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Is axillary imaging for invasive lobular carcinoma accurate in determining clinical node staging?

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Abstract

Purpose

Preoperative evaluation of clinical N-stage (cN) is difficult in breast cancer patients with invasive lobular carcinoma (ILC). Our goal was to assess the predictive value of axillary imaging in ILC by comparing imaging cN and pathologic N-stage (pN).

Methods

A single-institution retrospective review was performed for newly diagnosed stage I–III ILC patients undergoing preoperative breast imaging from 2011 to 2016. Clinicopathologic factors; mammogram, MRI, and ultrasound findings; and surgical pathology data were reviewed. Sub-analysis for pN2-N3 patients was performed to determine imaging sensitivity for patients with a larger nodal disease burden. Statistical analysis included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each imaging modality.

Results

Of the total 349 patients included, 70.5% were cN0, and 62% were pN0 (p = 0.03). For all patients, mammogram sensitivity was 7%, specificity 97%, PPV 50%, NPV 72%; ultrasound sensitivity was 26%, specificity 86%, PPV 52%, NPV 67%; MRI sensitivity was 7%, specificity 98%, PPV 80%, NPV 51%. For pN2/N3 patients, 38% were identified as cN0. Mammogram sensitivity was 10%; ultrasound 42%; MRI 65%. Pathology evaluation of N2/N3 patients indicated LN were replaced with ILC but maintained normal architecture. The average largest pathologic tumor deposit (1.5 ± 0.8 cm) correlated with average largest imaging LN size (1.4 ± 0.6 cm) (p = 0.58).

Conclusion

A statistically significant difference between clinical and pathologic N-stage exists for ILC patients. MRI was most sensitive for identification of pN2-N3 patients and should be considered part of routine axillary imaging evaluation for ILC patients.

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Acknowledgements

The authors thank Holly R. Zink, MSA of the Department of Surgery, University of Kansas, Kansas City, KS, for providing medical writing and editorial support for this research and Sonora Thigpen, Research Program Administrator of the Department of Pathology and Laboratory Medicine, for her assistance with the pathology slide acquisition and images.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. School of Medicine, University of Kansas, 3901 Rainbow Blvd, Kansas City, Kansas, 66160, USA

    Katelyn Schumacher & Ishani Shah

  2. Department of Radiology, University of Kansas, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA

    Marc Inciardi

  3. Department of Pathology, University of Kansas, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA

    Maura O’Neil

  4. Department of Surgery, University of Kansas, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA

    Jamie L. Wagner, Amanda L. Amin, Christa R. Balanoff & Kelsey E. Larson

Authors
  1. Katelyn Schumacher
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  2. Marc Inciardi
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  4. Jamie L. Wagner
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  5. Ishani Shah
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  8. Kelsey E. Larson
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Corresponding author

Correspondence to Kelsey E. Larson.

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The authors have no financial or non-financial conflicts of interest to report.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. IRB approval was obtained for this study. Ethics approval and consent to participate were not required per IRB.

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Meeting Presentation & Abstract Publication

American College of Surgeons 2019 Clinical Congress, San Francisco, California, October 27 – 31, 2019. Citation: Shah, I. et al. Evaluation of Imaging Nodal Staging for Breast Invasive Lobular Carcinoma. Journal of the American College of Surgeons 229, S36–S37 (2019).

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Schumacher, K., Inciardi, M., O’Neil, M. et al. Is axillary imaging for invasive lobular carcinoma accurate in determining clinical node staging?. Breast Cancer Res Treat 185, 567–572 (2021). https://doi.org/10.1007/s10549-020-06047-w

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  • DOI: https://doi.org/10.1007/s10549-020-06047-w

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