Clinicopathological characteristics of multifocal breast cancer

doi:10.3877/cma.j.issn.1674-0807.2018.03.004

Abstract

Abstract:

Objective

To explore the clinicopathological characteristics of different lesions in multifocal breast cancer patients and provide the guidance for clinical treatment.

Methods

The clinical data of 41 multifocal breast cancer patients in the Department of Breast Surgery, the First Affiliated Hospital of Nanjing Medical University from November 2014 to August 2016 were retrospectively analyzed. Conventional pathological findings, immunohistochemical results and molecular subtypes between different lesions in multifocal breast cancer patients were analyzed. χ² test was used to compare the lesion size, histological grade, lymph node status and intravascular tumor thrombus between 41 multifocal breast cancer patients and 150 unifocal breast cancer patients enrolled in the same period.

Results

Among 41 multifocal breast cancer patients, 32 were detected with 2 lesions, 8 with 3 lesions, 1 with 4 lesions. The maximum diameter of the lesion was no less than 2 cm in 18 cases, more than 2 cm in 23 cases. The different lesions of one patient belonged to the same pathological type in 33 cases (80%), different pathological types in 8 cases (20%). The different lesions of one patient had the same histological grade in 38 cases (93%), different histological grades in 3 cases (7%). The different lesions of one patient presented the different expression levels of ER, PR, HER-2 and Ki67 in 3 cases (7%), 6 cases (15%), 5 cases (12%)and 3 cases (7%), respectively. Five cases (12%) had the different molecular subtypes. There were significant differences in histological grade 3 [51%(21/41) vs32%(48/150), χ²=5.154, P=0.023], lymph node metastasis [59%(24/41) vs 41%(61/150), χ²=4.163, P=0.041] and intravascular tumor thrombus [29%(12/41) vs8%(12/150), χ²=13.257, P<0.001] between multifocal and unifocal breast cancer patients, while the lesion size showed no significant difference [56%(23/41) vs 56%(84/150), χ²=0.001, P=0.991].

Conclusions

Clinicopathological results may vary in the lesions of multifocal breast cancer, so routine pathological and immunohistochemical examination should be carried out in all lesions so as to provide accurate and comprehensive pathological evidence for the optimal treatment. Multifocal breast cancer is prone to lymph node metastasis and intravascular tumor thrombus, indicating a poor prognosis.

Key words: Breast neoplasms, Pathology, Immunohistochemistry, Molecular subtypes

Le Hu, Xu Chen, Longquan Lou, Ziyi Yu, Cong Wang, Xiaoan Liu, Shui Wang, Yi Zhao. Clinicopathological characteristics of multifocal breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2018, 12(03): 146-149.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhrxbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0807.2018.03.004

https://zhrxbzz.cma-cmc.com.cn/EN/Y2018/V12/I03/146

Figures/Tables 3

References 15

[1]	赵平，陈万青. 2009中国肿瘤登记年报[M]．北京：军事医学科学出版社，2010: 26-37.
[2]	中华人民共和国卫生部，陈竺. 全国第三次死因回顾抽样调查报告[M]. 北京：中国协和医科大学出版社，2008：10-22.
[3]	Bendifallah S, Werkoff G, Borie-Moutafoff C, et al. Multiple synchronous (multifocal and multicentric) breast cancer: clinical implications [J]．Surg Oncol, 2010, 19(4): e115-123.
[4]	Eeles R, Knee G, Jhavar S, et al. Multicentric breast cancer: clonality and prognostic studies[J]. Breast Cancer Res Treat, 2011, 129(3): 703-716.
[5]	Jain S, Rezo A, Shadbolt B, et al. Synchronous multiple ipsilateral breast cancers: implications for patient management [J]．Pathology, 2009, 41(1): 57-67.
[6]	中国抗癌协会乳腺癌专业委员会．中国抗癌协会乳腺癌诊治指南与规范(2015版)[J]．中国癌症杂志，2015，25(9)：692-754.
[7]	Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013[J]．Ann Oncol, 2013, 24(9): 2206-2223.
[8]	Boros M, Podoleanu C, Georgescu R. Multifocal/multicentric breast carcinomas showing intertumoural heterogeneity: a comparison of histological tumour type and Nottingham histological grade of primary tumour and lymph node metastasis[J]．Pol J Pathol, 2015, 66(2): 125-132.
[9]	Sardanelli F, Giuseppetti GM, Panizza P, et al. Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in fatty and dense breasts using the whole-breast pathologic examination as a gold standard [J]. AJR Am J Roentgenol, 2004, 183(4): 1149-1157.
[10]	Girardi V, Carbognin G, Camera L, et al. Multifocal, multicentric and contralateral breast cancers: breast MR imaging in the preoperative evaluation of patients with newly diagnosed breast cancer[J]. Radiol Med, 2011, 116(8): 1226-1238.
[11]	Ilic＇ IR, Petrovic＇ A, Živkovic＇ VV, et al. Immunohistochemical features of multifocal and multicentric lobular breast carcinoma [J]．Adv Med Sci, 2017, 62(1): 78-82.
[12]	Sjöström-Mattson J, Von Boguslawski K, Bengtsson NO, et al. The expression of p53, bcl-2, bax, fas and fasL in the primary tumour and lymph node metastases of breast cancer[J]. Acta Oncol, 2009, 48(8): 1137-1143.
[13]	Middleton LP, Vlastos G, Mirza NQ, et al. Multicentric mammary carcinoma: evidence of monoclonal proliferation[J]. Cancer , 2002, 94(7): 1910-1916.
[14]	Choi Y, Kim EJ, Seol H, et al. The hormone receptor, human epidermal growth factor receptor 2, and molecular subtype status of individual tumor foci in multifocal/multicentric invasive ductal carcinoma of breast [J]．Hum Pathol, 2012, 43(1): 48-55.
[15]	Wolters R, Wöckel A, Janni W, et al. Comparing the outcome between multicentric and multifocal breast cancer: what is the impact on survival, and is there a role for guideline-adherent adjuvant therapy? A retrospective multicenter cohort study of 8935 patients[J]. Breast Cancer Res Treat, 2013, 142(3): 579-590.

临床病理特征		多病灶乳腺癌(n＝41)	单病灶乳腺癌(n＝150)	χ²值	P值
病灶直径		?	?	?	?
?	≤2 cm	18(44)	66(44)	0.001	0.991
?	>2 cm	23(56)	84(56)	0.001	0.991
组织学分级		?	?	?	?
?	1～2	20(49)	102(68)	5.154	0.023
?	3	21(51)	48(32)	5.154	0.023
淋巴结转移		?	?	?	?
?	阳性	24(59)	61(41)	4.163	0.041
?	阴性	17(41)	89(59)	4.163	0.041
脉管内癌栓		?	?	?	?
?	是	12(29)	12(8)	13.257	<0.001
?	否	29(71)	138(92)	13.257	<0.001

临床病理特征		多病灶乳腺癌(n＝41)	单病灶乳腺癌(n＝150)	χ²值	P值
病灶直径		?	?	?	?
?	≤2 cm	18(44)	66(44)	0.001	0.991
?	>2 cm	23(56)	84(56)	0.001	0.991
组织学分级		?	?	?	?
?	1～2	20(49)	102(68)	5.154	0.023
?	3	21(51)	48(32)	5.154	0.023
淋巴结转移		?	?	?	?
?	阳性	24(59)	61(41)	4.163	0.041
?	阴性	17(41)	89(59)	4.163	0.041
脉管内癌栓		?	?	?	?
?	是	12(29)	12(8)	13.257	<0.001
?	否	29(71)	138(92)	13.257	<0.001

类别		例数	病理类型		组织学分级		ER状态		PR状态		HER-2状态		增殖指数(Ki67)		分子亚型
类别		例数	相同	不同	相同	不同	相同	不同	相同	不同	相同	不同	相同	不同	相同	不同
多病灶乳腺癌		41	33(80)	8(20)	38(93)	3(7)	38(93)	3(7)	35(85)	6(15)	36(88)	5(12)	38(93)	3(7)	36(88)	5(12)
?	多中心乳腺癌	9	7(7/9^a)	2(2/9^a)	7(7/9^a)	2(2/9^a)	8(8/9^a)	1(1/9^a)	7(7/9^a)	2(2/9^a)	8(8/9^a)	1(1/9^a)	7(7/9^a)	2(2/9^a)	8(8/9^a)	1(1/9^a)
?	多灶性乳腺癌	32	26(81)	6(19)	31(97)	1(3)	30(94)	2(6)	28(86)	4(14)	28(86)	4(14)	31(97)	1(3)	28(86)	4(14)

类别		例数	病理类型		组织学分级		ER状态		PR状态		HER-2状态		增殖指数(Ki67)		分子亚型
类别		例数	相同	不同	相同	不同	相同	不同	相同	不同	相同	不同	相同	不同	相同	不同
多病灶乳腺癌		41	33(80)	8(20)	38(93)	3(7)	38(93)	3(7)	35(85)	6(15)	36(88)	5(12)	38(93)	3(7)	36(88)	5(12)
?	多中心乳腺癌	9	7(7/9^a)	2(2/9^a)	7(7/9^a)	2(2/9^a)	8(8/9^a)	1(1/9^a)	7(7/9^a)	2(2/9^a)	8(8/9^a)	1(1/9^a)	7(7/9^a)	2(2/9^a)	8(8/9^a)	1(1/9^a)
?	多灶性乳腺癌	32	26(81)	6(19)	31(97)	1(3)	30(94)	2(6)	28(86)	4(14)	28(86)	4(14)	31(97)	1(3)	28(86)	4(14)

病例	病灶	病灶直径(cm)	病理类型	组织学分级	ER	PR	HER-2(FISH)	Ki67(%)	分子亚型	类别
病例1	1	2.6	相同	相同	阴性	阴性	阴性	40	basal-like	多灶性乳腺癌
病例1	2	1.0	相同	相同	阴性	阴性	阳性	10	HER-2阳性	多灶性乳腺癌
病例2	1	2.7	相同	相同	阳性	阳性	阴性	50	luminal B (HER-2阴性)	多中心乳腺癌
病例2	2	1.7	相同	相同	阴性	阴性	阳性	50	HER-2阳性	多中心乳腺癌
病例3	1	1.6	相同	相同	阳性	阳性	阴性	50	luminal B (HER-2阴性)	多灶性
病例3	2	1.5	相同	相同	阳性	阳性	阳性	14	luminal B (HER-2阴性)	多灶性
病例4	1	2.0	不同	相同	阳性	阳性	阴性	70	luminal B (HER-2阴性)	多灶性
病例4	2	1.2	不同	相同	阴性	阴性	阳性	70	HER-2阳性	多灶性
病例5	1	1.8	相同	相同	阴性	阴性	阴性	60	basal-like	多灶性
病例5	2	1.5	相同	相同	阳性	阳性	阴性	60	luminal B(HER-2阴性)	多灶性

Please choose a citation manager

Content to export