Lobular Carcinoma and MRI Use

The data for preoperative MRI in the setting of either lobular or ductal carcinoma is controversial.

Routine preoperative MRI is not mandatory for either entity and is not anticipated to change the rate of repeat excision for positive margins or recurrence. It should be used on a case-by-case basis, taking into account other factors, such as breast density and additional risk factors.

Invasive lobular carcinoma is described pathologically as small cells that infiltrate the mammary stroma and adipose tissue in a single file pattern due to a lack of E-cadherin. The cells induce minimal reaction in the surrounding tissue, making them insidious both radiographically and pathologically. Classic-type invasive lobular carcinoma is usually positive for estrogen receptor and negative for HER2, but this is not universally true, as HER2 subtypes do exist. Lobular cancers respond less well to neoadjuvant chemotherapy than their ductal counterparts.

Orvieto E, Maiorano E, Bottiglieri L, et al. Clinicopathologic characteristics of invasive lobular carcinoma of the breast: results of an analysis of 530 cases from a single institution. Cancer. 2008;113:1511-1520.

Purushotham A, Pinder S, Cariati M, Harries M, Goldhirsch A. Neoadjuvant chemotherapy: not the best option in estrogen receptor-positive, HER2-negative, invasive classical lobular carcinoma of the breast? J Clin Oncol. 2010;28:3552-3554.

Turnbull L, Brown S, Harvey I, et al. Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomized controlled trial. Lancet. 2010;375:563-571.

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