Multicentric and multifocal lobular breast cancer: selection of radical surgical treatment

Abstract

Background: invasive lobular breast carcinoma is characterized by a high frequency of multicentric and multifocal growth, which complicates the choice of the extent of surgery. The feasibility of breast-conserving surgery in this category of patients, particularly in early-stage disease, remains a matter of debate. Most recommendations are based on data obtained for ductal carcinoma, which may not always be applicable because of the biological features of lobular carcinoma, including diffuse growth and low sensitivity of standard imaging modalities. Aim: to compare immediate and long-term outcomes of surgical treatment in patients with stage I–IIIA multicentric or multifocal invasive lobular breast carcinoma treated with different surgical approaches, and to identify criteria for the safe performance of breast-conserving procedures. Materials and Methods: a single-center retrospective cohort study was conducted at the Moscow Multidisciplinary Clinical Center "Botkin Hospital". The analysis included 99 patients with histologically verified stage I–IIIA invasive lobular breast carcinoma treated in 2023–2025. Multicentric or multifocal growth was diagnosed in 38 patients (38.3%). All patients were divided into three groups according to the extent of surgery: radical mastectomy — 22 patients (57.0%), subcutaneous mastectomy with immediate reconstruction — 5 patients (13.1%), and breast-conserving surgery — 11 patients (30.0%). Results: in the multifocal-growth group, breast-conserving surgery was performed in 43% of cases, whereas in the multicentric-growth group it was performed in 21%; however, the difference between the rates of radical mastectomy and breast-conserving surgery did not reach statistical significance (p=0.16). Most tumors (55.2%) belonged to the luminal A subtype. At a median follow-up of 18 months (interquartile range, 12–24 months), disease progression was recorded in only one patient from the subcutaneous mastectomy group and manifested as distant bone metastases. Conclusion: multicentric and multifocal growth of invasive lobular breast carcinoma is not an absolute contraindication to breast-conserving surgery. The choice of surgical extent should be based on individual clinicomorphological factors, including the size and location of tumor foci, the feasibility of achieving negative resection margins, patient age, and tumor biological subtype. With strict patient selection, breast- conserving surgery and subcutaneous mastectomy may be considered alternatives to radical mastectomy without compromising long-term outcomes. KEYWORDS: lobular breast carcinoma, multicentric growth, multifocal growth, mastectomy, breast-conserving surgery, subcutaneous mastectomy, recurrence, survival. FOR CITATION: Tatarova A.A., Titov K.S., Lebedinsky I.N., Sokolov N.Yu., Lebedev S.S., Karseladze D.A. Multicentric and multifocal lobular breast cancer: selection of radical surgical treatment. Russian Medical Inquiry. 2026;10(7):474–479 (in Russ.). DOI: 10.32364/2587-6821- 2026-10-7-4