Correlation of tumor volume and surface area with lymph node status in patients with multifocal/multicentric breast carcinoma

Abstract

BACKGROUND Multicentric breast carcinomas have a higher frequency of axillary lymph node metastasis than unifocal tumors of similar stage. It remains unclear whether this merely reflects larger tumor volumes or a different biologic behavior. The authors have shown previously that when aggregate tumor diameter are used for staging, unifocal and multifocal tumors have a similar frequency of axillary lymph node metastasis. However, summing diameter overestimates actual tumor volume because volume is proportional to the third power of the diameter. Therefore, the aim of the current study was to reanalyze the relation between size and axillary lymph node status by correcting for tumor volumes and surface areas. METHODS Volumes and surface areas of 122 breast tumor specimens with multiple macroscopic nodules (two foci: n = 95; three foci: n = 22; three foci: n = 5) were calculated by approximating the shape of each tumor nodule to an ellipsoid (for volume) or to a prolate spheroid (for area). For comparison, the authors used an internal control series, comprised of 469 macroscopic unifocal tumors. For all patients, multiple assessments of largest tumor size and combined size of all foci were correlated with the status of axillary lymph nodes. The associations between lymph node status, tumor volume or area, and multifocality were modeled using univariate and multivariate logistic regression. RESULTS When either the largest or the aggregate tumor volume was used as a size estimate, tumor specimens with multiple nodules had a higher frequency of lymph node involvement compared with unifocal tumors of a similar volume or area. The odds ratio (OR) for having positive lymph nodes was 2.34 for aggregate volume measurement (P < 0.001). Surface area estimates yielded similar results (OR = 2.2, P < 0.001). CONCLUSIONS Breast tumors with multiple macroscopic nodules had a different biology, with a propensity to dissemination at smaller tumor volumes (i.e., there was another factor besides volume alone that accounted for the differences in behavior). Cancer 2004;100:20–7. © 2003 American Cancer Society.

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.…”

Individualized treatment of early breast cancer

“…A major flaw is that, in cases of multifocality, the T stage indicates the largest invasive focus of the disease, but ignores the effective tumour burden, which may be significant if multiple foci are present. Our study accords with the findings of others in that the TNM system in its current form is not suitable for these purposes in the population of multifocal breast cancers [18,21,56,58]. We found that, despite the tumour being smaller, lymph node positivity was more prevalent among cancers containing multiple invasive foci, and a larger aggregate tumour burden involved a poorer outcome.…”

“…In general, multifocality is defined as the presence of two or more tumour foci separated by normal breast parenchyma. Some studies have attempted to analyze the association between the entire tumour burden and the outcome, by using the aggregate measure of the dimensions or volumes of the tumour foci [20,22,58,59]. These factors have been demonstrated as determinants of poorer characteristics and outcome [1,18,19,[21][22][23][24].…”

The Clinical Value of Hybrid Sentinel Lymphoscintigraphy to Predict Metastatic Sentinel Lymph Nodes in Breast Cancer

“…Most prior studies have predicted lymph node status by assessing the size and shape of lymph nodes [18][19][20][21]. Attempts at axillary staging by means of anatomical imaging of the axilla with CT or magnetic resonance imaging (MRI) have proved more useful than clinical examination [22].…”