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Invasive Lobular Carcinoma in the Screening Setting.

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Invasive lobular carcinoma (ILC) detection is improved with supplemental screening like tomosynthesis and ultrasound. Breast MRI offers the highest sensitivity for detecting ILC, especially in dense breasts.

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Area of Science:

  • Oncology
  • Radiology
  • Breast Imaging

Background:

  • Invasive lobular carcinoma (ILC) is the second most common breast cancer subtype.
  • ILC's infiltrating growth pattern can reduce mammography and ultrasound detectability.

Purpose of the Study:

  • To evaluate the effectiveness of various screening modalities for detecting invasive lobular carcinoma (ILC).

Main Methods:

  • Review of digital breast tomosynthesis (DBT), screening ultrasound (US), breast MRI, abbreviated breast MRI, and contrast-enhanced mammography for ILC detection.
  • Comparison of sensitivity and specificity across modalities, particularly in dense breasts.

Main Results:

  • DBT sensitivity for ILC is 80%-88%, outperforming digital mammography (DM) in dense breasts.
  • Screening US identifies additional ILCs post-DBT (0-1.2 per 1000 exams), accounting for 13% of incremental cancers.
  • Breast MRI shows 93% sensitivity for ILC; contrast-enhanced mammography offers improved sensitivity over DM with higher specificity than MRI.

Conclusions:

  • Supplemental screening modalities significantly increase ILC detection rates.
  • Breast MRI demonstrates the highest sensitivity for detecting invasive lobular carcinoma.