Invasive micropapillary carcinoma (IMPC) is an unusual and distinct subtype of invasive breast tumor with high propensity for regional lymph node metastases. This study was to identify risk factors accounting for IMPC of the breast and to develop a nomogram to preoperatively predict the probability of lymph node involvement.
A retrospective review of the clinical and pathology records was performed in patients diagnosed with IMPC between 2003 and 2014 from Surveillance, Epidemiology, and End Results (SEER) database. The cohort was divided into training and validation sets. Training set comprised patients diagnosed between 2003 and 2009, while validation set included patients diagnosed thereafter. A logistic regression model was used to construct the nomogram in the training set and then varified in the validation set. Nomogram performance was quantified with respect to discrimination and calibration using R 3.4.1 software.
Overall, 1407 patients diagnosed with IMPC were enrolled, of which 527 in training set and 880 in validation set. Logistic regression analysis indicated larger lesions, younger age at diagnosis, black ethnic and lack of hormone receptor expression were significantly related to regional nodes involvement. The AUC of the nomogram was 0.735 (95% confidential interval (CI) 0.692 to 0.777), demonstrating a good prediction performance. Calibration curve for the nomogram was plotted and the slope was close to 1, which demonstrated excellent calibration of the nomogram. The performance of the nomogram was further validated in the validation set, with AUC of 0.748 (95% CI 0.701 to 0.767).
The striking difference between IMPC and IDC remains the increased lymph node involvement in IMPC and therefore merits aggressive treatment. The nomogram based on the clinicalpathologic parameters was established, which could accurately preoperatively predict regional lymph node status. This nomogram would facilitate evaluating lymph node state preoperatively and thus treatment decision-making of individual patients.
Fisher ER, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (protocol no. 4): VI. Invasive papillary Cancer. Am J Clin Pathol. 1980;73(3):313–22. CrossRef
Siriaunkgul S, Tavassoli F. Invasive micropapillary carcinoma of the breast. Mod Pathol. 1993;6(6):660–2. PubMed
Tavassoli FA, Devilee P. Pathology and genetics of tumours of Breast and female genital organs: pathology and genetics. Verh Dtsch Ges Pathol. 2002;86:116–9.
Luna-More S, et al. Invasive micropapillary carcinoma of the breast*: a new special type of invasive mammary carcinoma. Pathology-Research and Practice. 1994;190(7):668–74. CrossRef
Luna-More S, et al. Estrogen and progesterone receptors, c-erbB-2, p53, and Bcl-2 in thirty-three invasive micropapillary breast carcinomas. Pathology-Research and Practice. 1996;192(1):27–32. CrossRef
Nassar H, et al. Clinicopathologic analysis of invasive micropapillary differentiation in breast carcinoma. Mod Pathol. 2001;14(9):836. CrossRef
Paterakos M, et al. Invasive micropapillary carcinoma of the breast: a prognostic study. Hum Pathol. 1999;30(12):1459–63. CrossRef
Middleton L, et al. Infiltrating micropapillary carcinoma of the breast. Mod Pathol. 1999;12(5):499–504. PubMed
Guo X, et al. Tumor infiltrating lymphocytes differ in invasive micropapillary carcinoma and medullary carcinoma of breast. Mod Pathol. 2008;21(9):1101. CrossRef
Wei J, et al. E-selectin and Sialyl Lewis X expression is associated with lymph node metastasis of invasive micropapillary carcinoma of the breast. Int J Surg Pathol. 2010;18(3):193–200. CrossRef
Liu F, et al. Increased expression of SDF-1/CXCR4 is associated with lymph node metastasis of invasive micropapillary carcinoma of the breast. Histopathology. 2009;54(6):741–50. CrossRef
Ren M, et al. Absence of caveolin-1 expression in carcinoma-associated fibroblasts of invasive micropapillary carcinoma of the breast predicts poor patient outcome. Virchows Arch. 2014;465(3):291–8. CrossRef
Li S, et al. Deep sequencing reveals small RNA characterization of invasive micropapillary carcinomas of the breast. Breast Cancer Res Treat. 2012;136(1):77–87. CrossRef
Wang X-X, et al. Loss of leucine zipper putative tumor suppressor 1 (LZTS1) expression contributes to lymph node metastasis of breast invasive micropapillary carcinoma. Pathology & Oncology Research. 2015;21(4):1021–6. CrossRef
Kramer AA, Zimmerman JE. Assessing the calibration of mortality benchmarks in critical care: the Hosmer-Lemeshow test revisited. Crit Care Med. 2007;35(9):2052–6. CrossRef
Rasponi A, et al. Breast cancer: primary tumor characteristics related to lymph node involvement. Tumori. 1981;67(1):19–26. CrossRef
Mohammed H, et al. Progesterone receptor modulates ERalpha action in breast cancer. Nature. 2015;523(7560):313–7. CrossRef
Page DL. Prognosis and breast cancer . Recognition of lethal and favorable prognostic types. Am J Surg Pathol. 1991;15(4):334–49. CrossRef
Li YS, et al. The reversed apical pattern of MUC1 expression is characteristics of invasive micropapillary carcinoma of the breast. Breast Cancer. 2006;13(1):58–63. CrossRef
Pettinato G, et al. Invasive micropapillary carcinoma of the breast: clinicopathologic study of 62 cases of a poorly recognized variant with highly aggressive behavior. Am J Clin Pathol. 2004;121(6):857–66. CrossRef
Tresserra F, et al. Invasive micropapillary carcinoma. Distinct features of a poorly recognized variant of breast carcinoma. Eur J Gynaecol Oncol. 1999;20(3):205–8. PubMed
Walsh MM, Bleiweiss IJ. Invasive micropapillary carcinoma of the breast: eighty cases of an underrecognized entity. Hum Pathol. 2001;32(6):583–9. CrossRef
Guo X, et al. Invasive micropapillary carcinoma of the breast: association of pathologic features with lymph node metastasis. Am J Clin Pathol. 2006;126(5):740–6. CrossRef
Zekioglu O, et al. Invasive micropapillary carcinoma of the breast: high incidence of lymph node metastasis with extranodal extension and its immunohistochemical profile compared with invasive ductal carcinoma. Histopathology. 2004;44(1):18–23. CrossRef
Adrada B, et al. Invasive micropapillary carcinoma of the breast: mammographic, sonographic, and MRI features. AJR Am J Roentgenol. 2009;193(1):W58–63. CrossRef
Chen L, et al. Breast carcinoma with micropapillary features: clinicopathologic study and long-term follow-up of 100 cases. Int J Surg Pathol. 2008;16(2):155–63. CrossRef
Yu JI, et al. Differences in prognostic factors and patterns of failure between invasive micropapillary carcinoma and invasive ductal carcinoma of the breast: matched case–control study. Breast. 2010;19(3):231–7. CrossRef
Liu Y, et al. Similar prognoses for invasive micropapillary breast carcinoma and pure invasive ductal carcinoma: a retrospectively matched cohort study in China. PLoS One. 2014;9(9):e106564. CrossRef
Yoshihara E, et al. Predictors of axillary lymph node metastases in early breast cancer and their applicability in clinical practice. Breast. 2013;22(3):357–61. CrossRef
Katz A, et al. Nomogram for the prediction of having four or more involved nodes for sentinel lymph node–positive breast cancer. J Clin Oncol. 2008;26(13):2093–8. CrossRef
Tang SL, et al. Clinicopathologic study of invasive micropapillary carcinoma of the breast. Oncotarget. 2017;8(26):42455–65. CrossRef
- Nomogram for predicting preoperative lymph node involvement in patients with invasive micropapillary carcinoma of breast: a SEER population-based study
- BioMed Central
Neu im Fachgebiet Onkologie
e.Med Kampagnen-Visual, Mail Icon II