Axillary Nodal Metastases in Invasive Lobular Carcinoma Versus Invasive Ductal Carcinoma: Comparison of Node Detection and Morphology by Ultrasound

Chung, Hannah; Tso, Hilda H.; Middleton, Lavinia P.; Sun, Jia; Leung, Jessica W.T.

doi:10.2214/ajr.21.26135

Cited by 9 publications

(9 citation statements)

References 30 publications

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“…The overall study population diagnostic accuracy of US was in concordance with recently published papers on a large cohort of patients of average risk [2,14,15]. We obtained an overall sensitivity of 75% with a PPV of 85%, but a slightly lower sensitivity of 66% due to the pathogenic mutation carrier patients.…”

Section: Discussionsupporting

confidence: 89%

The Role of US in Depicting Axillary Metastasis in High-Risk Breast Cancer Patients

Pintican

Duma²,

Szep

et al. 2021

JPM

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Purpose: The aim of this study is to evaluate the role of US in depicting axillary nodal disease in high-risk patients with and without pathogenic mutations. Methods: The retrospective study included consecutive high-risk breast cancer (BC) patients who underwent a multigene testing panel for hereditary cancers, pre-operative axillary US and breast/axillary surgery. The group was divided into patients with pathogenic mutations (PM group) and patients without PM. Statistical analyses were performed using GraphPad Prism by applying Chi-square and Fisher exact tests, with a reference p-value < 0.05 and a CI of 95%. Results: Out of 190 patients with BC, 96 (51%) were negative and 94 (49%) were positive for PM as follows: 28 (25.5%) BRCA1, 16 (17%) BRCA2, 15 (16%) CHECK2, 14 (14%) RAD Group, 7 (7%) PALB, 6 (6%) NBN, 3 (3%) TP53 and ATM and 2 (2%) BARD1. US was positive in 88 of the patients, 36 with PM and 52 without PM. US and surgery (>= N1 stage) were both positive in 31 (62%) of PM patients and 44 (88%) of patients without genetic changes. There were 19 (61%) false negative US examinations in the PM group and 6 (13%) in the group without genetic changes, respectively. If the US is positive, there is a 2.6 times greater risk of positive nodes in PM patients (p-value < 0.000, 95% CI = 4.2–37.9), and a 6.2 times greater risk of positive nodes in patients without genetic changes (p-value < 0.000, 95%CI = 8.4–37.4). In the PM group, US compared to surgery reached a sensitivity = 62, with PPV = 86 and NPV = 67. In the BRCA1/2 subgroup, there is 2.5 greater times risk of nodal disease if the US is positive (p-value = 0.001, 95%CI = 2.6–76). In patients without PM, US compared to surgery reached a sensitivity = 88, PPV = 84 and NPV = 86. Conclusion: US is more sensitive in depicting axillary nodal disease in high-risk patients without PM compared to PM patients. Furthermore, there are more false negative US examinations in PM patients, compared to surgery patients.

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Section: Discussionsupporting

confidence: 89%

The Role of US in Depicting Axillary Metastasis in High-Risk Breast Cancer Patients

Pintican

Duma²,

Szep

et al. 2021

JPM

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“…However, in our analysis, LOH was not detected in 73% of metastatic ALNs in ILC. Similarly, a recent retrospective study showed that the metastatic ALN exhibited diffuse cortical thickening without a hilar mass effect on US in 68.9% of patients with ILC vs. 28.8% of patients with IDC [ 4 ]. The detailed molecular mechanism of this difference is unclear; however, considering that nodular metastatic patterns were observed in approximately the same proportion (approximately 70%) of node-positive IDCs and ILCs on histopathologic examination [ 22 ], an expansive growth into the sinusoid by nodular metastatic foci might be less likely to occur in ILC than in IDC due to ILC non-cohesive and migratory properties.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings may have important implications for axillary ILC management in clinical settings. Previous studies have reported that ILC is subtle on preoperative imaging, and that metastatic ALNs of ILC are fewer and smaller than those of IDC [ 4 , 24 ]. Based on our results, by carefully observing the changes in cortical thickness and contour during MRI interpretation, false-negative results may be reduced.…”

Section: Discussionmentioning

confidence: 99%

“…ILC is characterized by E-cadherin loss, which is crucial in cell–cell adhesion, and typically shows small and non-cohesive epithelial cells dispersed individually. Its clinical presentation differs from that of invasive ductal carcinoma (IDC); Chung et al reported a different morphology of axillary lymph node (ALN) metastasis for ILC from that of IDC on US [ 4 ]. ILC has subtle imaging findings both on mammography and US because ILC frequently appears with a mass density that is less than or equal to that of normal fibroglandular breast tissue on a mammograph, and sometimes shows only a slight architectural distortion on US.…”

Section: Introductionmentioning

confidence: 99%

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High-accuracy prediction of axillary lymph node metastasis in invasive lobular carcinoma using focal cortical thickening on magnetic resonance imaging

et al. 2023

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Background Invasive lobular carcinoma (ILC) grows diffusely in a single-cell fashion, sometimes presenting only subtle changes in preoperative imaging; therefore, axillary lymph node (ALN) metastases of ILC are difficult to detect using magnetic resonance imaging (MRI). Preoperative underestimation of nodal burden occurs more frequently in ILC than in invasive ductal carcinoma (IDC), however, the morphological assessment for metastatic ALNs of ILC have not fully been investigated. We hypothesized that the high false-negative rate in ILC is caused by the discrepancy in the MRI findings of ALN metastases between ILC and IDC and aimed to identify the MRI finding with a strong correlation with ALN metastasis of ILC. Method This retrospective analysis included 120 female patients (mean ± standard deviation age, 57.2 ± 11.2 years) who underwent upfront surgery for ILC at a single center between April 2011 and June 2022. Of the 120 patients, 35 (29%) had ALN metastasis. Using logistic regression, we constructed prediction models based on MRI findings: primary tumor size, focal cortical thickening (FCT), cortical thickness, long-axis diameter (LAD), and loss of hilum (LOH). Results The area under the curves were 0.917 (95% confidence interval [CI] 0.869–0.968), 0.827 (95% CI 0.758–0.896), 0.754 (95% CI 0.671–0.837), and 0.621 (95% CI 0.531–0.711) for the FCT, cortical thickness, LAD, and LOH models, respectively. Conclusions FCT may be the most relevant MRI finding for ALN metastasis of ILC, and although its prediction model may lead to less underestimation of the nodal burden, rigorous external validation is required. Supplementary Information The online version contains supplementary material available at 10.1007/s12282-023-01457-2.

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“…This includes 5 patients who were cN0 at presentation and ypN2 (N = 3) or ypN3 (N = 2) at definitive surgery. This is most likely related to the underestimation of clinical nodal staging for ILC, even with axillary ultrasound as standard, [18][19][20][21] as opposed to progressive disease on therapy. 22 Unfortunately, even preoperative MRI following NACT has a low accuracy and false negatives for nodal staging, with a high rate of radiographically normal appearing axillary lymph nodes being positive at surgery.…”

Section: Discussionmentioning

confidence: 99%

Response Rates of Invasive Lobular Cancer in Patients Undergoing Neoadjuvant Endocrine or Chemotherapy

Jakub

Zhang

Solanki

et al. 2022

The American Surgeon

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Background A gap remains in the role of neoadjuvant therapy for patients with ILC. Method Single-institution retrospective review of patients with ILC who received neoadjuvant therapy between 2008 and 2019. Results 141 patients met inclusion criteria: 71 neoadjuvant chemotherapy (NACT) and 70 neoadjuvant endocrine therapy (NET). 7/71 (9.9%) patients had a pCR following NACT compared to 1/70 (1.4%) with NET ( P = .063). pCR was observed in 5/18 (27.8%) patients with Her2Neu-positive disease following NACT, compared to 2/53 (3.8%) with Her2Neu-negative disease ( P = .01). For luminal B tumors, median Ki-67 decrease was similar following NACT and NET (18.3 vs 16.3, P = .26). T category decreased in 59 (42.1%) patients following neoadjuvant therapy, increased in 9 (6.4%), and was unchanged in 72 (51.4%). More patients had an increase (28.6%) than decrease (12.1%) in their N category, including 13/60 (21.7%) who were clinically node-negative at diagnosis and identified to have node-positive disease following neoadjuvant therapy, at definitive surgery. Conclusion In Her2Neu-negative ILC, the potential of a pCR with NACT or NET is low. Most patients’ nodal status and tumor size remain unchanged. There is a potential for pathologic stage to be higher at surgery compared to the clinical stage prior to neoadjuvant therapy.

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Axillary Nodal Metastases in Invasive Lobular Carcinoma Versus Invasive Ductal Carcinoma: Comparison of Node Detection and Morphology by Ultrasound

Cited by 9 publications

References 30 publications

The Role of US in Depicting Axillary Metastasis in High-Risk Breast Cancer Patients

The Role of US in Depicting Axillary Metastasis in High-Risk Breast Cancer Patients

High-accuracy prediction of axillary lymph node metastasis in invasive lobular carcinoma using focal cortical thickening on magnetic resonance imaging

Response Rates of Invasive Lobular Cancer in Patients Undergoing Neoadjuvant Endocrine or Chemotherapy

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