BT, Giess CS, Lester SC, Hughes KS, Coopey SB, King TA: \u003cb\u003eEvaluating the Rate of Upgrade to Invasive Breast Cancer and/or Ductal Carcinoma In Situ Following a Core Biopsy Diagnosis of Non-classic Lobular Carcinoma In Situ\u003c/b\u003e. \u003cem\u003eAnn Surg Oncol\u003c/em\u003e 2019, \u003cb\u003e26\u003c/b\u003e(1):55\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Breast carcinoma in situ, breast neoplasm, core needle biopsy, lobular carcinoma in situ, surgical diagnostic technics ","lastPublishedDoi":"10.21203/rs.3.rs-711303/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-711303/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThere is a potential risk that lobular carcinoma in situ (LCIS) on preoperative biopsy might be diagnosed as ductal carcinoma in situ (DCIS) or invasive carcinoma in the final pathology. This study aimed to evaluate the rate of upgrade of LCIS on preoperative biopsy to DCIS or invasive carcinoma.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eData of 55 patients with LCIS on preoperative biopsy were analyzed. All patients underwent surgery between 1991 and 2016 at Severance Hospital in Seoul, Korea. We analyzed the rate of upgrade of preoperative LCIS to DCIS or invasive cancer in the final pathology. The clinicopathologic features related to the upgrade were evaluated.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe rate of upgrade of LCIS to DCIS or invasive carcinoma was 16.4% (9/55). In multivariate analysis, microcalcification and progesterone receptor expression were significantly associated with the upgrade of LCIS (\u003cem\u003eP\u003c/em\u003e = 0.023 and 0.044, respectively).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe current study showed a relatively high rate of upgrade of LCIS on preoperative biopsy to DCIS or invasive cancer. The presence of microcalcification and progesterone receptor expression may be potential predictors of upgradation of LCIS on preoperative biopsy. Surgical excision of the LCIS during preoperative biopsy could be a management option to identify the concealed malignancy.\u003c/p\u003e","manuscriptTitle":"Lobular Carcinoma in Situ During Preoperative Biopsy and the Rate of Upgrade","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-07-22 18:20:16","doi":"10.21203/rs.3.rs-711303/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b14f8c5b-b96b-42de-8006-3abf4e38460e","owner":[],"postedDate":"July 22nd, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":5890998,"name":"Cancer Biology"}],"tags":[],"updatedAt":"2021-12-30T06:37:43+00:00","versionOfRecord":{"articleIdentity":"rs-711303","link":"https://doi.org/10.4143/crt.2021.864","journal":{"identity":"cancer-research-and-treatment","isVorOnly":true,"title":"Cancer Research and Treatment"},"publishedOn":"2021-12-21 06:37:43","publishedOnDateReadable":"December 21st, 2021"},"versionCreatedAt":"2021-07-22 18:20:16","video":"","vorDoi":"10.4143/crt.2021.864","vorDoiUrl":"https://doi.org/10.4143/crt.2021.864","workflowStages":[]},"version":"v1","identity":"rs-711303","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-711303","identity":"rs-711303","version":["v1"]},"buildId":"pf3fE39SIOqb-0xH_OWvX","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}