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British Journal of Cancer logoLink to British Journal of Cancer
. 1999 Jul;80(10):1608–1616. doi: 10.1038/sj.bjc.6690570

Minimal breast cancer: evaluation of histology and biological marker expression

E A Dublin 1, R R Millis 1, P Smith 1, L G Bobrow 2
PMCID: PMC2363109  PMID: 10408407

Abstract

Ninety-eight minimal breast cancers (MBCs) diagnosed between 1975 and 1990, and all originally considered to be invasive were found, on review, to form three groups: (a) 28 predominantly invasive carcinomas ≤10 mm (‘predominant invasive’); (b) 48 predominantly ductal carcinoma in situ (DCIS) lesions with definite foci of invasion each ≤10 mm (‘predominant DCIS’); and (c) 22 DCIS without evidence of invasion (‘pure DCIS’). Tumour histology and immunohistochemical expression of Ki-67, c-erbB2, p53, oestrogen receptor (ER), progesterone receptor (PR), and Bcl-2 were compared. The major finding was the contrasting features in the two invasive groups, with significant differences in their extent of invasion (P < 0.0001), tumour grade (P = 0.03), DCIS type (P = 0.008) and in marker expression. In the predominant invasive group, the infiltrative component was usually greater than 5 mm, low-grade and associated with well-differentiated DCIS. Expression of Ki-67, c-erbB2 and p53 was generally low, and that of ER, PR and Bcl-2 high. The predominant DCIS group in contrast had a much smaller, commonly high-grade, invasive component, usually with poorly differentiated DCIS and the reverse pattern of marker expression. Although not significant, survival of patients in the predominant invasive group was slightly better. These findings suggest that invasive MBCs should perhaps be treated as separate entities, in order to aid more appropriate selection of treatment. © 1999 Cancer Research Campaign

Keywords: minimal breast cancer, differentiation, marker expression

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Selected References

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  1. Ackerman L. V., Katzenstein A. L. The concept of minimal breast cancer and the pathologist's role in the diagnosis of "early carcinoma". Cancer. 1977 Jun;39(6 Suppl):2755–2763. doi: 10.1002/1097-0142(197706)39:6<2755::aid-cncr2820390663>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  2. Allred D. C., Clark G. M., Molina R., Tandon A. K., Schnitt S. J., Gilchrist K. W., Osborne C. K., Tormey D. C., McGuire W. L. Overexpression of HER-2/neu and its relationship with other prognostic factors change during the progression of in situ to invasive breast cancer. Hum Pathol. 1992 Sep;23(9):974–979. doi: 10.1016/0046-8177(92)90257-4. [DOI] [PubMed] [Google Scholar]
  3. Arnesson L. G., Smeds S., Fagerberg G. Recurrence-free survival in patients with small breast cancer. An analysis of cancers 10 mm or less detected clinically and by screening. Eur J Surg. 1994 May;160(5):271–276. [PubMed] [Google Scholar]
  4. Barnes D. M., Bartkova J., Camplejohn R. S., Gullick W. J., Smith P. J., Millis R. R. Overexpression of the c-erbB-2 oncoprotein: why does this occur more frequently in ductal carcinoma in situ than in invasive mammary carcinoma and is this of prognostic significance? Eur J Cancer. 1992;28(2-3):644–648. doi: 10.1016/s0959-8049(05)80117-0. [DOI] [PubMed] [Google Scholar]
  5. Barnes D. M., Dublin E. A., Fisher C. J., Levison D. A., Millis R. R. Immunohistochemical detection of p53 protein in mammary carcinoma: an important new independent indicator of prognosis? Hum Pathol. 1993 May;24(5):469–476. doi: 10.1016/0046-8177(93)90158-d. [DOI] [PubMed] [Google Scholar]
  6. Barsky S. H., Doberneck S. A., Sternlicht M. D., Grossman D. A., Love S. M. 'Revertant' DCIS in human axillary breast carcinoma metastases. J Pathol. 1997 Oct;183(2):188–194. doi: 10.1002/(SICI)1096-9896(199710)183:2<188::AID-PATH898>3.0.CO;2-7. [DOI] [PubMed] [Google Scholar]
  7. Bartkova J., Barnes D. M., Millis R. R., Gullick W. J. Immunohistochemical demonstration of c-erbB-2 protein in mammary ductal carcinoma in situ. Hum Pathol. 1990 Nov;21(11):1164–1167. doi: 10.1016/0046-8177(90)90154-w. [DOI] [PubMed] [Google Scholar]
  8. Bellamy C. O., McDonald C., Salter D. M., Chetty U., Anderson T. J. Noninvasive ductal carcinoma of the breast: the relevance of histologic categorization. Hum Pathol. 1993 Jan;24(1):16–23. doi: 10.1016/0046-8177(93)90057-n. [DOI] [PubMed] [Google Scholar]
  9. Elston C. W., Ellis I. O. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. 1991 Nov;19(5):403–410. doi: 10.1111/j.1365-2559.1991.tb00229.x. [DOI] [PubMed] [Google Scholar]
  10. Goldstein N. S., Murphy T. Intraductal carcinoma associated with invasive carcinoma of the breast. A comparison of the two lesions with implications for intraductal carcinoma classification systems. Am J Clin Pathol. 1996 Sep;106(3):312–318. doi: 10.1093/ajcp/106.3.312. [DOI] [PubMed] [Google Scholar]
  11. Harris J. R., Schnitt S. J. Is radiotherapy as curative as mastectomy for patients with ductal carcinoma in situ? Int J Radiat Oncol Biol Phys. 1990 Oct;19(4):1091–1103. doi: 10.1016/0360-3016(90)90039-m. [DOI] [PubMed] [Google Scholar]
  12. Holland R., Peterse J. L., Millis R. R., Eusebi V., Faverly D., van de Vijver M. J., Zafrani B. Ductal carcinoma in situ: a proposal for a new classification. Semin Diagn Pathol. 1994 Aug;11(3):167–180. [PubMed] [Google Scholar]
  13. Joensuu H., Toikkanen S. Prognosis of breast cancer with small primary tumor (pT1). Acta Oncol. 1991;30(7):793–796. doi: 10.3109/02841869109091822. [DOI] [PubMed] [Google Scholar]
  14. Lagios M. D., Margolin F. R., Westdahl P. R., Rose M. R. Mammographically detected duct carcinoma in situ. Frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence. Cancer. 1989 Feb 15;63(4):618–624. doi: 10.1002/1097-0142(19890215)63:4<618::aid-cncr2820630403>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  15. Lampejo O. T., Barnes D. M., Smith P., Millis R. R. Evaluation of infiltrating ductal carcinomas with a DCIS component: correlation of the histologic type of the in situ component with grade of the infiltrating component. Semin Diagn Pathol. 1994 Aug;11(3):215–222. [PubMed] [Google Scholar]
  16. Lampejo O. T., Barnes D. M., Smith P., Millis R. R. Evaluation of infiltrating ductal carcinomas with a DCIS component: correlation of the histologic type of the in situ component with grade of the infiltrating component. Semin Diagn Pathol. 1994 Aug;11(3):215–222. [PubMed] [Google Scholar]
  17. Lovekin C., Ellis I. O., Locker A., Robertson J. F., Bell J., Nicholson R., Gullick W. J., Elston C. W., Blamey R. W. c-erbB-2 oncoprotein expression in primary and advanced breast cancer. Br J Cancer. 1991 Mar;63(3):439–443. doi: 10.1038/bjc.1991.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Mack L., Kerkvliet N., Doig G., O'Malley F. P. Relationship of a new histological categorization of ductal carcinoma in situ of the breast with size and the immunohistochemical expression of p53, c-erb B2, bcl-2, and ki-67. Hum Pathol. 1997 Aug;28(8):974–979. doi: 10.1016/s0046-8177(97)90014-9. [DOI] [PubMed] [Google Scholar]
  19. Moriya T., Silverberg S. G. Intraductal carcinoma (ductal carcinoma in situ) of the breast. A comparison of pure noninvasive tumors with those including different proportions of infiltrating carcinoma. Cancer. 1994 Dec 1;74(11):2972–2978. doi: 10.1002/1097-0142(19941201)74:11<2972::aid-cncr2820741113>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  20. Mustafa I. A., Cole B., Wanebo H. J., Bland K. I., Chang H. R. Prognostic analysis of survival in small breast cancers. J Am Coll Surg. 1998 May;186(5):562–569. doi: 10.1016/s1072-7515(98)00076-3. [DOI] [PubMed] [Google Scholar]
  21. Nathan B., Gusterson B., Jadayel D., O'Hare M., Anbazhagan R., Jayatilake H., Ebbs S., Micklem K., Price K., Gelber R. Expression of BCL-2 in primary breast cancer and its correlation with tumour phenotype. For the International (Ludwig) Breast Cancer Study Group. Ann Oncol. 1994 May;5(5):409–414. doi: 10.1093/oxfordjournals.annonc.a058871. [DOI] [PubMed] [Google Scholar]
  22. Patchefsky A. S., Schwartz G. F., Finkelstein S. D., Prestipino A., Sohn S. E., Singer J. S., Feig S. A. Heterogeneity of intraductal carcinoma of the breast. Cancer. 1989 Feb 15;63(4):731–741. doi: 10.1002/1097-0142(19890215)63:4<731::aid-cncr2820630422>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  23. Querzoli P., Albonico G., Ferretti S., Rinaldi R., Beccati D., Corcione S., Indelli M., Nenci I. Modulation of biomarkers in minimal breast carcinoma: a model for human breast carcinoma progression. Cancer. 1998 Jul 1;83(1):89–97. doi: 10.1002/(sici)1097-0142(19980701)83:1<89::aid-cncr12>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  24. Rosner D., Lane W. W. Node-negative minimal invasive breast cancer patients are not candidates for routine systemic adjuvant therapy. Cancer. 1990 Jul 15;66(2):199–205. doi: 10.1002/1097-0142(19900715)66:2<199::aid-cncr2820660202>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  25. Schnitt S. J., Silen W., Sadowsky N. L., Connolly J. L., Harris J. R. Ductal carcinoma in situ (intraductal carcinoma) of the breast. N Engl J Med. 1988 Apr 7;318(14):898–903. doi: 10.1056/NEJM198804073181406. [DOI] [PubMed] [Google Scholar]
  26. Scott M. A., Lagios M. D., Axelsson K., Rogers L. W., Anderson T. J., Page D. L. Ductal carcinoma in situ of the breast: reproducibility of histological subtype analysis. Hum Pathol. 1997 Aug;28(8):967–973. doi: 10.1016/s0046-8177(97)90013-7. [DOI] [PubMed] [Google Scholar]
  27. Sinn H. P., Oelmann A., Anton H. W., Diel I. J. Metastatic potential of small and minimally invasive breast carcinomas. Virchows Arch. 1994;425(3):237–241. doi: 10.1007/BF00196145. [DOI] [PubMed] [Google Scholar]
  28. Tabár L., Fagerberg G., Day N. E., Duffy S. W., Kitchin R. M. Breast cancer treatment and natural history: new insights from results of screening. Lancet. 1992 Feb 15;339(8790):412–414. doi: 10.1016/0140-6736(92)90090-p. [DOI] [PubMed] [Google Scholar]
  29. Tubiana M., Koscielny S. Natural history of human breast cancer: recent data and clinical implications. Breast Cancer Res Treat. 1991 Aug;18(3):125–140. doi: 10.1007/BF01990028. [DOI] [PubMed] [Google Scholar]
  30. van Dongen J. A., Holland R., Peterse J. L., Fentiman I. S., Lagios M. D., Millis R. R., Recht A. Ductal carcinoma in-situ of the breast; second EORTC consensus meeting. Eur J Cancer. 1992;28(2-3):626–629. doi: 10.1016/s0959-8049(05)80113-3. [DOI] [PubMed] [Google Scholar]

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