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Comparison of the clinicopathological features of invasive ductal, invasive lobular, and mixed (invasive ductal + invasive lobular) carcinoma of the breast

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Abstract

Background

In this retrospective analysis, the clinicopathological features and pattern of metastatic spread of invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), and mixed ductal/lobular carcinoma (MDLC), together with the type and outcome of surgical intervention, were comparatively evaluated.

Methods

A total of 633 breast cancer patients with histopathological subtype IDC, ILC or MDLC were included in the study. The mean age was 52.6 ± 12.7 years. Follow-up period ranged between 0 and 33 (median 6.0) years. The groups were compared with respect to age, tumor size, nodal involvement, stage, hormonal therapy, multicentricity, multifocality, bilaterality, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2)/neu, p53, and Ki67 expression, disease-free survival (DFS) and overall survival (OS) rates, and surgical approach.

Results

The distribution of patients was as follows: IDC 508 (80.3 %), ILC 78 (12.3 %), MDLC 47 (7.4 %). Among the parameters evaluated, statistically significant differences were observed in mean tumor size (IDC 2.5 ± 1.98 cm, ILC 3.0 ± 1.8 cm, MDLC 3.2 ± 2.4 cm), advanced T stage (T3 + T4) at diagnosis (IDC 14.7 %, ILC 21.4 %, MDLC 25.6 %), N stage (N0 was dominant in IDC and ILC; N3 was dominant in MDLC), tumor–node–metastasis (TNM) stage (stage II was dominant in IDC and ILC; stage III was dominant in MDLC), HER2/neu expression (IDC 23.8 %, ILC 11.8 %, MDLC 21.4 %), and frequency of bone metastasis (IDC 14.3 %, ILC 17.9 %, MDLC 25.5 %).

Conclusions

MDLC-type tumors have different histopathological characteristics and are often diagnosed at advanced stage. However, their survival outcomes do not vary significantly from ILC and IDC.

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References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–917.

    Article  CAS  PubMed  Google Scholar 

  2. Rosen PP. The pathological classification of human mammary carcinoma: past, present and future. Ann Clin Lab Sci. 1979;9:144–56.

    CAS  PubMed  Google Scholar 

  3. Tulinius H, Bjarnason O, Sigvaldason H, Bjarnadottir G, Olafsdottir G. Tumours in Iceland. 10. Malignant tumours of the female breast. A histological classification, laterality, survival and epidemiological considerations. APMIS. 1988;96:229–38.

    Article  CAS  PubMed  Google Scholar 

  4. National Comprehensive Cancer Network (NCCN) Guidelines Version 1.2012. Invasive Breast Cancer, pp. 12–19.

  5. Lesser ML, Rosen PP, Kinne DW. Multicentricity and bilaterality in invasive breast carcinoma. Surgery. 1982;91:234–40.

    CAS  PubMed  Google Scholar 

  6. Krecke KN, Gisvold JJ. Invasive lobular carcinoma of the breast: mammographic findings and extent of disease at diagnosis in 184 patients. AJR Am J Roentgenol. 1993;161:957–60.

    Article  CAS  PubMed  Google Scholar 

  7. Harris M, Howell A, Chrissohou M, Swindell RI, Hudson M, Sellwood RA. A comparison of the metastatic pattern of infiltrating lobular carcinoma and infiltrating duct carcinoma of the breast. Br J Cancer. 1984;50:23–30.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Arpino G, Bardou VJ, Clark GM, Elledge RM. Infiltrating lobular carcinoma of the breast: tumor characteristics and clinical outcome. Breast Cancer Res. 2004;6:R149–56.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Wasif N, Maggard MA, Ko CY, Giuliano AE. Invasive lobular vs. ductal breast cancer: a stage-matched comparison of outcomes. Ann Surg Oncol. 2010;17(7):1862–9.

    Article  PubMed  Google Scholar 

  10. Pestalozzi BC, Zahrieh D, Mallon E, Gusterson BA, Price KN, Gelber RD, et al. Distinct clinical and prognostic features of infiltrating lobular carcinoma of the breast: combined results of 15 International Breast Cancer Study Group Clinical Trials. J Clin Oncol. 2008;26(18):3006–14.

    Article  PubMed  Google Scholar 

  11. Moran MS, Yang Q, Haffty BG. The Yale University experience of early-stage invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) treated with breast conservation treatment (BCT): analysis of clinical-pathologic features, long-term outcomes, and molecular expression of COX-2, Bcl-2, and p53 as a function of histology. Breast J. 2009;15(6):571–8.

    Article  PubMed  Google Scholar 

  12. Viale G, Rotmensz N, Maisonneuve P, Orvieto E, Maiorano E, Galimberti V, et al. Lack of prognostic significance of “classic” lobular breast carcinoma: a matched, single institution series. Breast Cancer Res Treat. 2009;117(1):211–4.

    Article  PubMed  Google Scholar 

  13. Hanagiri T, Nozoe T, Mizukami M, Ichiki Y, Sugaya M, Yasuda M, et al. Clinicopathological characteristics of invasive lobular carcinoma of the breast. Asian J Surg. 2009;32(2):76–80.

    Article  PubMed  Google Scholar 

  14. Ellis IO, Collins L, Ichihara S, Mac Grogan G. Invasive carcinoma of no special type. Tumours of the breast. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, Van de Vijvereditors MJ, editors. Classification of tumours. Pathology and genetics. Tumours of the breast. Lyon: IARC Press; 2012. p. 36.

    Google Scholar 

  15. Jung SY, Jeong J, Shin SH, Kwon Y, Kim EA, Ko KL, et al. Accumulation of p53 determined by immunohistochemistry as a prognostic marker in node negative breast cancer; analysis according to St Gallen consensus and intrinsic subtypes. J Surg Oncol. 2011;103(3):207–11.

    Article  CAS  PubMed  Google Scholar 

  16. Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 2010;28(16):2784–95.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Rossner P Jr, Gammon MD, Zhang YJ, Terry MB, Hibshoosh H, Memeo L, et al. Mutations in p53, p53 protein overexpression and breast cancer survival. J Cell Mol Med. 2009;13(9B):3847–57.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Hill KA, Sommer SS. p53 as a mutagen test in breast cancer. Environ Mol Mutagen. 2002;39(2–3):216–27.

    Article  CAS  PubMed  Google Scholar 

  19. Cheang MC, Chia SK, Voduc D, Gao D, Leung S, Snider J, et al. Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. J Natl Cancer Inst. 2009;101(10):736–50.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thürlimann B, Senn HJ, Panel members. Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the primary therapy of early breast cancer 2011. Ann Oncol. 2011;22(8):1736–47.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Viale G, Regan MM, Mastropasqua MG, Maffini F, Maiorano E, Colleoni M, International Breast Cancer Study Group, et al. Predictive value of tumor Ki-67 expression in two randomized trials of adjuvant chemoendocrine therapy for node-negative breast cancer. J Natl Cancer Inst. 2008;100(3):207–12.

    Article  CAS  PubMed  Google Scholar 

  22. Viale G, Giobbie-Hurder A, Regan MM, Coates AS, Mastropasqua MG, Dell’Orto P, Breast International Group Trial 1-98, et al. Prognostic and predictive value of centrally reviewed Ki-67 labeling index in postmenopausal women with endocrine-responsive breast cancer: results from Breast International Group Trial 1-98 comparing adjuvant tamoxifen with letrozole. J Clin Oncol. 2008;26(34):5569–75.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Rakha EA, Gill MS, El-Sayed ME, Khan MM, Hodi Z, Blamey RW, et al. The biological and clinical characteristics of breast carcinoma with mixed ductal and lobular morphology. Breast Cancer Res Treat. 2009;114(2):243–50.

    Article  PubMed  Google Scholar 

  24. Bharat A, Gao F, Margenthaler JA. Tumor characteristics and patient outcomes are similar between invasive lobular and mixed invasive ductal/lobular breast cancers but differ from pure invasive ductal breast cancers. Am J Surg. 2009;198(4):516–9.

    Article  PubMed  Google Scholar 

  25. Biglia N, Mariani L, Sgro L, Mininanni P, Moggio G, Sismondi P. Increased incidence of lobular breast cancer in women treated with hormone replacement therapy: implications for diagnosis, surgical and medical treatment. Endocr Relat Cancer. 2007;14(3):549–67.

    Article  CAS  PubMed  Google Scholar 

  26. Li CI, Anderson BO, Daling JR, Moe RE. Trends in incidence rates of invasive lobular and ductal breast carcinoma. JAMA. 2003;289(11):1421–4.

    Article  PubMed  Google Scholar 

  27. Li CI, Anderson BO, Porter P, Holt SK, Daling JR, Moe R. Changing incidence rate of invasive lobular breast carcinoma among older women. Cancer. 2000;88(11):2561–9.

    Article  CAS  PubMed  Google Scholar 

  28. Goldstein NS. Does the level of E-cadherin expression correlate with the primary breast carcinoma infiltration pattern and type of systemic metastases? Am J Clin Pathol. 2002;118(3):425–34.

    Article  CAS  PubMed  Google Scholar 

  29. Sastre-Garau X, Jouve M, Asselain B, Vincent-Salomon A, Beuzeboc P, Dorval T, et al. Infiltrating lobular carcinoma of the breast. Clinicopathologic analysis of 975 cases with reference to data on conservative therapy and metastatic patterns. Cancer. 1996;77:113–20.

    Article  CAS  PubMed  Google Scholar 

  30. Horvath JW, Barnett GE, Jimenez RE, Young DC, Povoski SP. Comparison of intraoperative frozen section analysis for sentinel lymph node biopsy during breast cancer surgery for invasive lobular carcinoma and invasive ductal carcinoma. World J Surg Oncol. 2009;7:34. doi:10.1186/1477-7819-7-34.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Korhonen T, Huhtala H, Holli K. A comparison of the biological and clinical features of invasive lobular and ductal carcinomas of the breast. Breast Cancer Res Treat. 2004;85(1):23–9.

    Article  CAS  PubMed  Google Scholar 

  32. Suryadevara A, Paruchuri LP, Banisaeed N, Dunnington G, Rao KA. The clinical behavior of mixed ductal/lobular carcinoma of the breast: a clinicopathologic analysis. World J Surg Oncol. 2010;8:51. doi:10.1186/1477-7819-8-51.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Truin W, Voogd AC, Vreugdenhil G, van der Sangen MJ, van Beek MW, Roumen RM. Influence of histology on the effectiveness of adjuvant chemotherapy in patients with hormone receptor positive invasive breast cancer. Breast. 2011;20(6):505–9.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of General Surgery, Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital, Saim Cıkrıkcı Cad. No: 59 Bozyaka, Izmir, 35 110, Turkey

    Baha Zengel, Ali Duran, Adam Uslu, Mehmet Ali Demırkıran, Fevzi Cengiz & Cenk Şimşek

  2. Department of Nuclear Medicine, Medical Faculty, Ege University, Bornova, Izmir, Turkey

    Ulkem Yararbas

  3. Department of Pathology, Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital, Izmir, Turkey

    Nukhet Elıyatkın, Hakan Postacı & Enver Vardar

  4. Department of Public Health, Medical Faculty, Ege University, Bornova, Izmir, Turkey

    Raika Durusoy

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  1. Baha Zengel
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Correspondence to Baha Zengel.

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Zengel, B., Yararbas, U., Duran, A. et al. Comparison of the clinicopathological features of invasive ductal, invasive lobular, and mixed (invasive ductal + invasive lobular) carcinoma of the breast. Breast Cancer 22, 374–381 (2015). https://doi.org/10.1007/s12282-013-0489-8

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  • DOI: https://doi.org/10.1007/s12282-013-0489-8

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