Tumor histology as a prognostic determinant in carcinoma of the breast

At St. Joseph's Hospital in 1970 and 1971, 100 patients with invasive ductal adenocarcinoma of the breast were analyzed, retrospectively. Microscopic review of the original tumor was conducted in order to determine histologic grade, degree of circumscription and the presence of vascular or lymphatic invasion, or both. Clinical characteristics of the patients were obtained from patient charts and survival determined through follow-up study at St. Joseph's Tumor Registry. When patients were grouped according to the criteria already mentioned, survival time could be predicted with a degree of accuracy similar to the standard criteria of tumor size and nodal involvement. Specifically, patients in whom tumors had no adverse histologic criteria (that is, low grade, well circumscribed and no vascular or lymphatic invasion) had a 73 per cent ten year survival rate, while those with three adverse criteria (high grade, poorly circumscribed, with lymphatic invasion) had a 33 per cent ten year survival rate. Similarly, 14 per cent of the patients without any adverse histologic criteria had nodal involvement, while 44 per cent of those patients with any adverse criteria proved to have positive nodes. It is suggested that the evaluation of the criteria described provides the surgeon with a reliable means of predicting survival time, based upon the results of the original specimen taken at biopsy. The use of these histologic characteristics has significant potential as it relates to the planning of both primary and adjuvant therapy, based upon evaluation of the specimen. Currently, it should be used in conjunction with axillary dissection and determination of nodal involvement. With further refinement and confirmation of these findings, the potential exists for accurate prognostication prior to axillary dissection.