Invasive Lobular Carcinoma Unmasked: A Multimodality Imaging Roadmap for Accurate Detection-Podcast

Описание: Invasive Lobular Carcinoma Unmasked: A Multimodality Imaging Roadmap for Accurate Detection and Staging

Professional Summary

This RadioGraphics Fundamentals educational presentation, Invasive Lobular Carcinoma: A Multimodality Imaging Primer, provides a comprehensive, imaging-centered framework for understanding, detecting, and managing invasive lobular carcinoma (ILC)—the second most common subtype of invasive breast cancer and one of the most diagnostically challenging entities in breast imaging .

ILC is characterized by unique histopathologic features, including loss of E-cadherin–mediated cell adhesion and a single-file infiltrative growth pattern, resulting in low tumor cell density and minimal desmoplastic response. These properties underlie its atypical clinical presentation, frequent absence of a discrete palpable mass, and subtle or occult findings on conventional imaging, leading to missed or delayed diagnosis.

Educational Objectives and Scope
The presentation systematically integrates pathology, clinical findings, and multimodality imaging, with the following core objectives:
1. Correlate the pathologic features of ILC with its characteristic clinical and imaging manifestations.
2. Identify the subtle and often underestimated mammographic signs of ILC.
3. Recognize classic sonographic appearances and common diagnostic pitfalls.
4. Define the critical role of contrast-enhanced breast MRI in disease detection, staging, and surgical planning.

Key Imaging Insights by Modality
Mammography
Sensitivity: ~57–81%, with normal or benign-appearing studies in up to 16% of cases.

Most common findings include:
1. Spiculated or indistinct masses (≈44–65%)
2. Architectural distortion (≈10–34%)
3. Asymmetry, often visible on only one view (classically CC) due to diffuse infiltrative growth

Mammography frequently underestimates tumor size and disease extent.

Ultrasound
Sensitivity: ~68–98%, outperforming mammography for detecting multifocality and multicentricity.

Typical appearance:
Irregular hypoechoic mass with angular margins and posterior acoustic shadowing

Notably, up to 10% of lesions may be sonographically occult, and posterior shadowing may be absent in a subset of cases.

Magnetic Resonance Imaging (MRI)
Highest sensitivity: ~93–95%

MRI is the most accurate modality for assessing extent of disease, often altering clinical or surgical management.

Common manifestations:
1. Irregular enhancing masses with spiculated margins
2. Nonmass enhancement (up to 40%)

ILC demonstrates slower contrast uptake and less washout than invasive ductal carcinoma (IDC), reflecting its distinct tumor biology.

MRI excels in identifying multifocal, multicentric, bilateral, and contralateral disease not detected on mammography or US.

Disease Extent and Metastatic Patterns
Compared with IDC, ILC more frequently presents at a larger size and later stage, yet may have favorable stage-matched outcomes. It has a distinct metastatic predilection for the peritoneum, retroperitoneum, gastrointestinal and genitourinary tracts, leptomeninges, and myocardium, with hydronephrosis as a notable complication—features that underscore the importance of whole-patient and cross-sectional imaging awareness .

Clinical Implications
1. Multimodality imaging is essential for accurate diagnosis, staging, and treatment planning in ILC.
2. Breast MRI should be strongly considered at initial diagnosis to guide surgical decision-making and reduce re-excision rates.
3. Radiologists must maintain a high index of suspicion when confronted with subtle asymmetries, architectural distortion, or discordant clinical findings.

Conclusion
This presentation delivers a clear, practice-oriented synthesis of how the unique biology of invasive lobular carcinoma shapes its imaging appearance.

By integrating mammography, ultrasound, and MRI, it equips radiologists with the diagnostic insight required to detect this elusive malignancy earlier, assess its true extent more accurately, and ultimately improve patient outcomes .

APA 7th Edition Citation (PDF)
Manning, P., Fazeli, S., Lim, V., Ladd, W. A., Eghtedari, M., Chong, A., Rakow-Penner, R., & Ojeda-Fournier, H. (2022). Invasive lobular carcinoma: A multimodality imaging primer. RadioGraphics Fundamentals, Radiological Society of North America. Presented at the RSNA Annual Meeting.

Hashtags
#BreastImaging #InvasiveLobularCarcinoma #RadiologyEducation #MultimodalityImaging
#BreastMRI #Mammography #Ultrasound #RSNA #RadioGraphics #OncologicImaging
#BreastCancerAwareness #Radiology #ILC #LobularBreastCancer #MedicalImaging #MedEd #Oncology #Pathology #DeepDive #WomensHealth #EarlyDetection

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