title: Tumour size and vascular invasion predict distant metastasis in stage I breast cancer. Grade distinguishes early and late metastasis.
abstract: BACKGROUND
  Recent Dutch guidelines recommend adjuvant systemic treatment (AST) for women with high grade stage I breast carcinoma > or =1 cm. High grade is defined as Bloom and Richardson grade 3 (B&R3), Nottingham modification, or mitotic activity (MAI) > or =10/1.59 mm2.
  
  
  OBJECTIVE
  To investigate the validity of these histological prognostic factors as the exclusive defining criteria.
  
  
  METHODS
  Fifty patients with stage I breast carcinoma who developed distant metastases and 50 matched controls without metastasis were studied; none had received AST.
  
  
  RESULTS
  Cases more often had tumours > or =1 cm (p = 0,019), B&R3 tumours (p = 0.059), grade 3 nuclei (p = 0.005), and vascular invasion (p = 0.007). No differences were found for MAI > or =10 (p = 0.46). In multivariate analysis, the only significant variables were vascular invasion and tumour size (odds ratios: 8.21 and 5.35, respectively). In a separate analysis, the 50 cases were divided into 25 patients with early and 25 with late metastasis. Those with early metastasis more often had B&R3 tumours (p = 0.009) and grade 3 nuclei (p = 0.006). No differences were found for tumours > or =1 cm, vessel invasion, or MAI > or =10. Using the present Dutch guidelines for AST, based on B&R3, 20 cases and 11 controls would have received AST. Based on MAI > or =10, 14 cases and 11 controls would have received AST.
  
  
  CONCLUSIONS
  Tumour size and vessel invasion are the best prognostic factors for disease free survival in patients with stage I breast cancer. Dutch selection criteria for AST for these patients need to be improved. Some prognostic factors are time dependent, making their use as selection criteria for AST more complicated.
authors.affiliation: Pathologisch Laboratorium voor Dordrecht eo, Laan van Londen 1800, 3315 HG Dordrecht, The Netherlands. pwestenend@paldordt.com
authors.forename: P J
authors.initials: PJ
authors.lastname: Westenend
authors.forename: C J C
authors.initials: CJ
authors.lastname: Meurs
authors.forename: R A M
authors.initials: RA
authors.lastname: Damhuis
mesh_terms: D000277:Adjuvants, Pharmaceutic / Q000627:therapeutic use; D000368:Aged; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology*; D016022:Case-Control Studies; D002467:Cell Nucleus / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D008940:Mitotic Index; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012042:Registries; D018709:Statistics, Nonparametric; D019043:Vascular Neoplasms / Q000473:pathology
chemical_list: D000277:Adjuvants, Pharmaceutic