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E-Cadherin Staining Can Distinguish Ductal From Lobular Carcinoma: Presented at IAP

By Alison Palkhivala

MONTREAL, CANADA -- September 19, 2006 -- The E-cadherin stain, available for only a few years, can make the important distinction between lobular and ductal carcinoma of the breast, according to a retrospective review.

These findings are clinically significant, said Annie Kurian, MD, medical resident, department of pathology, McMaster University, Hamilton, Ontario, Canada, because the clinical implications of a diagnosis of lobular versus ductal carcinoma are different.

Lobular carcinoma in situ (LCIS), "can be multicentric [and bilateral], so you have to be careful. If you see LCIS in 1 breast, it can be multifocal in the same breast or it can be in the other breast. … Whereas with ductal [carcinoma], if you see it in 1 breast, you're [somewhat] sure it's only in that area," she explained.

Loss of the E-cadherin gene from chromosome 16q is a frequent finding in lobular carcinoma of the breast but is not typically found in low grade ductal carcinomas. A recently developed E-cadherin stain, therefore, is believed to help distinguish the 2 and has become an important tool in pathology. The usefulness of this stain, however, has received little investigative attention, Dr. Kurian said.

To test the ability of the E-cadherin stain to differentiate between lobular and ductal carcinomas, Dr. Kurian and colleagues reviewed more than 1,000 pathology slides taken from 92 patients who had been diagnosed with lobular carcinoma in the previous 10 years.

Using the stain, they reclassified 21% of these patients as having ductal carcinoma. Overall, 9 patients had LCIS, 3 had LCIS with infiltrating ductal cancer, 27 had invasive lobular carcinoma, 25 had signs of both LCIS and invasive lobular carcinoma, and 9 had invasive ductal and invasive lobular carcinoma. The investigators also found evidence of pagetoid spread in 54 patients, 9 of which were associated with LCIS. Two patients had signs of ductal carcinoma in situ (DCIS) and LCIS in the same ducts.

In her poster presentation here on September 17^th at the 26^th International Congress of the International Academy of Pathology (IAP), Dr. Kurian said that the researchers found that 19 of the patients whose pathology slides were reviewed were wrongly classified as being lobular when they were actually ductal carcinoma. "And we could prove that by doing the E-cadherin study," she explained. "Some of the cases had coexisting lobular and ductal [carcinoma], which were missed because the E-cadherin stain wasn't done [until] the early 2000's."


[Presentation title: Lobular Carcinoma of the Breast. A Ten Year Retrospective Study. Poster 51]

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