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Results of a worldwide survey on the currently used histopathological diagnostic criteria for invasive lobular breast cancer.

ABSTRACT: Invasive lobular carcinoma (ILC) represents the second most common subtype of breast cancer (BC), accounting for up to 15% of all invasive BC. Loss of cell adhesion due to functional inactivation of E-cadherin is the hallmark of ILC. Although the current world health organization (WHO) classification for diagnosing ILC requires the recognition of the dispersed or linear non-cohesive growth pattern, it is not mandatory to demonstrate E-cadherin loss by immunohistochemistry (IHC). Recent results of central pathology review of two large randomized clinical trials have demonstrated relative overdiagnosis of ILC, as only ~60% of the locally diagnosed ILCs were confirmed by central pathology. To understand the possible underlying reasons of this discrepancy, we undertook a worldwide survey on the current practice of diagnosing BC as ILC. A survey was drafted by a panel of pathologists and researchers from the European lobular breast cancer consortium (ELBCC) using the online tool SurveyMonkey®. Various parameters such as indications for IHC staining, IHC clones, and IHC staining procedures were questioned. Finally, systematic reporting of non-classical ILC variants were also interrogated. This survey was sent out to pathologists worldwide and circulated from December 14, 2020 until July, 1 2021. The results demonstrate that approximately half of the institutions use E-cadherin expression loss by IHC as an ancillary test to diagnose ILC and that there is a great variability in immunostaining protocols. This might cause different staining results and discordant interpretations. As ILC-specific therapeutic and diagnostic avenues are currently explored in the context of clinical trials, it is of importance to improve standardization of histopathologic diagnosis of ILC diagnosis.

SUBMITTER: De Schepper M

PROVIDER: S-EPMC9708574 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Results of a worldwide survey on the currently used histopathological diagnostic criteria for invasive lobular breast cancer.

De Schepper Maxim M Vincent-Salomon Anne A Christgen Matthias M Van Baelen Karen K Richard François F Tsuda Hitoshi H Kurozumi Sasagu S Brito Maria Jose MJ Cserni Gabor G Schnitt Stuart S Larsimont Denis D Kulka Janina J Fernandez Pedro Luis PL Rodríguez-Martínez Paula P Olivar Ana Aula AA Melendez Cristina C Van Bockstal Mieke M Kovacs Aniko A Varga Zsuzsanna Z Wesseling Jelle J Bhargava Rohit R Boström Pia P Franchet Camille C Zambuko Blessing B Matute Gustavo G Mueller Sophie S Berghian Anca A Rakha Emad E van Diest Paul J PJ Oesterreich Steffi S Derksen Patrick W B PWB Floris Giuseppe G Desmedt Christine C

Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 20220803 12

Invasive lobular carcinoma (ILC) represents the second most common subtype of breast cancer (BC), accounting for up to 15% of all invasive BC. Loss of cell adhesion due to functional inactivation of E-cadherin is the hallmark of ILC. Although the current world health organization (WHO) classification for diagnosing ILC requires the recognition of the dispersed or linear non-cohesive growth pattern, it is not mandatory to demonstrate E-cadherin loss by immunohistochemistry (IHC). Recent results o ...[more]

PMID: 35922548

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Project description:There is growing awareness of the unique etiology, biology, and clinical presentation of invasive lobular breast cancer (ILC), but additional research is needed to ensure translation of findings into management and treatment guidelines. We conducted a survey with input from breast cancer physicians, laboratory-based researchers, and patients to analyze the current understanding of ILC, and identify consensus research questions. 1774 participants from 66 countries respondents self-identified as clinicians (N = 413), researchers (N = 376), and breast cancer patients and advocates (N = 1120), with some belonging to more than one category. The majority of physicians reported being very/extremely (41%) to moderately (42%) confident in describing the differences between ILC and invasive breast cancer of no special type (NST). Knowledge of histology was seen as important (73%) and as affecting treatment decisions (51%), and most agreed that refining treatment guidelines would be valuable (76%). 85% of clinicians have never powered a clinical trial to allow subset analysis for histological subtypes, but the majority would consider it, and would participate in an ILC clinical trials consortium. The majority of laboratory researchers, reported being and very/extremely (48%) to moderately (29%) confident in describing differences between ILC and NST. They reported that ILCs are inadequately presented in large genomic data sets, and that ILC models are insufficient. The majority have adequate access to tissue or blood from patients with ILC. The majority of patients and advocates (52%) thought that their health care providers did not sufficiently explain the unique features of ILC. They identified improvement of ILC screening/early detection, and identification of better imaging tools as top research priorities. In contrast, both researchers and clinicians identified understanding of endocrine resistance and identifying novel drugs that can be tested in clinical trials as top research priority. In summary, we have gathered information from an international community of physicians, researchers, and patients/advocates that we expect will lay the foundation for a community-informed collaborative research agenda, with the goal of improving management and personalizing treatment for patients with ILC.

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Results of a worldwide survey on the currently used histopathological diagnostic criteria for invasive lobular breast cancer.

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Results of a worldwide survey on the currently used histopathological diagnostic criteria for invasive lobular breast cancer.

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