Magnetic resonance imaging for invasive lobular carcinoma: is it worth it?

Abstract

Background: Invasive lobular cancer (ILC) of the breast can provide diagnostic and therapeutic challenges due to its often mammographically occult and multifocal nature. UK guidelines recommend magnetic resonance imaging (MRI) when considering breast conserving surgery (BCS) in women with a diagnosis of ILC. A small number of studies have shown that due to its low specificity, MRI can lead to additional invasive investigations whilst rarely identifying additional tumour foci that affect management. We carried out a retrospective study of patients diagnosed with ILC to assess the impact of MRI on management and to evaluate if breast density on mammography could indicate likelihood of additional disease being found on MRI. Methods: A retrospective analysis of the electronic patient records for all cases of ILC diagnosed between January 2013 and December 2016 was carried out. Results: A total of 110 cases of ILC were identified of which 69 women were considered for BCS and 58 (84.1%) women underwent MRI. A further abnormality was seen in 22 (37.9%) patients of whom 13 (59.1%) had a further core biopsy with 4 cases being positive for malignancy. Overall MRI changed the surgical plan from BCS to mastectomy in 7 (10.1%). Breast density did not predict the presence of additional findings on MRI. Conclusions: MRI assessment of ILC rarely affects the management when BCS is considered. Having radiologically denser breasts did not correlate with increased reoperation rate. Larger prospective studies may provide further guidance on MRI specificity and breast density.

Invasive Lobular Breast Cancer as a Distinct Disease: Implications for Therapeutic Strategy

“…Sensitivity of mammography for ILC ranges from 57 to 81% [ 40 , 41 ]. Furthermore, whilst magnetic resonance imaging (MRI) offers improved resolution, studies suggest that the ability of MRI to assess suitability for breast-conserving surgery is often suboptimal in cases of ILC [ 42 ]. In addition, compared with other subtypes, there is evidence that synchronous contralateral (i.e., bilateral) primary disease occurs more frequently in ILC (20.9% in ILC versus 11.2% in IDC; p < 0.0001) [ 43 ].…”

“…Consequently, patients with ILC are more likely to undergo breast removal by mastectomy. Whilst offering greater resolution, MRI scanning may also increase false-positive detection of regional disease leading to an inappropriate increase in rates of mastectomy [42]. Following surgery, patients with ILC often undergo contralateral mastectomy because of the known tendency for bilateral ILC to occur [48].…”

Lobular Carcinoma of the Breast: A Comprehensive Review with Translational Insights

“…The most common presentation of ILCs on MRI is irregular or spiculated margins or a non-mass lesion [181]. Magnetic resonance imaging (MRI) has been reported to reach near-perfect sensitivity rates (93-100%) in ILC detection and has higher accuracy rates while detecting synchronous and bilateral lesions [174,[181][182][183][184]. However, an increase in sensitivity has the downside of low specificity and consequently higher false positive rates [174,184].…”

Multimodality imaging in lobular breast cancer: Differences in mammography, ultrasound, and MRI in the assessment of local tumor extent and correlation with molecular characteristics

“…Moreover, ILC is often multifocal, multicentric, or even bilateral, each of which influences choice of therapeutic procedure. That is why, for many years, MRI has been recognized as a diagnostic standard for ILC as it has the highest sensitivity among the available imaging methods (2,(8)(9)(10).…”