Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five national surgical adjuvant breast and bowel project protocols of node-negative breast cancer. Increased lymph node positivity in multifocal and multicentric breast cancer. the contents by NLM or the National Institutes of Health. Surgical specimens were examined after slicing at 5-mm intervals. Of these, 2982 (76%) patients had UF breast cancer and 942 (24%) patients had MF (n=695) or MC (n=247) breast cancer in their pathology specimens. As a library, NLM provides access to scientific literature. Bookshelf As advances in preoperative imaging continue, the number of MF and MC tumors identified increases [35], and better guidelines for their management are needed. Fisher ER, Gregorio R, Redmond C, et al. Tumor size and survival in multicentric and multifocal breast cancer. AN conceived the study, participated to data collection and analysis, drafted the manuscript. Careers, Unable to load your collection due to an error. Hi Management of Multifocal-Multicentric Breast Cancer: Current I will meet the plastician soon and hopefully have the surgery at the beginning of November. In order to compare such prognostic significance to that of the other clinical and pathological factors, a multivariate analysis was performed by means of Cox regression analysis; the model of regression included those factors that were significantly related to prognosis in univariate analysis. Joukainen S, Laaksonen E, Vanninen R, Kaarela O, Sudah M. Ann Surg Oncol. The site is secure. The site is secure. HHS Vulnerability Disclosure, Help HHS Vulnerability Disclosure, Help Going thru this once is already devastating. Clipboard, Search History, and several other advanced features are temporarily unavailable. Pathological prognostic factors in breast cancer. However, while studies have consistently shown a correlation between multifocality and multicentricity and the rate and extent of lymph node metastases [1, 714], the literature is divided on whether there is a corresponding impact on survival outcomes. Multifocal Breast Cancer - Verywell Health Management of Multifocal-Multicentric Breast Cancer: Current Perspective. "The beginning of wisdom is the definition of terms" - Socrates. Multifocal multicentric breast cancer has traditionally been considered a contraindication to breast conserving surgery because of concerns regarding locoregional control and risk of disease recurrence. Multicentric mammary carcinoma: evidence of monoclonal proliferation. Follow-up data were collected from our outpatient clinic records, where the patients followed a standardised program of clinical and instrumental examinations; only patients with a follow-up of at least 36months were included in the study. and transmitted securely. Accessibility Indeed, the biological and clinical significance of MF/MC breast cancer is still controversial. Our findings suggest that multifocal/multicentric disease may be associated with worse outcomes versus unifocal disease regardless of type of surgery. 150.3204.5) and with mastectomy (145.19months, 95% C.I. Multifocality as a prognostic factor in breast cancer patients registered in Danish Breast Cooperative Group (DBCG) 19962001. histopathologically, discontinued tumors with intra-ductal invasion. Bethesda, MD 20894, Web Policies Holland R, Veling SH, Mravunac M, Hendriks JH. Her-2/neu was evaluated by immunohistochemistry giving a score range of 01+ (negative) to 3+ (positive); all 2+ scores were verified by fluorescent in situ hybridisation. Middleton LP, Vlastos G, Mirza NQ, Eva S, Sahin AA. Breast cancers were defined as multifocal (MF) if there was more than one focus of invasive breast cancer separated by benign tissue in the same quadrant, and multicentric (MC) when distinct tumour foci were found in different quadrants of the breast. Accessibility Katz A, Strom EA, Buchholz TA, et al. 2005;23 (30): 7497-502. 2022 Jan;29(1):427-436. doi: 10.1245/s10434-021-10800-w. Epub 2021 Oct 6. We found a multifocal breast cancer in 131 cases (11.3%) and a multicentric breast cancer in 60 cases (5.2%). Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Women undergoing preoperative MRI have a significantly higher proportion of MF/MC breast cancer diagnosed, and consequently a higher number of mastectomies performed [16, 17]. It is related to but distinct from the term multifocal breast cancer. Also, I would like to go aesthetic flat where the plastician does a very smooth work hopefully, no silicone, no flap surgery. MF and MC tumors were also associated with a higher N stage, with a larger percentage of patients with N2 (3.8% versus 2.3%) and N3 (3.2% versus 1.1%) (P<0.001) disease. PMC Poliana, what are you learning about MMBC that is influencing your diagnostic and treatment options? Breast cancer-specific survival estimates comparing multifocal (MF) with unifocal disease (A), multicentric (MC) with unifocal disease (B) and MF and MC with unifocal disease (C). Atkins H, Hayward JL, Klugman DJ, Wayte AB. Risk factors that were significant on univariate analysis were evaluated. The prognostic influence of multifocality in breast cancer patients. Unit of Surgical Oncology, Department of Oncology of the University Hospital of Siena, Siena, Italy, Department of Medicine, Surgery and Neurosciences of the University of Siena, Policlinico Le Scotte, v.le Bracci 14, 53100 Siena, Italy, Unit of Pathology, Department of Oncology of the University Hospital of Siena, Siena, Italy. For the purposes of the present study, the Scientific Committee of the Department granted access to patient data contained in the database. MF/MC breast cancers have been reported with an incidence of 4070% in serial-sectioning studies of mastectomy specimens [68], and are usually considered a contraindication to breast-conserving surgery [9] because of an increased risk of local recurrence [10, 11]. There is always so much information coming at you at the beginning and I remember feeling an urgency to make decisions right then. BMC Med Imaging. None of this is easy. Turnbull L, Brown S, Harvey I, Olivier C, Drew P, Napp V, et al. Janeva S, Krabbe E, Parris TZ, Nasic S, Sundquist M, Karlsson P, Audisio RA, Olofsson Bagge R, Kovcs A. I believe that I will go for a mastectomy because I am afraid of cancer recurring and reconstruction options are better without radiation. Federal government websites often end in .gov or .mil. Breast conservation treatment for multifocal and multicentric breast cancers in women with small-volume breast tissue. Despite the limitations of a retrospective study, our experience supports the hypothesis that MF/MC cancers are biologically more aggressive than unifocal tumours, have an increased propensity to metastatic diffusion and are related to a worse outcome. Kurtz JM, Jacquemier J, Amalric R, Brandone H, Ayme Y, Hans D, et al. Early Breast Cancer Trialists Group Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10801 women in 17 randomised trials. Wilkinson LS, Given-Wilson R, Potts H, Potts H, Sharma AK, Smith E. Increasing the diagnosis of multifocal primary breast cancer by the use of bilateral whole-breast ultrasound. In multivariate analysis, MF/MC cancers were independent prognostic factors for poorer BCSS together with higher number of metastatic axillary lymphnodes, absence of oestrogen receptors and high proliferative activity as expressed by Mib-1 staining (Table5).MF and MC cancers were related to a significantly shorter BCSS in patients submitted to mastectomy as well as those submitted to conservative surgery (Figures1 and and22). MF cancers treated with conservative surgery had an ipsilateral breast recurrence rate of 8.3%, higher than the rate (5.9%) of unicentric cancers, but similar to the 7.7% incidence of local recurrences of MF/MC cancers submitted to mastectomy. Please share if you had experience with Multifocal/Multicentric Breast cancer. Breast cancers are defined as multifocal when there is more than one distinct tumour within the same quadrant of the breast (MF) and multicentric when multiple cancers develop in different quadrants of the breast (MC) [ 5 ]. Epub 2020 Feb 18. and transmitted securely. Sardanelli F, Giuseppetti GM, Panizza P, et al. We did not include tumors that were MF or MC by virtue of in situ disease only. This short narrative review summarises current evidence on the role of surgery in multifocal multicentric breast cancer and shows that when technically feasible the option of breast conservation is oncologically safe. Most of the authors do not differentiate between MF and MC tumors, and those who do almost universally lump the groups together for analysis. Tot T, Gere M, Pekar G, et al. Thank you for your response and thought process. government site. TM conceived the study, participated to data collection and analysis and to pathological review of cases and contributed to manuscript draft. The reported incidence of MF/MC breast cancers in the literature ranges from less than 10% to more than 60% [8, 24]; such variability depends either on different definitions of multicentric and multifocal disease or on the techniques of breast specimen sampling used. The site is secure. Fowble B, Yeh IT, Schultz DJ, Solin LJ, Rosato EF, Jardines L, Hoffman J, Eisenberg B, Weiss MC, Hanks G. Int J Radiat Oncol Biol Phys. Become a Gold Supporter and see no third-party ads. 1993 Oct 20;27(3):567-73. doi: 10.1016/0360-3016(93)90381-5. Clinical evaluation of molecular surrogate subtypes in patients with ipsilateral multifocal primary breast cancer. Unilateral multicentric breast cancer. In this narrative review we analyzed differences between MC and MF early breast cancer, the role of magnetic resonance imaging (MRI) in detection of multiple breast lesions, and its role in the surgical approach. Bethesda, MD 20894, Web Policies Multivariate Cox regression analysis for breast cancers specific survival in the whole population. Relapse at any site was higher in the subgroup of MF and MC cancers but the incidence of loco-regional and distant recurrences did not differ between patients treated with mastectomy or breast conserving surgery. 8600 Rockville Pike "Clinical significance of multifocal and multicentric breast cancers Egan LR. A mastectomy was performed in 631 (55.5%) patients and a conservative surgery in 527 (44.5%); all patients submitted to partial mastectomy received radiation therapy on the residual breast with a boost on the tumour bed. O'Daly BJ, Sweeney KJ, Ridgway PF, Quinn C, McDermott EW, O'Higgins NJ, et al. Multivariate analysis shows that MF or MC did not have an independent impact on RFS, BCSS, or OS. Indeed, breast-conserving surgery may be safely performed in the case of MF/MC cancer provided that the disease can be adequately excised with a good cosmetic result [12]. Complete your request online or contact us by phone. Our study and many others have shown an association between MF and MC breast cancer and the increased incidence and burden of regional lymph node metastases. We thank Prof. Piero Tosi and co-workers who provided medical writing services. The https:// ensures that you are connecting to the https://www.sciencedirect.com/science/article/abs/pii/S0960740410000587, https://connect.mayoclinic.org/discussion/mastectomy-1/. Zati Zehni A, Batz F, Cavaills V, Sixou S, Kaltofen T, Keckstein S, Heidegger HH, Ditsch N, Mahner S, Jeschke U, Vilsmaier T. Cancers (Basel). In the absence of compelling evidence to dictate otherwise, the convention according to the current TNM-staging guidelines has been to stage and treat MF and MC patients according to the diameter of the largest lesions, without taking other foci of disease into consideration [15]. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. The importance of multifocal/multicentric tumor on the disease-free Even if we analysed the prognostic influence of MF/MC cancers treated with mastectomy and conservative surgery separately, this aspect may be a limitation of our study. Joergensen LE, Gunnarsdottir KA, Lanng C, Moeller S, Rasmussen BB. All Rights Reserved. In spite of the negative prognostic significance of MF/MC cancers suggested in early studies [8], the current edition of TNM stages breast tumours using only the diameter of the largest focus [21] and the presence of additional foci is not taken into account in deciding adjuvant therapies. sharing sensitive information, make sure youre on a federal 8600 Rockville Pike It looks like when you have Multifocal/ Multicentric Breast cancer, the chances of finding lymph nodes positive is higher, them the unifocal breast cancer. Received 2014 Feb 3; Accepted 2015 Jan 7. At a median follow-up of 88months (range 11248), we observed 304 disease recurrences with a median time to relapse of 32months, and 172 patients died of breast cancer. One of the biggest obstacles in interpreting the current literature on MF and MC breast tumors is the lack of a standard definition. A significantly negative impact of MF/MC breast cancers on BCSS was present in patients who received an adjuvant treatment (either chemotherapy or hormone therapy), and in patients who did not receive any adjuvant treatment. Using the Breast Cancer Management System database of The University of Texas MD Anderson Cancer Center (MDACC), we retrospectively identified all patients diagnosed with invasive breast cancer between 1997 and 2010. FOIA J. Clin. I wish I would have taken the time and had this resource when I was diagnosed. FOIA In contrast to our findings, Boyages et al. *Difference statistically not significant between breast conserving surgery and mastectomy for local recurrence (p 0.92). Patients with synchronous bilateral breast cancers were excluded from the study. Have you read this conversation yet. At a pathological level It can also mean 2 Multifocal and multicentric breast cancer, is it time to think again? Andea AA, Bouwman D, Wallis T, et al. Gupta D, Nath M, Layfield LJ. Multicentric and multifocal versus unifocal breast cancer: is the tumor-node-metastasis classification justified? This study is retrospective in nature, and therefore subject to inherent biases. Andea AA, Wallis T, Newman LA, et al. 7Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, USA. Multiple synchronous (multifocal and multicentric) breast cancer: Clinical implications https://www.sciencedirect.com/science/article/abs/pii/S0960740410000587, Excerpt The Institutional Review Board of The University of Texas, MDACC, approved the retrospective study. Can you tell me what your thoughts are on how to decide? Connect with thousands of patients and caregivers for support and answers. A Retrospective Matched-Cohort Analysis. The KaplanMeier product limit was used to calculate recurrence-free survival (RFS), breast cancer-specific survival (BCSS), and overall survival (OS). Five-year RFS, BCSS, and OS were calculated from the date of diagnosis to the date of local or distant recurrence, death attributable to breast cancer or death, or last follow-up, respectively. [1] found a 3.4% decrease in BCSS, but not OS, at 10 years when compared with the UF group. official website and that any information you provide is encrypted Unauthorized use of these marks is strictly prohibited. The prognostic impact of MF/MC breast cancers was confirmed when patients were stratified for tumour size and number of metastatic axillary lymph nodes (Table4). Multifocal and multicentric breast cancer, is it time to think again Have expanded currently and will have reconstruction around October 23. Moreover, the presence of occult MF/MC breast cancer was a well-known issue when the first trials of conservative surgery were conducted. Increasingly, many breast surgeons are advocating breast conservation in selected cases. I have had some time to think about this, do some research and talk to the surgeon again to answer some questions. [23] found that for tumors larger than 2cm, MF and MC cancers had a worse 10-year BCSS when compared with UF cancer, but the difference was eliminated by assigning a T stage to MF and MC tumors based on the aggregate diameter. The median follow-up was 51 months (range 1162 months). Anderson SJ, Wapnir I, Dignam JJ, Fisher B, Mamounas EP, Jeong JH, et al. [11] compared 288 patients with MF and MC tumors based on clinical and radiographic findings with a cohort of matched UF controls and found that these patients had statistically significantly worse RFS (HR 1.74) and BCSS (HR 1.57) on multivariate analysis. An official website of the United States government. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, Breast cancer, Multifocal breast cancer, Multicentric breast cancer, Breast cancer surgery, Breast cancer prognosis. However, when these factors are controlled for, they do not have a worse RFS, BCSS, or OS. official website and that any information you provide is encrypted 2021 Jul 26;13(15):3756. doi: 10.3390/cancers13153756. Multivariate Cox regression analysis for breast cancers specific survival in mastectomy and breast conserving surgery. I feel like we are in sort of of the same situation. The present study was directed to analyse, in a large retrospective series of breast cancer patients treated at a single institution, the impact of MF/MC breast cancers on the long-term survival in relation to other known pathological and clinical factors and to the type of treatment received. I have two tumors in my left breast one is 2cm and another 1cm or", "There is always so much information coming at you at the beginning and I remember feeling", "My head is spinning. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Our results indicate that MF/MC cancers have a negative impact on prognosis and are related to higher loregional and distant relapse independently from the type of surgery performed. It is related to but distinct from the term multifocal breast cancer. I found this study that supports your understanding of lymph node spread and dissection options: The majority of MF/MC cancers in our series were treated by mastectomy. A recent meta-analysis of 22 studies including The site is secure. I didnt have lumpectomy option. Comparing radical mastectomy with quadrantectomy, axillary dissection and radiotherapy in patients with small cancers of the breast. I. Conservative surgery in patients with multifocal/multicentric breast cancer. MF tumors are classically defined as two or more separate tumors in the same quadrant of the breast, with MC tumors occupying more than one quadrant and separated by normal breast tissue [16]. 2003;27 (2): 693-8. Silverstein MJ, Savalia N, Khan S, Ryan J. found a difference in survival outcomes only in MF and MC tumors >2cm, suggesting that there may be a difference in the behavior of macroscopically evident MF and MC tumors and those only microscopically apparent. Ustaalioglu BO, Bilici A, Kefeli U, eker M, Oncel M, Gezen C, Gumus M, Demirelli F. Am J Clin Oncol. These findings are in accordance with the hypothesis that a more aggressive surgical approach does not improve either the locoregional control or the distant outcome of MF/MC tumours [20]. . One hundred and three patients (2.6%) died from their breast cancer: 71 (2.4%) in the UF group, 19 (2.7%) in the MF group, and 13 (5.3%) in the MC group (supplementary Table S2, available at Annals of Oncology online). I decided to go with mastectomy as mine is multifocal. I would have chosen mastectomy over lumpectomy anytime. My head is spinning. Cabioglu N, Ozmen V, Kaya H, et al. The incidence of multifocality is probably often underestimated. HHS Vulnerability Disclosure, Help Although multifocal (MF) and multicentric (MC) breast tumors are a common entity, their clinical behavior is not well characterized. Tong Y, Sun F, Zhang C, Yang S, Yu Z, Zhao Y. The .gov means its official. Histology was reviewed by TM and DT. 2022 May 25;12(6):867. doi: 10.3390/jpm12060867. Finally, in 1154 patients with two or more invasive lesions anywhere in the same breast, Yerushalmi et al. A multicentric breast cancer is a term given to a breast cancerwhere there are two or more breast cancers separated by normal breast tissue (often taken as 5 cm of separation 4). The accuracy of combined versus largest diameter in staging multifocal breast cancer. Better Information for Better Women's Health - WebMD The negative prognostic impact of MF/MC cancers on BCSS was present in both cases treated with conservative surgery and with radical surgery. Prognostic relevance of proliferative activity evaluated by Mib-1 immunostaining in node negative breast cancer. Multicentric breast cancer is a similar type of cancer. However, re-assigning the T stage based on the combined diameter of all of the foci corrected this disparity and the rate of lymph node metastases between MF and MC and UF tumors became equal. Chirurgia (Bucur). In the literature, few studies have investigated the prognosis of MF/MC cancers, and they have produced contrasting results: some investigators have not found any influence on long-term survival [2224] while other recent series have reported a worse outcome for MF/MC breast cancers [25, 26]. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Unable to process the form. 3. Epub 2023 Feb 3. Weissenbacher TM, Zschage M, Janni W, Jeschke U, Dimpfl T, Mayr D, et al. Milulescu A, Di Marino L, Peradze N, Toesca A; -. Gland Surg. Distribution of clinical and pathological factors in unicentric and multifocal/multicentric breast cancers. Adjuvant therapies did not modify the poorer outcome, but in patients receiving adjuvant anthacyclines, the differences with unicentric tumors were reduced. 194214 months) of unicentric cancers (p<0.001). Alternatively, some studies use definitions based on the distance of uninvolved tissue between lesions [1719]. Some authors have proposed that the aggregate diameter of MF/MC tumours may be an effective estimate of the tumour load [30] and should be considered when planning the treatment of these patients, but these data were not confirmed in other studies [31]. 2022 Oct;29(11):6716-6727. doi: 10.1245/s10434-022-11977-4. The same results were recently reported by Weissenbacher et al. However, in our experience, breast-conserving surgery was performed in almost half of the patients and this may have underestimated the real incidence of MF/MC as, in these cases, only the surgically removed quadrant was examined. Increasingly, many breast surgeons are advocating breast conservation in selected cases. eCollection 2022. Check for errors and try again. @dmart37. Before Patients were categorized as UF, MF, or MC. We excluded patients with metastatic disease at diagnosis and those treated with neoadjuvant chemotherapy, leaving 6735 patients. Factors independently related to multifocal/multicentric breast cancers in multivariate analysis (Logistic Regression).

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