title: Clinical implications of growth pattern and extension of tumor-associated intraductal carcinoma of the breast.
abstract: Tumor specimens from 410 patients with primary invasive breast cancer were investigated to identify the clinically relevant features of tumor-associated intraductal component (IDC) surrounding invasive breast cancer. A tumor-associated IDC associated with invasive tumor was mostly localized between the tumor and nipple. Thus, segmental resection of breast tissue is suggested.
  
  
  BACKGROUND
  The goal of the present study was to identify the clinically relevant features of tumor-associated intraductal component (IDC) surrounding invasive breast cancer.
  
  
  METHODS
  The tumor specimens from 410 patients with primary invasive breast cancer were investigated. The distance between the surgical margins and tumor edge (invasive and intraductal areas) was measured prospectively.
  
  
  RESULTS
  Of the 410 investigated patients, 395 were eligible for analysis. An IDC was observed in 241 specimens (61.0%) and was associated with a younger age at diagnosis, postmenopausal status, and positive estrogen receptor, progesterone receptor, and human epidermal growth factor 2 (HER2) expression status. Most cases with tumor-associated ductal carcinoma in situ (DCIS) were found in the upper-outer quadrants of the breasts. An extended intraductal component (EIC) tended to be present in the outer and lower quadrants of the breasts. In the study cohort of 187 patients with tumor-associated DCIS, 1496 surgical margins were investigated. IDC was associated with invasive tumor growth predominantly in the nipple direction. The nipple-associated growth of DCIS correlated with patient age > 40 years, tumor size ≤ 2 cm, poor histologic differentiation of the noninvasive and invasive components, and positive estrogen and progesterone receptor status and negative HER2 status.
  
  
  CONCLUSIONS
  Our data provide evidence that in patients with primary breast cancer, the EIC areas will be mostly segmentally localized between the invasive tumor and the nipple. Therefore, if EIC is present or assumed, surgery should consist of segmental resection of the breast tissue, at least in patients with breast cancer who are > 40 years old, with a tumor size of < 2 cm, and with hormone receptor-positive and HER2-negative, poorly differentiated tumors.
authors.affiliation: Department of Obstetrics and Gynecology, University Clinic Magdeburg, Magdeburg, Germany.
authors.forename: Holm
authors.initials: H
authors.lastname: Eggemann
authors.affiliation: Institute of Pathology, University Clinic Magdeburg, Magdeburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kalinski
authors.affiliation: Department of Obstetrics and Gynecology, University Clinic Magdeburg, Magdeburg, Germany.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Ruhland
authors.affiliation: Department of Obstetrics and Gynecology, University Clinic Magdeburg, Magdeburg, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Ignatov
authors.affiliation: Department of Obstetrics and Gynecology, University Clinic Magdeburg, Magdeburg, Germany.
authors.forename: Serban Dan
authors.initials: SD
authors.lastname: Costa
authors.affiliation: Department of Obstetrics and Gynecology, University Clinic Magdeburg, Magdeburg, Germany. Electronic address: atanas.ignatov@gmail.com.
authors.forename: Atanas
authors.initials: A
authors.lastname: Ignatov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009558:Nipples / Q000473:pathology*; D011230:Precancerous Conditions / Q000473:pathology*; D012189:Retrospective Studies
keywords: Breast cancer; Breast-conserving surgery; DCIS; EIC; Intraductal component