Invasive Lobular Carcinoma (ILC)


Written by :

Invasive lobular Cancer (ILC) is diagnosed by the 'Triple Test Score'. This includes :

    (a) A thorough medical history and a clinical examination of the breast.

    (b) Imaging of the breast through mammography or ultrasound and/or MRI

    (c) Non-excisional biopsy of the suspicious area - this includes both fine needle aspiration cytology and core biopsy.

The triple test is considered positive if any one of the three component is indeterminate, suspicious or malignant. This will then merit further investigations.

For ILC to be ruled out, all three parts of the triple test must be definitely benign.

Diagnosis of Invasive Lobular Cancer

  • Medical History: A thorough medical history to assess the risks of breast cancer should be taken. Risk factors, particularly strong family history of breast /ovarian cancer should be noted down.

    The Breast Cancer Risk Assessment Tool (BCRAT) can be used by health personnel to assess a women's risk of getting invasive breast cancer over a 5-year period of time and up to age 90 (lifetime risk).

    A detailed history of any thickening of the breast or pain or lump - how long it has been present, whether painful, any changes since first noted, relation to the menstrual cycle, presence of lumps elsewhere specially in the armpit or neck - should be noted down.

  • Breast Examination: Breast Examinations cannot identify Invasive Lobular Cancer until it is 5 cm in size. Below 5 cms, it may appear as just a thickening of the breast tissue and may be missed.

  • Screening Mammography: Mammography is not very effective in identifying ILC. This is because the cells in ILC do not form a definite lump but may only show up as a somewhat thicker area of the breast tissue which may or may not be due to cancerous growth.

  • Diagnostic Mammography: It is important that any thickening of breast tissue identified on a screening mammography is rescanned with a diagnostic mammography. This is a more detailed study of the breast which takes views at higher magnification and from more angles.

    Mammography and ultrasound are often used in a complementary capacity to give more detailed information in the evaluation of normal breast anatomy as well as breast abnormalities.

  • Ultrasound of the breast: Ultrasound imaging, also known as ultrasonography or sonogram, produces a picture of the internal structures of the breast and can help identify a breast mass and its characteristics. A special type of ultrasound, known as Doppler ultrasound can evaluate blood flow or lack of flow in any breast mass. A malignant mass will have more blood flow than normal tissue.

  • MRI of the breast: Magnetic resonance imaging (MRI) of the breast is primarily used as a supplemental tool to breast screening with mammography or ultrasound.

    A breast MRI is mainly used in women who have been already been diagnosed with breast cancer, to help measure the size of the cancer, look for other tumors in the breast and to check for tumors in the opposite breast.

    For certain women at high risk for breast cancer, a screening MRI is recommended along with a yearly mammogram.

    MRI is not recommended as a screening test for women at average risk of breast cancer since it is known to give some false positive results.

    MRI showing Invasive Lobular Cancer

  • Breast Biopsy: If the areas identified by mammography and ultrasound need more evaluation, the next step is a breast biopsy. There are different types of breast biopsies.

    • Fine Needle Aspiration Biopsy: This procedure uses a very thin needle and syringe to remove either fluid from a cyst or clusters of cells from a solid mass. Removal of tissue from a small mass with a fine needle requires a great deal of expertise.

      Invasive Lobular Cancer Pathology

    • Core Needle Biopsy: This procedure uses a somewhat larger needle with a sharp cutting edge. A core of tissue is cut from inside the mass. If the breast mass is quite large, as many as 15 samples, each about the size of a grain of rice, may be taken and sent to a lab for microscopic analysis.

    • Stereotactic Biopsy: This is a procedure in which tissue is removed from lumps which can be seen on a mammogram but cannot be felt on physical examination. It is done under the guidance of a mammogram or ultrasound. It helps in accurate localizing of the suspicious area.

    • Surgical Biopsy: In surgical biopsy, the suspicious area is first identified by mammogram. A needle is then inserted and fixed in the mass. Using this needle as a guide, the lump can be more accurately identified on the operating table and biopsied. If the lump is small enough, it may be completely removed - it is then called an excision biopsy.

    Read More :

    Previous: Risk factors of ILC

    Next: Treatment of ILC