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Open Access 17-06-2024 | Mastectomy | Breast Oncology

Guideline-Concordant Surgical Care for Lobular Versus Ductal Inflammatory Breast Cancer

Authors: Yoshiko Iwai, MS, Stephany Perez-Rojas, MSc, Samantha M. Thomas, MS, Audree B. Tadros, MD, Steven G. Woodward, MD, Jennifer Q. Zhang, MD, Leisha C. Elmore, MD, MPHS, Gary M. Freedman, MD, Julia C. Tchou, MD, PhD, Aaron D. Bleznak, MD, MBA, Oluwadamilola M. Fayanju, MD, MA, MPHS

Published in: Annals of Surgical Oncology

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Abstract

Introduction

Quality of surgical care is understudied for lobular inflammatory breast cancer (IBC), which is less common, more chemotherapy-resistant, and more mammographically occult than ductal IBC. We compared guideline-concordant surgery (modified radical mastectomy [MRM] without immediate reconstruction following chemotherapy) for lobular versus ductal IBC.

Methods

 Female individuals with cT4dM0 lobular and ductal IBC were identified in the National Cancer Database (NCDB) from 2010–2019. Modified radical mastectomy receipt was identified via codes for “modified radical mastectomy” or “mastectomy” and “≥10 lymph nodes removed” (proxy for axillary lymph node dissection). Descriptive statistics, chi-square tests, and t-tests were used.

Results

A total of 1456 lobular and 10,445 ductal IBC patients were identified; 599 (41.1%) with lobular and 4859 (46.5%) with ductal IBC underwent MRMs (p = 0.001). Patients with lobular IBC included a higher proportion of individuals with cN0 disease (20.5% lobular vs. 13.7% ductal) and no lymph nodes examined at surgery (31.2% vs. 24.5%) but were less likely to be node-negative at surgery (12.7% vs. 17.1%, all p < 0.001). Among those who had lymph nodes removed at surgery, patients with lobular IBC also had fewer lymph nodes excised versus patients with ductal IBC (median [interquartile range], 7 (0–15) vs. 9 (0–17), p = 0.001).

Conclusions

Lobular IBC patients were more likely to present with node-negative disease and less likely to be node-negative at surgery, despite having fewer, and more frequently no, lymph nodes examined versus ductal IBC patients. Future studies should investigate whether these treatment disparities are because of surgical approach, pathologic assessment, and/or data quality as captured in the NCDB.
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Metadata
Title
Guideline-Concordant Surgical Care for Lobular Versus Ductal Inflammatory Breast Cancer
Authors
Yoshiko Iwai, MS
Stephany Perez-Rojas, MSc
Samantha M. Thomas, MS
Audree B. Tadros, MD
Steven G. Woodward, MD
Jennifer Q. Zhang, MD
Leisha C. Elmore, MD, MPHS
Gary M. Freedman, MD
Julia C. Tchou, MD, PhD
Aaron D. Bleznak, MD, MBA
Oluwadamilola M. Fayanju, MD, MA, MPHS
Publication date
17-06-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-15540-1
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