Ewha Med J.  2018 Apr;41(2):27-34. 10.12771/emj.2018.41.2.27.

Invasive Lobular Carcinoma: Detection and Multiplicity with Multimodalities

Affiliations
  • 1Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea. aqua0724@ewha.ac.kr
  • 2Department of Radiology, National Cancer Center, Goyang, Korea.
  • 3Department of Nuclear Medicine, Ewha Womans University College of Medicine, Seoul, Korea.

Abstract


OBJECTIVES
We aimed to compare the diagnostic performances of digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US), magnetic resonance imaging (MRI), breast specific gamma imaging (BSGI) and/or positron emission tomography/computed tomography (PET/CT) for the detection of invasive lobular carcinoma (ILC).
METHODS
Index ILCs and multifocal/multicentric (multiple) ILCs were analyzed using various imaging modalities. The final surgical pathology was regarded as the reference standard. The detection rate for index cancers and the diagnostic performance for multiple ILCs per breast were evaluated.
RESULTS
Seventy-eight ILCs in 76 women were enrolled. Twenty-six breasts had multiple ILCs. DM (n=72), DBT (n=15), US (n=77), MRI (n=76), BSGI (n=50), and /or PET/CT (n=74) were performed. For index cancer, the detection rate was 100% for DBT, US, and MRI. For multiple ILCs, the sensitivity was 100% for DBT and MRI (P<0.001). The diagnostic accuracy for multiple ILCs were 73.3% for DBT and 73.0% for PET/CT (P=0.460).
CONCLUSION
DBT was the most accurate imaging modality for both index and multiple ILCs. PET/CT was also valuable for multiple ILCs, whereas DM and BSGI showed relatively low diagnostic performances. DBT and PET/CT have promising roles in the diagnosis of multiple ILCs.

Keyword

Breast; Invasive lobular carcinoma; Mammography; Positron-emission tomography; Computed tomography

MeSH Terms

Breast
Carcinoma, Lobular*
Diagnosis
Electrons
Female
Humans
Magnetic Resonance Imaging
Mammography
Pathology, Surgical
Positron-Emission Tomography
Positron-Emission Tomography and Computed Tomography
Ultrasonography

Figure

  • Fig. 1 Case of a 42-year-old woman who presented for screening. (A) Digital mammography shows asymmetry (arrow) in the left breast. (B) An irregular, spiculated and hypoechoic mass was noted at the left breast. It was confirmed as an invasive lobular carcinoma by ultrasound-guided core needle biopsy. (C) Breast specific gamma imaging showed a focal faint radiotracer uptake (arrow) uptake in the left inner breast. (D) Positron emission tomography image does not show abnormal fludeoxyglucose uptake in the left breast. (E) Dynamic contrast enhanced magnetic resonance imaging show a rim enhancing mass (arrow) in left breast.

  • Fig. 2 A 45-year-old woman with known invasive lobular carcinoma in right breast. (A) Right craniocaudal and mediolateral oblique views of digital mammography and (B) digital breast tomosynthesis images revealing known index cancer (arrows) in right upper central breast. (C) The spiculated margin of index cancer is more clearly seen on digital breast tomosynthesis images than digital mammography. Different level image of tomosynthesis shows an additional asymmetry (arrow) in right outer breast, which is not depicted on digital mammography. (D) An irregular, spiculated and hypoechoic mass was noted at 9 o'clock of right breast on breast ultrasound. It was proven as an additional invasive lobular carcinoma by ultrasound-guided core needle biopsy.


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