Dr Mukhtar on Challenges in the Diagnosis and Management of Invasive Lobular Carcinoma

Rita Mukhtar, MD, breast oncologic surgeon, associate professor of surgery, Division of Surgical Oncology, Lobular Breast Cancer Program, University of California, San Francisco, discusses challenges in the diagnosis and locoregional management of invasive lobular carcinoma.

Invasive lobular carcinoma is the second most common type of breast cancer behind invasive ductal carcinoma, comprising approximately 10% to 15% of patients, Mukhtar begins. Research over the past 15 years has helped identify more histological differences between invasive lobular carcinoma and invasive ductal carcinoma, she adds.

Historically, breast cancer histology did not significantly influence treatment planning, Muktar continues. However, research has demonstrated that patients with invasive lobular carcinoma face unique challenges compared with those with invasive ductal carcinoma. One notable difference is the growth pattern of invasive lobular carcinoma, which tends to be more diffuse, she says, adding that this complicates detection via imaging modalities such as mammograms, often resulting in later-stage diagnoses for patients with invasive lobular carcinoma. Consequently, invasive lobular carcinoma tumors are generally larger at the time of detection and may have a higher likelihood of lymph node involvement, Muktar says.

Additionally, the difficulty in accurately visualizing invasive lobular carcinoma tumors through imaging also poses significant implications for surgical treatment, Mukhtar explains. Surgeons may enter the operating room without a clear understanding of the tumor's true size, increasing the risk of positive margins, she notes. This uncertainty can lead to the need for additional surgeries, including re-excisions or even mastectomies, to achieve clear margins. The potential for multiple operations could increase the physical and emotional burden for patients, and delay the overall treatment process, she says.

Mukhtar emphasizes the importance of developing improved imaging techniques and strategies tailored specifically for patients with invasive lobular carcinoma to enhance early detection and precise surgical planning. Although the overall understanding of invasive lobular carcinoma has improved, significant challenges remain in its locoregional management, she says. Continued research and the development of specialized imaging techniques are essential to improve the management and outcomes for patients with invasive lobular carcinoma, Mukhtar concludes.