| Objective:To analyze the clinical and pathological characteristics of multifocal/multicentric breast cancer(MMBC)by comparing the differences between MMBC and unifocal breast cancer(UFBC)and the intertumoral heterogeneity of MMBC and and its impact on treatment decision by studying the histological characteristics,molecular biomarkers and molecular type of MMBC.Methods:The clinicopathological data of 75 patients with MMBC and 150patients with UFBC which randomly selected as control group admitted in the breast surgery of Affiliated Hospital of Southwest Medical University from May 2013 to October 2018 were retrospectively collected to analyze the clinicopathological characteristics of MMBC.The heterogeneity of histological characteristics and immunohistochemical results such as estrogen receptor(ER)and progesterone receptor(PR)and human epidermal growth factor receptor2(HER-2)and nuclear-associated antigen(Ki-67)of each focus in MMBC were compared.And we determined the heterogeneity of molecular type between cancer lesions based on immunohistochemical results and its impact on treatment decisions.SPSS17.0 software system was used for statistical analysis of data,t-test was used for quantitative data,counting data describe the number and percentage,chi-square test or Fisher exact probability method was used for counting data analysis,multivariate analysis was performed using Logistic stepwise regression analysis.P<0.05 was considered to be statistically significant.Results:1.In the analysis of clinicopathological features,there were 50(66.7%)premenopausal patients and 25 cases(33.3%)postmenopausal patients in MMBC group,and there were 73(48.7%)premenopausal patients and 77 cases(51.3%)postmenopausal patients in the UFBC group.The number of premenopausal patients in the MMBC group were statistically significantly more than the UFBC group(χ~2=6.537,P=0.011).The mastectomy and breast-conserving surgery were performed in both groups.There were 70patients(93.3%)in MMBC group and 116 patients(77.3%)in UFBC group performed mastectomy,and there were 5 patients(6.7%)in MMBC group and34 patients(22.7%)in UFBC group performed breast-conserving surgery,there were significant differences in surgical procedures between the two groups(χ~2=8.933,P=0.003).In MMBC group,56 patients(74.7%),6 patients(8.0%)and 13 patients(17.3%)were invasive ductal carcinoma,invasive lobular carcinoma and others,respectively.And 130 cases(86.7%),3 cases(2.0%)and 17 cases(11.3%)were found respectively in the control group,there were significant differences in pathological types between the two groups(χ~2=6.341,P=0.042).If the sum of the maximum diameter of all lesions is taken as T stage for MMBC patients,there were 6 cases(8.0%),47 cases(62.7%)and 22 cases(29.3%)with T stage of T1,T2 and T3 respectively in MMBC group.There were 67 cases(44.7%),80 cases(53.3%)and 3 cases(2.0%)with T stage of T1,T2 and T3 respectively in UFBC group.The T stage of MMBC was statistically significantly higher than that of UFBC(χ~2=55.111,P=0.000).In MMBC group,21 cases(28.0%),24 cases(32.0%),12 cases(16.0%)and 18cases(24.0%)were respectively classified as N0,N1,N2 and N3.In UFBC group,73 cases(48.7%),54 cases(36.0%),15 cases(10.0%)and 8 cases(5.3%)were respectively classified as N0,N1,N2 and N3.Comparing the lymph node metastasis rate in both groups,the lymph node metastasis rate of the MMBC was significantly higher than that of the UFBC(χ~2=21.919,P=0.000).In the MMBC group,there were 30 patients(40.0%)had Lymphatic vascular invasion(LVI)and 45 patients(60.0%)had not,which was significantly higher than that in the UFBC group(20 cases(13.3%)had LVI and 130 cases(86.7%)had not).The difference was statistically significant(χ~2=120.571,P=0.000).The above statistically significant factors,namely menopausal status,surgical procedure,histological type,the sum of maximum diameters of all lesions as T stage,N stage,LVI(all P<0.05)were included as independent variables in multivariate analysis.Logistic regression analysis was used to further analyze which showed that the menopausal status(β=-0.750、OR=0.472、P=0.032),the sum of maximum diameters of all lesions as T stage(β=1.886、OR=6.594、P=0.000),N stage(β=0.394、OR=1.483、P=0.023),LVI(β=0.818、OR=2.267、P=0.040)were significantly different between the two groups.That is to say,MMBC is more prone to be premenopausal state,have higher T stage which determined by the sum of the diameter of each lesion,have higher lymph node metastasis rate and LVI.2.In the analysis of chi-square test,there were significant differences in surgical approach and histological type between MMBC and UFBC group(all P<0.05),but there was no significant difference in multivariate analysis(all P>0.05).There were no significant differences in age,family history,T stage,ER,PR,Ki-67,HER-2 and molecular type between the two groups(P>0.05).3.The detection rate of breast ultrasonography in MMBC was 78.7%,and that was 56.0%of mammography.There was a significant difference between the two imaging methods(P=0.005).The sensitivity of the two imaging examinations combined to detect MMBC was 86.7%,which was higher than that of the two methods.4.Among 75 patients of MMBC,7(9.3%)patients and 6(8.7%)patients had heterogeneity in histological type and WHO classification,while 7(9.3%)patients,6(8.0%)patients,4(8.0%)patients,8(10.7%)patients and 14(18.6%)patients had heterogeneity in ER,PR,HER-2,Ki-67 and molecular type,respectively.Among the 14 MMBC patients with inconsistent molecular type,11 patients(14.7%)molecular typing of other lesions other than the largest tumor can influence the choice of treatment decision-making.Conclusion:1.Compared with UFBC,MMBC have more premenopausal patients,higher T stage which decided by the sum of maximum diameters of all lesions,more axillary lymph node metastasis and higher incidence of LVI,suggesting that MMBC is more aggressive.2.The detection rate of MMBC by breast ultrasonography is higher than that by mammography.Preoperative ultrasonography combined with mammography can increase the accuracy of preoperative diagnosis of MMBC and reduce missed diagnosis.3.Intertumoral heterogeneity of MMBC was existed in histological features and immunohistochemistry results.Immunohistochemistry tests carried out in all lesions to determine molecular type is necessary for the full treatment of MMBC. |
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