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Resection margin status in lumpectomy specimens of infiltrating lobular carcinoma
K T Mai1, H M Yazdi, P A Isotalo
1Department of Laboratory Medicine, The Ottawa Hospital, Ontario, Canada.
Insights
Resection margin status in infiltrating lobular carcinoma (ILC) lumpectomy is linked to tumor factors like size and grade. Preoperative assessment aids surgical planning for ILC versus infiltrating ductal carcinoma (IDC).
Area of Science:
- Oncology
- Surgical Pathology
- Breast Cancer Research
Background:
- Infiltrating lobular carcinoma (ILC) presents unique challenges in surgical management.
- Lumpectomy is a common breast-conserving surgery, making margin status critical.
Purpose of the Study:
- To evaluate the resection margin status in patients with infiltrating lobular carcinoma (ILC) undergoing lumpectomy.
- To compare margin status between ILC and infiltrating ductal carcinoma (IDC) after lumpectomy.
Main Methods:
- Retrospective comparison of 66 ILC cases with 66 IDC cases treated with lumpectomy.
- Analysis of margin status based on ILC subtype (typical, variant, mixed), tumor size, nuclear grade, and extensive intraductal component.
Main Results:
- ILC cases showed higher rates of positive/close margins (52% typical, 33% variants/mixed) compared to IDC (26%).
- Typical ILCs >2 cm had 70% positive/close margins; those <2 cm with low grade were comparable to IDC.
- Positive extensive intraductal component and high nuclear grade were associated with positive margins in ILC.
Conclusions:
- Resection margin status in ILC lumpectomy is influenced by extensive intraductal component, tumor size, grade, and ILC variants.
- Preoperative factors like mammography and biopsy can predict margin status, guiding surgical strategy towards mastectomy if needed.
Aims:
To study the status of resection margins in specimens from patients with infiltrating lobular carcinoma (ILC) treated with lumpectomy.
Materials And Methods:
Sixty-six consecutive cases of ILC were compared with the same number of consecutive cases of infiltrating ductal carcinoma (IDC). All cases were treated with lumpectomy.
Results:
ILCs were divided into 42 cases of typical ILC, 15 variants of ILC (alveolar or solid types) and 9 cases of mixed ILC and IDC. These groups were associated with positive or close resection margins in 22 (52%), 5 (33%) and 3 (33%) cases, respectively. For the group of IDC with partial mastectomies, matched for patient's age and tumor size, positive or close resection margins were observed in 26%. ILCs, measuring less than 2 cm in greatest diameter and having low nuclear grade, had rates of positive or close margins comparable with those of IDC. Typical ILCs, measuring more than 2 cm in diameter, had rates of positive or close margins of 70%. All cases with a positive extensive intraductal component had positive margins. Furthermore, in all types of ILC, tumors with a high nuclear grade tended to be associated with a high rate of positive margins.
Conclusions:
The status of resection margins in lumpectomy specimens for infiltrating lobular carcinoma is related to the extensive intraductal component status, tumor size and grade, and the presence of variants of ILC or mixed ILC and IDC. Most of these factors can be determined preoperatively by mammography and histopathological evaluation of breast core biopsies, therefore, aiding in planning the surgical strategy of mastectomy.