Invasive lobular carcinoma: clinicopathological features and subtypes

Danzinger, Sabine; Hielscher, N; Izsó, M; Metzler, Johanna; Trinkl, C; Pfeifer, Christian; Tendl-Schulz, Kristina; Singer, Christian F.

doi:10.1177/03000605211017039

Cited by 6 publications

(17 citation statements)

References 46 publications

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“…This has been reported previously in several studies [13,17,29,31]. According to our findings, more frequent ER-positivity in ILC was observed in different studies comparing these tumors with IDC [7,9,10,16,17,29,36]. We found more HER2-negative tumors with ILC, and several similar reports exist in the literature [1,10,12,13,37].…”

supporting

confidence: 91%

“…Patients with ILC presented more frequently with grade 2 tumors in comparison with IDC patients. This has been reported previously in several studies [13,17,29,31]. According to our findings, more frequent ER-positivity in ILC was observed in different studies comparing these tumors with IDC [7,9,10,16,17,29,36].…”

supporting

confidence: 91%

“…The axillary lymph node (ALN) involvement represents one of the most important prognostic factors in early BC [19][20][21][22][23][24][25]; however, previous studies have shown controversial results regarding the ALN status between ILC and IDC. There are many studies demonstrating that the ALN involvement does not differ between both groups [10,26,27]; however, some studies showed an association between ILC and a higher incidence of positive ALN involvement [8,28,29]. In contrast, there are studies reporting less frequent ALN positivity in ILC [30,31].…”

Section: Introductionmentioning

confidence: 99%

“…In the descriptive analysis, we found a significantly different pN distribution between ILC and IDC. The multivariate analysis identified pN2 and pN3 as associated with ILC; however, published data on the ALN status in ILC compared with IDC are controversial [8,10,[26][27][28][29][30][31]. Table 4 represents an overview of published data on the nodal status in association with the histological subtype.…”

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confidence: 99%

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Axillary lymph node status and invasive lobular breast cancer

Danzinger

Pöckl

Kronawetter

et al. 2023

Wien Klin Wochenschr

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Summary Background Invasive lobular carcinoma (ILC) represents the second most common type of invasive breast cancer (BC). Although ILC generally have good prognostic properties (positive estrogen receptor, ER, low tumor grade), they are generally diagnosed at a more advanced stage. The data on the axillary lymph node status in ILC compared to invasive ductal carcinoma (IDC) are considered controversial. Therefore, the aim of this study was to compare the pathological node stage (pN) between ILC and IDC in an Austria-wide register. Methods Data of the Clinical Tumor Register (Klinisches TumorRegister, KTR) of the Austrian Association for Gynecological Oncology (AGO) were retrospectively analyzed. Patients with primary early BC, invasive lobular or ductal, diagnosed between January 2014 and December 2018, and primary surgery were included. A total of 2127 tumors were evaluated and compared in 2 groups, ILC n = 303, IDC n = 1824. Results A total of 2095 patients were analyzed in the study. In the multivariate analysis, pN2 and pN3 were observed significantly more frequently in ILC compared with IDC (odds ratio, OR 1.93; 95% confidence interval, CI 1.19–3.14; p = 0.008 and OR 3.22; 95% CI: 1.47–7.03; p = 0.003; respectively). Other factors associated with ILC were tumor grades 2 and 3, positive ER, and pathological tumor stage (pT) 2 and pT3. In contrast, concomitant ductal carcinoma in situ, overexpression of the human epidermal growth factor receptor 2 (HER2), and a moderate and high proliferation rate (Ki67) were found less frequently in ILC. Conclusion The data show an increased risk of extensive axillary lymph node metastasis (pN2/3) in ILC.

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supporting

confidence: 91%

supporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Axillary lymph node status and invasive lobular breast cancer

Danzinger

Pöckl

Kronawetter

et al. 2023

Wien Klin Wochenschr

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“…The two claudin-low cohorts did not differ significantly in the percentage of pre-menopausal women at diagnosis (Fisher's exact test p = 0.15), although the claudin-low/ER-negative/HER2-negative cohort had a higher percentage of pre-menopausal women, which was intermediate between the two other groups (Table 2). The claudin-low/ER-positive and/or HER2-positive cohort had a higher prevalence of lobular cancers than the two ER-negative/HER2-negative cohorts, reflecting the association of this histology with ER positivity [20]. In contrast, the claudin-low/ER-negative/HER2-negative cohort had 12.9% of cases with non-ductal or lobular histology.…”

Section: Resultsmentioning

confidence: 85%

Comparison of Clinical Subtypes of Breast Cancer within the Claudin-Low Molecular Cluster Reveals Distinct Phenotypes

Voutsadakis

2023

Cancers

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Background: Molecular subtyping of breast cancer has provided a new perspective on the pathogenesis of the disease and a foundation for building a clinical classification for this heterogeneous disease. The initial classification categorizing breast cancers into five groups, luminal A, luminal B, ERBB2-overexpressing, basal-like and normal-like, was later supplemented by an additional group, claudin-low tumors. However, the claudin-low group has been more difficult to align with clinically used immunohistochemical categories. The identity of this group among clinical cases remains ill defined. Methods: The METABRIC cohort comprising more than 1700 breast cancers and providing information for classifying them in both clinical groups and the genomic PAM50/claudin-low groups was analyzed to derive relationships and clarify potential pathogenic ramifications. Comparisons of the claudin-low cases bearing different clinical group classifications and of the respective cases with the same clinical non-claudin-low classifications were performed. Results: ER-negative/HER2-negative breast cancers are predominantly (88.4%) basal-like and claudin low. Conversely, most basal-like cancers (83.6%) are ER negative/HER2 negative. However, claudin-low breast cancers are only in 68.4% of cases ER negative/HER2 negative and the other clinical phenotypes, mostly ER positive/HER2 negative/low proliferation, are also represented in more than 30% of claudin-low cancers. These claudin-low non-ER-negative/HER2-negative breast cancers differ from claudin-low ER-negative/HER2-negative cases in grade, prevalence of integrative clusters, and prevalence of common mutations and common amplifications. Differences also exist between the two groups classified clinically as ER negative/HER2 negative, that are genomically basal-like or claudin-low, including in menopause status, grade, histology, prevalence of high tumor mutation burden, distribution of integrative clusters, prevalence of TP53 mutations and of amplifications in the MYC and MCL1 loci. Furthermore, distinct characteristics are observed between the luminal A and claudin-low groups within the clinical ER-positive/HER2-negative/low proliferation group. Conclusion: Within genomically claudin-low breast cancers, the ER-negative/HER2-negative group is distinct from the group with either ER or HER2 positivity. Conversely, within clinical phenotypes, claudin-low and non-claudin-low breast cancers differ in clinical characteristics and molecular attributes.

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Quantifying hormone receptor status in lobular breast cancer in an institutional series: the relationship between estrogen and progesterone receptor status and outcomes

Clelland¹,

Rothschild²,

Patterson³

et al. 2023

Breast Cancer Res Treat

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Purpose Recent guidelines defined a new reporting category of ER-low-positive breast cancer based on immunohistochemistry (IHC). While low positivity of either hormone receptor is uncommon in invasive lobular carcinoma (ILC), we sought to investigate whether relatively low hormone receptor positivity was associated with tumor characteristics and patient outcomes in a single institutional cohort. Methods We searched an institutional database for cases of stage I-III ILC with available IHC reports. Based on prior published categories in ILC, ER was classified as low, medium, or high as defined by ER staining of 10–69%, 70–89%, and ≥ 90% respectively. PR low and high tumors were defined by < 20%, or ≥ 20% staining respectively. We used chi-squared tests, t-tests, and Cox proportional hazards models to evaluate associations between ER/PR categories and tumor characteristics or disease-free survival (DFS). Results The cohort consisted of 707 ILC cases, with 11% of cases categorized as ER low, 15.1% as medium, and 73.8% as high. The majority (67.6%) were PR high. Patients with ER low/medium expression were significantly younger, and more likely to also have PR low and/or HER2 positive tumors compared to those that were ER high. In a Cox proportional hazards model adjusting for age, stage, grade, pleomorphic histology, and treatment, ER category was not prognostic for DFS, but PR negative and PR low status each had significantly worse DFS compared to PR high status (HR 3.5, 95% CI 1.8–6.7, p < 0.001; and HR 2.0, 95% CI 1.1–3.5, p = 0.015, respectively). Conclusion These findings highlight the relevance of quantifying ER and PR within ILC.

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Invasive lobular carcinoma: clinicopathological features and subtypes

Cited by 6 publications

References 46 publications

Axillary lymph node status and invasive lobular breast cancer

Axillary lymph node status and invasive lobular breast cancer

Comparison of Clinical Subtypes of Breast Cancer within the Claudin-Low Molecular Cluster Reveals Distinct Phenotypes

Quantifying hormone receptor status in lobular breast cancer in an institutional series: the relationship between estrogen and progesterone receptor status and outcomes

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