Multifocal breast cancer documented in large‐format histology sections

Abstract

BACKGROUND:The prognostic significance of molecular phenotype in breast cancer is well established in the literature. Recent studies have demonstrated that subgross lesion distribution (unifocal, multifocal, and diffuse) and disease extent also carry prognostic significance in this disease. However, the correlation of molecular phenotypes with subgross parameters has not yet been investigated in detail. METHODS: In total, 444 consecutive invasive breast cancers that were documented in large-format histology slides and worked up with detailed radiologic-pathologic correlation were sampled into tissue microarray blocks and stained immunohistochemically to delineate the molecular subtypes. RESULTS: Diffuse or multifocal distribution of the invasive component of breast carcinomas in this series was associated with a 4.14-fold respectively 2.75-fold risk of cancer-related death compared with unifocal tumors irrespective of molecular phenotype. Patients who had human epidermal growth factor receptor 2 (HER2)-positive cancers; estrogen receptor-negative, progesterone receptor-negative, and HER2-negative (triple-negative) cancers; or basal-like cancers had a 2.18-fold, 2.33-fold, and 4.07-fold risk of dying of disease, respectively, compared with patients who had luminal A carcinomas. Unifocal luminal A, HER2-positive, and basal-like cancers were associated with significantly better long-term survival outcomes than their multifocal or diffuse counterparts; luminal B and triple-negative tumors also had the same tendency. In multivariate analysis, patient age, tumor size category, lymph node status, lesion distribution, and molecular phenotypes remained significant. CONCLUSIONS: Multifocality and diffuse distribution of the invasive component were associated with significantly poorer survival in women with breast carcinomas compared with unifocal disease in patients with luminal A, HER2 type, and basal-like cancers. Molecular classification of breast cancer is a powerful tool but gains in power when combined with conventional and subgross morphologic parameters. Cancer 2013;119:1132-9. V C 2012 American Cancer Society.KEYWORDS: breast, breast cancer, multifocality, diffuse, molecular phenotypes, survival. INTRODUCTIONBreast cancer mortality has decreased significantly in countries that have organized, population-based mammography screening 1 ; however, despite using the most recent diagnostic tools and modern therapeutic regimens, women are still dying from this disease. Therefore, exploring the prognostic information generated by radiologic, histologic, and molecular tumor characteristics is essential to facilitate individualized treatment and further decrease disease-specific mortality.Patient age, tumor size, histologic grade, and lymph node status still remain powerful prognostic indicators in patients with breast cancer.2,3 On the other hand, many second-generation prognostic parameters have emerged and have been introduced into routine practice, and the most prominent are estrogen receptor (ER), progesterone recepto...

Effect of multifocality and multicentricity on outcome in early stage breast cancer: a systematic review and meta-analysis

“…Meta-regression showed that there was a positive association between year of publication and the OR for DFS at 5 years (b = 0.279, P \ 0.001). There was also a positive association of small magnitude between the proportion of patients undergoing There was significant inter-study heterogeneity (Cochran's Q P = 0.005, I 2 = 70 %) with four smaller studies [29][30][31][32] showing higher magnitude of effect than two larger studies [8,24]. Exclusion of these four smaller studied led to loss of the association between multifocality and worse DSS (OR 1.15, 95 % CI 0.97-1.35, P = 0.10).…”

Mammographic tumour appearance and triple-negative breast cancer associated with long-term prognosis of breast cancer death: A Swedish Cohort Study

“…The proposed new classification with ductal origin of the tumour shown on mammogram -such as casting type and architectural distortion -again underscores the independent role of mammographic appearance [17,20]. In addition, the recently proposed histological tumour distribution (including unifocal, multifocal, and diffuse) plays an important role in the prognosis of breast cancer death [21]. Accordingly, the combination of these markers, particularly the triple-negative feature, with mammographic appearance, together with conventional prognostic variables, has the potential to further stratify the risk of breast tumours and to inform individual treatment decisions.…”

“…The method has been described in previous studies [21][22][23]. Briefly, before operating, a tumour casting and architectural distortion than among tumours with other types of mammographic appearance.…”

“…Data on IHC markers were collected by standard antibody staining in the largest invasive tumour component for each patient, as has been described in previous studies [21][22][23]. The antibodies used for staining are as follows: ER (clone SP1; Ventana Medical Systems, Tucson, Ariz; 1:200 dilution), PR (clone PgR 636; Dako, Glostrup, Denmark; 1:50 dilution), and HER2 (code A 0485; Dako; 1:250 dilution).…”

Invasive Lobular Carcinoma of the Breast: The Use of Radiological Appearance to Classify Tumor Subtypes for Better Prediction of Long-Term Outcome

“…Correlation of the radiologic tumor features with large section histology and long-term patient outcome has demonstrated that the mammographic appearance of breast cancers is a strong prognostic factor [4][5][6][7][8]. Thus, breast imaging, especially mammography, simplifies the histologic complexity of invasive breast cancers, since different histologic subtypes may have identical mammographic presentation.…”