This article will help you read and understand your pathology report for lobular carcinoma in situ (LCIS).
by Jason Wasserman, MD PhD FRCPC, reviewed on August 13, 2019
Adult breast tissue is made up of small structures called glands which are arranged into groups called lobules. Under certain conditions, these glands can produce milk, which is transported to the nipple by a series of small channels called ducts.
The inside of both glands and ducts is lined by specialized cells called epithelial cells which form a barrier called the epithelium. The tissue surrounding glands and ducts is called stroma and contains long, thin cells called fibroblasts.
LCIS is not a cancer. However, the diagnosis of LCIS is associated with an increased risk of developing breast cancer over time. The increased risk applies to both breasts, not just the breast diagnosed with lobular carcinoma in situ.
The diagnosis of LCIS is usually made after a small sample of tissue is removed in a procedure called a core needle biopsy. LCIS is also commonly diagnosed after surgery is performed for another disease such as invasive ductal carcinoma or ductal carcinoma in situ.
There are two different types of LCIS based on how the cells look when examined under a microscope.
Both classic and pleomorphic LCIS are associated with an increased risk of breast cancer but the risk is higher if the cells are pleomorphic.
The nucleus is the part of the cell that contains most of the cells genetic material (the DNA). The abnormal cells in LCIS are given a nuclear grade between 1 and 3 based on the shape and size of the nuclei and the number of abnormal cells dividing to creating new cells (mitotic figures).
Instead of a numerical grade (1 through 3), some pathology reports divide the grade in low, intermediate, and high.
The nuclear grade is important because grade 3 (high grade) LCIS is associated with a higher risk of cancer compared to grade 1 (low grade) LCIS.
Necrosis is a type of cell death. Comedonecrosis is a special type of necrosis sometimes seen in LCIS. In comedonecrosis, the dead cells are in the centre of a duct and surrounded by living cells.
Comedonecrosis is more likely to be seen in high grade LCIS. It is also associated with an increased risk of cancer compared to LCIS without comedonecrosis.