Which findings on magnetic resonance mammography (breast MRI) are characteristic of invasive lobular carcinoma (ILC)?

Updated: Feb 25, 2019
  • Author: Preeti Gupta, MD, FRCR; Chief Editor: Eugene C Lin, MD  more...
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Answer

Invasive lobular carcinoma (ILC) accounts for 10-15% of breast carcinomas. ILC lesions can be mammographically occult or subtle in 20-40% of cases. [65, 66] As many as 85% are isointense relative to glandular parenchyma, and a minority have malignant microcalcifications. [67] The incidence of multifocal, multicentric, and bilateral, synchronous or metachronous involvement is much higher with ILC than with IDC.

Mammography and ultrasonography tend to underestimate the extent of ILC. Breast MRI has been shown to be more accurate, correctly demonstrating the extent of disease in about 85% of cases. [68] In the authors' center, breast MRI is routinely used in all women with a preoperative diagnosis of ILC.

In most cases, ILC shows focal, irregular, strong, rapid enhancement typical of a malignancy. Single or multiple masses in one or more quadrants may be demonstrated. However, ILC occasionally has weak or moderate enhancement, and it may be difficult to distinguish from glandular parenchyma with this criterion alone. [32] Recognizing this problem is easier if the diagnosis is already known from needle biopsy results. In these cases, a masslike contour or associated architectural distortion is usually present. Despite this limitation, breast MRI is better than conventional imaging for preoperative staging of breast ILCs.


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