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Synchronous Multiple Breast Cancers-Do We Need to Reshape Staging?

Minodora Onisâi1,2, Adrian Dumitru3, Iuliana Iordan2

  • 1Faculty of General Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania.

Medicina (Kaunas, Lithuania)
|May 15, 2020
PubMed
Summary

Breast cancer heterogeneity is common in multifocal and multicentric tumors. Current staging may underestimate aggressive secondary tumors, necessitating treatment plan adjustments for better patient outcomes.

Keywords:
breast cancerhistopathological characteristicslobular carcinomamismatchtumors

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Area of Science:

  • Oncology
  • Pathology
  • Genetics

Background:

  • Breast cancer exhibits significant heterogeneity at multiple levels, including histology, grade, and molecular profile.
  • Current breast cancer treatment guidelines lack explicit recommendations for managing discrepancies in surgical specimens, particularly in multicentric or multifocal lesions.
  • Synchronous breast cancer provides a unique model for studying inter- and intra-tumoral heterogeneity.

Purpose of the Study:

  • To investigate intertumoral heterogeneity in synchronous breast cancer patients with multicentric and multifocal lesions.
  • To assess the impact of tumor heterogeneity on staging, prognosis, and treatment decisions.
  • To propose improvements to the current staging system for multifocal and multicentric breast cancer.

Main Methods:

  • A prospective observational study was conducted on 235 breast cancer patients undergoing surgery.
  • Thirty-seven patients with multiple synchronous breast tumors (multicentric or multifocal) were included for heterogeneity assessment.
  • Histopathological, immunohistochemical (ER, PR, Ki-67), and molecular phenotype data were analyzed for index and secondary tumors.

Main Results:

  • Significant mismatches were observed in histopathology (8.1%), grade (35.1%), ER status (29.8%), PR status (32.4%), molecular phenotype (21.6%), and Ki-67 (45.9%) between index and secondary tumors.
  • In 13.5% of cases, secondary tumors were dominant, requiring reclassification and potentially altering therapeutic decisions.
  • The study identified cases where secondary tumors were more aggressive or had a larger cumulative mass than the primary tumor.

Conclusions:

  • The current Tumor-Node-Metastasis (TNM) staging system for synchronous breast tumors does not account for the characteristics or size of secondary foci.
  • Treatment plans for multifocal/multicentric breast cancer should be adapted when secondary lesions are more aggressive or contribute significantly to the cumulative tumor burden.
  • Incorporating data from secondary foci and assessing cumulative tumor burden into staging and treatment decisions is crucial to avoid under-treatment.