Multifocal/multicentric breast carcinoma

Sobin, Leslie H.; Greene, Frederick L.

doi:10.1002/cncr.20286

Cited by 7 publications

(8 citation statements)

References 30 publications

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“…These findings are consistent with several studies [24][25][26][27][28]. To our knowledge, however, no other study to date has examined the overall survival as well as the relapse-free survival.…”

Section: Distant Metastasessupporting

confidence: 94%

“…Many studies point out an increased risk for metastatic dissemination and, therefore, poorer outcome, a finding that is not currently reflected in the TNM classification [23][24][25][26][27]. As mentioned above, the prognostic relevance of the T category is a constant factor in regard to current and past classification [4] and survival of patients with breast cancer depends on several prognostic factors.…”

Section: Distant Metastasesmentioning

confidence: 95%

“…The currently used algorithms, which employs the diameter of the largest nodule, result in the downplaying of multifocal breast carcinomas due to the underestimation of actual tumor size [24,25]. It has been suggested that studies should indicate the number of macroscopically recognizable tumors in parentheses after the T classification [26,27]. Andea et al [25] showed that, when a combined diameter assessment was used, the frequency of lymph node positivity was not significantly different in multifocal versus unifocal cases.…”

Section: Distant Metastasesmentioning

confidence: 97%

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Multicentric and multifocal versus unifocal breast cancer: is the tumor-node-metastasis classification justified?

Weißenbacher¹,

Zschage²,

Janni

et al. 2010

Breast Cancer Res Treat

137

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For classification of breast cancer (BC), tumor-node-metastasis (TNM) staging has been considered state of the art for more than 50 years. The T category is well defined, and in multicentric and multifocal tumors, tumor size is assessed by the largest tumor focus. The aim of this study was to compare multicentric/multifocal tumor spread in breast cancer with unifocal disease and to evaluate the diagnostic relevance of multifocality. A retrospective analysis was performed on survival related events in a series of 5,691 breast cancer patients between 1963 and 2007. By matched-pair analysis, patients were entered into two comparable groups of 288 patients after categorizing them as having multifocal/multicentric or unifocal breast cancers. Matching criteria were tumor size, grading, and hormone receptor status, which were equally distributed between both groups (P = 1.000 each). Disease free survival and the occurrence of relapse or of metastatic disease were evaluated. Cox's regression analysis was used for multivariate analysis. In the unifocal group, the mean breast cancer-specific survival time was 221.6 months as opposed to 203.3 months in the multicentric/multifocal group (P < 0.001, log-rank test). The occurrence of local relapse and distant metastasis was significantly increased in the multifocal group in comparison to the unifocal equivalent group (P < 0.001 and P < 0.003, respectively). Cox regression analysis for multivariate analyses demonstrated focality and centricity to be highly significant predictors for reduced overall survival (P = 0.016), local relapse (P = 0.001) and distant metastasis (P = 0.038). Tumor size, histopathological grading, hormone receptor status, and staging of lymph nodes are well-established prognostic parameters. Additionally, the number of foci should be considered as an independent prognostic parameter, which is currently not reflected in the TNM classification. We conclude that multicentric/multifocal BC is an independent BC risk factor and should be included in the risk assessment by re-evaluating the current TNM classification of the UICC.

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Section: Distant Metastasessupporting

confidence: 94%

Section: Distant Metastasesmentioning

confidence: 95%

Section: Distant Metastasesmentioning

confidence: 97%

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Multicentric and multifocal versus unifocal breast cancer: is the tumor-node-metastasis classification justified?

Weißenbacher¹,

Zschage²,

Janni

et al. 2010

Breast Cancer Res Treat

137

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“…The current standard for staging MF/MC breast cancers is using the largest tumor diameter for T‐staging although it is unclear whether the current staging accurately predicts LN involvement. Multiple studies have demonstrated that aggregation of tumor foci may result in better prediction of nodal disease . On the other hand, a recent study by Duraker and Caynak found no difference in the incidence of node positivity when staging by aggregated tumor size versus largest tumor dimension in patients with MF/MC breast cancers .…”

Section: Discussionmentioning

confidence: 95%

Multifocal and Multicentric Breast Cancer is Associated with Increased Local Recurrence Regardless of Surgery Type

Shaikh

Tam

et al. 2015

Breast J

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Multifocal and multicentric breast cancers have been correlated with poor prognostic factors and worse outcomes versus unifocal disease. We evaluated the impact of multifocal and multicentric disease versus case controls with unifocal disease, matching for age, grade, T-, and N-stage. A total of 110 patients with multifocal (n = 93) or multicentric (n = 17) disease and 263 matched case controls were identified with a median follow-up of 53 months and 64 months, respectively. The actuarial local control rates for the multifocal/multicentric and unifocal group were 88% and 97%, respectively at both 5 and 10 years (p < 0.001). On multivariate analysis, multifocal/multicentric disease remained associated with higher local recurrence after controlling for other covariates including surgery type. The disease-free survival rates in the multifocal/multicentric group at 5 and 10 years were 75% and 71%, respectively, versus 87% and 78% at 10 years (p = 0.01). On multivariate analysis, multifocal/multicentric disease was no longer associated with worse disease-free survival. There was no difference in the cohorts in terms of regional control, overall survival, or cancer specific survival. Our findings suggest that multifocal/multicentric disease may be associated with worse outcomes versus unifocal disease regardless of type of surgery. This suggests a more biologically aggressive cancer and may be an important consideration when managing these patients. Further studies are needed to better understand the impact of multifocal/multicentric breast cancers on outcomes.

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“…Data on MF MC breast cancer as a risk factor for increased LR after BCT or MX are limited. The incidence of MF or MC breast cancer ranges from 4% to 65% between studies, partly attributable to differences in definitions (2,92). Approximately 30–63% of patients, clinically and mammographically suspected of unifocal disease, are found to have additional foci on serial sectioning of the MX specimen, approximately 80% of which lie outside the index quadrant (4,5,93–95).…”

Section: Discussionmentioning

confidence: 99%

Oncological and Aesthetic Considerations of Conservational Surgery for Multifocal/Multicentric Breast Cancer

Patani¹,

Carpenter²

2010

The Breast Journal

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Conventional indications for mastectomy (MX) reflect circumstances where breast conserving therapy (BCT) could compromise oncological or cosmetic outcome. MX continues to be recommended for the majority of women with multiple lesions within the same breast. In this article, we review the oncological safety and aesthetic considerations of BCT in the context of multifocal (MF) or multicentric (MC) breast cancer. Literature review facilitated by Medline and PubMed databases. Published studies have reported divergent results regarding the oncological adequacy of BCT in the management of MF or MC disease. Earlier studies demonstrated high rates of local recurrence (LR) for BCT. More recent series have found BCT to be comparable to MX in terms of LR, distant failure, disease free and overall survival. Few studies have adequately evaluated cosmetic outcomes following BCT for MF or MC breast cancer. Contemporary oncoplastic techniques have extended the clinical utility of BCT and are of particular relevance to breast conservation in the context of MF or MC lesions. Appropriate case selection, preoperative oncological and aesthetic planning, satisfactory clearance of the surgical margins and adjuvant radiotherapy are of paramount importance. In the absence of level-1 guidance concerning the management of women with MF or MC disease, each case requires discussion with regard to tumor and patient related factors in the context of the multidisciplinary team. In selected patients with MF or MC disease, BCT is oncologically safe and cosmetically acceptable. Uniformity of practice and the establishment of a standard of care will require an evidence-base from prospective studies.

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Multifocal/multicentric breast carcinoma

Cited by 7 publications

References 30 publications

Multicentric and multifocal versus unifocal breast cancer: is the tumor-node-metastasis classification justified?

Multicentric and multifocal versus unifocal breast cancer: is the tumor-node-metastasis classification justified?

Multifocal and Multicentric Breast Cancer is Associated with Increased Local Recurrence Regardless of Surgery Type

Oncological and Aesthetic Considerations of Conservational Surgery for Multifocal/Multicentric Breast Cancer

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