Staging of Invasive Lobular Carcinoma of the Breast (ILC)

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Staging:
    • All breast cancers are staged using the TNM staging system:
      • As defined by the American Joint
        Committee on Cancer (AJCC)
  • Patients are initially staged clinically based on physical examination and imaging findings:
    • They are later staged pathologically based on pathologic data obtained from the surgical specimens
  • Tumor size (T):
    • Comprises the first component of the TNM stage
    • Particularly relevant to ILCs:
      • Which more often present as multifocal / multicentric tumors:
        • Final T stage is based on the size of
          the largest mass           on surgical pathology:
          • Not an additive sum of multiple tumors if present
    • If bilateral cancers are present, each cancer is staged separately
    • Most studies, including a large Surveillance, Epidemiology, and End Results (SEER) registry analysis of 263,408 women with either IDC or ILC:
      • Have observed a significantly higher likelihood for ILCs to be sized over 2 cm (T2 or higher) at diagnosis compared with IDC
    • Nodal status (N):
      • Known to be an important predictor of prognosis in breast cancer:
        • Is similarly staged both clinically and pathologically
        • The quantification of the size of nodal metastases as either
          isolated tumor cells (ITCs), micrometastases (sized 0.2 mm to 2 mm), or macrometastases (sized greater than 2 mm):
          • Is relevant in ILC, which has been shown in recent series to independently predict for
            the presence of micrometastatic disease            , another proposed consequence of its discohesive biology
  • The M stage:
    • Is determined by the presence of distant metastases:
      • With bone being the most
        common site of spread         for all breast cancer types
      • Other frequent sites of metastasis, common to both IDC and ILC, include:
        • The lungs and central nervous system
      • Interestingly, ILCs display a
        unique predilection for:
        • Gastrointestinal, peritoneal, and ovarian metastases
    • The commonly ER-positive nature of ILCs also results in:
      • More frequent presentation of late metastases
    • The diagnosis of yet subclinical metastatic cancer in patients with locally advanced disease may be made
      by:
      • CT, bone scanning, or PET
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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