Abstract：
BACKGROUND: Invasive lobular carcinoma (ILC) is the second most common subtype of breast cancer. Although mammography is known to have low sensitivity for ILC, there are no data to guide the optimal surveillance after treatment. We explored surveillance strategies after breast-conserving surgery (BCS) for ILC and determined the proportion of imaging-detected recurrences versus interval cancers.
METHODS: From an institutional database of 813 women, we retrospectively identified patients who underwent BCS for stage I-III ILC and subsequently had a recurrence. We categorized patients by surveillance strategy and determined the modality of recurrence detection. Interval cancer rates for local recurrences were compared across surveillance strategies using the Chi-square test. We evaluated overall survival with the log-rank test and a Cox proportional hazards model.
RESULTS: We included 58 patients with ILC who had a recurrence after BCS. Of these, 22 (37.9%) had local recurrence, 27 (46.6%) had distant recurrence, and 9 (15.5%) had both local and distant recurrence. Most patients underwent routine mammographic surveillance (65.2%), with 19.6% having supplemental breast magnetic resonance imaging (MRI) and 15.2% having no surveillance. The interval cancer rate was significantly higher in the mammographic surveillance group compared with the MRI surveillance group (61.9% vs. 16.7%; p < 0.001).
CONCLUSIONS: In this study of patients with recurrence after BCS for primary treatment of stage I-III ILC, we found that most local recurrences were not detected by surveillance mammography. These data support further investigation of supplemental imaging beyond mammography specifically for patients with ILC who undergo BCS.
METHODS: From an institutional database of 813 women, we retrospectively identified patients who underwent BCS for stage I-III ILC and subsequently had a recurrence. We categorized patients by surveillance strategy and determined the modality of recurrence detection. Interval cancer rates for local recurrences were compared across surveillance strategies using the Chi-square test. We evaluated overall survival with the log-rank test and a Cox proportional hazards model.
RESULTS: We included 58 patients with ILC who had a recurrence after BCS. Of these, 22 (37.9%) had local recurrence, 27 (46.6%) had distant recurrence, and 9 (15.5%) had both local and distant recurrence. Most patients underwent routine mammographic surveillance (65.2%), with 19.6% having supplemental breast magnetic resonance imaging (MRI) and 15.2% having no surveillance. The interval cancer rate was significantly higher in the mammographic surveillance group compared with the MRI surveillance group (61.9% vs. 16.7%; p < 0.001).
CONCLUSIONS: In this study of patients with recurrence after BCS for primary treatment of stage I-III ILC, we found that most local recurrences were not detected by surveillance mammography. These data support further investigation of supplemental imaging beyond mammography specifically for patients with ILC who undergo BCS.
摘要：
背景：浸润性小叶癌（ILC）是第二常见的乳腺癌亚型。尽管已知乳房X线照相术对ILC的敏感性较低，没有数据指导治疗后的最佳监测.我们探索了ILC保乳手术（BCS）后的监视策略，并确定了影像学检测到的复发与间期癌症的比例。
方法：来自813名女性的机构数据库，我们回顾性地确定了因I-III期ILC接受BCS治疗并随后复发的患者.我们通过监测策略对患者进行分类，并确定复发检测的方式。使用卡方检验在不同的监测策略中比较局部复发的间期癌症发生率。我们用对数秩检验和Cox比例风险模型评估了总生存期。
结果：我们纳入了58例BCS后复发的ILC患者。其中,22例（37.9%）局部复发，27例（46.6%）远处复发，9例(15.5%)有局部和远处复发.大多数患者接受了常规乳房X光检查（65.2％），19.6%有补充乳腺磁共振成像(MRI)，15.2%没有监测。与MRI监测组相比，乳房X线摄影监测组的间期癌症发生率明显高于MRI监测组（61.9％vs.16.7%；p<0.001)。
结论：在这项研究中，针对BCS后复发的患者进行I-III期ILC的主要治疗，我们发现，大多数局部复发没有通过乳房X光检查发现。这些数据支持对乳房X线照相术以外的补充成像的进一步研究，特别是针对接受BCS的ILC患者。
方法：来自813名女性的机构数据库，我们回顾性地确定了因I-III期ILC接受BCS治疗并随后复发的患者.我们通过监测策略对患者进行分类，并确定复发检测的方式。使用卡方检验在不同的监测策略中比较局部复发的间期癌症发生率。我们用对数秩检验和Cox比例风险模型评估了总生存期。
结果：我们纳入了58例BCS后复发的ILC患者。其中,22例（37.9%）局部复发，27例（46.6%）远处复发，9例(15.5%)有局部和远处复发.大多数患者接受了常规乳房X光检查（65.2％），19.6%有补充乳腺磁共振成像(MRI)，15.2%没有监测。与MRI监测组相比，乳房X线摄影监测组的间期癌症发生率明显高于MRI监测组（61.9％vs.16.7%；p<0.001)。
结论：在这项研究中，针对BCS后复发的患者进行I-III期ILC的主要治疗，我们发现，大多数局部复发没有通过乳房X光检查发现。这些数据支持对乳房X线照相术以外的补充成像的进一步研究，特别是针对接受BCS的ILC患者。
