Pathologic analysis of tumor size and lymph node status in multifocal/multicentric breast carcinoma

Abstract

BACKGROUND For unifocal invasive breast carcinoma, increasing tumor diameter predictably correlates with a greater frequency of lymph node involvement, thereby facilitating treatment decisions. In invasive breast tumors presenting with multiple nodules, however, it is unclear whether tumor size correlates with lymph node dissemination in a similar manner. METHODS The authors analyzed a series of 101 invasive breast carcinomas presenting with multiple macroscopically apparent lesions (2 foci: n = 77; 3: n = 20; 4: n = 4). Two different assessments of the tumor size (diameter of largest focus and combined diameter of all the foci) were then correlated with the status of axillary lymph nodes. For comparison with unifocal tumors, the authors used both external and internal control series (the latter consisting of 469 patients from their institution). The associations between lymph node status, tumor size, and multifocality were modeled using univariate and multivariate logistic regression, for each modality of tumor size assessment. RESULTS The logistic curves for multifocal and unifocal tumors were significantly different when the largest diameter was used as a tumor size estimate. Multifocal cases had higher frequencies of lymph node involvement than unifocal lesions of similar size category. In a multivariate logistic regression, the odds ratio of positive lymph node status in multifocal versus unifocal cases was 2.8 using largest diameter as a tumor size estimate (P < 0.0001). When the combined diameter assessment was used, however, the regression curve of multifocal cases was similar to that of unifocal cases, and the frequency of lymph node positivity was not significantly different in multifocal versus unifocal cases of the same size (odds ratio, 1.4; P = 0.13). CONCLUSIONS The authors' results show that, if aggregate diameters are used, unifocal and multifocal breast carcinomas are similar with respect to frequency of regional lymph node metastasis. Currently used algorithms, which use the diameter of the largest nodule, result in understaging of multifocal breast carcinomas due to underestimation of actual tumor size. Cancer 2002;94:1383–90. © 2002 American Cancer Society. DOI 10.1002/cncr.10331

Clinical relevance of the distribution of the lesions in 500 consecutive breast cancer cases documented in large‐format histologic sections

“…These findings indicate a greater propensity of multifocal tumors to disseminate compared with unifocal ones and are in concordance with the results of Coombs and Boyages, 7 who also reported a statistically significant difference in the proportion of lymph nodepositive cases between unifocal and multifocal breast carcinomas (37.5% and 52.1%, respectively) as well as with the results of some other related studies. 5,6 LVI was clearly found to be associated with lymph node metastasis in the current study. These findings as well as the proportion of cases with LVI were comparable to the results in many other publications.…”

“…Despite the well-recognized importance of the distribution of cancer within the breast for optimizing breast-conserving surgery, 4 there are conflicting results in the related literature regarding the significance of breast cancer multifocality, depending on the methodologic limitations and the various definitions used lacking a wide international consensus. [1][2][3][5][6][7][8][9][10][11][12][13][14] The diffuse growth pattern of some highly aggressive breast carcinomas 10 remains mainly unrecognized.…”

Conservative surgery in patients with multifocal/multicentric breast cancer

“…The distance between tumors should also be regarded with caution, as overall proportion with breast size should be also taken into account. It is interesting to note that despite the high rate of node metastases (55% of the patients), as expected in MF/MC breast cancer [15,16], distant metastases occurred in only 10.7% of the patients. One might speculate that the high rate of endocrine-responsive tumours in this series (87.6%), which is probably related to the high prevalence of invasive lobular carcinomas, might lead to a better outcome following adequate adjuvant treatment at least during the first 5 years.…”

Prevalence and predictive factors for the detection of carcinoma in cavity margin performed at the time of breast lumpectomy

“…Bi-or multifocality was defined by the presence of two or more foci of invasive carcinoma separated by normal tissue. 14 In cases of subsequent re-excisions, the specimen was completely embedded. In cases of subsequent mastectomies, specimens were sliced at 0.5-1 cm intervals and all suspicious areas were sampled for histological examination.…”