When classic LCIS or atypical lobular hyperplasia (ALH) is identified incidentally at biopsy — with confirmed radiologic-pathologic concordance and no additional high-risk lesion present — a specific, evidence-based management pathway applies.
Classic LCIS and ALH are characterised by e-cadherin negative, discohesive cells confined to the terminal ductal lobular unit (TDLU). These findings are typically discovered incidentally during biopsy performed for a separate imaging target. This protocol applies when concordance is confirmed and no co-existing high-risk lesion — such as atypical ductal hyperplasia or non-classic LCIS — is identified.
In this setting, the structured protocol does not involve surgical excision. Instead, it centres on a defined active surveillance strategy — with clinical and imaging follow-up — to monitor for stability over time. The complete follow-up schedule and the full criteria for management are detailed in the structured protocol.