Pathologic correlates of survival in 378 lymph node-negative infiltrating ductal breast carcinomas: mitotic count is the best single predictor

Article Abstract:

Statistics indicate that women treated for breast cancer in the earliest stages enjoy excellent chances of long-term survival. One of the best indicators of early disease progression is the presence of cancer cells in the lymph nodes of the armpits. However, even women with negative lymph nodes may, despite early treatment, develop metastatic disease. There is some suggestion that adjuvant chemotherapy may improve the chances for survival even among women diagnosed in the earliest stages of breast cancer. Furthermore, chemotherapy should be seriously considered for women with negative nodes if some unfavorable prognostic indicator is present. A study was undertaken to determine which features of breast cancer are the most accurate prognostic indicators in women with node-negative breast cancer. Pathological specimens from 378 women with node-negative infiltrating ductal breast carcinoma were examined. Tumor grade was determined according to several different pathologic criteria. As would be expected, the survival of patients with poorly differentiated high-grade cancers was worse than the survival of patients with moderately and well differentiated low-grade cancers. However, the best prognostic indicator turned out to the be the presence of mitotic figures. These are the condensed chromosomes, visible under the microscope, that indicate the cell is in the process of dividing. Looking at the cancer specimens under high power, more than 4.5 mitotic cells in 10 high-power fields of view was associated with a poor prognosis. The 20-year tumor-related survival of the patients with fewer than 4.5 mitotic figures was 73 percent. In contrast, the patients with more than 4.5 mitotic figures had a 20-year tumor-related survival of 48 percent. The cancer grading systems provided no useful additional information once the mitotic count had established the prognosis for an individual case. The mitotic count may provide prognostic information comparable to that obtained using more complicated and more expensive techniques such as flow cytometry. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Mitosis

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Breast sarcoma: a clinicopathologic review of 25 cases

Article Abstract:

The majority of breast cancers are carcinomas, that is, cancers of tissues that stem from the ectoderm or endoderm of the developing embryo. Sarcomas, which arise in tissues which stem from the embryonic mesoderm, account for less than one percent of all cases of breast cancer. A review of pathological specimens revealed different types of breast sarcomas and their relative frequency and clinical behavior. At total of 114 cases were found to have been reported as breast sarcoma but, upon re-examination, 77 were found to be cystosarcoma phylloides and 4 were carcinoma with osseous metaplasia. Of the remaining 33 cases of true breast sarcoma, patient records were available for 25. Of these 25 cases, 44 percent were malignant fibrous histosarcoma, 24 percent were liposarcoma, and 16 percent were fibrosarcoma. One case each was observed of clear cell sarcoma, neurogenic sarcoma, leiomyosarcoma, and alveolar soft part sarcoma. Nineteen of the patients had been treated with simple mastectomy or wide local excision of the cancer. Eleven had local recurrence and nine of these patients also developed metastases. Of the eight remaining surgically treated patients who did not develop local recurrence, only two developed metastases. None of the patients recorded developed metastases after five years. Among the patients in this study, the five-year survival was 36 percent; the available data suggest that patients who survive for five years will not die of breast sarcoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Carcinogenesis, Sarcoma

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Metaplastic carcinomas of the breast; III. Carcinosarcoma

Article Abstract:

The use of the classification of breast carcinosarcoma has been used as generic term for disease in which there are both carcinoma (cancer of epithelial, or surface cells) and sarcoma (cancer of connective, fibrous, and fatty tissue). The clinical and anatomical features and disease progression of breast carcinosarcoma are described in this report. The content of certain specific proteins was studied in 40 of the 70 cases of carcinosarcoma. The clinical findings are reviewed, as are the overall appearance and microscopic findings. The treatment of these breast cancers is discussed. The five-year survival rate was 49 percent, worse than for other forms of carcinoma. Thirty-three of 34 patients with metastases (spread of tumor cells outside the original site) died, while those with only local recurrence had a 60 percent survival rate. Smaller tumors were also associated with improved survival rate. (Consumer Summary produced by Reliance Medical Information, Inc.)

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