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The current TNM classification of breast carcinomas: Controversial issues in early breast cancer

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memo - Magazine of European Medical Oncology Aims and scope Submit manuscript

Summary

The TNM is the most widely used staging system for malignant disease. Its seventh edition has been updated in several respects, but there still remain controversial issues requiring further improvement. The current review highlights the items related to early breast cancer. It deals separately with contradictions found in the online resources, those related to the different categories, the stages, grade and finally it places the TNM in the milieu of biological markers often used to tailor individual patient treatment. Although TNM has lost its nearly unique role in assessing patient risk and in selecting systemic therapy for breast cancer, it is still of importance in reflecting the anatomic extent of disease in a categorical way, selecting surgical treatment and comparing similar tumours of different extent.

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Abbreviations

EBC:

early breast cancer

LN:

lymph node

SLN:

sentinel lymph node

References

  • Sobin L, Gospodarowicz M, Wittekind Ch. (eds) UICC TNM classification of malignant tumours, 7th edn. John Wiley and Sons Inc., New York, 2009

    Google Scholar 

  • Edge SB, Byrd DR, Compton CC, et al. (eds) AJCC Cancer Staging Handbook: from the AJCC Cancer Staging Manual. Springer, New York, 2009

    Google Scholar 

  • Edge SB, Byrd DR, Compton CC, et al. (eds) AJCC Cancer Staging Manual. Springer, New York, 2009

    Google Scholar 

  • Wittekind Ch, Greene F, Hutter RVP, et al. (eds) TNM supplement: a commentary on uniform use. Wiley, New York, 2003

    Google Scholar 

  • Maluf HM, Koerner FC. Solid papillary carcinoma of the breast. A form of intraductal carcinoma with endocrine differentiation frequently associated with mucinous carcinoma. Am J Surg Pathol, 19: 1237–1244, 1995

    Article  PubMed  CAS  Google Scholar 

  • Collins LC, Carlo VP, Hwang H, et al. Intracystic papillary carcinomas of the breast: a reevaluation using a panel of myoepithelial cell markers. Am J Surg Pathol, 30: 1002–1007, 2006

    Article  PubMed  Google Scholar 

  • Collins LC, Schnitt SJ. Papillary lesions of the breast: selected diagnostic and management issues. Histopathology, 52: 20–29, 2008

    Article  PubMed  CAS  Google Scholar 

  • Schnitt SJ, Collins LC. Biopsy interpretation of the breast. Lippincott William & Wilkins, Philadelphia, 2009

    Google Scholar 

  • Rosen PP. Rosen's breast pathology, 3rd edn. Lippincott William & Wilkins, Philadelphia, 2009

    Google Scholar 

  • Tavassoli FA, Eusebi V. Tumors of the mammary gland. AFIP Atlas of Tumor Pathology, Series 4. American Registry of Pathology, Washington, 2009

  • Leal C, Costa I, Fonseca D, et al. Intracystic (encysted) papillary carcinoma of the breast: a clinical, pathological, and immunohistochemical study. Hum Pathol, 29: 1097–1104, 1998

    Article  PubMed  CAS  Google Scholar 

  • Tot T. Clinical relevance of the distribution of the lesions in 500 consecutive breast cancer cases documented in large-format histologic sections. Cancer, 110: 2551–2560, 2007

    Article  PubMed  Google Scholar 

  • Tot T, Tabár L, Dean P. Practical breast pathology. Thieme, Stuttgart-New York, 2002

    Google Scholar 

  • Verschraegen C, Vinh-Hung V, Cserni G, et al. Modeling the effect of tumor size in early breast cancer. Ann Surg, 241: 309–318, 2005

    Article  PubMed  Google Scholar 

  • Tabar L, Tot T, Dean PB. Breast cancer – The art and science of early detection with mammography: perception, interpretation, histopathologic correlation. Thieme, Stuttgart, 2005

    Google Scholar 

  • Tot T. Metastatic capacity of multifocal breast carcinomas: extensive tumors versus tumors of limited extent. Hum Pathol, 40: 199–205, 2009

    Article  PubMed  Google Scholar 

  • Weissenbacher TM, Zschage M, Janni W, et al. Multicentric and multifocal versus unifocal breast cancer: is the tumor-node-metastasis classification justified? Breast Cancer Res Treat, 122: 27–34, 2010

    Article  PubMed  CAS  Google Scholar 

  • Giuliano AE, Dale PS, Turner RR, et al. Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg, 222: 394–401, 1995

    Article  PubMed  CAS  Google Scholar 

  • Cserni G, Amendoeira I, Apostolikas N, et al. Pathological work-up of sentinel lymph nodes in breast cancer. Review of current data to be considered for the formulation of guidelines. Eur J Cancer, 39: 1654–1667, 2003

    Article  PubMed  CAS  Google Scholar 

  • Cserni G, Amendoeira I, Bianchi S, et al. Distinction of isolated tumour cells and micrometastasis in lymph nodes of breast cancer patients according to the new Tumour Node Metastasis (TNM) definitions. Eur J Cancer, 2010 Dec 16 [E-pub ahead of print]

  • Cserni G. Pathological evaluation of sentinel lymph nodes. Surg Oncol Clin North Am, 16: 17–34, 2007

    Article  Google Scholar 

  • Viale G, Dell'Orto P, Biasi MO, et al. Comparative evaluation of an extensive histopathologic examination and real-time reverse-transcription-polymerase chain reaction assay for mammaglobin and cytokeratin 19 on axillary sentinel lymph nodes of breast carcinoma patients. Ann Surg, 247: 136–142, 2008

    Article  PubMed  Google Scholar 

  • Visser M, Jiwa M, Horstman A, et al. Intra-operative rapid diagnostic method based on CK19 mRNA expression for the detection of lymph node metastases in breast cancer. Int J Cancer, 122: 2562–2567, 2008

    Article  PubMed  CAS  Google Scholar 

  • Dowlatshahi K, Fan M, Snider HC, et al. Lymph node micrometastases from breast carcinoma: reviewing the dilemma. Cancer, 80: 1188–1197, 1997

    Article  PubMed  CAS  Google Scholar 

  • Truong PT, Vinh-Hung V, Cserni G, et al. The number of positive nodes and the ratio of positive to excised nodes are significant predictors of survival in women with micrometastatic node-positive breast cancer. Eur J Cancer, 44: 1670–1677, 2008

    Article  PubMed  Google Scholar 

  • Montagna E, Viale G, Rotmensz N, et al. Minimal axillary lymph node involvement in breast cancer has different prognostic implications according to the staging procedure. Breast Cancer Res Treat, 118: 385–394, 2009

    Article  PubMed  CAS  Google Scholar 

  • Pereira H, Pinder SE, Sibbering DM, et al. Pathological prognostic factors in breast cancer. IV: Should you be a typer or a grader? A comparative study of two histological prognostic features in operable breast carcinoma. Histopathology, 27(3): 219–226, 1995

    Article  PubMed  CAS  Google Scholar 

  • Tavassoli FA, Devilee P. World Health Organization classification of tumours. Tumours of the breast and female genital organs. IARC Press, Lyon, 2003

    Google Scholar 

  • Fitzgibbons PL, Page DL, Weaver D, et al. Prognostic factors in breast cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med, 124: 966–978, 2000

    PubMed  CAS  Google Scholar 

  • Goldhirsch A, Ingle JN, Gelber RD, et al. Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2009. Ann Oncol, 20: 1319–1329, 2009

    Article  PubMed  CAS  Google Scholar 

  • National Comprehensive Cancer Network Practice guidelines in oncology – Breast cancer (V.2.2011.) http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf (Accessed 22 January 2011)

  • Veronesi U, Viale G, Rotmensz N, et al. Rethinking TNM: breast cancer TNM classification for treatment decision-making and research. Breast, 15: 3–8, 2006

    Article  PubMed  Google Scholar 

  • Veronesi U, Zurrida S, Goldhirsch A, et al. Breast cancer classification: time for a change. J Clin Oncol, 27: 2427–2428, 2009

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary

    G. Cserni

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  1. G. Cserni
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Correspondence to G. Cserni.

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Cserni, G. The current TNM classification of breast carcinomas: Controversial issues in early breast cancer. memo 4, 144–148 (2011). https://doi.org/10.1007/s12254-011-0280-5

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  • DOI: https://doi.org/10.1007/s12254-011-0280-5

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