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Topic: IDC with lobular features - anyone get this DX?

Forum: IDC (Invasive Ductal Carcinoma) — Just diagnosed, in treatment, or finished treatment for IDC.

Posted on: Feb 8, 2017 06:43PM

mellee wrote:

I recently noticed, buried in my path report, that my tumor was described as "Invasive ductal carcinoma with lobular features" (IDC-L). However, none of the MOs or ROs I consulted with (or my BS) said anything about it.

I've done a bit of research on it, and I know it's not considered a separate diagnosis from IDC. However, some researchers believe it is a distinct variation on IDC that behaves more like ILC. Specifically, when compared to IDC, IDC-L tends to have more favorable pathology (low grade, strongly hormone positive, less likely to overexpress Her2) but a higher rate of nodal metastasis (51% vs 35%). It also has a higher rate of second primary breast cancers, but a lower rate of metastatic spread.

Anyone know anything about this? I'm wondering if I should factor it into my radiation decision.

Here is a report on it, as well as a link to the full study:

Mixed Ductal/Lobular Carcinoma May Be Unique IDC Variant: http://www.medscape.com/viewarticle/774485?pa=0dG9...

Invasive ductal carcinoma with lobular features: a comparison study to invasive ductal and invasive lobular carcinomas of the breast: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC39066...

Diagnosed with a 2.3 cm tumor (Grade 1, Luminal A). 100% ER+, 97% PR+, Her2-, Ki67 6%. Oncotype: 17. Mammaprint: Low risk. 2 years later: local recurrence due to needle biopsy seeding. Dx 10/6/2016, IDC, Right, 2cm, Stage IIB, Grade 1, 2/32 nodes, ER+/PR+, HER2- (IHC) Surgery 11/8/2016 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 2/3/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 6/8/2017 Reconstruction (right): Silicone implant Dx 12/8/2018, IDC, Right, Grade 1, ER+/PR+, HER2- (IHC) Surgery 1/10/2019 Lumpectomy: Right Radiation Therapy 2/28/2019 Whole-breast: Chest wall Hormonal Therapy 3/13/2019 Zoladex (goserelin) Hormonal Therapy 6/8/2019 Aromasin (exemestane)
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Feb 9, 2017 09:50AM Gully wrote:

Hello Mellee,

My report also describes my IDC as containing lobular features. As you can see I had IDC in both breasts. One a surprise after surgery. Also I was ER/PR positive and Her2 neg. Negative nodes at least on the left. The right side was never tested. I did not have rads a recommendation from the docs of the tumor board. I did not ask specific reasons for their decision...just ran with it :) I did have chemo... dx at 45, SBBC, and oncotypes of 5 on right and 19 on left and LVI...gray iffy area. I also had a low proliferation index. Thanks for the article..this information is new for me.

Gully

Dx 1/18/2013, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 3/6/2013 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 3/8/2013, IDC, Right, <1cm, Stage IA, Grade 1, 0/0 nodes, ER+/PR+, HER2- (FISH) Chemotherapy 5/2/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 8/6/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 8/29/2013 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 2/21/2017 Arimidex (anastrozole)
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Feb 20, 2017 11:40PM gardengypsy wrote:

Yes, I had this pathology. My surgeon called it "tricky lobular."

I don't remember if that had an effect on whether or not I had radiation. My tumor was already large and aggressive at Dx.

Dx 10/29/2015, ILC/IDC, Left, 5cm, Stage IIIA, Grade 3, 1/1 nodes, ER+/PR+, HER2- Surgery 12/3/2015 Lymph node removal: Sentinel; Mastectomy; Reconstruction (left): Tissue expander placement Chemotherapy 1/8/2016 AC + T (Taxol) Surgery 5/23/2016 Hormonal Therapy 5/27/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 6/5/2016 Whole-breast: Breast, Lymph nodes, Chest wall
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Feb 21, 2017 09:01AM EastcoastTS wrote:

I have IDC (originally diagnosed as ILC) with LCIS. I wonder if I would fall into this camp. Fully expecting a change possibly on final path after surgery 2/27. <?>

Dx@ 49. Oncotype: 14, BRCA 1/2- Dx 1/4/2017, ILC, Left, 1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2- Surgery 2/27/2017 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 9/7/2017 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Mar 6, 2017 06:18AM kal52 wrote:

The two papers you posted are very interesting Mellee. I don't know if the knowledge would have changed my treatment but I obviously fit the profile. Have you decided to have the radiation?

Kathy

Dx 7/18/2007, ILC/IDC, Right, 1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- (IHC) Surgery 7/27/2007 Lumpectomy: Right; Lymph node removal: Right, Sentinel Radiation Therapy 9/9/2007 Whole-breast: Breast Hormonal Therapy 11/30/2007 Arimidex (anastrozole) Dx 7/22/2015, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- (IHC) Surgery 8/2/2015 Lumpectomy; Lymph node removal: Left, Sentinel Chemotherapy 9/9/2015 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 1/14/2016 Whole-breast: Breast Surgery 4/13/2017 Prophylactic mastectomy: Left, Right; Reconstruction (left): DIEP flap, Nipple reconstruction, Nipple tattoo; Reconstruction (right): DIEP flap, Nipple reconstruction, Nipple tattoo
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Mar 6, 2017 06:32AM pupmom wrote:

Yes, that was also in my pathology report. My biopsy actually stated I was ILC, no mention of IDC. But the tumor was IDC with Lobular features. I had radiation, but no chemo, due to low Oncotype score. Thanks for the articles. They are very informative.

Life is what happens while we're making other plans. Dx 10/18/2011, IDC, Right, 1cm, Stage IIA, Grade 1, 2/21 nodes, ER+/PR+, HER2-
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Mar 6, 2017 02:14PM mellee wrote:

I've decided against radiation. One big factor was that I'm still having wound-healing complications with one of my surgical incisions. So I'm already at 4 months out from surgery -- which is past the most effective window for radiation anyways. And I can't start radiation until I'm fully healed anyways, which could be another month or more.

Diagnosed with a 2.3 cm tumor (Grade 1, Luminal A). 100% ER+, 97% PR+, Her2-, Ki67 6%. Oncotype: 17. Mammaprint: Low risk. 2 years later: local recurrence due to needle biopsy seeding. Dx 10/6/2016, IDC, Right, 2cm, Stage IIB, Grade 1, 2/32 nodes, ER+/PR+, HER2- (IHC) Surgery 11/8/2016 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 2/3/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 6/8/2017 Reconstruction (right): Silicone implant Dx 12/8/2018, IDC, Right, Grade 1, ER+/PR+, HER2- (IHC) Surgery 1/10/2019 Lumpectomy: Right Radiation Therapy 2/28/2019 Whole-breast: Chest wall Hormonal Therapy 3/13/2019 Zoladex (goserelin) Hormonal Therapy 6/8/2019 Aromasin (exemestane)
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Mar 7, 2017 04:26AM Meow13 wrote:

I had one ILC tumor and one IDC. I believe the IDC had lobular features.

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Mar 18, 2017 12:39PM Tpralph wrote:

This is what my initial pathology says as well. I am still in the very early stages of dx and treatment. Seeing my surgical oncologist in two days for initial. Pretty stressed like everyone else!  Sleeping pills help lol.  thanks for the read, I will look at it.


Dx 3/10/2017, IDC, Right, 2cm, Stage IIB, Grade 2, 1/21 nodes, ER+/PR+, HER2- (IHC) Dx 4/10/2017, IDC, Right, <1cm, Grade 1, ER+/PR+, HER2- Surgery 5/18/2017 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Chemotherapy 6/28/2017 AC + T (Taxol) Surgery 11/29/2017 Lymph node removal: Underarm/Axillary Radiation Therapy 1/15/2018 Whole-breast: Lymph nodes, Chest wall
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May 26, 2017 03:32PM cling wrote:

Hi, Just found this thread. Mellee thanks for posting the IDC-L links. My path report 6 years ago was "IDC with lobular features". At that time, I could not find any proper articles, so I just believe that my cancer is IDC. For 6 1/2 years, my CT scan from the very first one in 9/2010 indicated there are possible mets to bones, but all these years my bone scans have always been normal. Even after MD Anderson retested my two bone biopsies and confirmed I did have mets to bone marrow, the bone scans still showed normal. Until a recent CT showed some shadow in my renal fascia and biopsy confirmed the progression. This time the path report said it is a "typical ILC spread" because there is no solid tumor.

I did not believe that IDC will turn into ILC, until someone pointed out that I must misread the original report, then I remember that "with lobular features" term. So IDC-L does have the tendency and possibility to develop into ILC.

Dx 9/7/2010, IDC, 4cm, 12/12 nodes, ER+/PR-, HER2- Dx 6/5/2014, Stage IV, mets
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May 26, 2017 04:26PM - edited May 26, 2017 05:39PM by lrwells50

My radiologist, a friend, said he's seen a lot of path reports that are IDC with lobular features, but mine is the first ILC with ductalfeatures

Diagnosed at 66, OncotypeDx 24, I think because although I was 100% ER+, I was very weakly PR+ . BARD1 mutation, mother had breast cancer twice. Dx 12/5/2016, ILC, Left, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery 3/8/2017 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 5/19/2017 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy Arimidex (anastrozole)
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May 26, 2017 04:32PM Lily55 wrote:

I had 3 kinds of cáncer - and the Oncologist told me they always take the one that is the largest as the guide for treatment, I had ILC predominantly, some IDC and some LCIS.......I wish I had not accepted radiation as its has left me with ongoing problems

Dx 4/2012, ILC, 5cm, Stage IIIA, Grade 2, 7/14 nodes, ER+/PR+, HER2- Surgery 5/3/2012 Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right Radiation Therapy 8/15/2012 Breast, Lymph nodes Hormonal Therapy 7/19/2013 Aromasin (exemestane) Radiation Therapy 3/7/2019 External: Bone Chemotherapy Taxol (paclitaxel)
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Sep 17, 2018 12:24PM Ashweb901 wrote:

me too me too me too! I think our hybrid is pretty unique. I have my appt with MO on the 19th, so I’ll know more then, I hope. She is a lobular expert, and I’m hoping she’s up to speed on this little sub-set.


Does anyone know if there are images of our slides stored anywhere? I want to know *which* features of lobular. There’s no standard for path reports to include the detail

7 tiny tumors, R, Multifocal Dx 7/3/2018, IDC, Right, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 8/20/2018 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 5/26/2019 Femara (letrozole)
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Sep 17, 2018 02:51PM mellee wrote:

I'd be very interested to hear what your MO has to say. Good luck with your appointment!

Diagnosed with a 2.3 cm tumor (Grade 1, Luminal A). 100% ER+, 97% PR+, Her2-, Ki67 6%. Oncotype: 17. Mammaprint: Low risk. 2 years later: local recurrence due to needle biopsy seeding. Dx 10/6/2016, IDC, Right, 2cm, Stage IIB, Grade 1, 2/32 nodes, ER+/PR+, HER2- (IHC) Surgery 11/8/2016 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 2/3/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 6/8/2017 Reconstruction (right): Silicone implant Dx 12/8/2018, IDC, Right, Grade 1, ER+/PR+, HER2- (IHC) Surgery 1/10/2019 Lumpectomy: Right Radiation Therapy 2/28/2019 Whole-breast: Chest wall Hormonal Therapy 3/13/2019 Zoladex (goserelin) Hormonal Therapy 6/8/2019 Aromasin (exemestane)
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Sep 18, 2018 01:58PM - edited Sep 18, 2018 02:02PM by ctmbsikia

I was told I am a mixed type, which by reading this is not the same as IDC-L.  Not much activity in the mixed type forum.

My path says invasive mammary carcinoma with ductal and lobular features.  However, looking at that tumor on the ultra sound and in the surgeons office it looked to be in the duct.  Which is why I just put IDC on my signature.  Good info, they study everything.  Thanks for posting that study.

Dx 12/14/2017, DCIS/IDC, Left, 4cm, Stage IIB, Grade 2, 1/2 nodes, ER+/PR+, HER2- Dx 1/16/2018, LCIS, Right Surgery 1/30/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 4/10/2018 Whole-breast: Breast Hormonal Therapy 6/25/2018 Arimidex (anastrozole)
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Sep 18, 2018 06:12PM Ashweb901 wrote:

melee, Meow, Lily, Cling: have you all got updates on how your IDC-L is doing and responding/not recurring?

I’ve been studying lobular to see what I can glean before my appointment bc i want my treatment not to be just lumped in to IDC protocols but take into account this oddness - and in my case multifocal x7.

Tamoxifen allegedly does not work for lobular, so that is a major topic I want to discuss. The aromatase inhibitors are better for lobular.

And my surveillance needs to include the other areas where lobular goes - the “wrapping” of the peritoneum, meninges, ureter, etc. it also goes to bones, but i want surveillance on the other stuff too.

I will report back on Wednesday. Please let me know how you are and what you have learned, if anything

7 tiny tumors, R, Multifocal Dx 7/3/2018, IDC, Right, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 8/20/2018 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 5/26/2019 Femara (letrozole)
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Sep 19, 2018 06:10PM - edited Sep 19, 2018 06:11PM by Meow13

Ashweb, my cancer has been gone for 7 years. It was removed during mx in Nov 2011 and hasn't been seen since. I did 4 years total AI anastrozole and exemestane. My tumors were 2 masses each 1cm in size.

AI drugs also more effective for er+pr- cancers which mine were.

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Sep 19, 2018 08:49PM letsgogolf wrote:

I think they also refer to IDC/L as mixed type. My reports state it both ways.

Oncotype DX = 3. IDC with Lobular Features. Sentinel Node had Micrometastases - Estrogen 100%, Progesterone 99.89%, Ki67= 3.3% Dx 2/14/2017, IDC, Left, 1cm, Stage IB, Grade 1, 0/8 nodes, ER+/PR+, HER2- Surgery 2/26/2017 Lumpectomy: Left Radiation Therapy 4/5/2017 Whole-breast: Lymph nodes Hormonal Therapy 5/31/2017 Arimidex (anastrozole) Targeted Therapy
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Sep 20, 2018 11:16AM cling wrote:

Ashweb, how did your expert lobular doctor say? I am interested to know more about Tamoxifen is ineffective to ILC. After last year CT finding that cancer is wrapping around me peritoneum, I have gone thru Halaven, Ibrance/Letrozole, and Adriamycin/Cytoxan. The last CT showed stable, so I requested a chemo vacation. I just went on Tamoxifen. This maybe my last oral med. I certainly hope to stay on it for a while.

Dx 9/7/2010, IDC, 4cm, 12/12 nodes, ER+/PR-, HER2- Dx 6/5/2014, Stage IV, mets
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Feb 5, 2019 03:36PM mellee wrote:

Just thought I'd report back on my situation. I found a small nodule in my right breast right under the skin and it turned out to be cancer. It has the same pathology as before: IDC with lobular features. Grade 1. Well-differentiated. Strongly ER/PR positive, Her2-, low Ki67. My surgeon and MO believe it is residual disease that was seeded from my original core biopsy.

On ultrasound, it appeared to be only 5 mm, but when my surgeon operated there were 2 foci: one was 1.7 cm and one was 2 mm.

Ashweb -- what did you find out about tamoxifen for lobular? I'd never heard that it wasn't as useful. But it makes sense because my 100% ER+ cancer grew while on tamoxifen. My MO is considering switching me to ovarian suppression + Aromasin.

I did ask my MO about IDC with lobular features and she said there is no difference in the survival rates vs. garden variety IDC. But I'm getting a 2nd opinion on Friday and will grill the MO about this. It seems clear to me from research that IDC with lobular features behaves differently and so I'd like my doctors to really think about how that might impact treatment.

My cancer has behaved oddly from the start, so my assumption is that this will continue!

Diagnosed with a 2.3 cm tumor (Grade 1, Luminal A). 100% ER+, 97% PR+, Her2-, Ki67 6%. Oncotype: 17. Mammaprint: Low risk. 2 years later: local recurrence due to needle biopsy seeding. Dx 10/6/2016, IDC, Right, 2cm, Stage IIB, Grade 1, 2/32 nodes, ER+/PR+, HER2- (IHC) Surgery 11/8/2016 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 2/3/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 6/8/2017 Reconstruction (right): Silicone implant Dx 12/8/2018, IDC, Right, Grade 1, ER+/PR+, HER2- (IHC) Surgery 1/10/2019 Lumpectomy: Right Radiation Therapy 2/28/2019 Whole-breast: Chest wall Hormonal Therapy 3/13/2019 Zoladex (goserelin) Hormonal Therapy 6/8/2019 Aromasin (exemestane)
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Feb 5, 2019 06:13PM - edited Feb 5, 2019 06:14PM by Georgia1

Hi Mellee and Ashweb901. I have never heard that Tamoxifen "doesn't work" on lobular breast cancer. That's what I'm on now, because I have osteoporosis. Perhaps Ashweb is talking about research showing that some women are just poor metabolizers of Tamoxifen? I discussed that with my MO and decided to do the genetic test for that. I'd be interested in any studies you can share.


Cancer touched my breast so I kicked its ass. Dx 9/3/2017, ILC/IDC, Right, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- Dx 10/10/2017, LCIS, Right, 0/1 nodes Surgery 10/10/2017 Lumpectomy; Lymph node removal: Right, Sentinel Radiation Therapy 11/27/2017 Whole-breast: Breast Hormonal Therapy 1/2/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Feb 5, 2019 08:15PM - edited Feb 5, 2019 08:16PM by mellee

Hi Georgia,

I'm just starting my research, but I have found some information that suggests tamoxifen may not be as effective as AIs for ILC. Here's one excerpt from a 2016 journal article (https://www.oatext.com/A-review-of-invasive-lobula...):

Even though ILC responds poorly to neoadjuvant chemotherapy, it has been shown to respond well to endocrine therapy [47]. However, the magnitude of benefit differs with different endocrine therapy. There is also preclinical data that tamoxifen is not an ideal endocrine therapy in ILC patients, with ILC tumour models showing a paradoxical induction of cellular proliferation in response to the drug, suggesting that the estrogen receptor may have different isoforms [48,49], or drive different signaling pathways in the two histological subtypes [50,51]. Differential ER activity between the IDC and ILC has also been suggested at a gene expression level [26]. Clinically, this has also been observed in several retrospective analyses showing that post-menopausal patients with ILC derive more a greater magnitude of benefit from aromatase inhibitors than do patients with IDC [52,53]. Analysis of patients in the Breast International Group (BIG) 1-98 trial showed that letrozole was associated with a 50 – 66% reduction in DFS event risk in ILC patients compared to a 0 – 35% risk reduction in patients with IDC [52]. This difference may however possibly be ameliorated by a switch from tamoxifen to an aromatase inhibitor [54].

But everyone is different, so this doesn't necessarily mean that tamoxifen is never an option for ILC.


Diagnosed with a 2.3 cm tumor (Grade 1, Luminal A). 100% ER+, 97% PR+, Her2-, Ki67 6%. Oncotype: 17. Mammaprint: Low risk. 2 years later: local recurrence due to needle biopsy seeding. Dx 10/6/2016, IDC, Right, 2cm, Stage IIB, Grade 1, 2/32 nodes, ER+/PR+, HER2- (IHC) Surgery 11/8/2016 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 2/3/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 6/8/2017 Reconstruction (right): Silicone implant Dx 12/8/2018, IDC, Right, Grade 1, ER+/PR+, HER2- (IHC) Surgery 1/10/2019 Lumpectomy: Right Radiation Therapy 2/28/2019 Whole-breast: Chest wall Hormonal Therapy 3/13/2019 Zoladex (goserelin) Hormonal Therapy 6/8/2019 Aromasin (exemestane)
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Feb 5, 2019 08:28PM mellee wrote:

Here's another 2016 study:

Differences between invasive lobular and invasive ductal carcinoma of the breast: results and therapeutic implicationshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC49520...

This article discusses tamoxifen vs. AI for patients with ILC, and points to several studies that indicate letrozole is superior to tamoxifen for ILC. However, they also note that data is limited, and needs to be validated by larger studies.

Diagnosed with a 2.3 cm tumor (Grade 1, Luminal A). 100% ER+, 97% PR+, Her2-, Ki67 6%. Oncotype: 17. Mammaprint: Low risk. 2 years later: local recurrence due to needle biopsy seeding. Dx 10/6/2016, IDC, Right, 2cm, Stage IIB, Grade 1, 2/32 nodes, ER+/PR+, HER2- (IHC) Surgery 11/8/2016 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 2/3/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 6/8/2017 Reconstruction (right): Silicone implant Dx 12/8/2018, IDC, Right, Grade 1, ER+/PR+, HER2- (IHC) Surgery 1/10/2019 Lumpectomy: Right Radiation Therapy 2/28/2019 Whole-breast: Chest wall Hormonal Therapy 3/13/2019 Zoladex (goserelin) Hormonal Therapy 6/8/2019 Aromasin (exemestane)
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Feb 5, 2019 08:50PM jessie123 wrote:

Here is another very interesting article on IDC-L or mixed carcinoma. This one makes me happy!

Oncologist. 2018 Dec 5. pii: theoncologist.2018-0363. doi: 10.1634/theoncologist.2018-0363. [Epub ahead of print]

Mixed Invasive Ductal and Lobular Carcinoma of the Breast: Prognosis and the Importance of Histologic Grade.

Metzger-Filho O1, Ferreira AR2,3, Jeselsohn R2, Barry WT2, Dillon DA2, Brock JE2, Vaz-Luis I2, Hughes ME2, Winer EP2, Lin NU2.

Author information Abstract BACKGROUND:

The diagnosis of mixed invasive ductal and lobular carcinoma (IDC-L) in clinical practice is often associated with uncertainty related to its prognosis and response to systemic therapies. With the increasing recognition of invasive lobular carcinoma (ILC) as a distinct disease subtype, questions surrounding IDC-L become even more relevant. In this study, we took advantage of a detailed clinical database to compare IDC-L and ILC regarding clinicopathologic and treatment characteristics, prognostic power of histologic grade, and survival outcomes.

MATERIALS AND METHODS:

In this retrospective cohort study, we identified 811 patients diagnosed with early-stage breast cancer with IDC-L or ILC. Descriptive statistics were performed to compare baseline clinicopathologic characteristics and treatments. Survival rates were subsequently analyzed using the Kaplan-Meier method and compared using the Cox proportional hazards model.

RESULTS:

Patients with ILC had more commonly multifocal disease, low to intermediate histologic grade, and HER2-negative disease. Histologic grade was prognostic for patients with IDC-L but had no significant discriminatory power in patients with ILC. Among postmenopausal women, those with IDC-L had significantly better outcomes when compared with those with ILC: disease-free survival (DFS) and overall survival (OS; adjusted hazard ratio [HR], 0.54; 95% confidence interval [CI] 0.31-0.95). Finally, postmenopausal women treated with an aromatase inhibitor had more favorable DFS and OS than those treated with tamoxifen only (OS adjusted HR, 0.50; 95% CI, 0.29-0.87), which was similar for both histologic types (p = .212).

CONCLUSION:

IDC-L tumors have a better prognosis than ILC tumors, particularly among postmenopausal women. Histologic grade is an important prognostic factor in IDC-L but not in ILC.

IMPLICATIONS FOR PRACTICE:

This study compared mixed invasive ductal and lobular carcinoma (IDC-L) with invasive lobular carcinomas (ILCs) to assess the overall prognosis, the prognostic role of histologic grade, and response to systemic therapy. It was found that patients with IDC-L tumors have a better prognosis than ILC, particularly among postmenopausal women, which may impact follow-up strategies. Moreover, although histologic grade failed to stratify the risk of ILC, it showed an important prognostic power in IDC-L, thus highlighting its clinical utility to guide treatment decisions of IDC-L. Finally, the disease-free survival advantage of adjuvant aromatase inhibitors over tamoxifen in ILC was consistent in IDC-L.

© AlphaMed Press 2018.

Dx 11/2018, LCIS/ILC, Left, 2cm, Stage IB, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 2/21/2019 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 4/15/2019 Whole-breast: Breast
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Feb 5, 2019 09:04PM mellee wrote:

I just saw that study. Very encouraging!

Diagnosed with a 2.3 cm tumor (Grade 1, Luminal A). 100% ER+, 97% PR+, Her2-, Ki67 6%. Oncotype: 17. Mammaprint: Low risk. 2 years later: local recurrence due to needle biopsy seeding. Dx 10/6/2016, IDC, Right, 2cm, Stage IIB, Grade 1, 2/32 nodes, ER+/PR+, HER2- (IHC) Surgery 11/8/2016 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 2/3/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 6/8/2017 Reconstruction (right): Silicone implant Dx 12/8/2018, IDC, Right, Grade 1, ER+/PR+, HER2- (IHC) Surgery 1/10/2019 Lumpectomy: Right Radiation Therapy 2/28/2019 Whole-breast: Chest wall Hormonal Therapy 3/13/2019 Zoladex (goserelin) Hormonal Therapy 6/8/2019 Aromasin (exemestane)
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Feb 10, 2019 06:26PM Georgia1 wrote:

Thank you Mellee and Jessie.

Cancer touched my breast so I kicked its ass. Dx 9/3/2017, ILC/IDC, Right, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- Dx 10/10/2017, LCIS, Right, 0/1 nodes Surgery 10/10/2017 Lumpectomy; Lymph node removal: Right, Sentinel Radiation Therapy 11/27/2017 Whole-breast: Breast Hormonal Therapy 1/2/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)

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