Surgery for T4 Breast Carcinoma: Implications for Local Control

Yeh, Karen A.; Jillella, Anand; Wei, J. P.

doi:10.1177/000313480006600305

Cited by 3 publications

(1 citation statement)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The only other study that has focused specifically on management of women with T4 breast carcinoma is by Yeh et al 4 The incidence of local recurrence was 11 per cent in their patients, compared to only 3 per cent in our patients. This may be partially explained by the fact that only about one-fourth of their patients had metastatic disease at presentation, versus nearly onehalf in the current study.…”

Section: Table 2 Treatment and Survivalcontrasting

confidence: 60%

Management of Women who Present with T4 Breast Cancer

Poole

Thigpen²,

Vance³

et al. 2004

The American Surgeon

View full text Add to dashboard Cite

The purpose of this study was to review the clinical presentation and outcome of women who present with large or locally invasive (T4) breast carcinoma. This retrospective study was conducted at the University of Mississippi Medical Center, a state tertiary care referral institution. One hundred twenty-nine women between the ages of 28 and 85 years (mean, 55 years) presented with T4 breast carcinoma. Follow-up was available for 128 women. Only 23 women have survived (18%), 5 of whom (21.7%) have metastatic disease. Mean survival for those who died was 21.6 months, compared to 76.3 months for survivors. Survival was not influenced by tumor characteristics ( P > 0.5), but was strongly influenced by nodal status ( P < 0.001) and by the presence of metastases at the time of diagnosis ( P < 0.001). Survival was strongly related to mode of therapy ( P < 0.01), but this was principally related to very high mortality rates in women who received no therapy (100%), surgery only (92.3%), or chemotherapy only (95%). The best survival was seen in women who received chemotherapy prior to surgery (40%); their survival was superior to that of women treated initially by surgery, followed by chemotherapy (16.3%, P = 0.04). However, when women who presented with metastatic disease were excluded, survival was not different between these two groups ( P = 0.18). Despite public education efforts and the wide availability of screening programs for breast carcinoma, many women still present with locally advanced disease. Outcome can be favorable in the absence of node involvement or metastatic disease, even in the presence of large, fungating tumors. Multimodality therapy gives the best results, but early surgery may be required for progression of disease during chemotherapy or because of extensive ulceration at initial presentation.

show abstract

Section: Table 2 Treatment and Survivalcontrasting

confidence: 60%

Management of Women who Present with T4 Breast Cancer

Poole

Thigpen²,

Vance³

et al. 2004

The American Surgeon

View full text Add to dashboard Cite

show abstract

T4 breast cancer under closer inspection: A case for revision of the TNM classification

et al. 2007

View full text Add to dashboard Cite

The presence of skin involvement in breast cancer results in the classification of the tumor into the highest tumor category, and accordingly into the highest non-metastatic disease stage (current TNM classification: T4/stage III). This traditional view is no longer justifiable, as tumors that show non-inflammatory skin involvement (T4b) make up a considerably heterogeneous group with a high percentage of small-sized tumors. Classifying all lesions demonstrating this feature together results in the combination of tumors with widely differing prognostic and therapeutic implications into a single group. This violates the basic principle of the TNM concept in that only tumors exhibiting similar extension and prognosis should be grouped into one category/stage. Furthermore, the currently valid definitions of non-inflammatory skin involvement are misconceived for the substantial group of small tumors which often have ambiguous morphologic findings: the clinical classification depends on the subjective perception of the individual observer, and the pathologic staging considers histologic criteria that are not justifiable from a functional-morphological point of view. For these reasons, we strongly feel that there is a need to revise the current T4 category. We recommend that breast carcinomas currently classified as T4a-c should be eliminated from the T4 category and classified simply according to their tumor size (T1-3). The prognostically very unfavorable inflammatory carcinoma (T4d) should be maintained as the only clinicopathologic entity in the T4 category. This proposal, which will also lead to a revision of the stage III group, adheres more closely to the goals and principles of the TNM classification than do the current classification guidelines. Through the revision of the T4 category, the definitions and guidelines of inflammatory breast carcinoma should be adapted to the internationally accepted nomenclature.

show abstract