Increased Lymph Node Positivity in Multifocal and Multicentric Breast Cancer

Cabıoğlu, Neslihan; Özmen, Vahit; Kaya, Hakan; Tuzlali, Sıtkı; İğci, Abdullah; Müslümanoğlu, Mahmut; Keçer, Mustafa; Dağoğlu, Türkan

doi:10.1016/j.jamcollsurg.2008.09.001

Cited by 73 publications

(81 citation statements)

References 27 publications

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“…The 24 studies had retrospective observational designs, comprising 17 comparative studies20, 21, 22, 23 27, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43 and seven case series28 44, 45, 46, 47, 48, 49 ( Table 1; Table S1, supporting information). The studies included a total of 3537 women with MIBC undergoing BCS: 2677 with tumours defined as MF, 292 as MC, and 568 not defined as either MF or MC, but reported as MIBC.…”

Section: Resultsmentioning

confidence: 99%

“…The studies included a total of 3537 women with MIBC undergoing BCS: 2677 with tumours defined as MF, 292 as MC, and 568 not defined as either MF or MC, but reported as MIBC. Assessment of the observational studies using the NOS showed that three20 27, 43 were of high quality (score at least 7) and 1421, 22, 23 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 of moderate quality (score 4–6) ( Table S2, supporting information).…”

Section: Resultsmentioning

confidence: 99%

“…Seventeen studies20 21, 27 28, 32 34, 35, 36, 37 40, 41, 42 44, 46, 47, 48, 49 were from single centres, four33 38, 39 45 involved two centres, and there were three multicentre studies22 23, 43 comprising a regional cancer registry (British Columbia Cancer Agency)43, a German regional study group (BRENDA Study Group: Breast Cancer Care under Evidence‐based Guidelines)23 and a substudy within three multicentre RCTs of neoadjuvant chemotherapy (German Breast Group (Gepar) trials)22 ( Table 1; Table S1, supporting information).…”

Section: Resultsmentioning

confidence: 99%

“…Studies reported varied inclusion criteria for MIBC. Twelve studies20 23, 27 32, 34 36, 37 40, 42 43, 48 49 based inclusion on TNM staging, with three of these23 32, 42 mandating inclusion by size of the largest cancer. Another six studies21 28, 39 44, 46 47 used the feasibility of BCS to define eligibility.…”

Section: Resultsmentioning

confidence: 99%

“…Yerushalmi and colleagues43 used a matched analysis (3 : 1) of clinicopathological characteristics, accounting for three times more unifocal cancers than MIBC. Retrospective study designs made it difficult to compare clinical data, compounded by significantly larger numbers of unifocal cancers20, 21, 22, 23 41, 42. With the exception of one recent study22, no studies reported the distribution of molecular subtypes (luminal A, luminal B, non‐luminal HER2, basal and triple‐negative).…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Winters¹,

Horsnell

Elvers

et al. 2018

BJS Open

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BackgroundThe clinical effectiveness of treating ipsilateral multifocal (MF) and multicentric (MC) breast cancers using breast‐conserving surgery (BCS) compared with the standard of mastectomy is uncertain. Inconsistencies relate to definitions, incidence, staging and intertumoral heterogeneity. The primary aim of this systematic review was to compare clinical outcomes after BCS versus mastectomy for MF and MC cancers, collectively defined as multiple ipsilateral breast cancers (MIBC).MethodsComprehensive electronic searches were undertaken to identify complete papers published in English between May 1988 and July 2015, primarily comparing clinical outcomes of BCS and mastectomy for MIBC. All study designs were included, and studies were appraised critically using the Newcastle–Ottawa Scale. The characteristics and results of identified studies were summarized.ResultsTwenty‐four retrospective studies were included in the review: 17 comparative studies and seven case series. They included 3537 women with MIBC undergoing BCS; breast cancers were defined as MF in 2677 women, MC in 292, and reported as MIBC in 568. Six studies evaluated MIBC treated by BCS or mastectomy, with locoregional recurrence (LRR) rates of 2–23 per cent after BCS at median follow‐up of 59·5 (i.q.r. 56–81) months. BCS and mastectomy showed apparently equivalent rates of LRR (risk ratio 0·94, 95 per cent c.i. 0·65 to 1·36). Thirteen studies compared BCS in women with MIBC versus those with unifocal cancers, reporting LRR rates of 2–40 per cent after BCS at a median follow‐up of 64 (i.q.r. 57–73) months. One high‐quality study reported 10‐year actuarial LRR rates of 5·5 per cent for BCS in 300 women versus 6·5 per cent for mastectomy among 887 women.ConclusionThe available studies were mainly of moderate quality, historical and underpowered, with limited follow‐up and biased case selection favouring BCS rather than mastectomy for low‐risk patients. The evidence was inconclusive, weakening support for the St Gallen consensus and supporting a future randomized trial.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Winters¹,

Horsnell

Elvers

et al. 2018

BJS Open

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Multifocal breast cancer documented in large‐format histology sections

Pekár

Hofmeyer

Tabár

et al. 2012

Cancer

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BACKGROUND:The prognostic significance of molecular phenotype in breast cancer is well established in the literature. Recent studies have demonstrated that subgross lesion distribution (unifocal, multifocal, and diffuse) and disease extent also carry prognostic significance in this disease. However, the correlation of molecular phenotypes with subgross parameters has not yet been investigated in detail. METHODS: In total, 444 consecutive invasive breast cancers that were documented in large-format histology slides and worked up with detailed radiologic-pathologic correlation were sampled into tissue microarray blocks and stained immunohistochemically to delineate the molecular subtypes. RESULTS: Diffuse or multifocal distribution of the invasive component of breast carcinomas in this series was associated with a 4.14-fold respectively 2.75-fold risk of cancer-related death compared with unifocal tumors irrespective of molecular phenotype. Patients who had human epidermal growth factor receptor 2 (HER2)-positive cancers; estrogen receptor-negative, progesterone receptor-negative, and HER2-negative (triple-negative) cancers; or basal-like cancers had a 2.18-fold, 2.33-fold, and 4.07-fold risk of dying of disease, respectively, compared with patients who had luminal A carcinomas. Unifocal luminal A, HER2-positive, and basal-like cancers were associated with significantly better long-term survival outcomes than their multifocal or diffuse counterparts; luminal B and triple-negative tumors also had the same tendency. In multivariate analysis, patient age, tumor size category, lymph node status, lesion distribution, and molecular phenotypes remained significant. CONCLUSIONS: Multifocality and diffuse distribution of the invasive component were associated with significantly poorer survival in women with breast carcinomas compared with unifocal disease in patients with luminal A, HER2 type, and basal-like cancers. Molecular classification of breast cancer is a powerful tool but gains in power when combined with conventional and subgross morphologic parameters. Cancer 2013;119:1132-9. V C 2012 American Cancer Society.KEYWORDS: breast, breast cancer, multifocality, diffuse, molecular phenotypes, survival. INTRODUCTIONBreast cancer mortality has decreased significantly in countries that have organized, population-based mammography screening 1 ; however, despite using the most recent diagnostic tools and modern therapeutic regimens, women are still dying from this disease. Therefore, exploring the prognostic information generated by radiologic, histologic, and molecular tumor characteristics is essential to facilitate individualized treatment and further decrease disease-specific mortality.Patient age, tumor size, histologic grade, and lymph node status still remain powerful prognostic indicators in patients with breast cancer.2,3 On the other hand, many second-generation prognostic parameters have emerged and have been introduced into routine practice, and the most prominent are estrogen receptor (ER), progesterone recepto...

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Uncovering the genomic heterogeneity of multifocal breast cancer

Desmedt

Fumagalli

Pietri

et al. 2015

The Journal of Pathology

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Multifocal breast cancer (MFBC), defined as multiple synchronous unilateral lesions of invasive breast cancer, is relatively frequent and has been associated with more aggressive features than unifocal cancer. Here, we aimed to investigate the genomic heterogeneity between MFBC lesions sharing similar histopathological parameters. Characterization of different lesions from 36 patients with ductal MFBC involved the identification of non‐silent coding mutations in 360 protein‐coding genes (171 tumour and 36 matched normal samples). We selected only patients with lesions presenting the same grade, ER, and HER2 status. Mutations were classified as ‘oncogenic’ in the case of recurrent substitutions reported in COSMIC or truncating mutations affecting tumour suppressor genes. All mutations identified in a given patient were further interrogated in all samples from that patient through deep resequencing using an orthogonal platform. Whole‐genome rearrangement screen was further conducted in 8/36 patients. Twenty‐four patients (67%) had substitutions/indels shared by all their lesions, of which 11 carried the same mutations in all lesions, and 13 had lesions with both common and private mutations. Three‐quarters of those 24 patients shared oncogenic variants. The remaining 12 patients (33%) did not share any substitution/indels, with inter‐lesion heterogeneity observed for oncogenic mutation(s) in genes such as PIK3CA, TP53, GATA3, and PTEN. Genomically heterogeneous lesions tended to be further apart in the mammary gland than homogeneous lesions. Genome‐wide analyses of a limited number of patients identified a common somatic background in all studied MFBCs, including those with no mutation in common between the lesions. To conclude, as the number of molecular targeted therapies increases and trials driven by genomic screening are ongoing, our findings highlight the presence of genomic inter‐lesion heterogeneity in one‐third, despite similar pathological features. This implies that deeper molecular characterization of all MFBC lesions is warranted for the adequate management of those cancers. © 2015 The Authors. Pathological Society of Great Britain and Ireland.

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Increased Lymph Node Positivity in Multifocal and Multicentric Breast Cancer

Cited by 73 publications

References 27 publications

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Multifocal breast cancer documented in large‐format histology sections

Uncovering the genomic heterogeneity of multifocal breast cancer

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