Florid Lobular Carcinoma In Situ: Imaging Characteristics and Pathologic Upgrade Rates on Surgical Excision

Background: Florid lobular carcinoma in situ is an uncommon lobular neoplasia variant that is frequently associated with invasive carcinoma. However, there remains a paucity of information to guide management. The authors aimed to study imaging features associated with pathologic upgrade rates for patients with florid lobular carcinoma in situ identified on core biopsy undergoing surgical excision. Methods: Patients with florid lobular carcinoma in situ on core biopsy were selected from an institutional pathology database. Patients were excluded if pleomorphic lobular carcinoma in situ was also present on core biopsy. Clinical, radiologic, and pathologic features for each case were reviewed focusing on imaging features which led to core biopsy and those associated with pathologic upgrade on surgical excision. Results: Eighteen cases of florid lobular carcinoma in situ underwent surgical excision. Upgrade rates on surgical excision were higher in cases with suspicious calcifications (8/11, 73%, p=0.049) compared to those without (1/7, 14.3%) and in cases with larger breast lesions (p=0.011). The overall upgrade rate was 50% (9/18), 89% (8/9) with invasive lobular carcinoma and 11% (1/9) with ductal carcinoma in situ. Of the 8 cases with upgrade to invasive lobular carcinoma, 7/8 (87.5%) were Stage I cancers and only 1/8 (12.5%) had macroscopic lymph node involvement and was upgraded to Stage II. Conclusion: Florid lobular carcinoma in situ on core biopsy had an upgrade rate on surgical excision of 50% overall, with 89% of these cases upgraded to invasive lobular carcinoma. Pathologic upgrade was seen more frequently with suspicious calcifications and larger breast lesions. These findings can help guide surgical management of this uncommon lobular neoplasia variant including planning extent of excision and consideration for lymph node evaluation.