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Invasive lobular carcinoma of the breast: local recurrence after breast-conserving therapy by subtype approximation and surgical margin

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Abstract

Invasive lobular carcinoma (ILC) typically presents at a later stage than invasive ductal carcinoma (IDC) and poses unique radiographic and surgical challenges. However, current principles of breast-conserving therapy (BCT) do not distinguish between histologic subtypes, raising uncertainty about the optimal approach for patients with ILC. We studied 998 BCT patients from 1998–2007, comprised 74 % IDC, 8 % ILC, and 18 % with mixed ILC/IDC. In light of recent guidelines addressing surgical margins, specimens were assessed for margin width and biologic subtype. The Kaplan–Meier method and Cox proportional hazards models were used to analyze effects of patient and disease characteristics on local recurrence (LR). At a median of 119 months, 45 patients had an isolated LR. 10-year LR was 5.5 % for patients with IDC, 4.4 % for ILC, and 1.2 % for mixed histology (p = 0.08). The majority of ILC cases had luminal A biologic subtype (91.1 %), and analysis among all luminal A cases revealed 10-year LR of 2.6 % for IDC, 3.4 % for ILC, and 0 % for mixed tumors (p = 0.12). Patients with ILC were more likely to have initially positive surgical margins (45.0 vs 17.5 %; p < 0.001) resulting in more frequent re-excision (57.1 % vs 40.4 %; p = 0.02), though final margins were similar between ILC and IDC (p = 0.88). No LR was observed among ILC or mixed histology patients with margins <2 mm (n = 28). On multivariate analysis, histologic subtype was not associated with LR (p = 0.52). Modern approaches confer similarly favorable LR rates for ILC, IDC, and mixed histology breast cancers despite inherent histologic differences. Patients with ILC did not require more extensive surgical margins than those with IDC.

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The authors report no conflicts of interest.

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Authors and Affiliations

  1. Harvard Radiation Oncology Program, Boston, MA, USA

    Lior Z. Braunstein

  2. Department of Pathology, Brigham and Women’s Hospital and the Dana-Farber Cancer Institute, Boston, MA, USA

    Jane E. Brock

  3. Department of Biostatistics, Dana Farber Cancer Institute, Boston, MA, USA

    Yu-Hui Chen

  4. Departments of Radiation Oncology, Brigham and Women’s Hospital and the Dana-Farber Cancer Institute, Dana 1622, 450 Brookline Ave., Boston, MA, 02215, USA

    Linh Truong, Nils D. Arvold & Jay R. Harris

  5. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA

    Andrea L. Russo

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  1. Lior Z. Braunstein
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  2. Jane E. Brock
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  3. Yu-Hui Chen
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  4. Linh Truong
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  6. Nils D. Arvold
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  7. Jay R. Harris
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Correspondence to Jay R. Harris.

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Braunstein, L.Z., Brock, J.E., Chen, YH. et al. Invasive lobular carcinoma of the breast: local recurrence after breast-conserving therapy by subtype approximation and surgical margin. Breast Cancer Res Treat 149, 555–564 (2015). https://doi.org/10.1007/s10549-015-3273-y

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  • DOI: https://doi.org/10.1007/s10549-015-3273-y

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