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Early (<10 mm) HER2-Positive Invasive Breast Carcinomas are Associated with Extensive Diffuse High-Grade DCIS: Implications for Preoperative Mapping, Extent of Surgical Intervention, and Disease-Free Survival

  • Breast Oncology
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The few publications on <10-mm invasive breast carcinomas have reported worse outcomes for women with human epidermal growth factor receptor 2 (HER2)-positive cancer compared with HER2-negative cases and indicated that the high risk of recurrence in HER2-positive cases is related to the high grade, hormone receptor negativity, and high proliferation index of the invasive tumor component.

Methods

We studied the subgross morphology of such tumors in a consecutive series of 203 cases documented in large-format histology slides and worked up with detailed radiological–pathological correlation.

Results

The invasive component was associated with a diffuse in situ component in 78 % of the HER2-positive and 26 % of HER2-negative tumors <10 mm in size (odds ratio [OR], 11.3936; P < .0001). The in situ component was of high grade in 75 % of HER2-positive and 9 % of HER2-negative cases (OR, 29.6000; P < .0001). Significant associations were also found between the HER2 positivity of the invasive component and diffuse combined lesion distribution (P > .0001), invasive tumor grade 3 (P = .0004), presence of vascular invasion (P = .0026), extensive disease (P = .0170), “not special” (ductal) histological tumor type (P = .0302), estrogen receptor negativity (OR, 7.8846; P < .0001), and high Ki67 proliferation index (OR, 5.0000; P = .0007). The HER2-positive tumors tended to be multifocal (OR, 2.000) and lymph node-positive (OR, 3.0147), but the tendency was not statistically significant.

Conclusions

The vast majority of <10-mm HER2-positive breast carcinomas exhibited a high-grade, diffuse, and extensive in situ component, which may explain the high risk of recurrence among these tumors.

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Acknowledgment

The author is thankful to his excellent colleagues: Drs. Nadja Lindhe, Mats Ingvarsson, and Prof. Laszlo Tabár, radiologists; Drs. Anders Cohen, Gunilla Christensson, and Maria Annerbo, breast surgeons; Drs. Maria Gere, Gyula Pekár, Syster Hofmeyer, breast pathologists; and all the other members of the Multidisciplinary Breast Team at Falun Central Hospital.

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  1. Department of Pathology and Clinical Cytology, Central Hospital Falun, Falun, Sweden

    Tibor Tot MD, PhD

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  1. Tibor Tot MD, PhD
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Correspondence to Tibor Tot MD, PhD.

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Tot, T. Early (<10 mm) HER2-Positive Invasive Breast Carcinomas are Associated with Extensive Diffuse High-Grade DCIS: Implications for Preoperative Mapping, Extent of Surgical Intervention, and Disease-Free Survival. Ann Surg Oncol 22, 2532–2539 (2015). https://doi.org/10.1245/s10434-015-4367-9

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  • DOI: https://doi.org/10.1245/s10434-015-4367-9

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