Journal of Perioperative & Critical Intensive Care Nursing
Open Access
ISSN: 2471-9870
ISSN: 2471-9870
Laszlo Tabar
University of Uppsala, Sweden
Scientific Tracks Abstracts: J Perioper Crit Intensive Care Nurs
responsible for more than its share of treatment failures. Long-term survival of women with classic ILC has not improved significantly over the past half century, despite major improvements in breast cancer therapy and diagnosis. Foote and Stewart considered lobular carcinoma in situ (LCIS) to be the precursor of ILC, and that the â??the mass eruption of tumor cellsâ? occurred through â??some lytic action of the tumor cells, naturally not to be detected by anatomic study.â? Ackerman and Del Regato accepted this proposed mechanism, concluding that ILC arises from the acinar epithelium of the breast lobule. Despite the absence of clear evidence, these speculations were accepted as established fact more than 70 years ago. An inconvenient observation, the lack of E-cadherin staining, was assumed to result from a â??lossâ? of that protein during tumor development. Our research group, the Swedish Organized Service Screening Evaluation Group, has examined all histologically proven ILC cases from Dalana County Sweden diagnosed from 1996-2019 with follow-up to the end of 2021. Histopathologic study of large section (8x10 cm) pathology slides, imaging and molecular biomarkers of 329 consecutive diffuse form of ILC showed a macroscopic structure unlike breast cancers of epithelial origin, a 19-year survival (56 %), poorer than expected from the histochemical biomarkers, and a growth pattern closely resembling that of normal breast tissue, hindering mammographic detection. Our group considered that ILC may originate from mesenchymal hybrid cells through the process of mesenchymal epithelial transition (MET). Our cell culture studies from typical ILC cases progressed through more than 10 cell cycles in one yearâ??s time and produced cells with the properties of mesenchymal hybrid cells. Histopathology-breast imaging correlation indicated two ILC subgroups with separate sites of origin. The classic, diffuse type of ILC appears to evolve from the extralobular mesenchyme of the breast. A second subgroup appears to evolve from and generally remain within the intralobular mesenchyme of the breast, appearing as multiple small colonies, each surrounding the acini and terminal ducts of the lobule, which invariably have normal, non-malignant epithelium. This intralobular subgroup has distinctly different imaging biomarkers, appearing as a distinct tumor mass easily detected at mammography. The 231 consecutive intralobular cases had 84% survival at 19-year follow-up. Differentiating the two is difficult based on the limited field of view offered by the conventional 1x3 inch glass slides. However, low-power histopathology of large sections correlates well with imaging findings and assists in differentiating these two subtypes. This translational research is consistent with new directions in precision medicine. Conclusions: The accepted terminology and assumptions of the nature of â??ILCâ? must be reconsidered if we are to improve the poor survival rate of this misunderstood malignancy. Therapies, such as radiation and chemotherapy, are effective in treating epithelial breast cancers but are less effective in treating classic ILC, possibly due to a stem cell origin. Likewise, the IHC biomarkers are less predictive of prognosis in classic ILC for the same reason. Further, surgical removal of this diffuse malignancy is often incomplete as the full disease extent is difficult to evaluate by any imaging technique. So long as this unusual breast malignancy is termed â??classic diffusely infiltrating lobular carcinoma,â? implying that it has its origin in the acinar cells of the terminal ductal lobular units (TDLUs), we are unlikely to achieve any real progress in our efforts to control it. Appreciation of its mesenchymal stem cell origin offers a radically new approach to research and treatment.
Laszlo Tabar is a Professor Emeritus at the University of Uppsala, Sweden, and a globally recognized expert in breast imaging and early cancer detection. With decades of experience in radiology, he has made groundbreaking contri butions to mammography, significantly improving breast cancer screening programs worldwide. His research and teaching have influenced radiologists and healthcare professionals across the globe, emphasizing the importance of early detection in reducing breast cancer mortality. Dr. TabĂĄr has authored numerous scientific publications and textbooks and continues to be a leading figure in the field of breast imaging.