A study of predictive and prognostic histopathologic factors in breast conservation therapy
Keywords:
Breast Conversation Therapy (BCT), Breast Cancer, Histopathology, Recurrence rate
Abstract
Background: Breast cancer is the second most common cancer after cervical cancer in Indian. Presently breast conservation therapy (BCT) is the preferred treatment for stage I and II breast cancer. Therefore, the present study was undertaken to identify and study these histopathologic factors and correlate them with local recurrence rate.
Method: The pathology records of a tertiary cancer referral hospital were systemically scrutinized for two years and 106 women in the age group of 25-70 years with primary operable invasive breast cancer treated by breast conversation therapy (BCT) were studied in depth. Follow-up ranged for 2 to 3 years. Every patient was followed up every 6 monthly by the onco-surgeon and radiotherapist. Cases in which the pathology slides and / or blocks were not available were excluded.
Result: The mean age of all the patients was 43.1 years. (Range: 25-67 years.) Majority of the patients are in the age group of 35-44 years (44.3%). Most of the tumours occurred in the upper outer quadrant (62.3%). IDC forms the main group (93.4%) in the various cases studied. Out of 99 IDC only 89 are pure IDC and 10 are with other components. Majority of the cases belongs to grade-III (63.2%). Maximum tumour size is in the range of 2-5 cm (52.8%). Necrosis was one of the main histological factor observed in the present study (12.3%). Overall 7.5% of our patients developed local recurrence, most of them occurred within the first year.
Conclusion: Predictive and prognostic histopathologic factors which increase the risk of recurrence are, Presence of extensive intraductal component, Positive cut margin of resection, Presence of Lymphovascular invasion.
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References
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22. Fisher ER, Sass R, Fisher B, Gregorio R, Brown R, Wickerham L. Pathologic findings from the National Surgical Adjuvant Breast Project (protocol 6). II. Relation of local breast recurrence to multicentricity. Cancer. 1986;57(9):1717-1724. doi:10.1002/1097-0142 (19860501)57:9<1717::aid-cncr2820570902>3.0.co;2-h
23. Osteen RT, Connolly JL, Recht A, Silver B, Schnitt SJ, Harris JR. Identification of patients at high risk for local recurrence after conservative surgery and radiation therapy for stage I or II breast cancer. Arch Surg. 1987; 122(11):1248-1252.doi:10.1001/archsurg.1987.0140023 0034005
24. Schnitt SJ, Connolly JL, Harris JR, Hellman S, Cohen RB. Pathologic predictors of early local recu-rrence in stage I and II breast cancer treated by primary radiation therapy. Cancer. 1984;53(5):1049-1057
25. Bartelink H, Borger JH, van Dongen JA, Peterse JL. The impact of tumor size and histology on local control after breast-conserving therapy. Radiother Oncol. 1988; 11(4):297-303. doi:10.1016/0167-8140(88)90200-9
26. Šeparović V, Šarčević B, Šeparović R, Ores̆ić V, Nola N, Vrdoljak M, Krus̆lin B. Prognostic value of prominent DCIS component in the breast-conserving therapy of stage I and II invasive ductal breast cancer. The Breast. 1999;8(2):72-76. doi: https://doi.org/10. 1016/ S0960-9776(99)90003-6
27. Gage I, Schnitt SJ, Nixon AJ, Silver B, Recht A, Troyan SL, et al. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer. 1996;78(9):1921-1928. doi: 10. 1002/(sici)1097-0142(19961101) 78:9<1921:: aid-cncr12>3.0.co;2-#
28. Spivack B, Khanna MM, Tafra L, Juillard G, Giuliano AE. Margin status and local recurrence after breast-conserving surgery. Arch Surg. 1994;129(9):952-956. doi:10.1001/archsurg.1994.01420330066013
29. Noguchi S, Koyama H, Kasugai T, Tsukuma H, Tsuji N, Tsuda H, et al. A case-control study on risk factors for local recurrences or distant metastases in breast cancer patients treated with breast-conserving surgery. Oncol. 1997;54(6):468-474. doi:10.1159/ 000 227605
30. Smitt MC, Nowels KW, Zdeblick MJ, Jeffrey S, Carlson RW, Stockdale FE, et al. The importance of the lumpectomy surgical margin status in long-term results of breast conservation. Cancer. 1995;76(2):259-267. doi:10.1002/1097-0142(19950715)76:2<259::aid-cncr 2820760216>3.0.co;2-2
31.Pittinger TP, Maronian NC, Poulter CA, Peacock JL. Importance of margin status in outcome of breast-conserving surgery for carcinoma. Surg. 1994;116 (4):605-608.
32. Schnitt SJ, Abner A, Gelman R, Connolly JL, Recht A, Duda RB, et al. The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy. Cancer. 1994;74(6):1746-1751. doi:10.1002/1097-0142 (19940915)74:6<1746::aid-cncr2820740617>3.0.co;2-y
33. Pinder SE, Ellis IO, Galea M, O'Rouke S, Blamey RW, Elston CW. Pathological prognostic factors in breast cancer. III. Vascular invasion: relationship with recurrence and survival in a large study with long-term follow-up.Histopathol. 1994;24(1):41-47. doi:10.1111/j. 1365-2559.1994.tb01269.x
34. Mate TP, Carter D, Fischer DB, Hartman PV, McKhann C, Merino M, Prosnitz LR, Weissberg JB. A clinical and histopathologic analysis of the results of conservation surgery and radiation therapy in stage I and II breast carcinoma. Cancer. 1986; 58(9): 1995- 2002.
2. Jain DK. National Cancer Registry Programme biennial report, 1988–89. New Delhi: NCRP Scientific Publication. 1992.
3. Jayant K, Rao RS, Nene BM, Dale PS. Early diagnosis of cervical cancers. Our experience at the Rural Cancer Registry, Barshi, India. Indian J Cancer. 1994; 31(2):59-63.
4. Alexe G, Dalgin GS, Scanfeld D, Tamayo P, Mesirov JP, Ganesan S, Delisi C, Bhanot G. Breast cancer stratification from analysis of micro-array data of micro-dissected specimens. InGenome Informatics 2007: Genome Informatics Series.2007;18:130-140.
5. Halsted WS. I. The Results of Operations for the Cure of Cancer of the Breast Performed at the Johns Hopkins Hospital from June, 1889, to January, 1894. Ann Surg. 1894;20(5):497-555. doi:10.1097/00000658-189407000-00075
6. Lacour J, Bucalossi P, Cacers E, Jacobelli G, Koszarowski T, Le M, et al. Radical mastectomy versus radical mastectomy plus internal mammary dissection. Five-year results of an international cooperative study. Cancer. 1976;37(1):206-214. doi:10. 1002/ 1097-0142 (197601) 37:1 <206::aid-cncr 2820370130 >3. 0.co;2-m
7. Urban JA, Marjani MA. Significance of internal mammary lymph node metastases in breast cancer. Am J Roentgenol Radium Ther Nucl Med. 1971; 111(1): 130-136. doi:10.2214/ajr.111.1.130
8. Patey DH, Dyson WH. The prognosis of carcinoma of the breast in relation to the type of operation performed. Br J Cancer. 1948;2(1):7-13. doi:10.1038/ bjc. 1948.2
9. Song WJ, Kim KI, Park SH, Kwon MS, Lee TH, Park HK, et al. The Risk Factors Influencing between the Early and Late Recurrence in Systemic Recurrent Breast Cancer. J Breast Cancer. 2012;15 (2): 218-223. doi: 10.4048/jbc.2012.15.2.218. Epub 2012 Jun 28.
10. Lê MG, Arriagada R, Spielmann M, Guinebretière JM, Rochard F. Prognostic factors for death after an isolated local recurrence in patients with early‐stage breast carcinoma. Cancer: Interdis Int J Am Can Soc. 2002; 94(11): 2813-2820. doi: https://doi.org/10. 1002/ cncr. 10572
11. Song WJ, Kim KI, Park SH, Kwon MS, Lee TH, Park HK. The risk factors influencing between the early and late recurrence in systemic recurrent breast cancer. J Breast Cancer. 2012;15(2):218-223. doi: 10.4048/jbc. 2012. 15.2.218. Epub 2012 Jun 28.
12. Voduc KD, Cheang MC, Tyldesley S, Gelmon K, Nielsen TO, Kennecke H. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol. 2010; 28(10): 1684-1691. doi: 10.1200/JCO. 2009. 24. 9284. Epub 2010 Mar 1.
13. NIH consensus conference. Treatment of early-stage breast cancer.JAMA. 1991; 265(3): 391-395. doi:10. 1001/ jama. 1991. 03460030097037
14. Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. C. W. Elston & I. O. Ellis. Histopathol. 2002;41(3A):151-152. doi: https://doi. org/10.1111/j. 1365-2559.1991.tb00229.x
15. Shousha S, Coady AT, Stamp T, James KR, Alaghband-Zadeh J. Oestrogen receptors in mucinous carcinoma of the breast: an immunohistological study using paraffin wax sections. J Clinic Pathol. 1989;42 (9): 902-905. doi: 10.1136/jcp.42.9.902
16. Roses DF, Bell DA, Flotte TJ, Taylor R, Ratech H, Dubin N. Pathologic predictors of recurrence in stage 1 (TINOMO) breast cancer. Am J Clin Pathol. 1982;78 (6):817-820. doi:10.1093/ajcp/78.6.817
17.FourquetA, Campana F, Zafrani B, Mosseri V, Vielh P, Durand JC, et al. Prognostic factors of breast recurrence in the conservative management of early breast cancer: a 25-year follow-up. Int J Radiat Oncol Biol Phys. 1989;17(4):719-725. doi:10.1016/0360-3016 (89) 90057-6
18.LockerAP,Ellis IO, MorganDA, Elston CW,Mitchell A, Blamey RW. Factors influencing local recurrence after excision and radiotherapy for primary breast cancer.Br J Surg. 1989;76(9):890-894. doi: 10.1002/bjs. 1800760906
19. Haffty BG, Fischer D, Rose M, Beinfield M, McKhann C. Prognostic factors for local recurrence in the conservatively treated breast cancer patient: a cautious interpretation of the data. J Clin Oncol. 1991;9(6):997-1003. doi:10.1200/JCO.1991.9.6.997
20. Kurtz JM, Jacquemier J, Amalric R, Brandone H, Ayme Y, Hans D, et al. Risk factors for breast recurrence in premenopausal and postmenopausal patients with ductal cancers treated by conservation therapy. Cancer. 1990; 65(8):1867-1878. doi:10.1002/ 1097-0142(19900415)65:8<1867::aid-cncr2820650833 >3.0.co;2-i
21.Rosai J. Ackeman’s Surgical Pathology, Harcourt Brace and company Asia PTE Ltd, 8th edition 1996: 1591.
22. Fisher ER, Sass R, Fisher B, Gregorio R, Brown R, Wickerham L. Pathologic findings from the National Surgical Adjuvant Breast Project (protocol 6). II. Relation of local breast recurrence to multicentricity. Cancer. 1986;57(9):1717-1724. doi:10.1002/1097-0142 (19860501)57:9<1717::aid-cncr2820570902>3.0.co;2-h
23. Osteen RT, Connolly JL, Recht A, Silver B, Schnitt SJ, Harris JR. Identification of patients at high risk for local recurrence after conservative surgery and radiation therapy for stage I or II breast cancer. Arch Surg. 1987; 122(11):1248-1252.doi:10.1001/archsurg.1987.0140023 0034005
24. Schnitt SJ, Connolly JL, Harris JR, Hellman S, Cohen RB. Pathologic predictors of early local recu-rrence in stage I and II breast cancer treated by primary radiation therapy. Cancer. 1984;53(5):1049-1057
25. Bartelink H, Borger JH, van Dongen JA, Peterse JL. The impact of tumor size and histology on local control after breast-conserving therapy. Radiother Oncol. 1988; 11(4):297-303. doi:10.1016/0167-8140(88)90200-9
26. Šeparović V, Šarčević B, Šeparović R, Ores̆ić V, Nola N, Vrdoljak M, Krus̆lin B. Prognostic value of prominent DCIS component in the breast-conserving therapy of stage I and II invasive ductal breast cancer. The Breast. 1999;8(2):72-76. doi: https://doi.org/10. 1016/ S0960-9776(99)90003-6
27. Gage I, Schnitt SJ, Nixon AJ, Silver B, Recht A, Troyan SL, et al. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer. 1996;78(9):1921-1928. doi: 10. 1002/(sici)1097-0142(19961101) 78:9<1921:: aid-cncr12>3.0.co;2-#
28. Spivack B, Khanna MM, Tafra L, Juillard G, Giuliano AE. Margin status and local recurrence after breast-conserving surgery. Arch Surg. 1994;129(9):952-956. doi:10.1001/archsurg.1994.01420330066013
29. Noguchi S, Koyama H, Kasugai T, Tsukuma H, Tsuji N, Tsuda H, et al. A case-control study on risk factors for local recurrences or distant metastases in breast cancer patients treated with breast-conserving surgery. Oncol. 1997;54(6):468-474. doi:10.1159/ 000 227605
30. Smitt MC, Nowels KW, Zdeblick MJ, Jeffrey S, Carlson RW, Stockdale FE, et al. The importance of the lumpectomy surgical margin status in long-term results of breast conservation. Cancer. 1995;76(2):259-267. doi:10.1002/1097-0142(19950715)76:2<259::aid-cncr 2820760216>3.0.co;2-2
31.Pittinger TP, Maronian NC, Poulter CA, Peacock JL. Importance of margin status in outcome of breast-conserving surgery for carcinoma. Surg. 1994;116 (4):605-608.
32. Schnitt SJ, Abner A, Gelman R, Connolly JL, Recht A, Duda RB, et al. The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy. Cancer. 1994;74(6):1746-1751. doi:10.1002/1097-0142 (19940915)74:6<1746::aid-cncr2820740617>3.0.co;2-y
33. Pinder SE, Ellis IO, Galea M, O'Rouke S, Blamey RW, Elston CW. Pathological prognostic factors in breast cancer. III. Vascular invasion: relationship with recurrence and survival in a large study with long-term follow-up.Histopathol. 1994;24(1):41-47. doi:10.1111/j. 1365-2559.1994.tb01269.x
34. Mate TP, Carter D, Fischer DB, Hartman PV, McKhann C, Merino M, Prosnitz LR, Weissberg JB. A clinical and histopathologic analysis of the results of conservation surgery and radiation therapy in stage I and II breast carcinoma. Cancer. 1986; 58(9): 1995- 2002.
CITATION
DOI: 10.17511/jopm.2019.i08.14
Published: 2019-08-31
How to Cite
Dr. Gauri Kelkar, & Dr. Nivedita S.B. (2019). A study of predictive and prognostic histopathologic factors in breast conservation therapy. Tropical Journal of Pathology and Microbiology, 5(8), 591-599. https://doi.org/10.17511/jopm.2019.i08.14
Section
Original Article
OAI - Open Archives Initiative
