Radiology Approach to Invasive Breast Lobular Carcinoma - Initial Experience

It is well known that invasive lobular carcinoma (ILC) accounts for approximately 5-15 % of invasive breast cancers that remain one of the most common malignancies among women globally. ILC is distinguished from the more common invasive ductal carcinoma (IDC) by characteristics histopathology features. The aim of the study was to emphasize the need of more specified diagnostic imaging approach in order to detect breast ILC, based on our institution experience. We describe a number of 17 female cases (58±7 years) who presented: breast fullness/asymmetry - 11 patients (64.7 %), pain - 2 patients (11.7 %), and the rest 4 patients (23.5 %) were asymptomatic. Diagnostic modalities used in this study were: 2D Mammography, Ultrasound, Digital Breast Tomosynthesis (DBT), and core biopsy in guidance by Ultrasound. On 2D Mammography, visible mass was found in 8 patients (47 %), and architectural distortion was found in 4 patients (23.5 %). On DBT additional 5 patients were examined from the total number of patients, and additional lesions were found such as occult lesions and additional architectural distortion. Using DBT, occult lesion was found in 3 patients (17.6 %) and architectural distortion was found in 2 patients (11.7%). Due to these inconclusive findings, DBT was carried out to improve visualization especially in those with more glandular tissue. The occult lesions were seen in 3 patients, which showed as false negative on 2D, as well as an architectural distortion in 2 patients, additionally seen on DBT. This multimodality approach, including DBT, holds promise for more reliable detection of occult lesions and distortions especially in denser breast, and for better clinical outcomes in patients with ILC, respectively.