title: Scope and significance of non-uniform classification practices in breast cancer with non-inflammatory skin involvement: a clinicopathologic study and an international survey.
abstract: BACKGROUND
  The study evaluates the scope of non-uniform classification practices concerning breast carcinomas with non-inflammatory skin involvement.
  
  
  METHODS
  We compared the clinical course of patients with histologically proven non-inflammatory skin involvement: 119 (65.4%) with clinically obvious 'classical' skin changes (Group A) and 63 (34.6%) with no or only discreet changes (Group B). A questionnaire was circulated to pathology departments in 24 countries to assess the practice concerning the placement of skin- involved breast carcinomas in the TNM classification.
  
  
  RESULTS
  Patients in Group B showed a significantly better disease specific survival (P=0.0002). Eighty-six respondents (70.5%) of the survey preferred the 'histological view' and classified tumors with only histological proven skin involvement as T 4 b/stage IIIB. The opposing classification principle ('clinical view'), which dictates that T 4 b breast cancer is a clinical diagnosis and the classical signs must be present, was supported by 31 respondents (25.4%).
  
  
  CONCLUSIONS
  A large number of breast cancer patients with non-inflammatory skin involvement are only histologically proven and show, compared with cases exhibiting the classical clinical signs, significant differences in clinical course and prognosis. In general, both subsets were aggregated in one T category/stage (T 4 b/IIIB). This results in a considerable distortion of the reported statistical data.
authors: Department of Gynecology and Obstetrics, University Hospital Basel, Switzerland. ugueth@uhbs.ch
authors: U
authors: U
authors: Güth
authors: G
authors: G
authors: Singer
authors: A
authors: A
authors: Schötzau
authors: I
authors: I
authors: Langer
authors: H
authors: H
authors: Dieterich
authors: C
authors: C
authors: Rochlitz
authors: L
authors: L
authors: Herberich
authors: W
authors: W
authors: Holzgreve
authors: E
authors: E
authors: Wight
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000145:classification* / Q000150:complications* / Q000473:pathology; D002277:Carcinoma / Q000145:classification* / Q000150:complications* / Q000473:pathology*; D004487:Edema / Q000145:classification / Q000209:etiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D007391:International Cooperation; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012871:Skin Diseases / Q000145:classification / Q000209:etiology*; D012883:Skin Ulcer / Q000145:classification / Q000209:etiology; D016019:Survival Analysis