Contrast-Enhanced Mammography for Detection and Characterization of Invasive Lobular Carcinoma

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Invasive lobular carcinoma (ILC) presents diagnostic challenges due to its infiltrative growth, often missed on conventional mammography, especially in dense breasts.
• Contrast-enhanced mammography (CEM) integrates anatomical and functional imaging, potentially improving ILC detection and staging over standard mammography.

Purpose of the Study:

• To review the imaging features of invasive lobular carcinoma (ILC) on contrast-enhanced mammography (CEM).
• To assess the utility of CEM in evaluating ILC size, extent, and conspicuity compared to other modalities.

Main Methods:

• Review of the spectrum of ILC imaging findings on CEM, including low-energy and recombined images.
• Comparison of CEM performance with MRI for assessing ILC tumor size and disease extent.

Main Results:

• CEM demonstrates value in assessing ILC tumor size and extent, particularly for multifocal and multicentric disease, though MRI remains superior.
• CEM accuracy may be limited for non-mass enhancement or tumors >3 cm; ILC may show lower enhancement conspicuity than invasive ductal carcinoma (IDC).

Conclusions:

• Familiarity with variable ILC imaging characteristics on CEM is crucial for radiologists as its clinical use grows.
• Accurate interpretation of CEM for ILC can support precise treatment planning and enhance patient outcomes.