Prediction of axillary nodal metastases from the morphology of primary mammary carcinomas.Guide to operative therapy

Abstract

This study assesses the ability of an experienced surgical pathologist to predict from microscopic examination of primary mammary carcinomas whether axillary metastases existed in the radical mastectomy specimens. Primary mammary carcinomas treated by radical mastectomy from 1956 to 1960 were reexamined and classified by type of cellular growth pattern and by configuration of the neoplastic borders (pushing or infiltrating). The only information available to the pathologist was the size of the primary tumor. The predictions were compared with the microscopic findings in the axillary nodes and with the survival of the patients. The accuracy of predicting axillary nodal metastases did not exceed 70% except when Type I neoplasms existed. The incidences of axillary nodal metastases differed significantly between the less‐well‐differentiated mammary carcinomas with pushing borders and those with infiltrating borders. However, the incidence of nodal metastases in the former group was high enough to prevent accurate assessment of the status of the axillary nodes from study of the borders of the primary tumors. Survival rates after radical mastectomy correlated with the cellular growth patterns of the primary tumors but not with the character of the tumor borders. The survival rates were adversely affected by the presence of axillary metastases only among those patients treated for the less‐well‐differentiated Type III and Type IV tumors. Radical mastectomy with axillary dissection but without sacrifice of the pectoral muscles would have removed the tumor‐bearing lymph nodes in at least 85 of the 89 Type I and Type II tumors. These tumors constituted over 20% of the mammary caracinomas treated by radical mastectomy in a five‐year period. On the basis of this study, a more conservative approach to the Type I and Type II tumors appears to be justified.

Axillary Dissection for Tubular Carcinoma of the Breast

“…Another possible source of discrepancies noted in studies reporting axillary metastases from tubular carcinomas is a failure to differentiate between pure tubular and mixed tubular carcinomas (1,2,4,8,9,12,(17)(18)(19).…”

“…Axillary lymph node metastases from tubular carcinomas are reputably rare although the reported frequency ranges from 0 to 30% (6, [9][10][11]. As efforts toward early detection for breast cancer increase, the incidence of tubular carcinoma may be expected to rise.…”

Protein expression and molecular profiling to predict lymph node status and prognosis in breast cancer

“…The prediction of axillary nodal involvement from features of the primary tumour characteristics was described in 1967 (Kouchoukos et al, 1967) and larger evaluations have occurred since (Gann et al, 1999). Kouchoukos et al (Kouchoukos et al, 1967) assessed 432 breast cancers and classified them into 4 subtypes based on histological appearance.…”

“…Kouchoukos et al (Kouchoukos et al, 1967) assessed 432 breast cancers and classified them into 4 subtypes based on histological appearance. The histological appearance, size of the primary tumour and the type of margins were evaluated to assess the usefulness in predicting axillary lymph node 48 involvement.…”