Adequacy of diagnostic tests and surgical management of symptomatic invasive lobular carcinoma of the breast.
BACKGROUND
Invasive lobular carcinoma (ILC) presents diagnostic and therapeutic challenges as it produces subtle radiological changes. It has been suggested that it is not suitable for breast conserving surgery (BCS). The aim of this study was to ascertain the diagnostic adequacy of modern mammography and ultrasonography in the context of a fast track symptomatic diagnostic clinic in the UK. It also sought to compare the mastectomy, re-excision and BCS rates for ILC with those for invasive ductal carcinoma (IDC).


METHODS
A retrospective analysis of prospectively collected data was carried out on all new symptomatic cancers presenting to the one-stop diagnostic clinic of a single breast unit between 1998 and 2007.


RESULTS
Compared with IDC, ILC was significantly larger at presentation (46mm vs 25mm), needed re-excision after BCS more often (38.8% vs 22.3%) and required mastectomy more frequently (58.8% vs 40.8%). Although mammography performs poorly in diagnosing ILC compared with IDC, when combined with ultrasonography, sensitivity of the combined imaging was not significantly different between these two histological types.


CONCLUSIONS
Provided ultrasonography is performed, standard radiological imaging is adequate for initial diagnosis of symptomatically presenting ILC but some additional preoperative workup should clearly be employed to reduce the higher number of reoperations for this histological type.
Imperial College Healthcare NHS Trust , UK.
D J
DJ
Hadjiminas
Imperial College Healthcare NHS Trust , UK.
K E
KE
Zacharioudakis
Imperial College Healthcare NHS Trust , UK.
M K
MK
Tasoulis
Imperial College Healthcare NHS Trust , UK.
J C C
JC
Hu
Imperial College Healthcare NHS Trust , UK.
S
S
Lanitis
Imperial College Healthcare NHS Trust , UK.
R
R
Bright-Thomas
Imperial College Healthcare NHS Trust , UK.
N G
NG
Dimopoulos
Imperial College Healthcare NHS Trust , UK.
G
G
Hornzee
Imperial College Healthcare NHS Trust , UK.
D A
DA
Cunningham
Imperial College Healthcare NHS Trust , UK.
S J
SJ
Cleator
Imperial College Healthcare NHS Trust , UK.
R
R
Al Mufti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016217:Ultrasonography, Mammary / Q000379:methods
Breast conserving surgery; Breast ultrasonography; Invasive ductal carcinoma; Invasive lobular carcinoma; Mammography