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Publications

Journal Article Review Ahead of print 1 citation

PubMed: 42571762 DOI: 10.1016/j.ejrad.2026.113152

Imaging patterns and diagnostic challenges in metastatic invasive lobular carcinoma.

Eur J Radiol 204:113152

Authors: C Malhaire, F Lecouvet, M Bereby-Kahane, C Ala Eddine, V Fourchotte, B Buecher, K Van Baelen, R D Seban, C Bonneau, F Mechta-Grigoriou, L Djerroudi, C Desmedt, A Vincent-Salomon, R Dresen, V Huchet

Affiliations

  • Medical Imaging Department, Institut Curie, Institute of Women's Cancers, PSL (Paris Sciences & Lettres) University, Paris, France; Imaging, Innovative Radiotherapy and Systems Medicine Laboratory (IRIS), Inserm U1353, CNRS UMR 9029, Versailles Saint-Quentin University, Orsay, France.
  • Department of Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium.
  • Medical Imaging Department, Institut Curie, Institute of Women's Cancers, PSL (Paris Sciences & Lettres) University, Paris, France.
  • Surgical Oncology Department, Institut Curie, Institute of Women's Cancers, PSL (Paris Sciences & Lettres) University, Paris, France.
  • Medical Oncology Department, Institut Curie, Institute of Women's Cancers, PSL (Paris Sciences & Lettres) University, Paris, France.
  • Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium; Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.
  • Imaging, Innovative Radiotherapy and Systems Medicine Laboratory (IRIS), Inserm U1353, CNRS UMR 9029, Versailles Saint-Quentin University, Orsay, France; Medical Imaging Department, Institut Curie, Institute of Women's Cancers, Saint-Cloud, France.
  • Surgical Oncology Department, Institut Curie, Institute of Women's Cancers, Versailles Saint-Quentin University, Saint-Cloud, France.
  • Stress and Cancer Laboratory, Equipe Labellisée par la Ligue Contre le Cancer, Inserm U1339, UMR 3666 CNRS, Institut Curie, Institute of Women's Cancers, PSL (Paris Sciences & Lettres) University, Paris, France.
  • Diagnostic and Theranostic Medicine - Pathology Department, Institut Curie, Institute of Women's Cancers, PSL (Paris Sciences & Lettres) University, Paris, France.
  • Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium.
  • Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging & Pathology, KU Leuven, Leuven, Belgium.

Abstract

Invasive lobular carcinoma (ILC) is the second most common subtype of breast cancer after invasive carcinoma of no special type (NST), previously referred to as invasive ductal carcinoma. Loss of E-cadherin-mediated adhesion drives its characteristic diffuse infiltration, producing subtle or ill-defined lesions on imaging and contributing to underdiagnosis. ILC is heterogeneous, comprising a classical form and several variants-some of which, such as pleomorphic ILC, are considered more aggressive and carry distinct prognostic implications. ILC demonstrates a distinctive metastatic tropism, with a higher prevalence of peritoneal, gastrointestinal, ovarian, and leptomeningeal involvement than NST, whereas pulmonary metastases are reported less often. ILC Metastases are frequently low-volume or infiltrative and may mimic benign or inflammatory conditions, complicating staging and follow-up. This didactic review provides a head-to-toe survey of metastatic ILC, combining radiology and nuclear medicine perspectives. It highlights diagnostic pitfalls and key imaging hallmarks, with emphasis on whole-body diffusion-weighted MRI (WB-DWI) and PET/CT strategies beyond^18F-fluorodeoxyglucose ({\,}^18F-FDG), given the often low or heterogeneous FDG avidity of ILC, including^18F-fluoroestradiol (FES) and fibroblast activation protein inhibitor (FAPI) imaging. By integrating biological insights with state-of-the-art imaging, this review emphasises how the distinctive metastatic behaviour of ILC can lead to delayed detection. Increased awareness of these patterns and need for dedicated imaging approach among radiologists and nuclear medicine physicians is necessary to reduce missed or late diagnoses.

MeSH

Radiology, Fluorodeoxyglucose F18, Nuclear Medicine, Carcinoma, Lobular