title: Breast carcinoma with noninflammatory skin involvement (T4b): time to abandon an historic relic from the TNM classification.
abstract: BACKGROUND
  In this study, the authors evaluated the clinical presentation of patients with T4b breast carcinoma, analyzed the impact of noninflammatory skin involvement on long-term survival, and addressed the question whether the T4 tumor category still has any justification.
  
  
  METHODS
  The clinical course of a study group of 119 patients with skin involvement was compared with the outcome of a control group of 299 consecutive patients who had tumors of the same size but without skin involvement. All tumors were stratified into 1 of 4 subsets according to greatest tumor dimension, as follows: Group A, < or = 3.0 cm; Group B, 3.1-5.0 cm; Group C, 5.1-10.0 cm; and Group D, > 10.0 cm.
  
  
  RESULTS
  The study group distribution of patients within the size subsets were as follows: Group A, 26.1%; Group B, 24.3%; Group C, 26.1%; and Group D, 23.5%. Differences in disease-specific survival between the tumor size subsets were significant (Groups A and B vs. Groups C and D; P < 0.0001). In contrast to large tumors (> 5.0 cm), carcinomas < or = 5.0 cm showed no statistical significant differences in disease-specific survival between study group patients and control group patients (Group A: P = 0.17; Group B: P = 0.31).
  
  
  CONCLUSIONS
  There is a broad range of clinicopathologic breast carcinoma entities within the T4b category. For > 50% of patients with T4b breast carcinoma, the feature noninflammatory skin involvement had no significant prognostic impact. Approximately 25% of patients had an extent of disease similar to that observed in patients with Stage I-II disease and, thus, falsely were considered to have more advanced disease. Heterogeneity and a lack of prognostic significance suggest that a revision of the T4 category, a relic of historic tumor classifications, is necessary.
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland. ugueth@uhbs.ch
authors.forename: Uwe
authors.initials: U
authors.lastname: Guth
authors.forename: Edward
authors.initials: E
authors.lastname: Wight
authors.forename: Andreas
authors.initials: A
authors.lastname: Schotzau
authors.forename: Igor
authors.initials: I
authors.lastname: Langer
authors.forename: Holger
authors.initials: H
authors.lastname: Dieterich
authors.forename: Christoph
authors.initials: C
authors.lastname: Rochlitz
authors.forename: Linda
authors.initials: L
authors.lastname: Herberich
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Holzgreve
authors.forename: Gad
authors.initials: G
authors.lastname: Singer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000145:classification* / Q000150:complications; D004487:Edema / Q000150:complications; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D012871:Skin Diseases / Q000150:complications*; D012883:Skin Ulcer / Q000150:complications; D016019:Survival Analysis