Infiltrating lobular carcinoma of the breast: Clinicopathologic analysis of 975 cases with reference to data on conservative therapy and metastatic patterns

Sastre-Garau, X.; Jouve, M; Asselain, Bernard; Vincent‐Salomon, Anne; Beuzeboc, Philippe; Durand, Jean‐Claude; Pouillart, P

doi:10.1002/(sici)1097-0142(19960101)77:1<113::aid-cncr19>3.0.co;2-8

Cited by 366 publications

(238 citation statements)

References 28 publications

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“…[20][21][22][23] The authors of the original study stressed that this grading system had clinical utility for both invasive lobular carcinoma and special type cancers. This was further validated by the work of Sastre-Garau et al, 24 who showed that histologic grade is as important for prognosis in invasive lobular carcinoma as it is in invasive ductal carcinomas. However, pathologists have been reluctant to utilize it in relation to invasive lobular carcinoma due primarily, it is thought, to the absence of any tubule formation in invasive lobular carcinomas, rendering that dimension of the three-tiered grading system redundant.…”

Section: Discussionmentioning

confidence: 77%

Invasive lobular carcinoma: to grade or not to grade

et al. 2005

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Grading of invasive ductal carcinoma of no special type using the Nottingham combined histologic grading system provides independent prognostic information. The prognostic utility of grading invasive lobular carcinomas, however, has not been fully elucidated. In addition, the relationship between grade in invasive lobular carcinomas and expression of predictive biomarkers is less certain. The purpose of this study was to correlate histologic grade in invasive lobular carcinoma with known prognostic and predictive markers. All primary resections for invasive mammary carcinomas diagnosed in Mount Sinai Hospital, Toronto, between the years 1996 and 2002 were reviewed (n ¼ 1053). Of these cases, 50 were pure invasive lobular carcinoma (incidence 4.7%). The median age at diagnosis was 64 years. These tumors were graded using the Nottingham combined histologic grading system and analyzed for estrogen receptor, progesterone receptor, HER2/neu and E-cadherin expression. Tumor grade was correlated with tumor size (P ¼ 0.03), and the American Joint Committee on Cancer nodal status (P ¼ 0.05). Assessment of the individual components of grade showed that the mitotic score was highly correlated with tumor size (P ¼ 0.02), lymph node positivity (P ¼ 0.02) and overall American Joint Committee on Cancer stage (P ¼ 0.01). Estrogen receptor and progesterone receptor were highly expressed irrespective of the grade of tumor. HER2/neu protein overexpression and E-cadherin protein expression was absent in all invasive lobular carcinomas studied. We conclude that pure invasive lobular carcinoma is uncommon and occurs predominantly in postmenopausal women. Increasing tumor grade is correlated with median tumor size and the American Joint Committee on Cancer nodal stage, but not correlated with the expression of estrogen receptor, progesterone receptor, E-cadherin or HER2/neu protein overexpression.

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Section: Discussionmentioning

confidence: 77%

Invasive lobular carcinoma: to grade or not to grade

et al. 2005

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“…Although some studies reported limited prognostic value for histological grading of invasive lobular carcinoma, 15 we and others have demonstrated that grading of these tumours, using the Nottingham grading system, is a strong and independent predictor of outcome, which supports the importance of routine assessment of histological grade in invasive lobular carcinoma. [16][17][18][19][20][21] Analysing the three components of grading separately revealed that mitotic count was of more prognostic power than the two other components. 16,21 This raises the question of whether pleomorphic lobular carcinoma as a distinct pathological subtype has any clinical value additional to grading, because conventional grading also includes cellular atypia and mitotic count as components.…”

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confidence: 99%

Pleomorphic lobular carcinoma of the breast: is it a prognostically significant pathological subtype independent of histological grade?

et al. 2013

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Pleomorphic lobular carcinoma is regarded as a biologically aggressive variant of invasive lobular carcinoma of the breast. However, there is no consensus on the definition and whether this subtype adds useful information to histological grade. Two-hundred and two grade 2 or grade 3 invasive lobular carcinomas were studied. Tumours were categorised according to the components of histological grade: tubules, pleomorphism and mitoses. Pleomorphic lobular carcinoma was defined as a carcinoma with a lobular growth pattern and marked nuclear pleomorphism (pleomorphism 3). Breast cancer-specific survival was used in analysis of prognosis. Grade 3 pleomorphic lobular carcinomas (tubules 3, pleomorphism 3, mitoses 2 and tubules 3, pleomorphism 3, mitoses 3) had a worse prognosis than grade 2 (tubules 3, pleomorphism 2, mitoses 1) carcinomas. Grade 2 lobular carcinomas with marked nuclear pleomorphism (tubules 3, pleomorphism 3, mitoses 1) had a similar prognosis to grade 2 carcinomas with moderate pleomorphism (tubules 3, pleomorphism 2, mitoses 1). Survival was associated with mitotic score, but not with nuclear pleomorphism on both univariate and multivariate analysis. A non-classical growth pattern was seen more frequently in all subgroups with marked nuclear pleomorphism and was associated with worse survival. Histological grade and nodal status were independent of prognostic factors. This study shows that histological grade (in particular the mitotic component) in invasive lobular carcinomas is of prognostic importance, but pleomorphic type does not provide useful additional prognostic information.

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“…The tumour characteristics of lobular carcinomas were those already found by Sastre and co-workers and others (SastreGarau et al, 1996;Cristofanilli et al, 2005). Patients diagnosed with lobular invasive carcinomas were significantly older (Sastre-Garau et al, 1996) Because of the frequent use of either exclusive or preoperative radiotherapy, the study of pathological response in our series was not relevant. Bearing in mind the mandatory caution in interpreting clinical response (Bollet et al, 2007), we found that the response to primary chemotherapy was significantly better for ductal invasive carcinomas than for lobular (X50% of clinical response in 60% for ductal vs 47% for lobular; P ¼ 0.04), confirming the notion developed by others that lobular carcinomas responded less than ductal carcinomas to neoadjuvant chemotherapy (Mathieu et al, 2004;Cristofanilli et al, 2005;Tubiana-Hulin et al, 2006;Wenzel et al, 2006;Katz et al, 2007).…”

Section: Discussionmentioning

confidence: 97%

“…However, data regarding the specific behaviour of invasive lobular carcinomas (ILC), a histological subtype of breast cancers representing 5 -15% of all breast cancer cases, are still scarce in this therapeutic setting. Lobular carcinomas are characterised by a specific morphology with discohesive small cells usually associated with estradiol receptor (ER), progesterone receptor (PR) positivity and with a low proliferation rate (Sastre-Garau et al, 1996). These factors are now well-established predictive markers of poor response to neoadjuvant chemotherapy (Pierga et al, 2003).…”

mentioning

confidence: 99%

“…These factors are now well-established predictive markers of poor response to neoadjuvant chemotherapy (Pierga et al, 2003). We, and others, have previously shown that ILC are often diagnosed as larger tumours than invasive ductal carcinomas (IDC) (Sastre-Garau et al, 1996), and for which a neoadjuvant treatment could be chosen to increase the rate of conservative surgery. This study aims to compare the outcome of lobular vs ductal carcinomas under neoadjuvant chemotherapy and to report their locoregional control.…”

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confidence: 99%

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High rates of breast conservation for large ductal and lobular invasive carcinomas combining multimodality strategies

et al. 2008

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The literature reports low rates of breast conservation after neoadjuvant chemotherapy for operable breast cancers not amenable to initial breast-conserving surgery. This study aims to compare the outcome of lobular vs ductal carcinomas after neoadjuvant chemotherapy. Between 1989 and 1999, 750 patients with clinical stage II/IIIA ductal (672) or lobular (78) invasive breast carcinomas were treated at the Institut Curie with primary anthracycline-based polychemotherapy followed by either breast conservation (surgery and/or radiotherapy) or mastectomy. Median follow-up was 10 years. Clinical response to primary chemotherapy was significantly worse for lobular than for ductal carcinomas (47 vs 60%; P ¼ 0.04), but only histological grade remained predictive in multivariate analysis. Breast conservation was high for both ductal and lobular carcinomas (65 and 54%; P ¼ 0.07), due, in part, to the use of radiotherapy, either exclusive or preoperative, for respectively 26 and 40% of patients. The lobular type had no adverse effect, neither on locoregional control nor on overall survival, even in the group of patients treated with breast conservation.

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Infiltrating lobular carcinoma of the breast: Clinicopathologic analysis of 975 cases with reference to data on conservative therapy and metastatic patterns

Abstract: Our analysis specifies the clinicopathological features of ILC and confirms that conservation therapy may be an appropriate treatment for this type of cancer.

Cited by 366 publications

References 28 publications

Invasive lobular carcinoma: to grade or not to grade

Invasive lobular carcinoma: to grade or not to grade

Pleomorphic lobular carcinoma of the breast: is it a prognostically significant pathological subtype independent of histological grade?

High rates of breast conservation for large ductal and lobular invasive carcinomas combining multimodality strategies

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