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Abstract
PurposeThe aim of this study was to describe the imaging features of patients with invasive ductolobular carcinoma of the breast in comparison with the proportion of the lobular component.Materials and methodsWe retrospectively reviewed mammographic, sonographic and MRI records of 113 patients with proven ductolobular carcinoma diagnosed between January 2008 and October 2012 according to the BI-RADS ® lexicon, and correlated these to the proportion of the lobular component.ResultsAt mammography the most common finding (62.9%) for invasive ductolobular carcinoma was an irregular, spiculated and isodense mass. On ultrasound an irregular and hypoechoic mass, with spiculated margins and posterior acoustic shadowing was observed in 46.8% of cases. Isolated mass and mass associated with non-mass like enhancement (NMLE) were the most common findings by MRI (89.4%). Washout pattern in delayed phase was seen in 61.2% and plateau curve was more frequently observed in patients with larger lobular component. Additional malignant findings (multifocality, multicentricity and contralateral disease) did not correlate significantly with the proportion of the lobular component.ConclusionInvasive ductolobular carcinoma mainly presents as an irregular, spiculated mass, isodense on mammography and hypoechoic with posterior acoustic shadowing. On MRI it is usually seen as an isolated mass or as a dominant mass surrounded by smaller masses or NMLE. Washout is the most ordinary kinetic pattern of these tumors. In general, the imaging characteristics did not vary significantly with the proportion of the lobular component.
Highlights
Breast cancer is a heterogeneous group of tumors with multivariate morphology, growth pattern, molecular profiles and response to treatment
Patients with ILC are generally older at the time of the diagnosis, (Sastre-Garau et al 1996; Moran et al 2009) ILC is usually larger in diameter, (Arpino et al 2004; Biglia et al 2013) is more frequently hormone receptor positive, (Arps et al 2013; Arpino et al 2004) has lower grade than invasive ductal carcinoma (IDC), (Arps et al 2013; Arpino et al 2004; Biglia et al 2013) is more frequently multifocal, multicentric and bilateral, and the organ distribution of metastatic disease tends to spread to pelvic organs, gastrointestinal tract and to distinct sites such as retroperitoneum, meninges, ovary and serosa
Between January 2008 and October 2012, 505 patients were diagnosed with breast cancer and invasive ductal carcinoma with lobular features was reported in 30% (155/505) of the patients
Summary
Breast cancer is a heterogeneous group of tumors with multivariate morphology, growth pattern, molecular profiles and response to treatment. ILC has the histological characteristic to spread in rows of single cell layers around normal ducts like a “spider web”, infiltrating the preexisting stroma without inducing a strong desmoplastic response (Michael et al 2008; Qureshi et al 2006). This growth pattern causes minimum disruption of the normal anatomical structures than IDC, turning the radiological and clinical diagnostic of this tumor into a real challenge (Yeatman et al 1995). MRI has a superior accuracy (Berg et al 2004; Boetes et al 2004) in defining the extent of ILC and is, essential for a correct surgical planning and further treatment of these patients (Boetes et al 1995; Orel et al 1994; Rodenko et al 1996; Mann et al 2008; Peters et al 2011; Lesser et al 1982)
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