Bilateral synchronous breast cancer: Mode of detection and comparison of histologic features between the 2 breasts

Hungness, Eric S.; Safa, Malek M.; Shaughnessy, Elizabeth; Aron, Bernard S.; Gazder, Paula; Hawkins, H H; Lower, Elyse E.; Seeskin, Connie; Yassin, Rawia; Hasselgren, Per Olof

doi:10.1067/msy.2000.108780

Cited by 77 publications

(51 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hungness et al 34 showed that the histologic type of breast carcinoma was the same in the two breasts in most patients. Coradini et al 5 reported that ER and PgR levels in the primary and contralateral breast tumors did not differ significantly.…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, most clinicians have approached bilateral disease more aggressively than unilateral disease and most studies have shown a disproportionately higher incidence of bilateral mastectomies performed in this cohort of patients. 34 This aggressive approach was adopted based on the suggestion that patients with SBIBC have a worse prognosis than patients with UIBC, according to the concept that patients with tumors with worse prognostic factors need more extensive surgical treatment. 25,35 Conversely, at our institution, the majority of patients underwent bilateral breast conservation treatment (57%) and only as few as 22% of the patients underwent bilateral mastectomy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinicopathologic characteristics of 143 patients with synchronous bilateral invasive breast carcinomas treated in a single institution

Intra

Rotmensz

Viale

et al. 2004

Cancer

View full text Add to dashboard Cite

BACKGROUNDSynchronous bilateral invasive breast carcinoma (SBIBC) ranged in incidence from 0.3% to as high as 12%.METHODSBetween April 1997 and February 2003, 143 consecutive patients with SBIBC were treated at the European Institute of Oncology (Milan, Italy). Their information was collected prospectively in a database. The bilateral tumors were divded into left and right tumors. Tumor size, histology, grade, lymph node status, estrogen (ER) and progesterone receptor (PgR) status, HER‐2 expression, peritumoral vascular invasion (PVI), Ki‐67 expression, extensive in situ component (EIC), and multifocality between the two groups were analyzed. During the same time period, 6218 patients with unilateral invasive breast carcinoma (UIBC) were analyzed in the same manner for comparison with the patients with SBIBC.RESULTSThere were no significant differences between left and right tumors, and the observed histopathologic agreement within the same patient was significantly superior than statistically expected for all characteristics except size, lymph node status, and multifocality. When compared with patients with UIBC, patients with SBIBC were more likely to present with smaller tumors and showed a higher frequency of invasive lobular carcinoma, lower histologic grade, higher rate of ER and PgR positivity, and lower PVI and Ki‐67 expression.CONCLUSIONSThe high concordance of histopathologic characteristics between SBIBC within the same patient could reflect a particular hormonal environment that influenced either the initiation and development of these lesions simultaneously and independently from the single or multi‐clonal origin, either a less aggressive biological behavior compared with UIBC. In particular, the strong agreement of the observed EIC in SBIBC within the same patient seemed to definitively exclude the metastatic origin of these tumors. Cancer 2004. © 2004 American Cancer Society.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinicopathologic characteristics of 143 patients with synchronous bilateral invasive breast carcinomas treated in a single institution

Intra

Rotmensz

Viale

et al. 2004

Cancer

View full text Add to dashboard Cite

show abstract

“…Keywords Contralateral breast cancer Á Diagnostic work-up Á Time trends Á Mammography Background A primary breast cancer in the opposite breast, contralateral breast cancer (CBC), is diagnosed in 1-2.6% of all women with breast cancer within 3 months of their first diagnosis, this subtype is referred to as synchronous [1][2][3][4]. CBCs diagnosed more than 3 months after primary diagnosis has a stable incidence of 0.5% per year throughout life and are referred to as metachronous [5][6][7][8].…”

mentioning

confidence: 99%

Diagnostic work-up of contralateral breast cancers has not improved over calendar period

Sandberg

Hartman

Edgren

et al. 2010

Breast Cancer Res Treat

View full text Add to dashboard Cite

Women who have been treated for breast cancer are typically followed up with regular mammography and palpation, with the aim of detecting recurrences and contralateral breast cancer (CBC). This study aims to investigate if the diagnostic work-up of breast cancer patients has improved over the last 25 years and resulted in earlier diagnoses of CBC. Two population-based cohorts were used; all CBCs in Sweden 1976Sweden -2004Sweden (n: 2932, and all CBCs in Stockholm, Sweden, 1976Sweden, -2005, both cohorts with a maximum of 3 years between the two cancers. Synchronous CBC was defined as two cancers \3 months apart, the remainder was defined as metachronous CBC. We calculated the odds ratio of being diagnosed synchronously, relative to metachronously, using logistic regression, adjusting for whether the second cancer was detected through clinical work-up or not. The odds of synchronous CBC were significantly increased: 1.27 (95% CI, 1.13-1.42) per 5-year period, compared to metachronous, and was not affected by detection mode, but seemed to be explained by adjuvant therapy. The proportion of CBCs detected by clinical work-up did not increase over the study period, and the mean size of the second tumor remained constant. We found an increase in the proportion of synchronous CBCs compared to metachronous, over calendar period, a change that was not associated with clinical work-up, but with adjuvant therapy. This study gives no indications that any improvement in diagnostic work-up of CBC have occurred over the last 25 years.

show abstract

“…15 Accumulating literature presents contradicting results. 11,[17][18][19][20][21][22][23][24][25] Some authors have demonstrated similarity in histologic subtype, 12,23 tumor grade, 17 and hormone receptor status 16,18 between the two tumors, suggesting a single-cell origin, whereas others had different results. 25 In addition, similar mammographic appearance may be seen in bilateral breast carcinomas with a mirror image location.…”

mentioning

confidence: 99%

Diagnostic and Prognostic Utility of Molecular Markers in Synchronous Bilateral Breast Carcinoma

et al. 2008

View full text Add to dashboard Cite

Histologic criteria have a limited role in determining whether the synchronous bilateral breast carcinomas represent two primaries or a metastasis to the contralateral breast. We studied the molecular analysis of synchronous bilateral breast carcinoma and whether they are originating from a single or different clone. We examined 17 patients with breast carcinoma, including 12 patients with synchronous bilateral carcinomas and control group of 5 infiltrating ductal carcinomas with regional lymph node metastases. Mutations were quantitatively determined to detect loss of heterozygosity (LOH) and microsatellite size alterations for a broad panel of 15 markers, involving 10 chromosomes using polymerase chain reaction. The carcinomas were classified as de novo or metastasis based on three levels of concordance: (1) marker-affected tumors were considered concordant if 50% or more of the same markers were mutated, (2) same gene copy affected, and (3) temporal sequence of mutation acquisition. In synchronous bilateral breast carcinoma patients, molecular analysis showed discordant mutations in all cases, supporting the diagnosis of de novo bilateral primary breast carcinomas. In patients with lymph node metastases, the primary breast carcinoma and metastases shared the same mutations, revealing a metastatic lesion. In conclusion, the application of molecular technology may play an important role for the differential diagnosis of dual primary carcinomas vs a metastatic breast cancer to contralateral breast. In this study, synchronous bilateral breast cancers represent two independent primaries rather than metastatic events. Keywords: synchronous bilateral breast carcinoma; molecular pathology; LOH Contralateral breast carcinoma is the most common second malignancy for breast carcinoma patients, with an incidence as high as 12%.1-3 Bilateral breast carcinomas exist in two forms, synchronous, in which both tumors occur at the same time, or metachronous, in which the carcinomas occur at different times. Synchronous bilateral breast carcinoma is uncommon, reported to range from 0.3 to 8% in the literature. [4][5][6][7] This wide range of reported incidence rates for synchronous bilateral breast carcinoma is a result of different time cutoff. Although some authors require both breast carcinomas to be diagnosed simultaneously or within less than 1 month, 7-10 others used up to 12 months as a cutoff time to differentiate synchronous from metachronous bilateral breast carcinomas.11-13 Using criteria of less than 1 month, the incidence of synchronous bilateral breast is less than 2%. 7,14 When cancer is detected in the opposite breast, the question arises whether this tumor is a second cancer (polyclonal origin) or a metastatic spread from the first breast cancer (monoclonal origin). The answer to this question is critical as both tumor staging and management will be different depending upon the results.11 Currently, this distinction is attempted using histopathologic features. Different histologic types, a better histologic diff...

show abstract

Bilateral synchronous breast cancer: Mode of detection and comparison of histologic features between the 2 breasts

Cited by 77 publications

References 14 publications

Clinicopathologic characteristics of 143 patients with synchronous bilateral invasive breast carcinomas treated in a single institution

Clinicopathologic characteristics of 143 patients with synchronous bilateral invasive breast carcinomas treated in a single institution

Diagnostic work-up of contralateral breast cancers has not improved over calendar period

Diagnostic and Prognostic Utility of Molecular Markers in Synchronous Bilateral Breast Carcinoma

Contact Info

Product

Resources

About