Assessment of tumor size for multifocal primary breast cancer

Fish, Edward B.; Chapman, Judy‐Anne W.; Link, Marilyn A.

doi:10.1007/bf02303863

Cited by 39 publications

(28 citation statements)

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“…En este estudio, el porcentaje de pacientes que se presentaron con tumores de mama MFMC (6,6%) fue menor que lo reportado en la literatura internacional, donde las cifras varían desde un 13 a un 70% [1][2][3] , lo que se debe probablemente a la menor disponibilidad de métodos diagnósticos como los son la ecotomografía y la RNM durante los primeros años de esta serie. La presencia de un cáncer de mama MFMC se asoció a factores de mal pronóstico conocidos en la literatura como lo son bilateralidad, mayor número de linfonodos comprometidos con tumor y un diagnóstico en etapas más avanzadas de la enfermedad.…”

Section: Discussionunclassified

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Cánceres de mama multifocales-multicéntricos: ¿Son realmente de peor pronóstico?

C²,

R³

et al. 2009

Rev Chil Cir

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Multifocal-multicentric breast cancers: are they of worse prognosis?The malignant mammary pathology can be presented like unifocal or multifocal-multicentric tumors (MFMC). The influence of this factor as prognostic is controversial. Objective: Establish if the presence of MFMC breast cancer, in comparison to the unifocal breast cancer, is associated to worse prognosis. Patients and Method: Combined prospective-retrospective cohort, corresponding to the totality of patients treated by surgery of breast cancer at Hospital FACH between 1972 and 2007 that fulfilled the inclusion criteria, obtaining a total of 589 patients. The statistic analysis was done with Kolmogorov-Smirnov tests and T-student for quantitative variables, chi square for qualitative variables and Kaplan-Meier curves with log rank test for survival. Results: The 93.4% of the patients had unifocal breast cancer, while the rest (6.6%) had MFMC cancer. There were no significant statistical differences between ages of both groups (57.88 and 54.92 years for unifocal and MFMC, respectively). MFMC cancer group presented more bilateral cancer than unifocal cancer group (7.7% versus 1.6%; p = 0.04); also, the lymph node affectation was greater in MFMC group (4.06 versus 1.83 lymph nodes; p = 0.001). There were no statistical significant differences in 5 years survival when comparing unifocal and MFMC tumors (81.8% and 90.4%, respectively; p = 0.223). There were no differences on 5 years free metastasis survival between both groups (Unifocals 86.2%; MFMC 75%; p = 0.651). Discussion: MFMC breast cancer was associated to bad prognostic factors, nevertheless, there was not significant differences in 5 years metastasis free survival and global survival between both groups, reason why multifocality-multicentricity would not confer worse prognosis to the disease.Key words: Breast cancer, multifocality, multicentricity, survival, prognosis. ResumenLa patología mamaria maligna puede manifestarse como tumores unifocales o multifocalesmulticéntricos (MFMC). La influencia de este factor en el pronóstico es controversial. Objetivo: Establecer si la presencia de cáncer de mama MFMC se asocia a peor pronóstico. Pacientes y Método: Cohorte combinada prospectiva-retrospectiva de 589 pacientes sometidas a cirugía por cáncer de mama en el HospiRev.

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Section: Discussionunclassified

“…Ahora bien, consideramos importante señalar que el último consenso del American Joint Committee on Cancer en cuanto a la clasificación TNM de las neoplasias malignas de mamapero hay otros estudios que señalan que de esta forma se subestima el compromiso locorregional de la enfermedad 4,12 , y por ende, la etapa clínica y el pronóstico de la misma.…”

Section: Discussionunclassified

Cánceres de mama multifocales-multicéntricos: ¿Son realmente de peor pronóstico?

C²,

R³

et al. 2009

Rev Chil Cir

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“…However, when we examined the group of patients without tumor multiplicity separately, the impact of MIB-1 expression on the risk of Lymph node metastasis was confirmed (data not shown). The influence of tumor multiplicity on axillary status has been reported in several studies (26). This may be due to a higher tumor volume in multicentric or multifocal tumors, where pT stage is classified according to the size of the dominant lesion, with respect to unifocal lesions.…”

Section: -------------------------------------------------mentioning

confidence: 96%

Mib-1 proliferation index is an independent predictor of lymph node metastasis in invasive breast cancer: A prospective study on 675 patients

Marrelli

Pinto²,

Neri³

et al. 2006

Oncol Rep

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Abstract. In order to evaluate the potential risk factors for Lymph node metastasis in invasive breast cancer patients submitted to axillary dissection, 675 patients who received surgery between January 1995 and December 2002 were included in a prospective study. In all cases, MIB-1 proliferation index was investigated by immunohistochemistry. Lymph node involvement was found in 248 out of 675 patients. Univariate analysis showed that peritumoral lymphovascular invasion, pT stage, tumor multiplicity, MIB-1 proliferation index >10%, oestrogen receptor status, histological type, tumor grade and progesterone receptor status were related to a higher incidence of Lymph node metastasis, with various levels of statistical significance. Multivariate analysis identified lymphovascular invasion [relative risk (RR, 7.69; p<0.001), pT stage (RR, 3.08; p<0.001), tumor multiplicity (RR, 3.89; p<0.001), and MIB-1 proliferation index (RR, 1.66; p=0.019)] as independent predictive variables. The impact of MIB-1 positivity on the incidence of Lymph node metastasis was particularly evident in intermediate risk groups (pT1c, pT2 without lymphovascular invasion), as well as in grade-2 tumors. In conclusion, the MIB-1 proliferation index could provide additional information about the risk of Lymph node metastasis in invasive breast cancer, and may be useful to identify grade-2 tumors with a more aggressive clinical behaviour. IntroductionNodal status is a strong prognostic factor in breast cancer and is one of the most important variables considered in deciding on adjuvant treatment after surgery. Sentinel node biopsy, although not the standard of care, is rapidly becoming widely accepted as an alternative staging procedure for the axilla in breast cancer. However, in subgroups of patients with a high risk of Lymph node metastasis, this procedure may not provide a clinical benefit and may involve a waste of resources as, in a high percentage of cases, it is followed by axillary dissection. The definition of tumor characteristics that are predictive of Lymph node metastasis may be useful in order to better select which patients to submit to axillary surgery (1).Besides commonly used pathological factors, cell proliferation has an important role as an indicator of biological aggressiveness in breast cancer. Ki-67 antibody reacts with a nuclear antigen which is present in G1, S, G2 phases and mitosis but is absent in G0 and is therefore considered a marker of the proliferative activity of the tumor (2). Unfortunately, the epitope that recognizes Ki-67 is destroyed in the fixation and paraffin embedding process. More recently, the MIB-1 antibody, which recognizes Ki-67 antigen in formalin-fixed, paraffin-embedded tissue, has been described and applied to breast cancer (3,4).Several studies have investigated the role of the proliferation index in breast cancer patients and a strong correlation between the MIB-1 labelling index and Lymph node metastasis has been reported (5,6), although this finding has not been confirmed by others (7-10)....

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“…The first author who referred to the presence of multiple breast tumors was John Hunter, in 1839, in "Lectures on the Principles of Surgery", where he suggested the possibility that the multifocality of breast carcinoma originated in multiple foci within the same breast that were rarely detected simultaneously (7). Since then, various definitions have been applied to report these tumors, but the clinical significance by using different definitions is still unknown (3,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Section: Definition and Terminologymentioning

confidence: 99%

“…Most of these authors only took into account grossly visible foci and ignored microscopic foci. Other authors (12,13,14,29) used both terms together, without making a difference between MF and MC by avoiding "quantitative" delimitations. They considered breast carcinomas to be multiple when multiple invasive foci separated by benign breast tissue are seen, regardless of the distance between foci; topographic criteria and distance between tumor foci are considered by these authors to be parameters of debatable biological significance (5).…”

Section: Definition and Terminologymentioning

confidence: 99%

Review on Practical Approach in Multiple Breast Carcinomas: Does Each Focus Matter?

Boros¹,

Georgescu²,

Podoleanu³

et al. 2017

chr

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RezumatCarcinomul mamar reprezintă cea mai frecventă tumoră malignă ce se dezvoltă la sexul feminin. De obicei, este o tumoră unică dar, uneori, poate fi multiplă. Datele din literatură cu privire la incidenţa, definiţia, profilul morfologic şi molecular, tratamentul şi prognosticul carcinoamelor mamare multiple sunt contradictorii, de aceea, acest articol prezintă o abordare practică pentru cei implicaţi în diagnosticul şi tratamentul unei astfel de leziuni care, poate prezenta heterogeneitate morfologică şi moleculară, acest lucru având un impact asupra managementului şi prognosticului. De aceea, este esenţial ca focarele tumorale multiple să se raporteze separat şi să fie luate în considerare în momentul unei decizii terapeutice.Cuvinte cheie: focare tumorale multiple, carcinom mamar Abstract Breast carcinoma is the most frequent form of cancer encountered in women worldwide. In the routine practice, most of breast carcinomas are diagnosed as unifocal, however, a variable proportion is represented by multiple tumor foci. Since data regarding the incidence, definition, morphological and molecular profile, treatment and

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Assessment of tumor size for multifocal primary breast cancer

Abstract: For patients with multifocal disease, the significance association with mortality for total surface area or volume may imply a biologic relevance or mode of tumor activity for the foci.

Cited by 39 publications

References 5 publications

Cánceres de mama multifocales-multicéntricos: ¿Son realmente de peor pronóstico?

Cánceres de mama multifocales-multicéntricos: ¿Son realmente de peor pronóstico?

Mib-1 proliferation index is an independent predictor of lymph node metastasis in invasive breast cancer: A prospective study on 675 patients

Review on Practical Approach in Multiple Breast Carcinomas: Does Each Focus Matter?

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