Open AccessThe Role of Magnetic Resonance Imaging in the Investigation and Management of Invasive Lobular Carcinoma—A 3‐Year Retrospective Study in Two District General Hospitals
Author(s) -
Derias Mina,
Subramanian Ashok,
Allan Simon,
Shah Elizabeth,
Teraifi Hassan El,
Howlett David
Publication year - 2016
Publication title -
the breast journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.533
H-Index - 72
eISSN - 1524-4741
pISSN - 1075-122X
DOI - 10.1111/tbj.12594
Subject(s) - medicine , magnetic resonance imaging , radiology , invasive lobular carcinoma , mammography , breast mri , ultrasound , occult , contraindication , breast cancer , mastectomy , biopsy , retrospective cohort study , breast imaging , cancer , surgery , pathology , alternative medicine , invasive ductal carcinoma
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.