The Role of Magnetic Resonance Imaging in the Investigation and Management of Invasive Lobular Carcinoma-A 3-Year Retrospective Study in Two District General Hospitals

Abstract

Invasive lobular carcinoma (ILC) accounts for 5-15% of breast cancers. In comparison to other types of breast cancer, ILC is more likely to be associated with multifocal and contralateral breast involvement as well as a tendency to a diffuse infiltrative growth pattern which can represent a diagnostic challenge. The National Institute of Clinical Excellence guidelines in 2009 recommended the use of magnetic resonance imaging (MRI) in the preoperative assessment of ILC. This study aims to assess compliance with the guidelines in two District General Hospitals and the utility of MRI in the investigation of ILC. All cases of ILC between 2011 and 2013 were retrospectively identified from the pathology database and their breast imaging findings, pathology report, and operative intervention were reviewed. A total of 126 patients were identified with ILC, of these 46 had MRI preoperatively (36.5%). MRI upgraded mammography/ultrasound diagnoses in 10 patients (21.7%). MRI showed multicentric unilateral disease in 17 patients (37.0%) occult on ultrasound/mammogram, with these patients undergoing mastectomy and 16/17 (94.1%) confirmed multifocality on pathology. MRI showed a contralateral lesion in 9 patients (19.6%), four (8.7%) of which were malignant and had bilateral surgery, and five (10.9%) were benign on further imaging/biopsy. MRI also downgraded three patients (6.5%) to unifocal disease with reported multifocal appearances on mammography/ultrasound, and these patients underwent breast-conserving surgery. MRI adds significant additional information to mammograms/ultrasound in ILC and should be undertaken in all such cases preoperatively assuming no contraindication.

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

“…Due to the typical growth pattern of ILC/IDLC, with increased likelihood of multifocal, multicentric, and contralateral disease [ 10 ], MRI could have a key role in preoperative staging of these patients. In the 37,4% of our patients a change in surgical management was documented.…”

“…A meta-analysis of 18 studies reported that MRI detected additional disease in 32% of patients, with a subsequent change in surgical management in 28% of women [ 13 ]. More recent retrospective reports on ILC patients confirmed that high sensitivity of preoperative MRI in detecting multicentric and contralateral disease yielded a more appropriate surgical management plan [ 10 ].…”

“…MRI is a suitable diagnostic examination in the preoperative work-up and staging of ILC patients, due to the higher incidence of multifocal, multicentric, and contralateral disease, if compared to other histological subtypes [ 4 ]. However, the existing literature about this topic is rather sparse [ 10 ]. Ductolobular invasive carcinoma (IDLC) has similar clinic-pathologic features to ILC, with comparable outcomes [ 11 ].…”

Multi-center study on patient selection for and the oncologic safety of intraoperative radiotherapy (IORT) with the Xoft Axxent® eBx® System for the management of early stage breast cancer in Taiwan

“…In the TARGIT-A trial [ 8 , 9 ], only patients with histological diagnosis of IDC were selected to receive IORT whereas in other study [ 11 ], patients with either IDC or DCIS were recruited. Preoperative histologic diagnosis of lobular carcinoma was a criterion for exclusion in the TARGIT-A trial [ 9 ] and other study [ 11 ] as lobular tumors are associated with a higher propensity for being multifocal [ 23 , 24 ]. However, in the ELIOT trial, lobular histology was neither a poor prognostic factor nor a contraindication for IORT [ 7 ].…”

Assessment of disease extent on contrast-enhanced MRI in breast cancer detected at digital breast tomosynthesis versus digital mammography alone

“…Although preoperative MRI is an accepted indication for evaluation of an occult primary tumour and for staging invasive lobular carcinoma [17, 18], the utility in preventing re-excision and recurrence is controversial. Although there is a prospective randomised clinical trial in preparation addressing this question (ACRIN 6694) at the time of writing, the role of breast MRI in the evaluation of extent of disease is largely based on retrospective studies and single-institution prospective studies.…”