Invasive lobular carcinoma: mammographic findings in a 10-year experience.

Abstract

From January 1, 1976 to December 30, 1985, 1,966 cases of breast carcinoma were diagnosed and treated at Malmo General Hospital, Malmo, Sweden. Of these cases, 185 (9.4%) involved invasive lobular carcinoma (ILC). Mammography in 137 cases demonstrated the following findings: spiculated opacity (53%), architectural distortion (16%), poorly defined opacity (7%), normal or benign findings (16%), and parenchymal asymmetry (4%). Radiographic definition of the ILC lesion varied greatly with projection: The craniocaudal view demonstrated significant findings more frequently than either the oblique or lateral views. Secondary radiographic findings were present in 31%, microcalcifications were rare, and physical findings were present in 89%. Because of its diffuse growth pattern and tendency to form lesions with opacity equal to or less than that of the parenchyma, ILC can be extremely difficult to detect mammographically. Therefore, the radiologist must be alert for subtle mammographic signs of malignancy and highly suspicious of any abnormal physical findings regardless of the mammographic appearance.

Invasive lobular carcinoma of the breast: mammographic and sonographic evaluation

“…We found that 11 cases (29%) manifested as only asymmetrical density, and 16 cases (42%) presented with mass and/or architectural distortions. Even large tumors may be undetectable by physical examination and mammography (26). Supporting this point, one of our cases with a 4-cm tumor that was found upon histopathologic assessment was undetectable by physical examination and mammography and could only be detected by sonography.…”

“…Characteristically, tumor cells surround the ducts without obstructing them. It is postulated that the lack of ductal invasion or obstruction may explain the low rates of microcalcifications associated with ILC (26). In our study, five out of 38 ILC cases (15%) showed clusters of microcalcifications that were consistent with BIRADS category 4-5.…”

“…In a study of Hilleren et al (26), 2% of 137 ILCs showed suspicious calcifications, and in a study by Krecke and Gisvold, 1% of 185 pure ILCs showed suspicious calcifications (10). The percentage of suspicious calcifications in a study of Cornford et al (31) was 28%, and this higher rate was thought to be due to this study's inclusion of mixed invasive lobular and ductal tumors in the infiltrating lobular carcinoma category.…”

“…The sensitivity of physical examinations for ILC detection ranges between 65% and 98%, with generally over 50% of patients presenting with palpation findings (15,(24)(25)(26). The sensitivity of mammography for ILC detection was reported to be between 57% and 81% (15,(24)(25)(26), and the false-negative interpretation rates of ILC in mammograms were reported to be in the range of 19-43% (10,26,27). In our study, the sensitivity of mammography was 71.05%, and the false-negative rate of mammography was 28.9%.…”

“…The most common sonographic finding for ILC is a heterogeneous hypoechoic mass with irregular borders and posterior acoustic shadowing (12,26,37). In a study of Butler et al (12), ten out of 81 ILC cases (12%) were sonographically occult, and 12 out of 81 patients (15%) showed focal shadowing without a discrete mass.…”