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Abstract：
Multifocal (MF) and multicentric (MC) breast cancer cases have been increasingly diagnosed owing to the extensive use of improved preoperative breast imaging. The current tumor-node-metastasis staging system uses the dimension of the largest tumor and recommends reporting the pathological features of the largest tumor in MF/MC breast cancers.
This study aimed to explore whether the largest or aggregate dimensions of MF and MC breast cancers can better predict tumor behavior. We also attempted to study the histological and biological heterogeneities of separate foci in MF and MC breast cancers to determine whether it was necessary to examine each lesion.
We retrospectively analyzed 121 patients with MF/MC (103 with MF and 18 with MC) breast cancers and 484 patients with unifocal breast cancer who were treated at the First Affiliated Hospital of Nanjing Medical University. Two methods were used to record the T stage (using the dimensions of the largest lesion and aggregate dimensions of all lesions). The histological grade, immunohistochemical parameters, and molecular subtypes of the largest lesion and other lesions in MF/MC breast cancers were studied to assess intertumoral heterogeneity.
The use of aggregate dimensions upstaged 63 patients with MF/MC breast cancers to a more advanced stage and removed the independent effect of cancer multiplicity on lymph node positivity compared with the use of the largest dimension. Mismatches were found in the pathological type (9.9%), histological grade (4.1%), and molecular subtype (8.3%) among different foci.
The tendency of MF/MC breast tumors to metastasize may be related to tumor load, which can be better predicted by the aggregate dimensions of all foci. The use of the current staging systems may require further evaluation and modification. Intertumoral heterogeneity indicates the necessity for pathological and immunohistochemical assessments of each lesion in patients with MF/MC breast cancers.
This study aimed to explore whether the largest or aggregate dimensions of MF and MC breast cancers can better predict tumor behavior. We also attempted to study the histological and biological heterogeneities of separate foci in MF and MC breast cancers to determine whether it was necessary to examine each lesion.
We retrospectively analyzed 121 patients with MF/MC (103 with MF and 18 with MC) breast cancers and 484 patients with unifocal breast cancer who were treated at the First Affiliated Hospital of Nanjing Medical University. Two methods were used to record the T stage (using the dimensions of the largest lesion and aggregate dimensions of all lesions). The histological grade, immunohistochemical parameters, and molecular subtypes of the largest lesion and other lesions in MF/MC breast cancers were studied to assess intertumoral heterogeneity.
The use of aggregate dimensions upstaged 63 patients with MF/MC breast cancers to a more advanced stage and removed the independent effect of cancer multiplicity on lymph node positivity compared with the use of the largest dimension. Mismatches were found in the pathological type (9.9%), histological grade (4.1%), and molecular subtype (8.3%) among different foci.
The tendency of MF/MC breast tumors to metastasize may be related to tumor load, which can be better predicted by the aggregate dimensions of all foci. The use of the current staging systems may require further evaluation and modification. Intertumoral heterogeneity indicates the necessity for pathological and immunohistochemical assessments of each lesion in patients with MF/MC breast cancers.
摘要：
背景：多病灶（MF）和多中心（MC）乳腺癌病例由于广泛使用了改良的术前乳腺成像技术而越来越多地被诊断。当前的肿瘤淋巴结转移分期系统使用最大肿瘤的尺寸，并建议报告MF/MC乳腺癌中最大肿瘤的病理特征。
目的：本研究旨在探讨MF和MC乳腺癌的最大或聚集尺寸是否可以更好地预测肿瘤行为。我们还试图研究MF和MC乳腺癌中单独病灶的组织学和生物学异质性，以确定是否有必要检查每个病灶。
方法：我们回顾性分析了南京医科大学第一附属医院收治的121例MF/MC（103例MF和18例MC）乳腺癌和484例单灶性乳腺癌患者。使用两种方法记录T分期(使用最大病变的尺寸和所有病变的聚集尺寸)。组织学分级,免疫组织化学参数，研究了MF/MC乳腺癌中最大病变和其他病变的分子亚型，以评估肿瘤间的异质性。
结果：与使用最大尺寸相比，使用集合尺寸将63例MF/MC乳腺癌患者的分期提高到更晚期，并消除了癌症多重性对淋巴结阳性的独立影响。病理类型不匹配(9.9%),组织学分级（4.1%），不同病灶中的分子亚型(8.3%)。
结论：MF/MC乳腺肿瘤的转移倾向可能与肿瘤负荷有关。可以通过所有焦点的聚合尺寸更好地预测。当前分级系统的使用可能需要进一步评估和修改。肿瘤间异质性表明MF/MC乳腺癌患者需要对每个病变进行病理和免疫组织化学评估。
目的：本研究旨在探讨MF和MC乳腺癌的最大或聚集尺寸是否可以更好地预测肿瘤行为。我们还试图研究MF和MC乳腺癌中单独病灶的组织学和生物学异质性，以确定是否有必要检查每个病灶。
方法：我们回顾性分析了南京医科大学第一附属医院收治的121例MF/MC（103例MF和18例MC）乳腺癌和484例单灶性乳腺癌患者。使用两种方法记录T分期(使用最大病变的尺寸和所有病变的聚集尺寸)。组织学分级,免疫组织化学参数，研究了MF/MC乳腺癌中最大病变和其他病变的分子亚型，以评估肿瘤间的异质性。
结果：与使用最大尺寸相比，使用集合尺寸将63例MF/MC乳腺癌患者的分期提高到更晚期，并消除了癌症多重性对淋巴结阳性的独立影响。病理类型不匹配(9.9%),组织学分级（4.1%），不同病灶中的分子亚型(8.3%)。
结论：MF/MC乳腺肿瘤的转移倾向可能与肿瘤负荷有关。可以通过所有焦点的聚合尺寸更好地预测。当前分级系统的使用可能需要进一步评估和修改。肿瘤间异质性表明MF/MC乳腺癌患者需要对每个病变进行病理和免疫组织化学评估。
