Patients with invasive lobular carcinoma should get MRI screening, study finds

A study presented Wednesday at the RSNA meeting adds further evidence to the recommendation women with newly diagnosed invasive lobular carcinoma should have their contralateral breast screened with MRI. Most women aren’t routinely screened in the contralateral breast because whether to do so is highly dependent on the surgeon’s preference. This research, however, provides more evidence why they should: MRI detected synchronous breast cancers in 16% of patients. 

Invasive lobular carcinoma (ILC) composes approximately 10% of all invasive breast cancers. It has already been reported that MRI is a useful tool in detecting and evaluating ILC, but recent literature reports a 4% to 8% rate, whereas the current study reports a much higher 16%.

“We looked back at our data and some of the cases were detected on second-look ultrasound, which would lower our rate to 8%. But we felt it was important to get the 16% number out there on how many undetected cancers are seen with MR,” said Dr. Jennifer Drukteinis from Brigham and Women’s Hospital in Boston.

The researchers included 37 patients with pathology-proven ILC and bilateral breast MRIs in their retrospective review. They also included patient age, findings in the contralateral breast, biopsy results of any BI-RADS 4 and 5 contralateral lesions, and additional clinical risk factors.

Of the 37 patients, 11 underwent contralateral breast biopsy. The researchers found six of the biopsies were malignant and five were benign.

Of these six contralateral breast malignancies, two were invasive lobular carcinoma.

The researchers also found 10 out of 37 patients had additional risk factors such as positive family history, history of previous invasive breast cancer, or history of breast risk lesion such as lobular neoplasia.

“While, of course, additional studies are needed with larger numbers, these results support the benefit of MRI screening in the contralateral breast in women with a recently diagnosed ILC,” Drukteinis said.