Role of Magnetic Resonance Imaging in the Preoperative Staging and Work-Up of Patients Affected by Invasive Lobular Carcinoma or Invasive Ductolobular Carcinoma

Abstract

Purpose The prevalence of invasive lobular carcinoma (ILC), the second most common type of breast cancer, accounts for 5%–15% of all invasive breast cancer cases. Its histological feature to spread in rows of single cell layers explains why it often fails to form a palpable lesion and the lack of sensitivity of mammography and ultrasound (US) to detect it. It also has a higher incidence of multifocal, multicentric, and contralateral disease when compared to the other histological subtypes. The clinicopathologic features and outcomes of Invasive Ductolobular Carcinoma (IDLC) are very similar to the ILC. The purpose of our study is to assess the importance of MRI in the preoperative management and staging of patients affected by ILC or IDLC. Materials and Methods We identified women diagnosed with ILC or IDLC. We selected the patients who had preoperative breast MRI. For each patient we identified the areas of multifocal, multicentric, or contralateral disease not visible to standard exams and detected by preoperative MRI. We analyzed the potential correlation between additional cancer areas and histological cancer markers. Results Of the 155 women who met our inclusion criteria, 93 (60%) had additional cancer areas detected by MRI. In 61 women, 39,4% of the overall population, the additional cancer areas were confirmed by US/tomosynthesis second look and biopsy. Presurgical MRI staging changed surgical management in the 37,4% of the patients. Only six patients of the overall population needed a reoperation after the initial surgery. No statistically significant correlation was found between MRI overestimation and the presence of histological peritumoral vascular/linfatic invasion. No statistically significant correlation was found between additional cancer areas and histological cancer markers. Conclusions Our study suggests that MRI is an important tool in the preoperative management and staging of patients affected by lobular or ductolobular invasive carcinoma.

Multifocality and Multicentrality in Breast Cancer: Comparison of the Efficiency of Mammography, Contrast-Enhanced Spectral Mammography, and Magnetic Resonance Imaging in a Group of Patients with Primarily Operable Breast Cancer

“…In our analysis, the use of MRI in preoperative diagnostics resulted in a change in the treatment regimen in 24% of subjects. Our results correspond with data obtained by other researchers-performing an MRI examination in breast cancer patients results in changes in the treatment method in every fifth patient [47]. Despite the evidence of frequent modification of therapeutic decisions after MRI examination in patients with breast cancer, this method remains controversial in this group of patients.…”

Comparison of the Efficiency of Mammography, Contrast-Enhanced Spectral Mammography and Magnetic Resonance Imaging in Female Patients with Multifocal and Multicentral Breast Cancer

“…In our analysis, the use of MRI in preoperative diagnostics resulted in a change in the treatment regimen in 24% of subjects. Our results are consistent with data obtained by other researchers -performing an MRI examination in breast cancer patients results in modi cations of the treatment method in every fth patient [41,42]. Despite the evidence of frequent change of therapeutic decision after MRI examination in patients with breast cancer, this method still remains controversial in this group of patients.…”

Breast MRI: State of the Art

“…The benefit of using MRI to assess tumor size is particularly strong for invasive lobular carcinomas (78)(79)(80). Likewise, the depiction of DCIS components related to invasive cancers is much better than that with mammography, the latter missing more than half of all lesions, whereas the sensitivity for large DCIS components with MRI approaches 100% (81,82).…”