Breast cancer with non-inflammatory skin involvement: Current data on an underreported entity and its problematic classification

Güth, Uwe; Huang, Dorothy Jane; Schötzau, Andreas; Dirnhofer, Stephan; Wight, Edward; Singer, Gad

doi:10.1016/j.breast.2009.11.008

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Volume 19, Issue 1 , Pages 59-64, February 2010

Breast cancer with non-inflammatory skin involvement: Current data on an underreported entity and its problematic classification

Uwe Güth
- University Hospital Basel (UHB), Department of Gynecology and Obstetrics, Spitalstrasse 21, CH-4031 Basel, Switzerland
- Corresponding author. Tel.: +41 61 2659028; fax: +41 61 2659037.
Dorothy Jane Huang
- University Hospital Basel (UHB), Department of Gynecology and Obstetrics, Spitalstrasse 21, CH-4031 Basel, Switzerland
Andreas Schötzau
- Schötzau & Simmen Institute for Biomathematics, Malzgasse 9, CH-4052 Basel, Switzerland
Stephan Dirnhofer
- UHB, Institute of Pathology, Schönbeinstrasse 40, CH-4031 Basel, Switzerland
Edward Wight
- University Hospital Basel (UHB), Department of Gynecology and Obstetrics, Spitalstrasse 21, CH-4031 Basel, Switzerland
Gad Singer
- UHB, Institute of Pathology, Schönbeinstrasse 40, CH-4031 Basel, Switzerland
- Cantonal Hospital Baden, Institute of Pathology, CH-5404 Baden, Switzerland

Received 15 June 2009; received in revised form 17 September 2009; accepted 25 November 2009. published online 17 December 2009.

Abstract

We evaluated 166 breast cancer cases with non-inflammatory skin involvement (NISI), which were classified in the TNM classification as T4b. The distribution of tumour sizes and stages was: ≤3cm:24.1%, 3.1–5cm:21.7%, 5.1–10cm:33.1%, >10cm:21.1%; stages:I/II:21.0%, III:43.4%, IV:35.6%. To assess the impact of NISI on axillary lymph node involvement (ALNI), we analyzed a sub-group of 50 patients with tumours ≤5cm and compared them with a matched control group. NISI was found to be associated with increased ALNI (HR, 2.66; 95%CI, 1.59–4.63; p<0.0001). According to the inherent rules of tumour classification, only tumours with similar morphologic extent and prognostic significance should be combined. Since there is a high grade of heterogeneity, this basic tenet is clearly violated regarding breast cancer with NISI. Our proposal is to eliminate these tumours from the T4 category and to classify them simply by size (T1-3). Due to its prognostic significance, NISI should be indicated by an optional descriptor (e.g. S1).