The Role of MRI in Invasive Lobular Carcinoma

PURPOSE: To determine the value of MR imaging in the detection and measurement of tumor size in patients with invasive lobular carcinoma (ILC) compared to mammography and ultrasound. MATERIALS AND METHODS: From 36 cases of ILC in 34 patients who were surgically treated, the pre-operative imaging measurements, being mammography, ultrasound and contrast enhanced MR, were retrospectively re-evaluated for tumor detection and size. Findings were compared with pathology. Two radiologists were used for evaluation of the mammograms, the other imaging modalities were only evaluated by one radiologist. The Pearsons correlation test was used to determine the correlation between histopathological and imaging measurements for each imaging modality. RESULTS: For mammography, ultrasound and MRI the false negative scores were respectively 14%, 3% and 0%. The percentage for underestimated, correctly estimated and overestimated measurements on imaging were 56%, 33% and 11% for radiologist 1 and 50%, 33% and 17% for radiologist 2 on mammography. For ultrasound and MRI these percentages were respectively 53%, 47%, 0% and 14%, 75%, 11%. The correlation coefficients for mammography were respectively r = 0.34 (p < 0.05) and r = 0.27 (p > 0.05) for both radiologists, for Ultrasound r = 0.24 (p > 0.05) and for MRI r = 0.81 (p < 0.01). CONCLUSION: Of the three imaging modalities contrast enhanced MR has the lowest false negative rate in detecting ILC and has the highest accuracy in measuring the size of the ILC. MR could play a key role in the pre-operative work-up for accurate tumor size determination.     

乳腺浸润性小叶癌的研究进展

乳腺浸润性小叶癌是一种较常见的乳腺癌类型,通常表现出显著的形态学、分子特征、以及独特的临床行为,其发生率也在逐年递增,近年来对小叶癌变异型的认识亦逐步加深。同时基于对乳腺癌基因特征的研究,发现除了E-cadherin基因外,其他基因也表现出差异性表达。本文综述了乳腺浸润性小叶癌的临床病理学特征以及分子病理学等方面的最新研究进展。      

Invasive Pleomorphic Lobular Carcinoma of the Breast: Clinicopathologic Characteristics and Prognosis Compared with Invasive Ductal Carcinoma

Purpose

Invasive pleomorphic lobular carcinoma (IPLC) is a very rare and distinct morphological variant of invasive lobular carcinoma (ILC), characterized by nuclear atypia and pleomorphism contrasted with the cytologic uniformity of ILC. This study evaluated clinicopathologic characteristics and prognosis of IPLC compared with invasive ductal carcinoma (IDC).

Methods

We retrospectively reviewed the medical records of 35 patients with IPLC and 6,184 patients with IDC, not otherwise specified. We compared the clinicopathologic characteristics, relapse-free survival (RFS) and disease specific survival (DSS) of patients who were surgically treated between January 1997 and December 2010.

Results

Patients with IPLC presented at an older age with larger tumor size, worse histologic grade, higher rates of N3 stage, more multifocal/multicentric tumors, and more nipple-areolar complex involvement than those of patients with IDC. During the follow-up period, the IPLC group experienced five cases (14.3%) of disease recurrence and three cases (8.6%) of disease specific mortality compared with 637 cases (10.4%) of recurrence and 333 cases (5.4%) of disease specific mortality in the IDC group. Univariate analysis using the Kaplan-Meier method revealed that the IPLC group showed a significantly poorer prognosis than that of the IDC group (RFS, p=0.008; DSS, p<0.001). However, after adjusting for clinicopathologic factors, a multivariate analysis showed no statistical differences in RFS (p=0.396) and DSS (p=0.168) between the IPLC and the IDC groups.

Conclusion

Our data suggest that patients with IPLC present with poor prognostic factors such as large tumor size, poor histologic grade and advanced stage at diagnosis. These aggressive clinicopathologic characteristics may result in poor clinical outcomes. Although our study could not link IPLC histology to poor prognosis, considering the aggressive characteristics of IPLC, early detection and considerate treatment, including proper surgical and adjuvant intervention, could be helpful for disease progression and survival.     

乳腺导管内癌及小叶原位癌的治疗策略

早期乳腺癌是指发生于乳腺导管或小叶的原位癌，有关早期乳腺癌的治疗策略争议较大，本文复习有关文献对其治疗策略进行了评述。１局部处理１．１导管内癌乳腺导管内癌（ductalcarcinomainsitu，DCIS）是指肿瘤局限于乳腺导管系统，未侵犯基底膜和周围间质阶段的乳腺癌。８０％的DCIS是由钼靶摄片诊断，随着钼靶摄片检查技术的改进与应用的普及，DCIS的检出率大大提高。在美国，自广泛开展乳腺钼靶检查以来，DCIS的临床检出率提高了７倍。１９９６年，DCIS占乳腺癌的１２％，占钼靶摄影检查检出乳腺癌的３０％犤１犦。既往通常按组…     

Clinicopathologic Factors Associated With Involved Margins After Breast-Conserving Surgery for Invasive Lobular Carcinoma

IntroductionObtaining negative margins for patients undergoing breast-conserving surgery (BCS) for invasive lobular carcinoma (ILC) can be difficult because of the unique histologic pattern of ILC. Our goal was to determine whether any specific patient- or disease-related factors influenced margin status.Patients and MethodsWe retrospectively reviewed 211 patients with ILC treated from 1994 through 2004 to determine if specific clinical and pathologic factors influenced the ability to obtain negative margins.ResultsWe identified 110 patients (52%) who underwent total mastectomy and 101 (48%) who underwent BCS. Among patients who underwent BCS, 50 (50%) had close or positive margins. Patients with close or positive margins were more likely to have architectural distortion on ultrasonography (vs. mass or calcifications; P = .049), to have undergone excisional biopsy (vs. core or fine-needle aspiration; P = .008), and to have associated ductal carcinoma in situ (P = .021). On multivariate analysis, only biopsy method retained significance (P = .006).ConclusionCore needle biopsy is the preferred method of diagnostic biopsy before surgical intervention. With appropriate patient selection, most patients with early-stage ILC can undergo successful BCS.     

Comparison of Clinicopathological Features and Treatment Results between Invasive Lobular Carcinoma and Ductal Carcinoma of the Breast

Purpose

The purpose of this study was to assess the incidence of invasive lobular carcinoma (ILC) and to compare the clinicopathological features and treatment results after breast conserving surgery (BCS) followed by radiotherapy between ILC and invasive ductal carcinoma (IDC).

Methods

A total of 1,071 patients who underwent BCS followed by radiotherapy were included in the study. Medical records and pathological reports were retrospectively reviewed.

Results

The incidence of ILC was 5.2% (n=56). Bilateral breast cancer, lower nuclear grade, and hormone receptor-positive breast cancer were more frequent in patients with ILC than in those with IDC. There were no cases of lymphovascular invasion or the basal-like subtype in patients with ILC. There were no statistically significant differences in patterns of failure or treatment outcomes between patients with ILC and those with IDC. The development of metachronous contralateral breast cancer was more frequent in patients with IDC (n=27). Only one patient with ILC developed contralateral breast cancer, with a case of ductal carcinoma in situ.

Conclusion

The incidence of ILC was slightly higher in our study than in previous Korean studies, but was lower than the incidences reported in Western studies. The differences we observed in clinico pathological features between ILC and IDC were similar to those described elsewhere in the literature. Although there were no statistically significant differences, there was a trend toward better disease-specific survival and disease-free survival rates in patients with ILC than in those with IDC.     

Impact of Preoperative MRI in Invasive Ductal Carcinoma With Lobular Features on Core Biopsy

BackgroundInvasive breast cancer is comprised of a wide spectrum of histological types with different clinical presentations, imaging characteristics, and behaviors. Almost 10% of breast cancers with predominantly invasive ductal features have lobular components on core biopsy at primary diagnosis. Although the role of magnetic resonance imaging (MRI) in patients with purely lobular cancers is well-established, it is not clear if preoperative MRI is indicated in ductal cancer with lobular features. The aim of this study was to assess the role of preoperative MRI in patients with invasive ductal cancers with lobular features on core biopsy.Materials and MethodsData regarding patients with lobular features on core biopsy who underwent a preoperative MRI from January 2015 to December 2017 were retrospectively identified and analyzed. Imaging findings, additional investigations, and changes in treatment plans following the MRI scan were reviewed.ResultsThe study included 120 patients, of whom 42 (35%) patients required a second-look ultrasound. Following a repeat ultrasound scan, 25 breasts and 4 axillae were biopsied. Thirty-eight percent of the breast biopsies and 50% of the axillary biopsies were malignant. Based on MRI findings, treatment plans changed in 22.5% of patients. MRI size was concordant with the histological size in 58.3% of cases, and MRI was accurate in 90% of patients in detecting multifocal disease requiring mastectomy. The majority of patients with changes in the management plans had mixed ductal and lobular cancer on final histology.ConclusionThis study has demonstrated that MRI picks up additional malignancies and changes management plans in patients with lobular features on core biopsy and should be considered in the preoperative workup.     

Modern Therapeutic Approaches in Metastatic Renal Cell Carcinoma

Renal cell carcinoma (RCC) is the most deadly urological malignancy with only 62% of all patients surviving 5 years in all stages. Approximately 20–30% present initially with metastatic disease as well as 20–40% of patients who will develop systemic spread after surgery. New insights in angiogenesis lead to the development of new drugs directed against receptors and downstream signaling molecules of angiogenetic regulation mechanisms. The results of clinical trials with these drugs will lead to a change of paradigm in the systemic treatment of RCC patients. Specially Sutent, Sorafenib and Temsirolimus proved efficacy in metastatic disease and should be added substantially to the therapeutic armamentarium when surgery of the primary or metastases is impossible.     

Effectiveness of Breast MRI and 18F-FDG PET/CT for the Preoperative Staging of Invasive Lobular Carcinoma versus Ductal Carcinoma

Purpose

We evaluated the utility of magnetic resonance imaging (MRI) and ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) for the preoperative staging of invasive lobular carcinoma (ILC) of the breast and compared the results with those of invasive ductal carcinoma (IDC).

Methods

The study included pathologically proven 32 ILCs and 73 IDCs. We compared clinical and histopathological characteristics and the diagnostic performances of MRI and ¹⁸F-FDG PET/CT for the primary mass, additional ipsilateral and/or contralateral lesion(s), and axillary lymph node metastasis between the ILC and IDC groups.

Results

Primary ILCs were greater in size, but demonstrated lower maximum standardized uptake values than IDCs. All primary masses were detected on MRI. The detection rate for ILCs (75.0%) was lower than that for IDCs (83.6%) on ¹⁸F-FDG PET/CT, but the difference was not significant. For additional ipsilateral lesion(s), the sensitivities and specificities of MRI were 87.5% and 58.3% for ILC and 100.0% and 66.7% for IDC, respectively; whereas the sensitivities and specificities of ¹⁸F-FDG PET/CT were 0% and 91.7% for ILC and 37.5% and 94.7% for IDC, respectively. The sensitivity of ¹⁸F-FDG PET/CT for ipsilateral lesion(s) was significantly lower in the ILC group than the IDC group. The sensitivity for ipsilateral lesion(s) was significantly higher with MRI; however, specificity was higher with ¹⁸F-FDG PET/CT in both tumor groups. There was no significant difference in the diagnostic performance for additional contralateral lesion(s) or axillary lymph node metastasis on MRI or ¹⁸F-FDG PET/CT for ILC versus IDC.

Conclusion

The MRI and ¹⁸F-FDG PET/CT detection rates for the primary cancer do not differ between the ILC and IDC groups. Although ¹⁸F-FDG PET/CT demonstrates lower sensitivity for primary and additional ipsilateral lesions, it shows higher specificity for additional ipsilateral lesions, and could play a complementary role in the staging of ILC as well as IDC.     

Borderline Phyllodes Tumor with an Incidental Invasive Tubular Carcinoma and Lobular Carcinoma In Situ Component: A Case Report

Phyllodes tumors are an infrequent breast tumor presentation. A phyllodes tumor with a synchronous invasive ductal carcinoma is rarely described and has never been reported with lobular carcinoma in situ component. A 53-year-old female presented with a nine-year history of twice core biopsy proven fibroadenoma. After an increase in the tumor''s growth velocity it was decided upon to undergo an excisional biopsy. Microscopic examination of the well-circumscribed pale-tan mass found focal areas of leaf like architecture with variable number of mitoses present, representing a phyllodes tumor of borderline malignant potential. Incidentally, at one edge of the mass was found a tubular carcinoma and lobular carcinoma in situ components. Thorough, routine follow-up of patients with biopsy proven benign breast masses is important to finding a masked malignant component.     

Point Mutation of the E–Cadherin Gene in Invasive Lobular Carcinoma of the Breast

Reduced or heterogeneous expression of E–cadherin has been demonstrated immunohistochemically in poorly differentiated carcinoma, which frequently shows weak intercellular adhesiveness and marked invasiveness. In vitro , not only reduced expression but also structural abnormalities of E–cadherin have been observed in human carcinoma cell lines which grow in a loosely adhering manner. To clarify the participation of structural abnormalities of E–cadherin in cancer invasion in vivo , sequence abnormalities were examined in the cadherin domain (exons 5, 6, 7 and 8) including the region essential for E–cadherin specific binding, using the polymerase chain reaction–single–strand conformation polymorphism method and direct sequencing in invasive lobular carcinoma of the breast, in which cancer cells become detached from each other and invade the stroma in a particularly scattered pattern. In 2 (10%) of the 20 cases examined, an identical sequence abnormality was detected in E–cadherin exon 7, i.e. a point mutation of codon 315 (AAT to AGT) which resulted in a single ainino acid substitution (asparagine to serine). This mutation may abolish the E–cadherin–mediated cell–cell adhesion and be at least partly responsible for the weak intercellular adhesiveness and scattered histological pattern of the tumor.     

Unifocal Invasive Lobular Carcinoma: Tumor Size Concordance Between Preoperative Ultrasound Imaging and Postoperative Pathology

Background

We systematically analyzed the extent of disease in unifocal invasive lobular carcinoma (ILC) using ultrasonography, with the histopathologic findings as the reference standard.

乳腺浸润性导管癌和浸润性小叶癌细胞粘附分子与雌、孕激素受体表达及意义

目的：探讨乳腺浸润性导管癌（invasive ductal carcinoma,IDC)和浸润性小叶癌（invasive lobular carcinomaILC)组织中细胞粘附分子和雌、孕激素受体（estrogen receptor,ER:progesterone receptor,PR)表达的意义。E -α-catenin,--catenin,γ-catenin和ER、PR的表达。结果：E-cadherin在IDC和ILC中表达缺失和明显减少的分别占18.7%和30%,α-catenin,β-catenin,γ-catenin在IDC中表达缺失和明显减少的分别为75%,43.8%和明显的正相关性;γ-catenin在乳腺浸润性癌中的表达缺失和明显减少与淋巴结转移病例之间有显著的关系。ER和PR在IDC中表达有明显的正相关性。结论：除E-cadherin外,α-catenin,β-catenin,γ-catenin在乳腺浸润性导管癌和浸润性小叶癌中表达明显缺失和减少。γ-catenin表达缺失和明显减少可作为乳腺浸润性癌伴有淋巴结转移的一个预后指标。ER、PR与E-cadherin,α-catenin,β-catenin,γ-catenin可能是乳腺浸润性癌两类独立的预后指标。     

Value Added of Preoperative Contrast-Enhanced Digital Mammography in Patients With Invasive Lobular Carcinoma of the Breast

Background

Invasive lobular carcinoma (ILC) is the second most frequently diagnosed breast cancer, accounting for 5% to 15% of all invasive breast cancers, yet it remains radiologically elusive in many cases. The goal of this study was to compare the ability to accurately assess disease extent with contrast-enhanced digital mammography (CEDM) and full-field digital mammography (FFDM) in patients with biopsy-proven ILC.