Annals of Surgical Oncology

, Volume 19, Issue 4, pp 1107–1114 | Cite as

Lobular Breast Cancer: Same Survival and Local Control Compared with Ductal Cancer, but Should Both Be Treated the Same Way? Analysis of an Institutional Database over a 10-Year Period

  • Lucio FortunatoEmail author
  • Alessandra Mascaro
  • Igor Poccia
  • Renato Andrich
  • Mostafà Amini
  • Leopoldo Costarelli
  • Giuliana Cortese
  • Massimo Farina
  • Carlo Vitelli
Breast Oncology



Invasive lobular carcinoma (ILC) is believed to be more often multicentric and bilateral compared with invasive ductal cancer (IDC), leading clinicians to pursue a more aggressive local and contralateral approach.


Retrospective review of a consecutive cohort of breast cancer patients operated at one institution from January 2000 to January 2010 was performed. Median follow-up was 4 years.


There were 171 ILC (14.5%) and 1,011 IDC patients in the study period. Median age (63 vs. 65 years) and tumor diameter (1.7 cm) were similar in the two groups. Diagnoses of ILC were more frequent in the second half of the study period (55/465 vs. 116/662, p < 0.01). Multicentricity was reported in 108/1,011 (10.6%) IDC and in 31/171 (18.1%) ILC patients (p < 0.01). A positive margin of resection at initial surgery was documented in 71/1,011 (7%) IDC and in 21/171 (12.3%) ILC patients (p < 0.001). Although the rate of mastectomy decreased over time in both groups, this was more pronounced for ILC patients (p < 0.001). Locoregional control, contralateral cancer, overall survival, disease-free survival, and survival according to diameter, nodal status, and type of surgical intervention did not differ between IDC and ILC. On multivariate analysis, stage of disease and hormone receptor status were associated with disease-free survival, but histology was not.


Although ILC is more often multicentric, bilateral, and associated with a positive margin of resection, local control and survival are similar to IDC. ILC can be treated similarly to IDC with good results.


Sentinel Lymph Node Human Epidermal Growth Factor Receptor Invasive Lobular Carcinoma Contralateral Breast Cancer Breast Conservation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by Fondazione Prometeus, ONLUS, for the development of research and training in oncology. This work was presented in part at the 7th European Breast Cancer Conference, Barcelona, Spain, 24–27th March, 2010.


There are no disclosures of potential conflicts of interests.


  1. 1.
    Foote FW Jr, Stewart FW. A histologic classification of carcinoma of the breast. Surgery. 1946;19:74–99.PubMedGoogle Scholar
  2. 2.
    Bouvet M, Ollila DW, Hunt KK et al. Role of conservation therapy for invasive lobular carcinoma of the breast. Ann Surg Oncol. 1997;4:650–54.PubMedCrossRefGoogle Scholar
  3. 3.
    Orvieto E, Maiorano E, Bottiglieri L et al. Clinicopathologic characteristics of invasive lobular carcinoma of the breast. Cancer. 2008;113:1511–20.PubMedCrossRefGoogle Scholar
  4. 4.
    Chung MA, Cole B, Wanebo HJ, Bland KI, Chang HR. Optimal surgical treatment of invasive lobular carcinoma of the breast. Ann Surg Oncol. 1997;4:545–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Molland JG, Donnellan M, Janu NC, Carmalt HL, Kennedy CW, Gillett DJ. Infiltrating lobular carcinoma—a comparison of diagnosis, management and outcome with infiltrating duct carcinoma. The Breast. 2004;13:389–96.PubMedCrossRefGoogle Scholar
  6. 6.
    Sastre-Garau X, Jouve M, Asselain B, 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.PubMedCrossRefGoogle Scholar
  7. 7.
    Mallon E, Varga Z: relapse of invasive lobular carcinoma. Breast Dis. 2009;30:53–6.PubMedGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 9.
    McGuire KP, Santillan AA, Kaur P. Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol. 2009;16:2682–90.PubMedCrossRefGoogle Scholar
  10. 10.
    Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.PubMedCrossRefGoogle Scholar
  11. 11.
    Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy. Cancer. 2003;98:697–702.PubMedCrossRefGoogle Scholar
  12. 12.
    Winchester DJ, Chang HR, Graves TA, Menck HR, Bland KI, Winchester DP. A comparative analysis of lobular and ductal carcinoma of breast: presentation, treatment, and outcomes. JACS. 1998;186:416–22.Google Scholar
  13. 13.
    Salvadori B, Biganzoli E, Veronesi P, et al. Conservative surgery for infiltrating lobular breast carcinoma. Br J Surg. 1997;84:106–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Yeatman TJ, Lyman GH, Smith SK, Reintgen DS, Cantor AB, Cox CE. Bilaterality and recurrence rates for lobular breast cancer: considerations for treatment. Ann Surg Oncol. 1997;4:198–202.PubMedCrossRefGoogle Scholar
  15. 15.
    Peiro G, Bornstein BA, Connolly JL. The influence of infiltrating lobular carcinoma on the outcome of patients treated with breast-conserving surgery and radiation therapy. Breast Cancer Res Treat. 2000;59:49–54.PubMedCrossRefGoogle Scholar
  16. 16.
    Mersin H, Yildrim E, Gulben K, Berberoglu U: Is invasive lobular carcinoma different from invasive ductal carcinoma? EJSO. 2003;29:390–5.PubMedGoogle Scholar
  17. 17.
    Santiago RJ, Harris EER, Qin L. Similar long-term results of breast-conservation treatment for stage I and II invasive lobular carcinoma compared with invasive ductal carcinoma of the breast. Cancer. 2005;103:2447–54.PubMedCrossRefGoogle Scholar
  18. 18.
    Vo TN, Meric-Bernstam F, Yi M, et al. Outcomes of breast-conservation therapy for invasive lobular carcinoma are equivalent to those for invasive ductal carcinoma. Am J Surg. 2006;192:552–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Fritz P, Klenk S, Goletz S, et al. Clinical impacts of histological subtyping primary breast cancer. Anticancer Res. 2010;30:5137–44.PubMedGoogle Scholar
  20. 20.
    Fortunato L, Mascaro A, Amini M, Farina M, Vitelli CE. Sentinel lymph node biopsy in breast cancer. Surg Oncol Clin North Am. 2008;17:673–99.CrossRefGoogle Scholar
  21. 21.
    Mann RM. The effectiveness of MR Imaging in the assessment of invasive lobular carcinoma of the breast. Magn Reson Imaging Clin North Am. 2010;18:259–76.CrossRefGoogle Scholar
  22. 22.
    Furman B, Gardner MS, Romilly P, et al. Effect of 0.5 Tesla magnetic resonance imaging on the surgical management of breast cancer patients. Am J Surg. 2003;186:344–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Brem RF, Ioffe M, Rapelyea JA, Yost KG, Weigert JM, Bertrand ML, Stern LH. Invasive lobular carcinoma; detection with mammography, sonography, MRI, and breast-specific gamma imaging. AJR. 2009;192:379–83.PubMedCrossRefGoogle Scholar
  24. 24.
    Siegmann KC, Baur A, Vogel U, Kraemer B, Hahn M, Claussen CD. Risk–benefit analysis of preoperative breast MRI in patients with primary breast cancer. Clin Radiol. 2009;64:403–13.PubMedCrossRefGoogle Scholar
  25. 25.
    Wagner PL, Kitabayashi N, Chen YT, Shin SJ. Clonal relationship between closely approximated low-grade ductal and lobular lesions in the breast. A molecular study of 10 cases. Am J Clin Pathol. 2009;132:871–6.PubMedCrossRefGoogle Scholar
  26. 26.
    De Leeuw WJ, Berx G, Vos CB, et al. Simultaneous loss of E-cadherin and catenina in invasive lobular breast canceer and lobular carcinoma in situ. J Pathol. 1997; 183:404–11.PubMedCrossRefGoogle Scholar
  27. 27.
    Cleton-Jansen AM. E-cadherin and loss of heterozygosity at chromosome 16 in breast carcinogenesis: different genetic pathways in ductal and lobular breast cancer? Breast Cancer Res. 2002;4:5–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Fisher ER, Gregorio RM, Fisher B, Redmond C, Vellios F, Sommers SC. The pathology of invasive breast cancer. A syllabus derived from findings of the National Surgical Adjuvant Breast Project (protocol no. 4). Cancer. 1975;36:1–85.PubMedCrossRefGoogle Scholar
  29. 29.
    Li CI, Anderson BO, Porter P, Holt SK, Daling JR, Moe RE. Changing incidence rate of invasive lobular breast carcinoma among older women. Cancer. 2000;88:2561–69.PubMedCrossRefGoogle Scholar
  30. 30.
    Choi YJ, Pinto MM, Hao L, Riba AK. Interobserver variability and aberrant E-cadherin immunostaining of lobular neoplasia and infiltrating lobular carcinoma. Mod Pathol. 2008;21:1224–37. Epub 2008 Jun 27.PubMedCrossRefGoogle Scholar
  31. 31.
    Longacre TA, Ennis M, Quennevill LA, et al. Interobserver agreement and reproducibility in classification of invasive breast carcinoma: an NCI breast cancer family registry study. Mod Pathol. 2006;19:195–207.PubMedCrossRefGoogle Scholar
  32. 32.
    Wasif N, Maggard MA, Ko CY, Giuliano AE. Invasive lobular vs. ductal breast cancer: a stage-matched comparison of outcomes. Ann Surg Oncol. 2010;17:1862–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Silverstein MJ, Lewinsky BS, Waisman JR, Gierson Ed, Colburn WJ, Senofsky GM, et al. Infiltrating lobular carcinoma. Is it different from infiltrating duct carcinoma? Cancer. 1994;73:1673–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Ashikari R, Huvos AG, Urban JA, Robbins GF. Infiltrating lobular carcinoma of the breast. Cancer. 1973;31:110–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Lesser M, Rosen PP, Kinne D. Multicentricity and bilaterality in invasive breast carcinoma. Surgery. 1982;91:234–40.PubMedGoogle Scholar
  36. 36.
    Horn PL, Thompson WD. Risk of contralateral breast cancer: association with histologic, clinical, and therapeutic factors. Cancer. 1988;62:412–24.PubMedCrossRefGoogle Scholar
  37. 37.
    Du Toit RS, Locker AP, Ellis IO, Elston CW, Nicholson RI, Blamey RW. Invasive lobular carcinomas of the breast—the prognosis of histopathological subtypes. Br J Cancer. 1989;60:605–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Mate TP, Carter D, Fischer DB, et al. A clinical and histopathologic analysis of the results of conservation surgery and radiation therapy in stage I and II breast carcinoma. Cancer. 1986;58:1995–2002.PubMedCrossRefGoogle Scholar
  39. 39.
    Hussien M, Lioe TF, Finnegan J, Spence RA. Surgical treatment for invasive lobular carcinoma of the breast. Breast. 2003;12:23–35.PubMedCrossRefGoogle Scholar
  40. 40.
    Viale G, Rotmensz N, Maisonneuve P, et al. Lack of prognostic significance of ‘‘classic’’ lobular breast carcinoma: a matched, single institution series. Breast Cancer Res Treat. 2009;117:211–4.PubMedCrossRefGoogle Scholar
  41. 41.
    Singletary SE, Patel-Parekh L, Bland KI: Treatment trends in errly-stage invasive lobular carcinoma; A report from the National Cancer Data Base. Ann Surg. 2005;242:281–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Gentilini O, Botteri E, Rotmensz N, et al. Conservative surgery in patients with multifocal/multicentric breast cancer. Breast Cancer Res Treat. 2009;113:577–83. Epub 2008 Mar 11.PubMedCrossRefGoogle Scholar
  43. 43.
    Jones NB, Wilson J, Kotur L, Stephens J, Farrar WB, Agnese DM. Contralateral prophylactic mastectomy for unilateral breast cancer: an increasing trend at a single institution. Ann Surg Oncol. 2009;16:2691–6. Epub 2009 Jun 9.PubMedCrossRefGoogle Scholar
  44. 44.
    Arrington AK, Jarosek SL, Virnig BA, Habermann EB, Tuttle TM. Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer. Ann Surg Oncol. 2009;16:2697–704.PubMedCrossRefGoogle Scholar
  45. 45.
    Schnitt SJ, Connolly JL, Recht A, Silver B, Harrir JR. Influence of infiltrating lobular histology on local tumor control in breast cancer patients treated with conservative surgery and radiotherapy. Cancer. 1989;64:448–54.PubMedCrossRefGoogle Scholar
  46. 46.
    White JR, Gustafson GS, Wimbish K, et al. Conservative surgery and radiation therapy for infiltrating lobular carcinoma of the breast. Cancer. 1994;74:640–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Weiss MC, Fowble BL, Solin LJ, Yeh IT, Schultz DL. Outcome of conservative therapy for invasive breast cancer by histologic subtype. Int J Radiat Oncol Biol Phys. 1992;23:941–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Poen JC, Tran L, Juillard G, et al. Conservation therapy for invasive lobular carcinoma of the breast. Cancer. 1992;69:2789–95.PubMedCrossRefGoogle Scholar
  49. 49.
    Santiago RJ, Wu L, Harris E, Fox J, Schultz D, Glick J, et al. Fifteen-year results of breast-conserving surgery and definitive irradiation for Stage I and II breast carcinoma: the University of Pennsylvania experience. Int J Radiat Oncol Biol Phys. 2004;58:233–40.PubMedCrossRefGoogle Scholar
  50. 50.
    Haffty BG, Goldberg NB, Rose M, et al. Conservative surgery with radiation therapy in clinical Stage I and II breast cancer. Results of a 20-year experience. Arch Surg. 1989;124:1266–1270.PubMedCrossRefGoogle Scholar
  51. 51.
    Gage I, Recht A, Gelman R, Nixon AJ, Silver B, Bornstein BA, et al. Long-term outcome following breast-conserving surgery and radiation therapy. Int J Radiat Oncol Biol Phys. 1995;33:245–51.PubMedCrossRefGoogle Scholar
  52. 52.
    Mansfield CM, Komarnicky LT, Schwartz GF, et al. Ten-year results in 1070 patients with Stages I and II breast cancer treated by conservative surgery and radiation therapy. Cancer. 1995;75:2328–36.PubMedCrossRefGoogle Scholar
  53. 53.
    Liljegren G, Holmberg L, Bergh J, Lindgren A, Tabar L, Nordgren H, et al. 10-year results after sector resection with or without postoperative radiotherapy for Stage I breast cancer: a randomized trial. J Clin Oncol. 1999;17:2326–33.PubMedGoogle Scholar
  54. 54.
    Li CI, Moe RE, Daling JR. Risk of mortality by histologic type of breast cancer among women aged 50 to 79 years. Arch Intern Med. 2003;163:2149–53.PubMedCrossRefGoogle Scholar
  55. 55.
    Allemani C, Sant M, Berrino F, et al. Prognostic value of morphology and hormone receptor status in breast cancer—a population-based study. Br J Cancer. 2004;91:1263–8.PubMedCrossRefGoogle Scholar
  56. 56.
    du Toit RS, Locker AP, Ellis IO, Elston CW, Nicholson RI, Robertson JG, et al. An evaluation of differences in prognosis, recurrence patterns and receptor status between invasive lobular and other invasive carcinomas of the breast. Eur J Surg Oncol. 1991;17:251–7.PubMedGoogle Scholar
  57. 57.
    Mhuircheartaigh JN, Curran C, Hennessy E, Kerin MJ. Prospective matched-pair comparison of outcome after treatment for lobular and ductal breast carcinoma. Br J Surg. 2008;95:827–33.PubMedCrossRefGoogle Scholar
  58. 58.
    Jayasinghe UW, Bilous AM, Boyages J. Is survival from infiltrating lobular carcinoma of the breast different from that of infiltrating ductal carcinoma? Breast J. 2007;13:479–85.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Lucio Fortunato
    • 1
    Email author
  • Alessandra Mascaro
    • 1
  • Igor Poccia
    • 1
  • Renato Andrich
    • 1
  • Mostafà Amini
    • 2
  • Leopoldo Costarelli
    • 2
  • Giuliana Cortese
    • 3
  • Massimo Farina
    • 1
  • Carlo Vitelli
    • 1
  1. 1.Department of Surgery, Senology UnitSan Giovanni Addolorata HospitalRomeItaly
  2. 2.Department of PathologySan Giovanni-Addolorata HospitalRomeItaly
  3. 3.Department of Statistical SciencesUniversity of PaduaPadovaItaly

Personalised recommendations