Tumor Size and Lymph Node Status in Multifocal Breast Cancer

Abstract

Tumor size correlates with lymph node metastasis in breast cancer. In multifocal lesions there is controversy about considering the summation of the largest diameter of each tumor. A total of 122 patients with multifocal breast cancer were compared in a retrospective study with 177 patients with unifocal tumors, correlating tumor size with lymph node metastasis. In multifocal tumors, two sizes were considered: the diameter of the largest tumor and the combined diameter of all lesions. Relationship was established by three different logistic models using variables such as age, number of lesions, histologic type, and grade. At a same size of the largest diameter of a unifocal or multifocal lesions and the combined diameter of a multifocal lesion, the latter shows less probability of nodal metastasis indicating that combined diameter is an overestimation of the lesion size. Our results indicate that in multifocal breast cancer, only the diameter of the largest tumor breast cancer has relationship with lymph node metastasis.

Computer-aided interpretation of dynamic magnetic resonance imaging reflects histopathology of invasive breast cancer

“…Furthermore, automatically calculated larger lesion volumes as well as voxel type subvolumes were associated with a higher locoregional metastasis rate. This finding is in agreement with previous publications on tumour size and nodal metastasis [22]. Aside from nodal status, hormone receptor and HER-2/neu status of invasive carcinomas were significantly influenced by enhancement characteristics in our study.…”

The distribution of lesions in 1–14-mm invasive breast carcinomas and its relation to metastatic potential

“…In multifocal tumors, however, using the combined diameter of the invasive foci has been proposed as being more accurate than using the largest dimension of the largest invasive focus [20,21]. Recent studies have not confirmed the value of using a combined diameter to define these tumors [22,23]; thus, in the present study, we used the standard definition, i.e., the largest dimension of the largest invasive focus, to define tumor size.…”

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

“…In contrast to their findings, some recent studies could not show any association of tumor multifocality and lymph node status. 9 These studies also pointed to the importance of tumor size in multifocal cancers, which appears to be an independent prognostic factor. The results of the current study also demonstrated some differences in tumor size between unifocal and multifocal lesions, but was focused on testing the importance of tumor distribution and extent.…”

“…Such studies are usually based on a traditional morphologic workup focused on macroscopically observed dominant masses and are characterized by a low proportion of multifocal cases and a lack of significant differences between 'unifocal' and 'multifocal' cancers. 8,9 With such an approach, the lesion in Figure 2 would have been classified as 'unifocal.' Defining multifocality using distance between the individual foci appears to impede the ability to obtain comparable and significant results, first because the biologic importance of a distance is hard to test, but also because it is impossible to achieve consensus regarding the required amount of millimeters.…”

“…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.…”