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Apparent Ipsilateral Decrease in Breast Size at Mammography: A Sign of Infiltrating Lobular Carcinoma¹

¹ From the Departments of Radiology (J.A.H.), Pathology (R.E.F.), and Surgery (M.M.M.), University of Virginia, Box 170, Charlottesville, VA 22908. Received September 10, 1998; revision requested October 22; final revision received June 9, 1999; accepted August 18. Address reprint requests to J.A.H.

PURPOSE: To assess if infiltrating lobular carcinoma (ILC) is associated with an ipsilateral mammographic decrease in breast size.

MATERIALS AND METHODS: Mammographic change in size was evaluated by measuring the distance from the nipple to the pectoralis major muscle on the mediolateral oblique view of the diagnostic mammogram and on a preceding mammogram in 30 patients with ILC. Clinical, mammographic, and histopathologic findings were retrospectively reviewed.

RESULTS: Five patients (17%) had an ipsilateral decrease in mammographic size. No patients noticed a physical decrease in breast size. Patients with an ipsilateral decrease in mammographic size most commonly had breast thickening at examination (four of five patients [80%], P < .001) and either a focal asymmetry density (three of five patients [60%]) or architectural distortion (one of five patients [20%]) at mammography; those patients with no change in size most commonly had a palpable mass (six of 25 patients [24%]) or normal findings (19 of 25 patients [76%]) and a mass (13 of 25 patients [52%]) at mammography. The mean tumor size was 66 mm for those with an ipsilateral size decrease and 16 mm for those with no size decrease (P < .001). At histologic analysis, tumors associated with an ipsilateral decrease in mammographic size had more diffuse involvement of the breast, and discrete masses were not seen.

CONCLUSION: An apparent decrease in mammographic size may help identify cases of ILC, especially when associated with thickening at clinical examination and focal asymmetric density at mammography.

Index terms: Breast, abnormalities, 00.327 • Breast neoplasms, diagnosis, 00.11, 00.327, 00.91

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