|The literature suggests that invasive lobular cancer can be
treated in a manner identical to invasive ductal cancer, with the
same results. Some representative studies:
Ann Surg Oncol 1997
Role of conservation therapy for invasive lobular
carcinoma of the breast.
Invasive lobular carcinoma (ILC) accounts for 5% to 10% of all invasive breast cancers.
All patients underwent surgical resection and postoperative radiation therapy. The
5-year actuarial locoregional recurrence rate was 9.8%, and the median time to recurrence
was 77 months (range 41 to 113 months).The 5-year disease-specific survival rate was
93.7%. CONCLUSIONS: Breast conservation therapy for ILC achieves locoregional control in
the majority of patients.
Ann Surg Oncol 1997 Oct-Nov;4(7):545-50
Optimal surgical treatment of invasive lobular carcinoma
of the breast.
Women with infiltrating ductal carcinoma (IDC) and invasive lobular breast carcinoma
(ILC) diagnosed during the years 1984 to 1994 were identified through a statewide tumor
registry. During the period 1984 to 1994, 4886 women were diagnosed with invasive lobular
or ductal breast carcinoma. Of these, 316 (6.5%) had infiltrating lobular cancer. The
5-year survival rates were 68% and 71% for ILC and IDC, respectively. The local recurrence
rates were 2.8% and 4.3% for ILC treated with lumpectomy and axillary nodal dissection
(LAND) and modified radical mastectomy (MRM), respectively, which were not significantly
different from that obtained with IDC (LAND = 2.5%, MRM = 2.1%). The incidence of
contralateral breast cancer during the period was 6.6% and 6.5% for ILC and IDC,
respectively. CONCLUSIONS: Invasive lobular carcinoma can be safely treated with breast
conservation with no difference in local recurrence or survival. In the absence of a
suspicious finding on clinical or radiologic examination, routine contralateral breast
intervention is not recommended.
Conservative surgery and radiation therapy for invasive lobular
carcinoma of the breast.
Francis M,.Aust N Z J Surg. 1999 Jun;69(6):450-4.
There is debate as to whether infiltrating lobular carcinoma (ILC) can be effectively
treated with breast conservative surgery (CS) and radiotherapy (RT) because of a perceived
high risk of local recurrence. This retrospective study examined the outcome of patients
with ILC treated by CS and RT. Between November 1979 and December 1994, 57 women with UICC
Stage I or II ILC were treated by CS and RT at Westmead Hospital, New South Wales,
Australia. After a median follow up of 69 months (range 36-162) three patients (5.3%) developed a local recurrence. One of 43 patients (2.3%)
with known clear margins developed a local recurrence compared with two of 14 patients
(14.3%) with positive or indeterminate margins (P = NS). The 5- and 10-year rates of
freedom from local recurrence were 96 and 93%, respectively. The 5-year disease-free
survival was 85% (node-negative, 92%; node-positive, 66%). Overall survival was 94% at 5
years. No patient developed a contralateral breast cancer. CONCLUSION:
Patients with ILC can be effectively treated with CS and RT.
Cancer 1989 Apr 15;63(8):1630-5
Conservation therapy for breast cancers other than
infiltrating ductal carcinoma.
For 67 patients with predominantly lobular carcinomas, the actuarial overall 5-year
survival was 100% and 77% for node-negative and node-positive patients, respectively. The
actuarial probability of recurrence in the treated breast (13.5% at 5 years) appeared to
be somewhat greater than that observed after treatment of invasive ductal cancers (8.8%).
The authors conclude that, in addition to its well-established efficacy in the treatment
of infiltrating ductal carcinomas, the combination of tumor excision and radiotherapy
appears to provide adequate local control for other histologic types as well. However,
patients with lobular cancer appear to be at somewhat greater risk of mammary failure, and
recurrences in such patients tend to be multifocal and multicentric.
Br J Surg. 1995 Oct;82(10):1364-6.
Lobular carcinoma of the breast can be managed by breast-conserving
This study is a retrospective review of 226 patients with pure invasive lobular carcinoma
4 cm or less treated by breast conservation therapy or mastectomy. Local
relapse occurred in four of 52 patients (8 per cent) after breast conservation compared
with 21 of 174 (12 per cent) after mastectomy. Breast conservation for invasive
lobular carcinoma did not result in a higher incidence of local relapse and patients with
invasive lobular and ductal carcinomas may be managed in a similar fashion.
Is invasive lobular carcinoma different from invasive ductal
Mersin H, Eur J Surg Oncol. 2003 May;29(4):390-5.
The purpose of this study is to determine whether the histopathologic features and outcome
in invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) are different, and
whether the histologic type is a prognostic factor for outcome. METHODS: A retrospective
cohort study was conducted in consecutive 510 stage I/II breast carcinoma patients who
underwent modified radical mastectomy. The features of 65 patients with ILC were compared
with those of 445 patients with IDC.The median ages in patients with ILC and those with
IDC were 52 and 41 (P=0.04). Tumor size, estrogen receptor positive expression and nodal
positivity were not significantly different between the histologic types. Patients with
ILC had more frequently (81.5%) low grade tumors and less lymphatic vascular invasion
(9.3%) in primary tumor than those with IDC (P<0.05). Whereas the rates of 5-year
overall survival were 94% in ILC and 90% in IDC, the rates of 5-year event-free survival
were 71 and 67%, respectively (P=NS). Multivariate analyses in all patients demonstrated
that tumor size, pathologic lymph node status and age at diagnosis were the most important
prognostic factors for overall and event-free survival. Histologic
type was not statistically significant for both outcomes. CONCLUSIONS: Although
patients with ILC had older age, low grade tumor and less lymphatic vascular invasion,
they had no survival advantage comparing with their counterparts. Histologic type was not
an independent prognostic factor for outcome.
The influence of infiltrating lobular carcinoma on the outcome of
patients treated with breast-conserving surgery and radiation therapy.
Peiro G, Breast Cancer Res Treat. 2000 Jan;59(1):49-54.
The role of conservative surgery and radiation therapy (CS and RT) in the treatment of
patients with infiltrating ductal carcinoma is well established. However, the efficacy of
CS and RT for patients with infiltrating lobular carcinoma is less well documented. The
goal of this study was to examine treatment outcome after CS and RT for patients with
infiltrating lobular carcinoma and to compare the results to those of patients with
infiltrating ductal carcinoma and patients with mixed ductal-lobular histology. METHODS:
Between 1970 and 1986, 1624 patients with Stage I or II invasive breast cancer were
treated with CS and RT consisting of a complete gross excision of the tumor and > or =
6000 cGy to the primary site. Slides were available for review for 1337 of these patients
(82%). Of these, 93 had infiltrating lobular carcinoma, 1089 had infiltrating ductal
carcinoma, and 59 had tumors with mixed ductal and lobular features; these patients
constitute the study population. The median follow-up time for surviving patients was 133
months. A comprehensive list of clinical and pathologic features was evaluated for all
patients. Additional histologic features assessed for patients with infiltrating lobular
carcinoma included histologic subtype, multifocal invasion, stromal desmoplasia, and the
presence of signet ring cells. RESULTS: Five and 10-year crude
results by site of first failure were similar for patients with infiltrating lobular,
infiltrating ductal, and mixed histology. In particular, the 10-year crude
local recurrence rates were 15%, 13%, and 13% for patients with infiltrating lobular,
infiltrating ductal, and mixed histology, respectively. Ten-year distant/regional
recurrence rates were 22%, 23%, and 20% for the three groups, respectively. In addition,
the 10-year crude contralateral breast cancer rates were 4%, 13% and 6% for patients with
infiltrating lobular, infiltrating ductal and mixed histology, respectively. In a multiple
regression analysis which included established prognostic factors, histologic type was not
significantly associated with either survival or time to recurrence. CONCLUSIONS: Patients
with infiltrating lobular carcinoma have a similar outcome following CS and RT to patients
with infiltrating ductal carcinoma and to patients with tumors that have mixed ductal and
lobular features. We conclude that the presence of infiltrating
lobular histology should not influence decisions regarding local therapy in patients with
Stage I and II breast cancer.
Cancer 1992 Jun 1;69(11):2789-95
Conservation therapy for invasive lobular carcinoma of
The 5-year actuarial risk of locoregional recurrence was 5%, with two of three failures
occurring in the regional lymphatics. The mean time to locoregional failure was 28 months.
The 5-year actuarial disease-free survival (84%) and overall survival (91%) were
comparable to those seen in several large series of similarly treated patients with
invasive ductal carcinoma. Contralateral breast cancer occurred at a rate of approximately
0.6% per year.
Br J Surg 1997 Jan;84(1):106-9
Conservative surgery for infiltrating lobular breast
RESULTS: No difference in cumulative local recurrence rate was found between the two
groups at 10 years (approximately 7 per cent). CONCLUSION: Conservative surgery is equally
safe for patients with infiltrating lobular or ductal carcinoma of the breast.
Infiltrating lobular carcinoma of the breast. Clinicopathologic
analysis of 975 cases with reference to data on conservative therapy and metastatic
Sastre-Garau X, Cancer. 1996 Jan 1;77(1):113-20.
The clinicopathologic features of infiltrating lobular carcinoma
(ILC), which represents 5% to 15% of all breast cancers, are still controversial.
In particular, the high frequency of multicentric lesions has led to questioning of the
effectiveness of conservative treatment for this type of cancer. By studying a large
number of cases, we aimed to compare the clinicopathological features of ILC with those of
nonlobular infiltrating carcinoma (NLIC) and to assess the advisability of conservative
therapy in the management of ILC. METHODS. The population analyzed included 726 cases of
ILC, 249 cases of mixed ILC/invasive ductal carcinoma (ILC/IDC), and 10,061 cases of NLIC.
The age of patients, TNM status, estrogen- and progesterone-receptor status (ER, PR), and
histologic grades of the 3 groups were compared. The follow-up was carried out on a
subgroup of 5846 cases. RESULTS. At diagnosis, ILC tumors were found to be larger on
average and were detected in patients older than those with NLIC, but the degree of lymph
node involvement was lower in patients with ILC than in NLIC. In ILC, tumors are more
frequently grade I and ER-positive than in NLIC. Multicentric lesions were not
significantly more frequent in ILC than in NLIC. The overall survival, locoregional
control, disease free interval, and metastatic spread rates were not different among the
three groups neither by univariate nor multivariate analysis, but the pattern of
metastatic dissemination was different. In 480 cases of ILC considered for conservation
therapy, the local recurrence and overall survival rates were similar to those observed
for IDC. CONCLUSIONS. Our analysis specifies the
clinicopathological features of ILC and confirms that conservation therapy may be an
appropriate treatment for this type of cancer.
Cancer 1989 Jul 15;64(2):448-54
Influence of infiltrating lobular histology on local
tumor control in breast cancer patients treated with conservative surgery and
The 5-year actuarial risk of local recurrence was similar for patients with
infiltrating lobular or ductal carcinoma when the latter was evaluated as a single group
(12% versus 11%). However, the 12% 5-year actuarial local recurrence risk for patients
with infiltrating lobular carcinoma was intermediate between that for patients with
infiltrating ductal carcinomas with an extensive intraductal component (23%) and those
without an extensive intraductal component (5%).
Does routine grading of invasive lobular cancer of the breast have
the same prognostic significance as for ductal cancers?
Sinha PS, Eur J Surg Oncol. 2000 Dec;26(8):733-7.
The routine tumour grading of invasive ductal carcinoma of the breast has been shown to be
a robust determinant of outcome but pathologists have been reluctant to grade lobular
cancers. The aim of this study was to determine the prognostic significance of the routine
reporting of lobular grade. METHODS: All patients with invasive lobular carcinoma (ILC)
treated between 1981 and 1996 were reviewed. Patients with ILC which had been graded were
included in the study. These cases were matched with two control patients with invasive
ductal carcinoma (IDC) who were operated on in the same year and were closest to the
patients in age. Recurrence-free survival was compared with grade for ILC cases and IDC
controls using life-table analysis. Similar comparisons were made with the Nottingham
Prognostic Index (NPI) between the different prognostic groups. RESULTS: Of 139 cases with
ILC, 33 were excluded from the study because 24 were ungraded, five had advanced disease
and four had mixed tumours. The mean length of follow-up for ILC cases was 75 months vs 70
months for IDC controls. Recurrence rates for grade I were 10% ILC vs 24% IDC, for grade
II 32%vs 32% and for grade III 33%vs 49%. The reported grades for ILC and IDC both showed
the expected trend for an increased recurrence rate with more severe tumour grade, but
this was only significant for IDC grade II vs grade III (P<0.02) on life-table
analysis; only 6% of lobular cancers were reported as grade III. However, there was
significant separation of the survival curves when NPI was compared for both lobular and
ductal cancers. CONCLUSION: The routine reporting of tumour grade
for ILC did not show significant difference in outcome between grade I and grade II, and
very few tumours were rated grade III. The validity of grading lobular cancer of the
breast requires further evaluation.
Invasive lobular carcinoma of the breast has better short- and
long-term survival than invasive ductal carcinoma.
Toikkanen S, Br J Cancer. 1997;76(9):1234-40.
The outcome and prognostic factors of 217 women with invasive lobular carcinoma (ILC) and
those of 1121 women with invasive ductal carcinoma (IDC) of the breast were compared. The
patients were followed up for 10-43 years. Women with ILC had axillary nodal metastases
less frequently than those with IDC (43% vs 53%, P = 0.02), although there was no
difference in the primary tumour size between the groups. ILCs were more frequently of low
grade, had lower mitotic counts and had less tumour necrosis. Furthermore, ILCs had lower
S-phase fractions and were more often DNA diploid in flow cytometric analysis than IDCs (P
< 0.0001 for all comparisons). The 5- and 30-year corrected survival rates of women
with ILC were 78% and 50%, respectively, compared with 63% and 37% for women with IDC (P =
0.001). Small pT1NOMO ILCs (n = 41) had 100% 10-year and 83% 20-year corrected survival
rates. In a multivariate analysis, a large primary tumour size, the presence of axillary
nodal metastases, a high mitotic count and the presence of tumour necrosis all had an
independent prognostic value in ILC. We conclude that ILC is
associated with better survival than IDC.
Am J Surg 1996 Nov;172(5):496-500
Lumpectomy and radiation treatment for invasive lobular
carcinoma of the breast.
Thirty-four patients (37%) were treated with lumpectomy and adjuvant postoperative
radiotherapy with one (3%) local recurrence and a mean overall survival of 83.6 months.
Fifty-nine patients (63%) were treated by modified radical mastectomy with two local
recurrences (3%) and a mean overall survival of 71.7 months.
J Am Coll Surg 1998 Apr;186(4):416-22
A comparative analysis of lobular and ductal carcinoma of
the breast: presentation, treatment, and outcomes.
The mean patient age at diagnosis was 61.0 years for invasive ductal carcinoma, 63.0
years for invasive lobular carcinoma, and 60.6 years for tumors with combined histology.
The anatomic location, tumor diameter, and tumor grade were similar for each histotype.
Breast-preservation therapy was less frequent for invasive lobular carcinoma. The 5-year
overall survival and local disease-free survival rates for women treated with breast
preservation were similar for invasive ductal carcinoma (84% overall survival; 97%
disease-free survival) and invasive lobular carcinoma (87% overall survival; 98%
Int J Radiat Oncol Biol Phys 1998 Jan 15;40(2):353-8
Lobular carcinoma in situ as a component of breast
cancer: the long-term outcome in patients treated with breast-conservation therapy.
The pathology reports of all patients treated with conservative surgery and radiation
therapy at our institution prior to 1992 were reviewed to identify patients who had LCIS
as a histologic component. A total of 51 patients were identified. Primary histology of
the 51 patients was as follows: 53% infiltrating lobular, 20% invasive and intraductal,
18% invasive ductal, 10% intraductal. There were no significant differences in age
of presentation, clinical stage, nodal status, estrogen receptor status, or adjuvant
therapy received between the two groups. The primary histology of the two populations
differed significantly with a larger percentage of infiltrating lobular primaries in the
LCIS group (53 vs. 5%, p < 0.001). The LCIS group also differed from the control group
with respect to the percentage of patients with bilateral disease (17 vs. 8%, p = 0.05),
and the percentage of patients with "false negative" mammograms (20 vs. 10%, p =
0.02). There was no statistically significant difference between the LCIS group and
control group in the 10-year overall survival (67 vs. 72%), distant disease-free survival
(62 vs. 79%), or ipsilateral breast tumor recurrence-free survival (77% LCIS vs. 84%
control). the comparable local control rates between conservatively treated patients with
or without LCIS suggests that patients with a histologic component of LCIS are suitable
candidates for conservative surgery and radiation therapy.