Increased Lymph Node Positivity in Multifocal and Multicentric Breast Cancer
- 31 October 2008
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 208 (1), 67-74
- https://doi.org/10.1016/j.jamcollsurg.2008.09.001
Abstract
Background Multifocal and multicentric (MF/MC) breast cancers have been reported to be associated with increased lymph node metastases. The limited data on this issue prompted us to investigate the pathologic and clinical differences between unifocal and MF/MC breast cancer. Study Design Between 1990 and 2002, 1,322 patients with operable invasive breast cancer underwent a definitive operation at our Breast Clinic. Patients with MF/MC breast cancer (n = 147, 11%) were compared with patients with unifocal breast cancer (n = 1,175; 89%) in terms of pathologic and clinical characteristics. Results Patients with MF/MC were found to have a higher frequency of lymph node metastases when the largest diameter was used as a tumor size estimate for MF/MC cancer (unifocal T1 and T2, 35% and 49%, respectively, versus MF/MC T1 and T2, 48% and 67%, respectively; p = 0.05 and p = 0.003, respectively). When the combined diameter assessment was used, the frequency of lymph node positivity was similarly higher in MF/MC patients versus unifocal patients (unifocal T1 and T2, 35% and 49%, respectively, versus MF/MC T1 and T2, 49% and 61%, respectively; p = 0.08 and p = 0.046, respectively). At a median followup of 55 months (range 12 to 153 months), 5-year disease-free survival (DFS; unifocal, 88% versus MF/MC, 82%, p = 0.14) and overall survival (OS) rates (unifocal, 92% versus MF/MC, 93%, p = 0.43) did not show any significant difference between two groups. Conclusions Our data suggest that breast tumors with multiple foci have a different biology, with an increased metastatic potential to axillary lymph nodes, regardless of tumor size, that reflects an advanced stage. The clinical relevance of the currently used TNM classification system, which uses the diameter of the largest nodule, is supported by our findings.Keywords
This publication has 23 references indexed in Scilit:
- Accuracy and Surgical Impact of Magnetic Resonance Imaging in Breast Cancer Staging: Systematic Review and Meta-Analysis in Detection of Multifocal and Multicentric CancerJournal of Clinical Oncology, 2008
- The Accuracy of Combined Versus Largest Diameter in Staging Multifocal Breast CancerJournal of the American College of Surgeons, 2007
- Tumor Size and Lymph Node Status in Multifocal Breast CancerThe Breast Journal, 2007
- Multifocal and Multicentric Breast Cancer: Does Each Focus Matter?Journal of Clinical Oncology, 2005
- The prognostic influence of multifocality in breast cancer patientsThe Breast, 2004
- Feasibility of breast-conserving therapy for macroscopically multiple ipsilateral breast cancerInternational Journal of Radiation Oncology*Biology*Physics, 2004
- Correlation of tumor volume and surface area with lymph node status in patients with multifocal/multicentric breast carcinomaCancer, 2003
- Increased False Negative Rates in Sentinel Lymph Node Biopsies in Patients with Multi-Focal Breast CancerBreast Cancer Research and Treatment, 2002
- What modifies the relation between tumour size and lymph node metastases in T1 breast carcinomas?Journal of Clinical Pathology, 2000
- Breast-conserving Therapy for Macroscopically Multiple CancersAnnals of Surgery, 1990