title: Clinico-pathological significance of extra-nodal spread in special types of breast cancer.
abstract: OBJECTIVE
  To investigate the significance of extra-nodal spread in special histological sub-types of breast cancer and the relationship of such spread with prognostic parameters.
  
  
  METHODS
  A total of 303 breast cancer cases were classified according to tumor type, and each tumor group was subdivided according to age, tumor diameter, lymph node metastasis, extra-nodal spread, vein invasion in the adjacent soft tissue, distant metastasis, and immunohistochemical characteristics [estrogen receptor (ER), progesterone receptor (PR) existence, p53, c-erbB-2, and proliferative rate (Ki-67)]. The 122 cases with extra-nodal spread were clinically followed up.
  
  
  RESULTS
  An extra-nodal spread was observed in 40% (122 cases) of the 303 breast cancer cases. The spread most frequently presented in micro papillary carcinoma histological sub-type (40 cases, 75%), but least frequently presents in mucinous carcinoma (2 cases, 8%). Patients with extra-nodal spread had a high average number of metastatic lymph nodes (8.3) and a high distant metastasis rate (38 cases, 31%) compared with patients without extra-nodal spread.
  
  
  CONCLUSIONS
  The existence of extra-nodal spread in the examined breast cancer sub-types has predictive value in forecasting the number of metastatic lymph nodes and the disease prognosis.
authors.affiliation: Department of Pathology, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul 34668, Turkey.
authors.forename: Ecmel Isik
authors.initials: EI
authors.lastname: Kaygusuz
authors.affiliation: Department of Pathology, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul 34668, Turkey.
authors.forename: Handan
authors.initials: H
authors.lastname: Cetiner
authors.affiliation: Department of Pathology, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul 34668, Turkey.
authors.forename: Hulya
authors.initials: H
authors.lastname: Yavuz
keywords: Breast cancer; extra-nodal spread; prognosis