[Pathologic-anatomic parameters for the prognosis of invasive breast cancer following amputation or saving the...

The axillary lymph-node-status is the most important prognostic factor in breast cancer patients without distant metastases. The proportion of node positive axillae depends on the number of histologically documented nodes (at least 6 according to TNM recommendations). The prognostic significance of solitary micro-metastases and of metastases detected only by serial sectioning or by immunocytochemistry is not yet established. An important prerequisite for successful conserving breast-cancer treatment is patient selection. Selection leads to a high proportion of patients with favourable prognosis: primary tumors less than 3 cm in diameter, at least 2/3 without axillary lymph-node-metastases, at least 1/3 less than 50 years old. That means attribution of prognostically less favourable patients to mastectomy. Tumor diameter and grading are established prognostic parameters of the primary. The significance of grading is independent of the system used and also independent of the reproducibility by different investigators. Measurement of tumor cell ploidy, proliferation and of epidermal growth factor-receptor content may add to the safety of prognosis prediction. Steroid hormone receptor content, eventually also Somatostatin-receptor and Aromatase activity in the tumor tissue can influence the therapeutic decisions.