Keywords:
Breast, MR, Audit and standards, Staging, Multidisciplinary cancer care, Workforce, Cancer
Authors:
K. D. Jethwa, E. Giannotti; Nottingham/UK
DOI:
10.1594/ecr2018/C-2194
Aims and objectives
Invasive lobular carcinoma (ILC) is the second most common cause of invasive carcinoma.
ILC is characterised,
pathologically,
by small round cells which invade the stroma in a ‘single file pattern’ resulting in linear strands.
There is no destruction of anatomical structure or fibrous reaction so a mass lesion is not always formed.
The conventional radiological detection of ILC is therefore difficult and patients often present with advanced disease.
Biologically,
ILC tumors are usually of a low histological grade and tend to have less lymph node metastasis.
ILC responds well to surgery and chemotherapy and has similar outcomes to invasive ductal carcinoma.
Once a histological diagnosis of ILC is made accurate staging of disease is essential to quantify the burden of disease which then guides further surgical management,
for example mastectomy versus breast conserving surgery.
However,
given the occult nature of ILC means it can be difficult to accurately quantify the burden of disease using conventional imaging techniques (mammography and ultrasonography).
NICE and EUSOMA recommend preoperative breast magnetic resonance imaging (bMRI) in all invasive lobular carcinoma (ILC) patients for staging.
Appropriate selection of ILC patients for bMRI may help tailor preoperative investigation thereby reducing costs and delays in treatment.
We explore the role of bMRI in the preoperative assessment of ILC patients and its impact on treatment decisions.