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Clinical Studies

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

British Journal of Cancer volume 128, pages 1030–1039 (2023)Cite this article

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.

Author information

Author notes

  1. Yujia Li

    Present address: Eli Lilly and Company, Indianapolis, IN, USA

  2. These authors contributed equally: Azadeh Nasrazadani, Yujia Li.

Authors and Affiliations

  1. Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Azadeh Nasrazadani

  2. Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA

    Yujia Li, Yusi Fang & George Tseng

  3. Graduate Program in Integrated Systems Biology, University of Pittsburgh, Pittsburgh, PA, USA

    Osama Shah

  4. Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee-Womens Research Institute, Pittsburgh, PA, USA

    Jennifer M. Atkinson, Priscilla F. McAuliffe, Adrian V. Lee & Steffi Oesterreich

  5. Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Joanna S. Lee & Priscilla F. McAuliffe

  6. Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA

    Rohit Bhargava & Peter C. Lucas

  7. UPMC Hillman Cancer Center, Magee Women’s Hospital, Suite 4628, 300 Halket Street, Pittsburgh, PA, USA

    Adrian V. Lee, Peter C. Lucas, Steffi Oesterreich & Norman Wolmark

  8. Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA

    Adrian V. Lee & Steffi Oesterreich

  9. NSABP Foundation, Inc, Pittsburgh, PA, USA

    Peter C. Lucas & Norman Wolmark

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  1. Azadeh Nasrazadani
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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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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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