Exploring the pathological changes in mastectomies for breast cancer

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Abstract

Background

A considerable number of patients treated with breast conservative surgery experience local recurrence even when the resection margins are cancer free.

Aim

The aim of this study was to detect whether premalignant changes are confined to the peritumoral area or are widespread in the breast, we dissected 250 mastectomies for breast cancer with a minimum of 18 sections sampled from each breast. We also aimed at determining the possible premalignant risk for columnar cell lesions.

Results

Multifocal (MF) and multicentric (MC) invasive tumor foci were detected in 43 (17.2%) specimens. MF/MC ductal carcinoma in situ (DCIS) was seen in 62 (24.8%) cases. The total number of mastectomies harboring MF/MC malignant tumors was 84 (33.6%). MF/MC DCIS correlated significantly with MF/MC invasive tumor. The most common proliferative lesion was columnar cell change (68.8%), followed by flat epithelial atypia (FEA) (50%), usual ductal hyperplasia (UDH) (37%), atypical ductal hyperplasia (ADH) (23%), and lobular carcinoma in situ (15%). A significant relation was found between MF/MC invasive tumor and columnar cell change, FEA, UDH, and ADH, and between MF/MC DCIS and FEA and UDH. FEA, UDH, ADH, and MF/MC invasive tumor were significantly associated with age younger than 50 years, which may be one of the causes for the more frequent breast cancer recurrence in this age group.

Conclusion

The high percentage of MF/MC in situ or invasive cancer in this study is an evidence of the wide intramammary distribution of breast cancer disease. The high frequency of columnar cell lesions in breasts removed for cancer adds plausibility to the premalignant potential of these lesions.

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