Invasive Lobular Carcinoma of the Breast III

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Classic ILC (represents 60% to70% of the cases):
    • More likely to have negative lymph nodes (cN0):
      • But is has a higher metastatic burden with more pN2:
        • ≥4 lymph nodes positive – 31% of the cases that NST (15%):
          • An adjusted lymph node ratio of 2.26
    • Among patients with SLN positive disease:
      • 68% of ILC showed non-SLN+ disease compared with 46% NST
        • 20% risk of clinical nodal under staging
    • Response to neoadjuvant chemotherapy (NACT) is limited (because most are ER positive and have low proliferation index):
      • PCR is roughly 5% (compared to 15% in matched NST)
      • Less down-staging:
        • ILC is an independent predictor of poor response to NACT
    • Neoadjuvant endocrine therapy (NAET):
      • May be a better option to down-staging but pCR is rare
      • Aromatase inhibitors may be better than tamoxifen
      • CDK4/6 inhibitor could be similar to NST
      • Immune checkpoint inhibitors, HER2 low:
        • Little data available
    • ILC have unique metastatic site:
      • More in the serosa (pleura, peritoneal cavity), GI and GYN and less in the lung, liver, and CNS
      • Wider metastatic spread
      • Recurrence pattern:
        • Early:
          • Less events that ER+ NST but continue to develop over time
        • Late (after 10 years)
  • Aggressive variants of ILC:
    • Pleomorphic:
      • High nuclear grade
    • Solid:
      • Solid growth pattern
      • High mitotic counts
    • Histiocytoid
    • Signet Ring
    • More frequently:
      • ER negative, HER2+ (around 10%)
      • High proliferation index
      • High risk Oncotype Dx
    • Current evidence indicates aggressive clinical behaviour and shorter survival:
      • Little evidence on response to therapy
    • Clinical trials of these variants are needed
    • Can be treated as high grade NST:
      • It may be better to avoid NACT even in ER- or HER2+ due to the lack of evidence of response and may result to progression of the disease
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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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