FEATURED , Breast Cancer

Alan Stolier, MD/


lobular versus ductal 1You will note on the link provided to the original manuscript that it is stamped accepted manuscript. I came across this manuscript thanks to a radiology colleague. Because there are sometimes changes made between the accepted manuscript and the final manuscript, I contacted the author (Chung et. al.). She assured me that there would be no changes made in the manuscript's content but only possibly the accompanying photos. This accepted manuscript is available on Pub Med.


Radiologic changes of invasive lobular carcinoma can be quite subtle. The researchers at MD Anderson Institute asked the question as to whether there was a detection rate difference by ultrasound between invasive lobular and invasive ductal carcinoma? The authors examined a mixed cohort of patients, which included 723 breast exams and 695 women. A single radiologist reviewed all films. The authors described the morphology of the lymph nodes based on the relationship between the cortex and the hilum.


Metastatic axillary nodes were not identified in 99 cases-15 lobular, 66 ductal, and 18 mixed were diagnosed by surgical biopsy. The remaining 624 metastatic lymph nodes (61 lobular, 520 ductal, 43 mixed) were seen on ultrasound and diagnosed by fine-needle aspiration biopsy (FNA). Metastatic carcinoma was detected in lobular nodes and 80.3% of lobular carcinomas versus 88.7% for ductal carcinomas (P = 0.04).


Metastatic lobular carcinomas tended to be smaller, with 65.6% less than or equal to 2 cm. This compared to 47.3% for ductal carcinomas being less than or equal to2 cm. The authors noted diffuse cortical thickening without

 lobular versus ductal2lobular versus ductal3


hilar mass effect in 68.9% of lobular carcinomas versus 28.8% of ductal carcinomas (see accompanying photo left). The remainder had diffuse hilar thickening with mass effect (see accompanying photo right).


It seems evident that metastatic nodes from invasive lobular carcinoma were less conspicuous due to lack of cell cohesion, in which the architecture of the node is maintained. In this study, lobular carcinoma metastatic to lymph nodes showed diffuse cortical thickening without mass effect in the hilum. In conclusion, the smaller tumor cells and potential buckshot spread pattern may make these metastatic nodes less apparent.


Comment: Even though metastatic axillary lymph nodes and lobular carcinoma were statistically less apparent than ductal carcinoma, the difference was less pronounced than one might expect. In the final analysis, there was only an 8% difference in the detection rate of lobular and ductal carcinomas.








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