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Breast Cancer Research and Treatment

, Volume 149, Issue 2, pp 555–564 | Cite as

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

  • Lior Z. Braunstein
  • Jane E. Brock
  • Yu-Hui Chen
  • Linh Truong
  • Andrea L. Russo
  • Nils D. Arvold
  • Jay R. Harris
Brief Report

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.

Keywords

Breast cancer Invasive lobular carcinoma Local recurrence Breast-conserving surgery Lumpectomy Biologic subtype 

Notes

Conflict of interest

The authors report no conflicts of interest.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Lior Z. Braunstein
    • 1
  • Jane E. Brock
    • 2
  • Yu-Hui Chen
    • 3
  • Linh Truong
    • 4
  • Andrea L. Russo
    • 5
  • Nils D. Arvold
    • 4
  • Jay R. Harris
    • 4
  1. 1.Harvard Radiation Oncology ProgramBostonUSA
  2. 2.Department of PathologyBrigham and Women’s Hospital and the Dana-Farber Cancer InstituteBostonUSA
  3. 3.Department of BiostatisticsDana Farber Cancer InstituteBostonUSA
  4. 4.Departments of Radiation OncologyBrigham and Women’s Hospital and the Dana-Farber Cancer InstituteBostonUSA
  5. 5.Department of Radiation OncologyMassachusetts General HospitalBostonUSA

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