Abstract
Invasive lobular carcinoma (ILC) is the second most common histological type of breast cancer, accounting for approximately 5–15% of cases. It is characterized by an insidious tissue infiltration pattern, providing challenging clinical and radiological diagnosis. Additionally to its unique clinical, molecular biology, and pathological features, there are histological subclassifications that describe different proportions of neoplastic patterns, such as classic (less aggressive) and pleomorphic (more undifferentiated and aggressive). Such differences may imply different strategies of local-regional and systemic therapy.
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Al-Baimani K, Bazzarelli A, Clemons M, Robertson SJ, Addison C, Arnaout A. Invasive pleomorphic lobular carcinoma of the breast: pathologic, clinical and therapeutic considerations. Clin Breast Cancer. 2015;15(6):421–5. Updated review of pleomorphic invasive lobular carcinoma. The authors support that although pleomorphic ILC is a rarer type of breast cancer, it is an important entity with distinct features. Interpretation: ILC is an aggressive variant and presents worse prognosis than classic ILC.
Arpino G, Bardou VJ, Clark GM, Elledge RM. Infiltrating lobular carcinoma of the breast: tumor characteristics and clinical outcome. Breast Cancer Res. 2004;6(3):R149–56. Retrospective cohort, encompassing 50,339 cases of breast cancer database, comparing histopathological characteristics and long-term oncological results of CINE and ILC. The ILC presents pathological clinical features with better prognosis than CINE, but the oncological results are no different. Interpretation: The ILC prognosis is similar to CINE.
Biglia N, Mariani L, Sgro L, Mininanni P, Moggio G. 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. Systematic literature review on hormone therapy (HT) and breast cancer. ILC presents more favorable biological characteristics than CINE. It has a greater incidence in women who underwent HT. Prognosis is similar to CINE regardless the treatment type. Interpretation: ILC is more frequent in HT users. Conservative surgery is safe and is not related to greater local recurrences.
Jacobs C, Clemons M, Addison C, Robertson S, Arnaout A. Issues affecting the loco-regional and systemic management of patients with invasive lobular carcinoma of the breast. Breast J. 2016;22:45–53. Canadian literature revision supporting that invasive lobular carcinoma represents a unique variant of breast cancer with biological, pathological, and clinical specificities. Demonstrate that the treatment should be individualized. Interpretation: Despite the differences between them, the ILC prognosis is similar to CINE’s.
Katz A, Saad ED, Porter P, Pusztai L. Primary systemic chemotherapy of invasive lobular carcinoma of the breast. Lancet Oncol. 2007;8(1):55–62. Review. Literature systematic review including all randomized trials of adjuvant and neo-adjuvant ILC therapy. Neo-adjuvant therapy presents reduced efficacy in ILC cases compared to CINE. On the other hand, there is no evidence to support that adjuvant therapy is ineffective in ILC cases. Hormone therapy plays a major role in ILC treatment. Interpretation: There is no evidence to support adjuvant therapy solely in histological type. Prospective studies are required to determine the role of chemotherapy in ILC.
Pestalozzi BC, Zahrieh D, Mallon E, Gusterson BA, Price KN, et al. International Breast Cancer Study Group. 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. Retrospective cohort encompassing patients from 15 IBCSG clinical studies comparing the clinical-pathological characteristics and oncological results between ILC and CINE. ILC presents better prognosis in the first five years. However, in the five consecutive years it presents worsening of the prognosis in comparison to CINE. Interpretation: ILC encompass specific prognostic and therapeutic implications for each variant, according to the individual histopathological characteristics.
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BBSG – Brazilian Breast Study Group. (2019). Invasive Lobular Carcinoma. In: Novita, G., Frasson, A., Millen, E., Zerwes, F., Cavalcante, F. (eds) Breast Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-13636-9_45
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DOI: https://doi.org/10.1007/978-3-030-13636-9_45
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