Comparative Long-term Study of a Large Series of Patients with Invasive Ductal Carcinoma and Invasive Lobular Carcinoma. Loco-Regional Recurrence, Metastasis, and Survival

Abstract

Our aim was to compare histologic and immunohistochemical features, surgical treatment and clinical course, including disease recurrence, distant metastases, and mortality between patients with invasive ductal carcinoma (IDC) or invasive lobular carcinoma (ILC). We included 1,745 patients operated for 1,789 breast tumors, with 1,639 IDC (1,600 patients) and 145 patients with ILC and 150 breast tumors. The median follow-up was 76 months. ILC was significantly more likely to be associated with a favorable phenotype. Prevalence of contralateral breast cancer was slightly higher for ILC patients than for IDC patients (4.0% versus 3.2%; p = n.s). ILC was more likely multifocal, estrogen receptor positive, Human Epidermal Growth Factor Receptor-2 (HER2) negative, and with lower proliferative index compared to IDC. Considering conservative surgery, ILC patients required more frequently re-excision and/or mastectomy. Prevalence of stage IIB and III stages were significantly more frequent in ILC patients than in IDC patients (37.4% versus 25.3%, p = 0.006). Positive nodes were significantly more frequent in the ILC patients (44.6% versus 37.0%, p = 0.04). After adjustment for tumor size and nodal status, frequencies of recurrence/metastasis, disease-free and specific survival were similar among patients with IDC and patients with ILC. In conclusion, women with ILC do not have worse clinical outcomes than their counterparts with IDC. Management decisions should be based on individual patient and tumor biologic characteristics rather than on lobular versus ductal histology.

Differences in race, molecular and tumor characteristics among women diagnosed with invasive ductal and lobular breast carcinomas

“…In a sample of 75 lobular tumors from the I-SPY trial, Lips et al (2012) determined PAM50 subtypes and reported an RFD of 44% for Luminal A subtype among lobular compared to ductal tumors, similar to our findings [50]. Other studies using IHC have reported RFDs for Luminal A subtype among lobular compared to ductal tumors ranging from 6 to 39%, reflecting tremendous molecular variability in the tumors studied [14, 16, 19, 22, 37, 47–49, 51, 52]. Proportions of Luminal A ductal tumors were also different between IHC subtype and RNA subtype data, suggesting RNA subtyping may be important for understanding associations between intrinsic subtype and histology.…”

Breast conservative surgery and local recurrence

“…This corresponds well with recent findings of Garcia-Fernandez A et al [39] who found at a median follow-up of 76 months a recurrence rate of 4% vs. 3.2% for invasive-ductal and invasivelobular breast cancer (p ¼ n.s.). Also in their study, lobular histology was more frequently associated with re-excision and/or mastectomy.…”

Factors associated with MRI detection of occult lesions in newly diagnosed breast cancers

“…18 Data analysis from the COMICE trial did not find statistically significant differences between tumor cell type and the detection of additional lesions on MRI. 10 Because ILC has been previously recognized as having a higher likelihood of multifocal, multicentric, and contralateral breast cancers than cancers of ductal origin, 19,20 that there were high rates of false-positivity associated with the identification of lesions by MRI alone. For example, 60.3% of multifocal lesions that were biopsied were not malignant.…”