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Annals of Oncology Advance Access published online on July 20, 2005
Annals of Oncology, doi:10.1093/annonc/mdi319
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© 2005 European Society for Medical Oncology
Received May 2, 2005
Revised June 13, 2005
Accepted June 14, 2005

Original article

Scope and significance of non-uniform classification practices in breast cancer with non-inflammatory skin involvement: a clinicopathologic study and an international survey

U. Güth 1* {dagger}, G. Singer 2 {dagger}, A. Schötzau 3, I. Langer 4, H. Dieterich 5, C. Rochlitz 6, L. Herberich 1, W. Holzgreve 1, and E. Wight 1

1 Departments of Gynecology and Obstetrics, University Hospital Basel, Switzerland
2 Institute of Pathology, University of Basel, Switzerland
3 JPS Institute for Biomathematics, Basel, Switzerland
4 Departments of Surgery, University Hospital Basel, Switzerland
5 Women's Hospital and Breast Center Rheinfelden, Rheinfelden, Germany
6 Departments of Medical Oncology, University Hospital Basel, Switzerland

* To whom correspondence should be addressed.
U. Güth, E-mail: ugueth{at}uhbs.ch


  Abstract

Background: The study evaluates the scope of non-uniform classification practices concerning breast carcinomas with non-inflammatory skin involvement.

Patients and 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 T4b/stage IIIB. The opposing classification principle (‘clinical view’), which dictates that T4b 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 (T4b/IIIB). This results in a considerable distortion of the reported statistical data.

Keywords: breast carcinoma; skin involvement; TNM classification; prognostic factors; survey.

{dagger}U. Güth and G. Singer contributed equally to the work.


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