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Clinical Studies

Mixed invasive ductal lobular carcinoma is clinically and pathologically more similar to invasive lobular than ductal carcinoma

Subjects

Abstract

Background

Mixed invasive ductal lobular carcinoma (mDLC) remains a poorly understood subtype of breast cancer composed of coexisting ductal and lobular components.

Methods

We sought to describe clinicopathologic characteristics and determine whether mDLC is clinically more similar to invasive ductal carcinoma (IDC) or invasive lobular carcinoma (ILC), using data from patients seen at the University of Pittsburgh Medical Center.

Results

We observed a higher concordance in clinicopathologic characteristics between mDLC and ILC, compared to IDC. There is a trend for higher rates of successful breast-conserving surgery after neoadjuvant chemotherapy in patients with mDLC compared to patients with ILC, in which it is known to be lower than in those with IDC. Metastatic patterns of mDLC demonstrate a propensity to develop in sites characteristic of both IDC and ILC. A meta-analysis evaluating mDLC showed shared features with both ILC and IDC with significantly more ER-positive and fewer high grades in mDLC compared to IDC, although mDLCs were significantly smaller and included fewer late-stage tumours compared to ILC.

Conclusions

These findings support clinicopathologic characteristics of mDLC driven by individual ductal vs lobular components and given the dominance of lobular pathology, mDLC features are often more similar to ILC than IDC. This study exemplifies the complexity of mixed disease.

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Fig. 1: Mixed invasive ductal lobular carcinoma contains co-existing ductal and lobular histologies. a
Fig. 2: Disease free survival and overall survival of patients with mDLC falls between what is observed for patients with IDC and ILC.
Fig. 3: Concordance of clinicopathologic parameters comparing mDLC, IDC, and ILC.
Fig. 4: Distribution of metastatic spread compared between mDLC, ILC, and IDC.
Fig. 5: Meta-analysis of clinicopathologic parameters comparing mDLC, IDC, and ILC.

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Funding

AN acknowledges support from the Gianni Bonadonna Breast Cancer Research Fellowship provided by the Conquer Cancer Foundation of the American Society of Clinical Oncology, and SO acknowledges support from the Breast Cancer Research Foundation (BCRF). In addition, the study was supported by the National Cancer Institute (NCI) of the National Institutes of Health (NIH; P30CA047904) and the Dynami Foundation.

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Authors

Contributions

Conceptualisation: AN, JMA, SO, JSL, PFM, GT, AVL, PCL. Manuscript preparation: AN, YL, YF. Data collection and analysis: AN, YL, YF. All authors read, edited, and approved the final manuscript.

Corresponding author

Correspondence to Azadeh Nasrazadani.

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The authors declare no competing interests.

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Institutional review board approval was obtained from the University of Pittsburgh prior to the initiation of the study.

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Nasrazadani, A., Li, Y., Fang, Y. et al. Mixed invasive ductal lobular carcinoma is clinically and pathologically more similar to invasive lobular than ductal carcinoma. Br J Cancer 128, 1030–1039 (2023). https://doi.org/10.1038/s41416-022-02131-8

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