Cytologic Diagnosis of Lobular Carcinoma
of the Breast
Experience With 555 Patients in the Rene Huguenin Cancer Center
Emmanuelle Menet, MD
V? eronique Becette, MD
Marianne Briffod, MD
Department of Pathology, Ren? e Huguenin Center,
St. Cloud, France.
BACKGROUND. Fine-needle aspiration generally produces results that are not as
good for lobular carcinoma as the results for ductal carcinoma of the breast. In
this study, the authors evaluated their team’s performance in cytologic diagnosis of
lobular carcinoma over 11 years and analyzed the reasons for diagnostic failure.
METHODS. Cytologic findings were analyzed in 555 consecutive fine-needle cyto-
puncture specimens from women with palpable, invasive lobular carcinoma of
the breast. The authors also examined the influence of the cytologist’s experience,
the clinical tumor size, the histologic subtype, and the histologic grade on diag-
nostic performance. All negative samples were re-examined, along with all sam-
ples that had been obtained during the last year of the study, to refine the
morphologic description of lobular carcinoma.
RESULTS. Malignancy was diagnosed in 68.8% of specimens overall. The indivi-
dual pathologists diagnosed malignancy in from 44.4% to 81.1% of specimens,
depending on their experience. Diagnostic performance was correlated with clini-
cal tumor size, histologic grade, and histologic subtype, and correct diagnoses
were significantly more frequent in pleomorphic subtypes than in ‘‘classic’’ types.
Re-examination of all 32 negative specimens reduced the false-negative rate from
5.8% to 3.8%.
CONCLUSIONS. Despite the pitfalls associated with lobular carcinoma of the breast,
fine-needle cytopuncture remains a useful diagnostic tool before treatment. Fail-
ures can be reduced through experience and by better knowledge of cytologic fea-
tures. Cancer (Cancer Cytopathol) 2008;114:111–7. ? 2008 American Cancer
KEYWORDS: breast, lobular carcinoma, fine-needle aspiration, cytologic diagnosis.
and inexpensive way of diagnosing malignancy in women with
palpable breast tumors. Coupled with physical examination and
imaging, as part of the triple diagnosis, FNA is used by many experi-
enced European and American teams with near-perfect sensitivity.1
However, FNA performs less well on certain types of cancer, includ-
ing lobular carcinoma of the breast.
Invasive lobular carcinoma, after ductal carcinoma, is the most
frequent type of breast cancer and accounts for approximately 5%
to 15% of cases.2Its incidence is increasing, especially because the
recognition of new subtypes that previously were categorized as
ductal carcinomas.3Lobular carcinoma not only has different mor-
phologic characteristics than ductal carcinoma, but it also has a dif-
ferent course, different clinical and radiologic features, and probably
qualifies for specific therapeutic management. FNA fails more fre-
ine-needle aspiration (FNA) is a rapid, safe, minimally invasive,
Address for reprints: Emmanuelle Menet, MD,
Service de Pathologie, Centre Ren? e Huguenin, 35,
rue Dailly, 92210 St. Cloud, France; Fax: (011)
33-1-47 11 15 16; E-mail: email@example.com
Received October 9, 2007; revision received
December 10, 2007; accepted December 19, 2007.
ª2008 American Cancer Society
Published online 25 February 2008 in Wiley InterScience (www.interscience.wiley.com).
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Cytologic Diagnosis of Lobular CA/Menet et al.117