1
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Özkurt E, Wong S, Rhei E, Golshan M, Brock J, Barbie TU. Omission of Surgical Axillary Lymph Node Staging in Patients with Tubular Breast Cancer. Ann Surg Oncol 2020; 28:2589-2598. [PMID: 33078312 DOI: 10.1245/s10434-020-09223-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/15/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND With more effective screening and treatment strategies, there is debate over whether surgical axillary staging should be deescalated for patients with small favorable breast cancers, such as tubular carcinoma (TC). PATIENTS AND METHODS We identified patients with TC [defined as > 90% tubular tubules (angulated, not multilayered)] and known surgical axillary staging from our institutional database (2000-2018). Using the National Cancer Database (NCDB) (2004-2015), we identified patients with TC, ductal carcinoma in situ (DCIS), and pT1 estrogen receptor (ER)-positive invasive ductal carcinoma (IDC). We determined the rates of lymph node (LN) metastases, and the 5- and 10-year overall survival (OS) for patients with LN-negative versus LN-positive disease using the Kaplan-Meier method and propensity match analysis. RESULTS In our institutional cohort, we identified 112 patients with T1 TC; only one (0.9%) patient had nodal involvement. In the NCDB cohort, we identified 6938 patients with T1 TC; 323 (4.7%) patients had axillary LN disease. The rate of axillary LN involvement for TC was comparable to that identified for patients with DCIS (4.2%), and much lower than that found for patients with grade I-III, T1, ER-positive IDC (20.5%), and patients with grade I, T1, ER-positive IDC (14.4%). There was no difference in 5-year (94.6% versus 95.4%, p = 0.67) and 10-year (83.9% versus 85.2%, p = 0.98) OS between TC patients with or without LN involvement. Kaplan-Meier survival curves even after propensity score matching suggest that tubular histology is independently associated with improved survival. CONCLUSIONS T1 TC is an excellent starting point for deescalation of surgical axillary staging.
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Affiliation(s)
- Enver Özkurt
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.,Breast Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Topkapi, Istanbul, Turkey
| | - Stephanie Wong
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.,Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Esther Rhei
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.,Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Mehra Golshan
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.,Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Jane Brock
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Thanh U Barbie
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA. .,Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
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2
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Abdelwahed A, Ahmed M. Rare epithelial breast cancer: surgery and adjuvant therapy. Transl Cancer Res 2019; 8:S479-S492. [PMID: 35117126 PMCID: PMC8797705 DOI: 10.21037/tcr.2019.05.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/10/2019] [Indexed: 01/30/2023]
Abstract
Breast cancer is a heterogenous disease, exhibiting a wide range of morphological phenotypes shaping its prognosis and clinical course. However, optimal management of rarer breast cancer subtypes is often undefined and controversial in literature due to the lack of large studies and randomised trials. This review aims to discuss the treatment of 13 rare epithelial subtypes, focussing on surgery and adjuvant therapies.
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Affiliation(s)
| | - Muneer Ahmed
- King's College London, Division of Cancer, Research Oncology, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
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3
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Chen JX, Zhang WW, Dong Y, Sun JY, He ZY, Wu SG. The effects of postoperative radiotherapy on survival outcomes in patients under 65 with estrogen receptor positive tubular breast carcinoma. Radiat Oncol 2018; 13:226. [PMID: 30458816 PMCID: PMC6247775 DOI: 10.1186/s13014-018-1177-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/07/2018] [Indexed: 01/27/2023] Open
Abstract
Background The value of postoperative radiotherapy in tubular breast carcinoma patients under 65 years is uncertain. Methods Data on patients with estrogen receptor positive T1N0M0 tubular breast carcinoma who were younger than 65 years and who received breast-conserving surgery between 2000 and 2013 were retrieved from the Surveillance, Epidemiology and End Results database. Demographic, clinicopathologic features, and receipt of postoperative radiotherapy were analyzed to investigate effects on survival. Results Data from 2442 patients were analyzed, of whom 2020 (82.7%) received postoperative radiotherapy and 422 (17.3%) did not. The number of patients treated with or without postoperative radiotherapy showed no differences during the study period (p = 0.184). Radiotherapy was more likely to be administered in patients with well differentiated tumors. Multivariate Cox analysis showed that postoperative radiotherapy delivery was significantly correlated with better breast cancer-specific survival (BCSS) (hazard ratio [HR] 0.297, 95% confidence interval [CI] 0.105–0.836, p = 0.022) and overall survival (OS) (HR 0.656, 95% CI 0.441–0.978, p = 0.038). Ten 10-year BCSS was 99.3% in patients who received postoperative radiotherapy and 98.1% in those who did not (p = 0.020), and 10-year OS was 93.4 and 91.0%, respectively (p = 0.029). Postoperative radiotherapy increased BCSS and OS in the subgroups of age < 50 years, non-Hispanic white, well differentiated tumors, and progesterone receptor positive tumors. Conclusions Postoperative radiotherapy after breast-conserving surgery improved survival outcomes in tubular breast carcinoma patients aged < 50 years. However, omitting postoperative radiotherapy may not decrease survival in patients aged ≥50 years.
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Affiliation(s)
- Jian-Xian Chen
- Department of Oncology, Division of Chemotherapy, the People's Hospital of Baise, Baise, 533000, People's Republic of China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Yong Dong
- Department of Oncology, the 3rd People's Hospital of Dongguan City, Dongguan, 523326, People's Republic of China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China.
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, the First Affiliated Hospital of Xiamen University, Xiamen, 361003, People's Republic of China.
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4
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Sun JY, Zhou J, Zhang WW, Li FY, He ZY, Wu SG. Tubular carcinomas of the breast: an epidemiologic study. Future Oncol 2018; 14:3037-3047. [PMID: 29989443 DOI: 10.2217/fon-2018-0385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM We explored the clinicopathologic characteristics, prognostic factors and outcomes in tubular carcinoma (TC) of the breast. METHODS We retrospectively assessed 8091 TC patients using the SEER database from 2000 to 2013. RESULTS Most patients were non-Hispanic white, well-differentiated disease, tumor size ≤2 cm, node-negative, nonmetastatic, hormone receptor-positive and HER2-negative status. The 10-year breast cancer-specific survival and overall survival were 98.1 and 82.0%, respectively. Multivariate analysis indicated that age, ethnicity, surgery procedures, radiotherapy and chemotherapy were independent predictors affecting survival outcomes. There was comparable breast cancer-specific survival between surgery and nonsurgery groups. CONCLUSION The patients with TC has excellent survival outcomes, which may in part be due to the favorable tumor characteristics.
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Affiliation(s)
- Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - Juan Zhou
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xiamen University, Xiamen 361003, PR China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - Feng-Yan Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, the First Affiliated Hospital of Xiamen University, Xiamen 361003, PR China
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5
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Ramzi S, Hyett EL, Wheal AS, Cant PJ. The case for the omission of axillary staging in invasive breast carcinoma that exhibits a predominant tubular growth pattern on preoperative biopsy. Breast J 2018; 24:493-500. [DOI: 10.1111/tbj.13000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Saed Ramzi
- Primrose Beast Care Centre; Derriford Hospital; Plymouth UK
| | | | - Abigail S. Wheal
- Department of Cellular & Anatomical Pathology; Derriford Hospital; Plymouth UK
| | - Peter J. Cant
- Primrose Beast Care Centre; Derriford Hospital; Plymouth UK
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6
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Comparison of failure patterns between tubular breast carcinoma and invasive ductal carcinoma (KROG 14-25). Breast 2018; 38:165-170. [PMID: 29413404 DOI: 10.1016/j.breast.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/03/2018] [Accepted: 01/21/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Information on tubular carcinoma (TC) of breast is limited due to its rarity. A multi-institutional study was performed to investigate the prognosis and failure patterns of TC compared to invasive ductal carcinoma (IDC). MATERIALS AND METHODS We collected retrospective data on 205 patients with TC from eleven institutions. For each TC case, 3 cases with IDC were matched according to similar size, t-stage, and n-stage from the same institution. Patterns of failure, disease free survival (DFS) and overall survival (OS) were assessed and compared between the groups. RESULTS DFS at 5 years was 98.8% and 97.3% and OS at 5 years was 99.5% and 99.6% in TC and IDC, respectively. Among the patients with TC, 5 patients (2.4%) developed contralateral breast cancer, while 3 patients (0.5%) presented with contralateral breast cancer in patients with IDC. CONCLUSIONS The TC of breast presents an excellent prognosis, but the contralateral breast cancer tends to be more frequently observed compared to IDC in Korean women.
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7
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Poirier É, Desbiens C, Poirier B, Boudreau D, Jacob S, Lemieux J, Doyle C, Diorio C, Hogue JC, Provencher L. Characteristics and long-term survival of patients diagnosed with pure tubular carcinoma of the breast. J Surg Oncol 2017; 117:1137-1143. [DOI: 10.1002/jso.24944] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/07/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Éric Poirier
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de Chirurgie; Université Laval; Pavillon Ferdinand-Vandry Quebec City QC Canada
| | - Christine Desbiens
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de Chirurgie; Université Laval; Pavillon Ferdinand-Vandry Quebec City QC Canada
| | - Brigitte Poirier
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de Chirurgie; Université Laval; Pavillon Ferdinand-Vandry Quebec City QC Canada
| | - Dominique Boudreau
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de Chirurgie; Université Laval; Pavillon Ferdinand-Vandry Quebec City QC Canada
| | - Simon Jacob
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de biologie moléculaire; biochimie médicale et pathologie; Université Laval; Pavillon Ferdinand-Vandry; Quebec City QC Canada
- Service de Pathologie; Hôpital du St-Sacrement; CHU de Québec; Quebec City QC Canada
| | - Julie Lemieux
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de Médecine, Université Laval; Pavillon Ferdinand-Vandry; Quebec City QC Canada
- Centre universitaire d'hématologie et d'oncologie de Québec; Quebec City QC Canada
| | - Catherine Doyle
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de Médecine, Université Laval; Pavillon Ferdinand-Vandry; Quebec City QC Canada
- Centre universitaire d'hématologie et d'oncologie de Québec; Quebec City QC Canada
| | - Caroline Diorio
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
| | - Jean-Charles Hogue
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
| | - Louise Provencher
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de Chirurgie; Université Laval; Pavillon Ferdinand-Vandry Quebec City QC Canada
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8
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Munzone E, Giobbie-Hurder A, Gusterson BA, Mallon E, Viale G, Thürlimann B, Ejlertsen B, MacGrogan G, Bibeau F, Lelkaitis G, Price KN, Gelber RD, Coates AS, Goldhirsch A, Colleoni M. Outcomes of special histotypes of breast cancer after adjuvant endocrine therapy with letrozole or tamoxifen in the monotherapy cohort of the BIG 1-98 trial. Ann Oncol 2015; 26:2442-9. [PMID: 26387144 DOI: 10.1093/annonc/mdv391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 09/14/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We investigated the outcomes of postmenopausal women with hormone receptor-positive, early breast cancer with special histotypes (mucinous, tubular, or cribriform) enrolled in the monotherapy cohort of the BIG 1-98 trial. PATIENTS AND METHODS The intention-to-treat BIG 1-98 monotherapy cohort (5 years of therapy with tamoxifen or letrozole) included 4922 women, of whom 4091 had central pathology review. Histotype groups were defined as: mucinous (N = 100), tubular/cribriform (N = 83), ductal (N = 3257), and other (N = 651). Of 183 women with either mucinous or tubular/cribriform tumors, 96 were randomly assigned to letrozole and 87 to tamoxifen. Outcomes assessed were disease-free survival (DFS), overall survival (OS), breast cancer-free interval (BCFI), and distant recurrence-free interval (DRFI). Median follow-up in the analytic cohort was 8.1 years. RESULTS Women with tubular/cribriform breast cancer had the best outcomes for all end points compared with the other three histotypes, and had less breast cancer recurrence (97.5% 5-year BCFI) than those with mucinous (93.5%), ductal (88.9%), or other (89.9%) histotypes. Patients with mucinous or tubular/cribriform carcinoma had better DRFI (5-year rates 97.8% and 98.8%, respectively) than those with ductal (90.9%) or other (92.1%) carcinomas. Within the subgroup of women with special histotypes, we observed a nonsignificant increase in the hazard of breast cancer recurrence with letrozole [hazard (letrozole versus tamoxifen): 3.31, 95% confidence interval 0.94-11.7; P = 0.06]. CONCLUSIONS Women with mucinous or tubular/cribriform breast cancer have better outcomes than those with other histotypes, although the observation is based on a limited number of events. In postmenopausal women with these histotypes, the magnitude of the letrozole advantage compared with tamoxifen may not be as large in patients with mucinous or tubular/cribriform disease. CLINICALTRIALSGOV NCT00004205.
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Affiliation(s)
- E Munzone
- Division of Medical Senology, European Institute of Oncology, Milan, Italy
| | - A Giobbie-Hurder
- Department of Biostatistics and Computational Biology, International Breast Cancer Study Group (IBCSG) Statistical Center, Dana-Farber Cancer Institute, Boston, USA
| | - B A Gusterson
- Institute of Cancer Sciences, Glasgow University, Glasgow
| | - E Mallon
- Southern General Hospital, Glasgow, UK
| | - G Viale
- Department of Pathology and Laboratory Medicine, IBCSG Central Pathology Laboratory, European Institute of Oncology, and University of Milan, Milan, Italy
| | - B Thürlimann
- Breast Center, Kantonsspital, St Gallen Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - B Ejlertsen
- Danish Breast Cancer Cooperative Group (DBCG), Rigshospitalet, Copenhagen, Denmark
| | - G MacGrogan
- Department of Pathology, Institut Bergonié, Bordeaux
| | - F Bibeau
- Department of Pathology, Val d'Aurelle Cancer Institute, Montpellier, France
| | - G Lelkaitis
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - K N Price
- International Breast Cancer Study Group (IBCSG) Statistical Center
| | - R D Gelber
- Department of Biostatistics and Computational Biology, International Breast Cancer Study Group (IBCSG) Statistical Center, Dana-Farber Cancer Institute, Boston, USA Harvard T.H. Chan School of Public Health, Harvard Medical School, Frontier Science and Technology Research Foundation, Boston, USA
| | - A S Coates
- International Breast Cancer Study Group, Bern, Switzerland University of Sydney, Sydney, Australia
| | - A Goldhirsch
- Program of Breast Health, European Institute of Oncology, Milan, Italy
| | - M Colleoni
- Division of Medical Senology, European Institute of Oncology, Milan, Italy
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9
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Lea V, Gluch L, Kennedy CW, Carmalt H, Gillett D. Tubular carcinoma of the breast: axillary involvement and prognostic factors. ANZ J Surg 2014; 85:448-51. [PMID: 25060384 DOI: 10.1111/ans.12791] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tubular carcinoma (TC) of the breast has a very favourable prognosis. The role for axillary staging in small TC was questioned. This study investigated the frequency of axillary metastases and prognostic factors in pure TC of the breast. It involved a retrospective review of prospectively collected data. METHODS A consecutive series of patients presenting to The Strathfield Breast Centre (TSBC) between 1988 and 2011 were reviewed. Only pure TC was included. Information collected included demographics, surgery, pathology, adjuvant therapy and survival. RESULTS Pure TC accounted for 146 out of 6110 cases of operable breast cancer. Ninety-five per cent were node negative (micrometastases and isolated tumour cells excluded). Ninety-eight per cent of those with known oestrogen receptor status were oestrogen receptor positive. Median tumour size was 10 mm (range 1-52 mm). Ten-year survival was 97%. Twelve per cent of patients had more than one tumour (either ipsilateral or contralateral). Eight patients had recurrent disease. All were node negative. Three of these patients died of their disease. CONCLUSION Axillary metastases are uncommon in pure TC. Recurrent disease is not readily predicted by tumour size or node status.
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Affiliation(s)
- Vivienne Lea
- Concord Repatriation Hospital, Sydney, New South Wales, Australia
| | - Laurence Gluch
- Concord Repatriation Hospital, Sydney, New South Wales, Australia.,The Strathfield Breast Centre, Sydney, New South Wales, Australia
| | | | - Hugh Carmalt
- Concord Repatriation Hospital, Sydney, New South Wales, Australia.,The Strathfield Breast Centre, Sydney, New South Wales, Australia
| | - David Gillett
- The Strathfield Breast Centre, Sydney, New South Wales, Australia
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10
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Maria Regina Bareggi C, Consonni D, Galassi B, Gambini D, Locatelli E, Visintin R, Runza L, Giroda M, Sfondrini MS, Onida F, Tomirotti M. Uncommon Breast Malignancies: Presentation Pattern, Prognostic Issue and Treatment Outcome in an Italian Single Institution Experience. TUMORI JOURNAL 2013; 99:39-44. [DOI: 10.1177/030089161309900107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Often neglected by large clinical trials, patients with uncommon breast malignancies have been rarely analyzed in large series. Patients and methods Of 2,052 patients diagnosed with breast cancer and followed in our Institution from January 1985 to December 2009, we retrospectively collected data on those with uncommon histotypes, with the aim of investigating their presentation characteristics and treatment outcome. Results Rare histotypes were identified in 146 patients (7.1% of our total breast cancer population), being classified as follows: tubular carcinoma in 75 (51.4%), mucinous carcinoma in 36 (24.7%), medullary carcinoma in 25 (17.1%) and papillary carcinoma in 10 patients (6.8%). Whereas age at diagnosis was not significantly different among the diverse diagnostic groups, patients with medullary and papillary subtypes had a higher rate of lymph node involvement, similar to that of invasive ductal carcinoma. Early stage diagnosis was frequent, except for medullary carcinoma. Overall, in comparison with our invasive ductal carcinoma patients, those with rare histotypes showed a significantly lower risk of recurrence, with a hazard ratio of 0.28 (95% CI, 0.12–0.62; P = 0.002). Conclusions According to our analysis, patients with uncommon breast malignancies are often diagnosed at an early stage, resulting in a good prognosis with standard treatment.
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Affiliation(s)
- Claudia Maria Regina Bareggi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Barbara Galassi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Donatella Gambini
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Elisa Locatelli
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Roberto Visintin
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Letterio Runza
- Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Massimo Giroda
- Breast Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Maria Silvia Sfondrini
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Francesco Onida
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Maurizio Tomirotti
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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11
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Stankov A, Bargallo-Rocha JE, Silvio AÑS, Ramirez MT, Stankova-Ninova K, Meneses-Garcia A. Prognostic factors and recurrence in breast cancer: experience at the national cancer institute of Mexico. ISRN ONCOLOGY 2012; 2012:825258. [PMID: 22830047 PMCID: PMC3399427 DOI: 10.5402/2012/825258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 04/28/2012] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to analyze the prognostic and predictive factors that relate to locoregional or distant recurrences in breast cancer patients who have been treated at the National Cancer Institute of Mexico. Multivariate, time-dependent Cox regression analyses indicate that the pN status (positive versus negative lymph node; P = 0.003; HR (hazard ratio), 3.47; CI (confidence interval), 1.52-7.91) and the pathological complete response of the patient to neoadjuvant chemotherapy (yes versus no; P = 0.061; HR, 0.38; CI, 0.14-1.04) were important prognostic factors for recurrence.
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Affiliation(s)
- A Stankov
- Breast Cancer Department, National Cancer Institute of Mexico, 14080 Tlalpan, DF, Mexico
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12
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Colleoni M, Rotmensz N, Maisonneuve P, Mastropasqua M, Luini A, Veronesi P, Intra M, Montagna E, Cancello G, Cardillo A, Mazza M, Perri G, Iorfida M, Pruneri G, Goldhirsch A, Viale G. Outcome of special types of luminal breast cancer. Ann Oncol 2012; 23:1428-36. [DOI: 10.1093/annonc/mdr461] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Li B, Chen M, Nori D, Chao KSC, Chen AM, Chen SL. Adjuvant radiation therapy and survival for pure tubular breast carcinoma--experience from the SEER database. Int J Radiat Oncol Biol Phys 2012; 84:23-9. [PMID: 22543207 DOI: 10.1016/j.ijrobp.2011.10.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 10/18/2011] [Accepted: 10/26/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE Pure tubular carcinoma of the breast (PTCB) represents a distinct subtype of invasive ductal carcinoma (IDC) that is generally thought to be associated with better prognosis than even low-grade IDC. There has been controversy as to the role of adjuvant radiation therapy (RT) in this population. We hypothesized that adjuvant RT would demonstrate a survival improvement. METHODS AND MATERIALS We queried the Surveillance, Epidemiology and End Results database for the years 1992-2007 to identify patients with pure tubular carcinomas of the breast. Patient demographics, tumor characteristics, and surgical and RT treatments were collected. Survival analysis was performed using the Kaplan-Meier method for univariate comparisons and Cox proportional hazards modeling for multivariate comparisons, stratifying on the basis of age with a cutoff age of 65. RESULTS A total of 6465 patients were identified: 3624 (56.1%) patients underwent lumpectomy with RT (LUMP+RT), 1525 (23.6%) patients underwent lumpectomy alone (LUMP), 1266 (19.6%) patients received mastectomy alone (MAST), and 50 (0.8%) patients underwent mastectomy with RT (MAST+RT). When we compared the LUMP+RT and LUMP groups directly, those receiving adjuvant RT tended to be younger and were less likely to be hormone receptor-positive. Overall survival was 95% for LUMP+RT and 90% for LUMP patients at 5 years. For those 65 or younger, the absolute overall survival benefit of LUMP+RT over LUMP was 1% at 5 years and 3% at 10 years. On stratified multivariate analysis, adjuvant RT remained a significant predictor in both age groups (P=.003 in age ≤ 65 and P=.04 in age >65 patients). Other significant unfavorable factors were older age and higher T stage (age >65 only). CONCLUSIONS Since sufficiently powered large scale clinical trials are unlikely, we would recommend that adjuvant radiation be considered in PTCB patients age 65 or younger, although consideration of the small absolute survival benefit is important. Adjuvant radiation can be omitted for patients older than 65.
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Affiliation(s)
- Baoqing Li
- Department of Radiation Oncology, Weill Cornell Medical College, New York, New York 10021, USA.
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14
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Rakha EA, Lee AHS, Evans AJ, Menon S, Assad NY, Hodi Z, Macmillan D, Blamey RW, Ellis IO. Tubular carcinoma of the breast: further evidence to support its excellent prognosis. J Clin Oncol 2009; 28:99-104. [PMID: 19917872 DOI: 10.1200/jco.2009.23.5051] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although tubular carcinoma (TC) is known to have a favorable prognosis, it is still unknown whether this subtype represents a distinct type of breast carcinoma or whether it behaves like other low-grade luminal A-type breast carcinomas. METHODS In this study, we performed a retrospective analysis of a large well-characterized series of breast cancers (2,608 carcinomas) to assess the clinicopathologic and molecular features and prognostic value of TC compared with grade 1 ductal carcinomas of the breast. Results When compared with grade 1 ductal carcinoma (n = 212), TC (n = 102) was more likely to be detected on mammographic screening, had smaller median size, and less frequently showed lymphovascular invasion. Compared with grade 1 ductal carcinoma, TC was associated with longer disease-free survival (chi(2) = 13.25, P < .001) and breast cancer-specific survival (chi(2) = 8.8, P = .003). In this study, none of the patients with TC developed distant metastasis or died from the disease without an intervening recurrence as invasive carcinoma of different histologic type. CONCLUSION We conclude that the biologic behavior of TC is excellent and is more favorable than that of grade 1 ductal carcinoma. Patients with TC may be at risk of developing second primary carcinomas in the contralateral breast, which may be of higher grade and poorer potential prognostic outcome. In addition, patients with TC seem to have a close to normal life expectancy, and as a consequence, adjuvant systemic therapy may not be justified in their routine management.
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Affiliation(s)
- Emad A Rakha
- FRCPath, Molecular Medical Sciences, University of Nottingham, Department of Histopathology, Nottingham City Hospital National Health Service Trust, Hucknall Rd, Nottingham, NG5 1PB, United Kingdom.
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15
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Expression of metalloproteases and their inhibitors in different histological types of breast cancer. J Cancer Res Clin Oncol 2009; 136:811-9. [PMID: 19916023 DOI: 10.1007/s00432-009-0721-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 10/26/2009] [Indexed: 10/24/2022]
Abstract
PURPOSE Metalloproteases (MMPs) and their tissue inhibitors of metalloproteases (TIMPs) are involved in several key aspects of tumoral growth, invasion and metastasis. The purpose of this study was to characterize on how the different histological types of breast cancer differ in the expression of several components of this enzymatic system. METHODS An immunohistochemical study was performed in 50 ductal, 23 lobular, 14 mucinous, 7 tubular, 4 papillary and 5 medullary invasive carcinomas, using tissue arrays and specific antibodies against 7 MMPs and 3 tisullar TIMPs. Staining results were categorized by means of a specific software program (score values). RESULTS Carcinomas of the ductal type showed higher score values for MMPs and TIMPs than the other histological types; whereas mucinous carcinomas had lower scores values for expressions of the majority of these proteins. Stromal fibroblasts were more frequently positive for MMP-1, -7 and -13 and TIMP-1 and -3, when present in carcinomas of the ductal type than in other histological types of breast carcinomas. Stromal mononuclear inflammatory cells were more frequently positive for MMP-1 and TIMP-3, but more often negative for MMP-7, -9 and -11, when located in carcinomas of the ductal type than in other histological types of breast carcinomas. CONCLUSIONS We found variations in MMP/TIMP expressions among the different histological subtypes of breast carcinomas suggesting differences in their tumor pathophysiology.
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Sirohi B, Leary A, Johnston SRD. Ipsilateral breast tumor recurrence: is there any evidence for benefit of further systemic therapy? Breast J 2009; 15:268-78. [PMID: 19645782 DOI: 10.1111/j.1524-4741.2009.00716.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To date, there are no standard guidelines for treating patients with ipsilateral breast tumor recurrence (IBTR). Current practice is to resect the recurrence with a radical intent followed possibly by radiotherapy if the patient has not received this before, but the role of further adjuvant medical (hormone or chemotherapy) therapy remains undefined. Currently Phase III trials are underway to answer this question. In this review, we will focus on published data relating to IBTR and discuss recent trials. The results from the Phase III trials will not be available for sometime. At the time of IBTR, it is reasonable to change the endocrine therapy with indirect evidence from sequencing of impact on outcome. There is currently no conclusive evidence to suggest that further adjuvant chemotherapy post loco-regional recurrence impacts on survival, though the use of noncross-resistant chemotherapy drugs may make sense in those at highest risk. Biopsy at IBTR is helpful to distinguish whether it is a true recurrence or a new primary tumor and receptor phenotyping may be helpful for HER2. Future trials in IBTR need to address the following issues: to be able to distinguish between true recurrence and new primary (consensus required on definitions); pathologic processing relating to margins needs to be standardized (1 or 5 mm wide specimens); documentation of the pattern of IBTR in relation to each histopathologic subtype and methods used for pathologic examination by centers. Regional nodal recurrence including supraclavicular node recurrence is not dealt with in this review.
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Affiliation(s)
- Bhawna Sirohi
- Breast Unit, Royal Marsden NHS Foundation Trust, Surrey, UK
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Javid SH, Smith BL, Mayer E, Bellon J, Murphy CD, Lipsitz S, Golshan M. Tubular carcinoma of the breast: results of a large contemporary series. Am J Surg 2009; 197:674-7. [DOI: 10.1016/j.amjsurg.2008.05.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Revised: 05/29/2008] [Accepted: 05/29/2008] [Indexed: 11/28/2022]
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Soerjomataram I, Louwman MWJ, Ribot JG, Roukema JA, Coebergh JWW. An overview of prognostic factors for long-term survivors of breast cancer. Breast Cancer Res Treat 2007; 107:309-30. [PMID: 17377838 PMCID: PMC2217620 DOI: 10.1007/s10549-007-9556-1] [Citation(s) in RCA: 326] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 02/20/2007] [Indexed: 12/23/2022]
Abstract
BACKGROUND Numerous studies have examined prognostic factors for survival of breast cancer patients, but relatively few have dealt specifically with 10+-year survivors. METHODS A review of the PubMed database from 1995 to 2006 was undertaken with the following inclusion criteria: median/mean follow-up time at least 10 years; overall survival and/or disease-specific survival known; and relative risk and statistical probability values reported. In addition, we used data from the long-standing Eindhoven Cancer Registry to illustrate survival probability as indicated by various prognostic factors. RESULTS 10-year breast cancer survivors showed 90% 5-year relative survival. Tumor size, nodal status and grade remained the most important prognostic factors for long-term survival, although their role decreased over time. Most studies agreed on the long-term prognostic values of MI (mitotic index), LVI (lymphovascular invasion), Her2-positivity, gene profiling and comorbidity for either all or a subgroup of breast cancer patients (node-positive or negative). The roles of age, socioeconomic status, histological type, BRCA and p53 mutation were mixed, often decreasing after correction for stronger prognosticators, thus limiting their clinical value. Local and regional recurrence, metastases and second cancer may substantially impair long-term survival. Healthy lifestyle was consistently related to lower overall mortality. CONCLUSIONS Effects of traditional prognostic factors persist in the long term and more recent factors need further follow-up. The prognosis for breast cancer patients who have survived at least 10 years is favourable and increases over time. Improved long-term survival can be achieved by earlier detection, more effective modern therapy and healthier lifestyle.
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Affiliation(s)
- Isabelle Soerjomataram
- Department of Public Health, Erasmus MC, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands.
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Lim M, Bellon JR, Gelman R, Silver B, Recht A, Schnitt SJ, Harris JR. A prospective study of conservative surgery without radiation therapy in select patients with Stage I breast cancer. Int J Radiat Oncol Biol Phys 2006; 65:1149-54. [PMID: 16750330 DOI: 10.1016/j.ijrobp.2006.02.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Revised: 02/03/2006] [Accepted: 02/04/2006] [Indexed: 12/27/2022]
Abstract
PURPOSE The effectiveness of radiation therapy (RT) in reducing local recurrence after breast-conserving surgery (BCS) in unselected patients with early stage invasive breast cancer has been demonstrated in multiple randomized trials. Whether a subset of women can achieve local control without RT is unknown. In 1986, we initiated a prospective one-arm trial of BCS alone for highly selected breast-cancer patients. This report updates those results. METHODS AND MATERIALS Eighty-seven (of 90 planned) patients enrolled from 1986 until closure in 1992, when a predefined stopping boundary was crossed. Patients were required to have a unicentric, T1, pathologic node-negative invasive ductal, mucinous, or tubular carcinoma without an extensive intraductal component or lymphatic-vessel invasion. Surgery included local excision with margins of at least 1 cm or a negative re-excision. No RT or systemic therapy was given. RESULTS Results are available on 81 patients (median follow-up, 86 months). Nineteen patients (23%) had local recurrence (LR) as a first site of failure (average annual LR: 3.5 per 100 patient-years of follow-up). Other sites of first failure included 1 ipsilateral axilla, 2 contralateral breast cancers, and 4 distant metastases. Six patients developed other (nonbreast) malignancies. Nine patients have died, 4 of metastatic breast cancer and 5 of unrelated causes. CONCLUSIONS Even in this highly selected cohort, a substantial risk of local recurrence occurred after BCS alone with margins of 1.0 cm or more. These results suggest that with the possible exception of elderly women with comorbid conditions, radiation therapy after BCS remains standard treatment.
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MESH Headings
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/surgery
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Humans
- Lymphatic Metastasis
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Recurrence, Local/surgery
- Poisson Distribution
- Prospective Studies
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Affiliation(s)
- May Lim
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Leikola J, Heikkilä P, von Smitten K, Leidenius M. The prevalence of axillary lymph-node metastases in patients with pure tubular carcinoma of the breast and sentinel node biopsy. Eur J Surg Oncol 2006; 32:488-91. [PMID: 16569494 DOI: 10.1016/j.ejso.2006.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Revised: 01/16/2006] [Accepted: 01/26/2006] [Indexed: 10/24/2022] Open
Abstract
AIMS We aimed to evaluate the prevalence of and the risk factors for axillary lymph-node metastases in pure tubular carcinoma (PTC) of the breast. The role of axillary staging and treatment in PTC was also evaluated. METHODS Between March 2001 and August 2004, 33 PTC patients underwent sentinel node (SN) biopsy as a part of their surgical treatment. Level I/II axillary clearance was carried out in case of tumour positive SN findings. To confirm the correct histological diagnosis (PTC, >90% tubular component), the breast tumours were reviewed by an expert breast pathologist. RESULTS The SN were successfully harvested in all patients. The median number of SN harvested in the axilla was 3 (range 1-10). Nine (27%) of the 33 patients had axillary nodal metastases. The median number of metastatic nodes was 1 (range 1-3). The median size of the SN metastases was 0.5 mm (mean 1.7 mm, range 0.4-5 mm). In six patients, micrometastases were the only tumour positive SN findings. The median histological tumour size was similar, 9 vs 10mm, in patients with or without axillary metastases. The median patient age was 54 (range 44-71) and 57 (range 39-80) years, respectively. After the histopathological review, six of the 27 patients with true PTC had axillary metastases. The review did not significantly change the risk factors for axillary metastases. CONCLUSIONS Every fourth PTC patient has axillary lymph-node metastases, most often micrometastases. SN biopsy appears as a feasible method for axillary staging in PTC patients.
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Affiliation(s)
- J Leikola
- Breast Surgery Unit, Maria Hospital, Helsinki, Finland
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21
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Sullivan T, Raad RA, Goldberg S, Assaad SI, Gadd M, Smith BL, Powell SN, Taghian AG. Tubular Carcinoma of the Breast: a Retrospective Analysis and Review of the Literature. Breast Cancer Res Treat 2005; 93:199-205. [PMID: 16142444 DOI: 10.1007/s10549-005-5089-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The favorable prognosis associated with tubular carcinoma of the breast has led some studies to propose less aggressive treatments for patients with this disease. This study aims to address the extent of therapy needed for tubular patients. METHODS A retrospective review identified 73 cases of tubular carcinoma treated at the Massachusetts General Hospital between 1980 and 2002. Primary treatment was conservative surgery (CS) plus radiation therapy (RT) in 67%, CS without RT in 18%, and mastectomy in 15%. Median follow-up time was 90.5 months. The published literature of 529 conservatively treated tubular carcinomas was reviewed along with the 62 conservative cases from this series. : No patients developed distant metastasis or died from this disease. Local failure occurred in three (4%) of the cases, after 13, 84 and 121 months. All three had initially been treated with CS + RT. Five cases were node-positive, three of which were associated with a primary tumor smaller than 1 cm. Thirteen women, with a median age of 74, were treated by CS without RT and none recurred. A literature review showed that adjuvant RT reduces local failure following CS for tubular carcinoma. CONCLUSIONS Tubular carcinoma is associated with an excellent prognosis, but long-term follow-up is essential for detecting local failures and a small primary tumor size does not preclude nodal involvement. Adjuvant RT reduces the incidence of local failure following CS for tubular carcinoma, however, elderly women treated by CS may have a very low risk of local recurrence without adjuvant RT.
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Affiliation(s)
- Timothy Sullivan
- Department of Radiation Oncology, Harvard Medical School, Boston, MA 02114, USA
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22
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Livi L, Paiar F, Meldolesi E, Talamonti C, Simontacchi G, Detti B, Salerno S, Bianchi S, Cardona G, Biti GP. Tubular carcinoma of the breast: outcome and loco-regional recurrence in 307 patients. Eur J Surg Oncol 2005; 31:9-12. [PMID: 15642419 DOI: 10.1016/j.ejso.2004.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2004] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study is to describe the University of Florence experience in evaluating clinical, pathologic and treatment factors as they are related to the outcome and loco-regional recurrence in patients with tubular breast carcinoma. MATERIAL AND METHODS Three hundred and seven patients (median age 56.4 years, range 26-91 years) with histological verified tubular carcinoma of the breast were consecutively treated at University of Florence from 1976 to 2001. All patients were followed for a median of 8.4 years (range 3 months to 20 years). Thirty-seven women underwent mastectomy and 270 underwent breast conserving surgery. Positive axillary nodes were found in 15% of patients. Fifty-two patients did not undergo radiotherapy to whole breast after having breast conserving surgery. Tamoxifen was prescribed in 108 patients and chemotherapy in 21 patients, 15 out of 21 had positive axillary nodes. RESULTS Cause specific survival was 99.6, 99.2 and 97.2% at 3, 5 and 10 years. Local recurrence rate was 1.9, 3.6 and 4.7% at 3, 5 and 10 years. Univariate statistical analysis was significant for specific survival and local recurrence for angiolymphatic invasion only (p=0.0004). CONCLUSIONS In the absence of axillary disease and angiolymphatic invasion, conserving surgery with adjuvant radiotherapy is effective treatment of disease.
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Affiliation(s)
- L Livi
- Department of Radiotherapy, Florence University, Florence, Italy.
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23
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Thurman SA, Schnitt SJ, Connolly JL, Gelman R, Silver B, Harris JR, Recht A. Outcome after breast-conserving therapy for patients with stage I or II mucinous, medullary, or tubular breast carcinoma. Int J Radiat Oncol Biol Phys 2004; 59:152-9. [PMID: 15093911 DOI: 10.1016/j.ijrobp.2003.10.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2003] [Revised: 10/06/2003] [Accepted: 10/15/2003] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the site of first failure of patients with early-stage tubular, mucinous, and medullary breast carcinoma after breast-conserving therapy and compare their results with those of patients with infiltrating ductal carcinoma (IDC). METHODS AND MATERIALS Twenty clinical Stage I and II patients with mucinous carcinoma, 27 with medullary carcinoma, 28 with tubular carcinoma, and 1055 with IDC were identified. The minimal potential follow-up was 10 years. RESULTS No statistically significant difference (p = 0.15) was seen in the site of first failure between the four histologic types within the first 10 years after treatment. When the IDC tumors were omitted from the comparison, the failure patterns of the remaining three histologic types were not significantly different (p = 0.31). In a polychotomous logistic model, histologic type was not significantly associated with the site of first failure (all p >0.17). Local failure was significantly associated with age <50 years (p = 0.04), positive surgical margins (p = 0.007), lymphovascular invasion (p = 0.04), and tumors with an extensive intraductal component (p <0.001). Regional/distant/opposite breast failure was significantly associated with clinical Stage T2 tumors (p <0.001), four or more positive lymph nodes (p = 0.004), and lymphovascular invasion-positive tumors (p <0.001). Second malignancy or death was significantly associated with age at diagnosis >60 years (p <0.001) and lymphovascular invasion-positive tumors (p = 0.03). CONCLUSION No statistically significant difference was noted in the site of first failure between patients with medullary, mucinous, or tubular carcinoma and patients with IDC. Although not statistically significant, we did note a trend toward a lower long-term rate of disease-free survival in patients with IDC.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/therapy
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/therapy
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Medullary/mortality
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/therapy
- Chemotherapy, Adjuvant
- Female
- Humans
- Logistic Models
- Lymph Node Excision
- Middle Aged
- Radiotherapy Dosage
- Radiotherapy, Adjuvant
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
- Sarah A Thurman
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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DeGrendele H, Gibson AD, Tyagi P, O'Shaughnessy JA. 2003 Highlights From: 39th Annual Meeting of the American Society of Clinical Oncology Chicago, Illinois May 31 to June 3, 2003. Clin Breast Cancer 2003. [DOI: 10.1016/s1526-8209(11)70620-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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