The Effect of the New Eighth Edition Breast Cancer Staging System on 100 Consecutive Patients

Abstract

Background In October 2016 the American Joint Committee on Cancer published the early eighth edition breast cancer prognostic staging system, incorporating biomarkers into previously accepted staging. The updated and current eighth edition became effective nationwide in January 2018 after a large update to its staging guidelines. This study’s aim was to compare patients’ anatomic seventh edition (anatomic), early eighth (pre-update, prognostic), and current eighth (post-update, prognostic) pathological stages and to assess the utility of recent inclusions to staging criteria. Additionally, we observed how the aforementioned stage changes aligned with breast cancer histologic subtypes. Methods An Institutional Review Board (IRB)-approved retrospective chart review was performed. Inclusion criteria included female patients between the ages of 35 to 95 years with a diagnosis of invasive ductal or lobular carcinoma of the breast (n = 100) at three Hackensack Meridian Health hospitals. The study evaluated any trends in patients’ stage changes between the seventh edition, early eighth edition, and current eighth edition breast cancer staging guidelines. Breast cancer restaging was performed using a novel staging tool on Microsoft Excel. Results Only 26% of patients’ stages changed when comparing the seventh edition stage vs. current eighth edition prognostic staging, most of which were downstaged. When comparing the seventh with early eighth edition prognostic staging, 38% of the patients’ stages changed, with a majority of them being upstaged. Lastly, 95% of total stage changes were downstages between the early eighth and current eighth edition staging guidelines. Conclusions When comparing the seventh edition vs. current eighth edition staging, few patients (especially those with early stage cancer) underwent a stage change. However, there were significant changes in stage when comparing early eighth vs. current eighth stages. Considering these changes were mostly downstages and many patients reverted to their original seventh edition stage, the current eighth edition is based on a personalized, less radical staging approach, one that is more synonymous with original seventh edition staging.

The clinical value of progesterone receptor expression in luminal breast cancer: A study of a large cohort with long‐term follow‐up

“…4 Although ER and PR are prognostic markers in invasive breast cancer (BC) and key markers for intrinsic subtype classification, 5 only ER is used in the clinical setting as a well-established predictive marker of endocrine therapy (ET) and its assessment is mandated in all BC. 6 Despite its prognostic significance, [7][8][9][10] and the recommendation for its routine assessment in BC by the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) 6 and the requirement of its availability by the American Joint Committee on Cancer Staging Manual (8th edition) for prognostic staging, 11 the assessment of PR status in the clinical settings remains controversial and some laboratories do not assess it routinely. The United Kingdom Royal College of Pathologists (RCPath) breast data set regards PR testing in BC as optional.…”

“…Despite its prognostic significance, 7–10 and the recommendation for its routine assessment in BC by the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) 6 and the requirement of its availability by the American Joint Committee on Cancer Staging Manual (8th edition) for prognostic staging, 11 the assessment of PR status in the clinical settings remains controversial and some laboratories do not assess it routinely. The United Kingdom Royal College of Pathologists (RCPath) breast data set regards PR testing in BC as optional 12 .…”

circRNAs in drug resistance of breast cancer

“…Tumor, node, metastasis (TNM) stage, tumor grade, the status of receptors for estrogen and progesterone (ER and PR), respectively, and human epidermal growth factor receptor 2 (Her-2) are used to select an adequate therapeutic modality. Subclassification based on intrinsic molecular subtypes, recognizes Luminal A, B, or Her-2enriched (hormone receptor-positive or negative), Her-2 positive, and triple-negative breast cancer (TNBC) [2,3].…”

Comparing scraping cytology with touch imprint cytology and frozen section analysis in the intraoperative diagnosis of sentinel lymph node metastasis in breast cancer

“…Breast cancer accounts for approximately one‐quarter of all cancers diagnosed in women and is the most common cause of cancer death globally 1 . The evaluation of axillary lymph nodes is a major part of breast cancer staging 2,3 . The nonsurgical assessment of axillary lymph nodes during physical examination may provide informative clues for possible metastasis.…”