Outcomes, Follow-up and Surveillance of Invasive Lobular Carcinoma (ILC) of the Breast

Rodrigo Arrangoiz MS, MD, FACS, FSSO

  • Outcomes and prognosis in ILC are generally favorable:
    • Consistent with the luminal A phenotype
  • The majority of evidence supporting similar or better survival as IDC:
    • These include a large SEER study of 263,408 women (27,639 with ILC and 235,769 with IDC) treated between 1993 and 2003:
      • A stage-matched analysis showed that ILC was more likely to be:
        • Greater than 2 cm
        • Lymph node positive
        • ER positive
      • The 5-year disease-free survival was significantly better for ILC than for IDC after matching for stage:
        • With an overall 14% survival benefit (HR 0.86) identified on multivariable analysis
      • As such, although overall stage-corrected prognosis appears to be favorable, some propose that this may be offset by a higher stage at presentation and higher rates
        of late metastatic recurrences        , often occurring in atypical sites
    • The pleomorphic subtype of ILC is:
      • Also a known exception to the generally favorable prognosis, having been shown in retrospective series to more frequently develop metastatic disease than other nonpleomorphic ILCs
  • Currently, there are no unique specifications for surveillance of ILC:
    • For all treated nonmetastatic breast cancers, NCCN guidelines recommend a history and physical examination one to four times per year as clinically appropriate for 5 years and then annually
    • Annual mammography should be performed for patients treated with BCT
    • The role of MRI in surveillance is unclear and presently recommended only for those with a lifetime risk greater than 20% of developing a second primary breast cancer
  • Adherence to hormonal therapy should be encouraged for those prescribed and yearly gynecologic assessment arranged for those without a previous hysterectomy
  • Signs of disease recurrence, either locoregional or systemic, should prompt evaluation with appropriate laboratory work and diagnostic imaging, which may include diagnostic
    CT or fluorodeoxyglucose PET/CT scans followed by biopsy to prove first recurrence of disease
  • It should be noted that the generally low-grade nature of ILC may limit the sensitivity of traditional PET/CT scans, and studies are ongoing for the use of alternative radiotracers using ER ligands for
    increased sensitivity
  • Confirmed LRRs (those of the breast / chest wall and / or regional lymph nodes alone):
    • Can be managed with complete surgical resection and systemic therapy
  • Distant metastatic disease (stage IV) is managed with individualized systemic therapy
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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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