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Avera E, Valentic L, Bui L. Current understanding and distinct features of multifocal and multicentric breast cancers. Cancer Rep (Hoboken) 2023; 6:e1851. [PMID: 37349265 PMCID: PMC10480409 DOI: 10.1002/cnr2.1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/30/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Multifocal (MF) and multicentric (MC) breast cancers are referred to as synchronous, multiple ipsilateral breast cancers; however, the definitions vary among the literature, which has made understanding and analyzing these diseases challenging. RECENT FINDINGS The incidence ranges from 1% to 60%, with a higher prevalence in pre-menopausal women. MF and MC breast cancers, compared with unifocal breast cancers, tend to be more aggressive and are associated with lower survival rates, higher recurrence, and lymph node metastasis. Typically, patients with MF/MC breast cancers are treated with radical surgery, while breast conservation therapy may also be considered. Investigations have focused on elucidating the distinct biological features of MF/MC breast cancers, including the clonality of the cancers, the genetic alterations, and the impact of these features on disease aggressiveness and patient prognosis. CONCLUSION These findings will broaden the understanding of these breast cancer subtypes and aid in the development of more tailored treatment plans for patients.
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Affiliation(s)
| | | | - Loan Bui
- Department of BiologyUniversity of DaytonDaytonOhioUSA
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Tong Y, Sun F, Zhang C, Yang S, Yu Z, Zhao Y. Multifocal/multicentric breast cancer: Does each focus matter? Cancer Med 2023; 12:8815-8824. [PMID: 36734288 PMCID: PMC10134382 DOI: 10.1002/cam4.5626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Multifocal (MF) and multicentric (MC) breast cancer cases have been increasingly diagnosed owing to the extensive use of improved preoperative breast imaging. The current tumor-node-metastasis staging system uses the dimension of the largest tumor and recommends reporting the pathological features of the largest tumor in MF/MC breast cancers. AIM This study aimed to explore whether the largest or aggregate dimensions of MF and MC breast cancers can better predict tumor behavior. We also attempted to study the histological and biological heterogeneities of separate foci in MF and MC breast cancers to determine whether it was necessary to examine each lesion. METHODS We retrospectively analyzed 121 patients with MF/MC (103 with MF and 18 with MC) breast cancers and 484 patients with unifocal breast cancer who were treated at the First Affiliated Hospital of Nanjing Medical University. Two methods were used to record the T stage (using the dimensions of the largest lesion and aggregate dimensions of all lesions). The histological grade, immunohistochemical parameters, and molecular subtypes of the largest lesion and other lesions in MF/MC breast cancers were studied to assess intertumoral heterogeneity. RESULTS The use of aggregate dimensions upstaged 63 patients with MF/MC breast cancers to a more advanced stage and removed the independent effect of cancer multiplicity on lymph node positivity compared with the use of the largest dimension. Mismatches were found in the pathological type (9.9%), histological grade (4.1%), and molecular subtype (8.3%) among different foci. CONCLUSION The tendency of MF/MC breast tumors to metastasize may be related to tumor load, which can be better predicted by the aggregate dimensions of all foci. The use of the current staging systems may require further evaluation and modification. Intertumoral heterogeneity indicates the necessity for pathological and immunohistochemical assessments of each lesion in patients with MF/MC breast cancers.
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Affiliation(s)
- Ying Tong
- Jiangsu Breast Disease Center, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Feixiang Sun
- Jiangsu Breast Disease Center, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Chuanpeng Zhang
- Jiangsu Breast Disease Center, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Susu Yang
- Jiangsu Breast Disease Center, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Ziyi Yu
- Jiangsu Breast Disease Center, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Yi Zhao
- Jiangsu Breast Disease Center, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
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Tan BY, Lim EH, Tan PH. Special Histologic Type and Rare Breast Tumors - Diagnostic Review and Clinico-Pathological Implications. Surg Pathol Clin 2022; 15:29-55. [PMID: 35236633 DOI: 10.1016/j.path.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Breast cancer is the most common malignant tumor in females. While most carcinomas are categorized as invasive carcinoma, no special type (NST), a diverse group of tumors with distinct pathologic and clinical features is also recognized, ranging in incidence from relatively more common to rare. So-called "special histologic type" tumors display more than 90% of a specific, distinctive histologic pattern, while a spectrum of tumors more often encountered in the salivary gland may also arise in the breast. Metaplastic carcinomas can present diagnostic challenges. Some uncommon tumors harbor pathognomonic genetic alterations. This article provides an overview of the key diagnostic points and differential diagnoses for this group of disparate lesions, as well as the salient clinical characteristics of each entity.
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Affiliation(s)
- Benjamin Yongcheng Tan
- Department of Anatomical Pathology, Singapore General Hospital, Level 10, Academia, 20 College Road, Singapore 169856, Singapore
| | - Elaine Hsuen Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Level 7, Diagnostics Tower, Academia, 20 College Road, Singapore 189856, Singapore.
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Moloney BM, McAnena PF, Ryan ÉJ, Beirn EO, Waldron RM, Connell AO, Walsh S, Ennis R, Glynn C, Lowery AJ, McCarthy PA, Kerin MJ. The Impact of Preoperative Breast Magnetic Resonance Imaging on Surgical Management in Symptomatic Patients With Invasive Lobular Carcinoma. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2020; 14:1178223420948477. [PMID: 32863709 PMCID: PMC7430084 DOI: 10.1177/1178223420948477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/14/2020] [Indexed: 01/28/2023]
Abstract
Objective Due to an insidious proliferative pattern, invasive lobular breast cancer (ILC) often fails to form a defined radiological or palpable lesion and accurate diagnosis remains challenging. This study aimed to determine the value of preoperative magnetic resonance imaging (MRI) for ILC and its impact on surgical outcomes. Methods Consecutive symptomatic patients diagnosed with ILC in a tertiary centre over a 9-year period were reviewed. The time from diagnosis until surgery, initial type of surgery/index operation (breast-conserving surgery [BCS]/mastectomy) and the rates of reoperation (re-excision/completion mastectomy) were recorded. Patients were grouped into those who received conventional imaging and preoperative MRI (MR+) and those who received conventional imaging alone (MR-). Results There were 218 cases of ILC, and 32.1% (n = 70) had preoperative MRI. Time from diagnosis to surgery was longer in the MR+ than the MR- group (32.5 vs 21.1 days, P < .001) even when adjusting for age and breast density. Initial BCS was performed on 71.4% (n = 50) of MR+ patients and 72.3% (n = 107) of the MR- group. While the rate of completion mastectomy following initial BCS was higher in the MR+ group (30.0%, n = 15 vs 14.0%, n = 15; χ2 = 5.63; P = .018), this association was not maintained in multivariable analysis. No difference was recorded in overall (initial and completion) mastectomy rate between the MR+ and MR- group (50.0%, n = 35 vs 37.8%, n = 56; χ2 = 2.89; P = .089). Margin re-excision following BCS was comparable between groups (8.0%, n =4, vs 9.3%, n = 10; χ2 = 0.076, P = .783) despite the selection bias for borderline conservable cases in the MR+ group. The rate of usage of MRI for ILC cases declined over the study period. Conclusion While MRI was associated with minor delays in treatment and did not reduce overall rates of margin re-excision or completion mastectomy, it altered the choice of surgical procedure in almost a quarter of MR+ cases. The benefit of preoperative breast MRI appears to be confined to select (younger, dense breast, borderline conservable) cases in symptomatic ILC.
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Affiliation(s)
- Brian M Moloney
- Department of Radiology, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland.,Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Peter F McAnena
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Surgery, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Éanna J Ryan
- Department of Surgery, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Ellen O Beirn
- Department of Surgery, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Ronan M Waldron
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Surgery, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - AnnaMarie O Connell
- Department of Radiology, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Sinead Walsh
- Department of Radiology, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Rachel Ennis
- Department of Radiology, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Catherine Glynn
- Department of Radiology, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Surgery, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Peter A McCarthy
- Department of Radiology, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Michael J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Surgery, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
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Microcalcifications Drive Breast Cancer Occurrence and Development by Macrophage-Mediated Epithelial to Mesenchymal Transition. Int J Mol Sci 2019; 20:ijms20225633. [PMID: 31718020 PMCID: PMC6888678 DOI: 10.3390/ijms20225633] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study aims to investigate: (a) the putative association between the presence of microcalcifications and the expression of both epithelial-to-mesenchymal transition and bone biomarkers, (b) the role of microcalcifications in the breast osteoblast-like cells (BOLCs) formation, and (c) the association between microcalcification composition and breast cancer progression. METHODS We collected 174 biopsies on which we performed immunohistochemical and ultrastructural analysis. In vitro experiments were performed to demonstrate the relationship among microcalcification, BOLCs development, and breast cancer occurrence. Ex vivo investigations demonstrated the significant increase of breast osteoblast-like cells in breast lesions with microcalcifications with respect to those without microcalcifications. RESULTS In vitro data displayed that in the presence of calcium oxalate and activated monocytes, breast cancer cells undergo epithelial to mesenchymal transition. Also, in this condition, cells acquired an osteoblast phenotype, thus producing hydroxyapatite. To further confirm in vitro data, we studied 15 benign lesions with microcalcification from patients that developed a malignant condition in the same breast quadrant. Immunohistochemical analysis showed macrophages' polarization in benign lesions with calcium oxalate. CONCLUSIONS Altogether, our data shed new light about the role of microcalcifications in breast cancer occurrence and progression.
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