Tailoring Management for Invasive Lobular Carcinoma: Imaging, Surgical Treatment, and Systemic Therapy Considerations

Invasive lobular carcinoma (ILC) represents the most common special subtype of breast cancer. Studies show challenges with imaging, surgical therapy, and systemic therapy selection, arguing for the need for improved treatment personalization for this histologic subtype of breast cancer. While standard imaging tools have decreased sensitivity for ILC, newer imaging approaches may be more effective in both early and advanced disease settings. Surgical treatment is notable for high rate of positive margins and need for more extensive surgery; this may be mitigated by improved imaging and incorporation of particular techniques. While endocrine therapy remains the mainstay of treatment for most patients with ILC, the unique molecular characteristics of this tumor type may provide targets for new therapeutic approaches. The preponderance of data supports the need for ILC specific studies and trials.