Local Recurrence of Breast Cancer Deck, MD, William H. Kern, MD \s=b\ Pathologic and surgical aspects of 1,027
Kenneth B.
breast cancer cases treated between 1961 and 1972 were reviewed. Sixty-eight (7%) of the cases recurred locally. This low rate of recurrence is associated with the small average diameter of 2.7 cm of all carcinomas and the correspondingly low rate of axillary lymph node metastasis of 40%. Subsequently recurring tumors had a higher incidence of axillary lymph node metastasis (68%). Eight hundred eighty-eight infiltrating duct carcinomas represented the largest group of cases and had a recurrence rate of 5.7%. Comedo, infiltrating papillary, and infiltrating lobular carcinomas recurred locally more frequently, but none of 26 mucinous carcinomas recurred. In eight cases, the recurrent tumor was of a more malignant histologic type than the primary lesion. The average width of the excised segments of skin decreased from 9.8 cm during the first three-year period (1961 to 1963) to 8.4 cm during the last period (1970 to 1972). The average width for the entire period was 9.1 cm, identical for locally recurring and nonrecurring tumors.
(Arch Surg 111:323-325, 1976) rate of local
Themastectomy,
as
recurrence
reported
in
of breast more
cancer
after
recently published
ranges from 6% to 17.5%.1~8 The size of the tumor and the presence of axillary lymph node métastases at the time of mastectomy appear importantly related to the incidence of recurrence.49 The effect of the type of treat¬ ment is less certain.:''7·1"-1This review of a large number of cases was undertaken to further evaluate pathologic factors that may influence the rate of recurrence, and specifically to investigate whether changes in surgical technique, in particular a tendency to perform a less radical procedure with resection of a small amount of skin, have influenced the rate of
series,
recurrence.
MATERIALS AND METHODS The pathologic reports of all mastectomies for breast cancer that were performed at the Hospital of the Good Samaritan between January 1961 and December 1972 were reviewed. The tumor type and size, presence or absence of axillary lymph node metastasis, length and width of the excised skin, and the type of operation performed were obtained from this report. Cases of lobular carcinoma in situ, sarcoma, and cases that lacked pertinent information, usually concerning the size of the excised skin, were excluded. A total of 1,027 cases were retained in the study group.
The records of the Department of Pathology were then searched for excisions or biopsies of local recurrences that were defined as any recurrent carcinomas in the suture line, skin, or soft tissues of the anterior chest wall. Late axillary, supraclavicular, or distant
Accepted
for publication Dec 29, 1975. From the departments of surgery (Dr Deck) and pathology (Dr Kern), the Hospital of the Good Samaritan, and the departments of surgery (Dr Deck) and pathology (Dr Kern), University of Southern California School of Medicine, Los Angeles. Read before the 83rd annual meeting of the Western Surgical Association, Colorado Springs, Colo, Nov 20, 1975. Reprint requests to the Hospital of the Good Samaritan, 1212 Shatto St, Los Angeles, CA 90017 (Dr Kern).
skin métastases were not included. The Tumor Registry of the hospital and the office records of the attending surgeons were also utilized. The sections of the originally resected carcinomas and the corresponding sections of the recurrent tumors were reviewed, compared, and in some cases reclassified, using a currently
preferred terminology." RESULTS
Sixty-eight (7%) of the 1,027 breast cancer patients who underwent mastectomy were subsequently treated for re¬ current carcinoma at the Hospital of the Good Samaritan. Table 1 summarizes the rate of recurrence based on the histologie type of the primary tumor. Eighty-six percent of the tumors had been classified as infiltrating duct carcino¬ mas. Fifty-one (5.7%) of this large group of cases recurred locally. The average diameter, as measured in the unfixed gross surgical specimens, was 3.1 cm for tumors that subsequently recurred as compared to 2.5 cm for cases without recurrence. Seventy-three percent of the patients with recurrent infiltrating duct carcinomas had had axil¬ lary lymph node métastases at the time of the original mastectomy. This significantly exceeds the incidence of regional metastasis when compared to nonrecurrent infil¬ trating duct carcinomas. The rate of recurrence differs according to the histologie type (P
Kenneth B.
breast cancer cases treated between 1961 and 1972 were reviewed. Sixty-eight (7%) of the cases recurred locally. This low rate of recurrence is associated with the small average diameter of 2.7 cm of all carcinomas and the correspondingly low rate of axillary lymph node metastasis of 40%. Subsequently recurring tumors had a higher incidence of axillary lymph node metastasis (68%). Eight hundred eighty-eight infiltrating duct carcinomas represented the largest group of cases and had a recurrence rate of 5.7%. Comedo, infiltrating papillary, and infiltrating lobular carcinomas recurred locally more frequently, but none of 26 mucinous carcinomas recurred. In eight cases, the recurrent tumor was of a more malignant histologic type than the primary lesion. The average width of the excised segments of skin decreased from 9.8 cm during the first three-year period (1961 to 1963) to 8.4 cm during the last period (1970 to 1972). The average width for the entire period was 9.1 cm, identical for locally recurring and nonrecurring tumors.
(Arch Surg 111:323-325, 1976) rate of local
Themastectomy,
as
recurrence
reported
in
of breast more
cancer
after
recently published
ranges from 6% to 17.5%.1~8 The size of the tumor and the presence of axillary lymph node métastases at the time of mastectomy appear importantly related to the incidence of recurrence.49 The effect of the type of treat¬ ment is less certain.:''7·1"-1This review of a large number of cases was undertaken to further evaluate pathologic factors that may influence the rate of recurrence, and specifically to investigate whether changes in surgical technique, in particular a tendency to perform a less radical procedure with resection of a small amount of skin, have influenced the rate of
series,
recurrence.
MATERIALS AND METHODS The pathologic reports of all mastectomies for breast cancer that were performed at the Hospital of the Good Samaritan between January 1961 and December 1972 were reviewed. The tumor type and size, presence or absence of axillary lymph node metastasis, length and width of the excised skin, and the type of operation performed were obtained from this report. Cases of lobular carcinoma in situ, sarcoma, and cases that lacked pertinent information, usually concerning the size of the excised skin, were excluded. A total of 1,027 cases were retained in the study group.
The records of the Department of Pathology were then searched for excisions or biopsies of local recurrences that were defined as any recurrent carcinomas in the suture line, skin, or soft tissues of the anterior chest wall. Late axillary, supraclavicular, or distant
Accepted
for publication Dec 29, 1975. From the departments of surgery (Dr Deck) and pathology (Dr Kern), the Hospital of the Good Samaritan, and the departments of surgery (Dr Deck) and pathology (Dr Kern), University of Southern California School of Medicine, Los Angeles. Read before the 83rd annual meeting of the Western Surgical Association, Colorado Springs, Colo, Nov 20, 1975. Reprint requests to the Hospital of the Good Samaritan, 1212 Shatto St, Los Angeles, CA 90017 (Dr Kern).
skin métastases were not included. The Tumor Registry of the hospital and the office records of the attending surgeons were also utilized. The sections of the originally resected carcinomas and the corresponding sections of the recurrent tumors were reviewed, compared, and in some cases reclassified, using a currently
preferred terminology." RESULTS
Sixty-eight (7%) of the 1,027 breast cancer patients who underwent mastectomy were subsequently treated for re¬ current carcinoma at the Hospital of the Good Samaritan. Table 1 summarizes the rate of recurrence based on the histologie type of the primary tumor. Eighty-six percent of the tumors had been classified as infiltrating duct carcino¬ mas. Fifty-one (5.7%) of this large group of cases recurred locally. The average diameter, as measured in the unfixed gross surgical specimens, was 3.1 cm for tumors that subsequently recurred as compared to 2.5 cm for cases without recurrence. Seventy-three percent of the patients with recurrent infiltrating duct carcinomas had had axil¬ lary lymph node métastases at the time of the original mastectomy. This significantly exceeds the incidence of regional metastasis when compared to nonrecurrent infil¬ trating duct carcinomas. The rate of recurrence differs according to the histologie type (P
