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      Ductal carcinoma of the breast: morphological aspects according to the age Translated title: Carcinoma ductal da mama: aspectos morfológicos de acordo com a idade

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          Abstract

          ABSTRACTIntroduction:Breast cancer is the most common cancer in women worldwide, and its morphological characteristics, despite the current molecular classification, also provide important information about the pattern of this disease.Objective:To analyze the morphological characteristics of invasive ductal breast carcinoma among women older and younger than 50 years.Method:302 cases of invasive ductal carcinoma patients treated at the Division of Mastology of the Universidade Federal do Ceará, in the period 2005-2014, aged ≤ 50 years and older. The following morphological characteristics were analyzed: larger tumor diameter (TD), lymph node metastasis (MX), and histological grade (HG).Results:The mean age of patients was 55.6 years. The average tumor size was 3.4 cm, 40% of tumors have diameter ≤ 2 cm and 60% > 2 cm. As for the histological grade, 23.7% were grade 1, 32.1% grade 2, and 42% grade 3. Axillary metastasis were present in 66% of the cases and 34% did not. Women aged ≤ 50 years had fewer tumors grade 1 (p = 0.002), compared with grades 2 and 3. Women older than 50 years had more grade 3 tumors (p = 0.002), and more tumors larger than 2 cm diameter (p < 0.001). The presence of metastasis predominated in both age groups when analyzed separately (p < 0.001).Conclusion:Women older than 50 years had larger and more morphologically undifferentiated tumors. Women aged ≤ 50 years had less well-differentiated tumors. There were no differences in morphology between these two age groups when compared each other.

          Translated abstract

          RESUMOIntrodução:O câncer de mama é o câncer que mais acomete mulheres no mundo, e suas características morfológicas, a despeito da atual classificação molecular, ainda fornecem informações importantes sobre o comportamento desta doença.Objetivo:Analisar as características morfológicas dos carcinomas ductais invasivos da mama em mulheres acima e abaixo de 50 anos de idade.Métodos:Trezentos e dois casos de carcinoma ductal de pacientes do serviço de Mastologia da Universidade Federal do Ceará (UFC), no período de 2005 a 2014, com idade ≤ 50 anos e acima de 50 anos. Foram analisadas as seguintes características morfológicas: maior diâmetro do tumor (DT), presença de metástase axilar (MX) e grau histológico (GH).Resultados:A idade média das pacientes foi de 55,6 anos; o tamanho médio dos tumores, de 3,4 cm. Quarenta por cento dos tumores possuíam diâmetro ≤ 2 cm e 60%, > 2 cm. Quanto ao grau histológico, 23,7% eram grau 1, 32,1%, grau 2 e 42%, grau 3. Sessenta e seis por cento dos casos apresentaram metástase axilar e 34% não. Mulheres com idade ≤ 50 anos apresentaram menos tumores grau 1 (p = 0,002) em relação aos graus 2 e 3. Mulheres acima de 50 anos apresentaram mais tumores grau 3 (p = 0,002) e mais tumores com mais de 2 cm de diâmetro (p < 0,001). A presença de metástase predominou nas duas faixas etárias quando analisadas isoladamente (p < 0,001).Conclusão:Mulheres acima de 50 anos apresentaram tumores maiores e de morfologia mais indiferenciada; mulheres com idade ≤ 50 anos, menos tumores bem diferenciados. Não houve diferença da morfologia entre as faixas etárias quando comparadas entre si.

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          Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up.

          Morphological assessment of the degree of differentiation has been shown in numerous studies to provide useful prognostic information in breast cancer, but until recently histological grading has not been accepted as a routine procedure, mainly because of perceived problems with reproducibility and consistency. In the Nottingham/Tenovus Primary Breast Cancer Study the most commonly used method, described by Bloom & Richardson, has been modified in order to make the criteria more objective. The revised technique involves semiquantitative evaluation of three morphological features--the percentage of tubule formation, the degree of nuclear pleomorphism and an accurate mitotic count using a defined field area. A numerical scoring system is used and the overall grade is derived from a summation of individual scores for the three variables: three grades of differentiation are used. Since 1973, over 2200 patients with primary operable breast cancer have been entered into a study of multiple prognostic factors. Histological grade, assessed in 1831 patients, shows a very strong correlation with prognosis; patients with grade I tumours have a significantly better survival than those with grade II and III tumours (P less than 0.0001). These results demonstrate that this method for histological grading provides important prognostic information and, if the grading protocol is followed consistently, reproducible results can be obtained. Histological grade forms part of the multifactorial Nottingham prognostic index, together with tumour size and lymph node stage, which is used to stratify individual patients for appropriate therapy.
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            Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases.

            Two of the most important prognostic indicators for breast cancer are tumor size and extent of axillary lymph node involvement. Data on 24,740 cases recorded in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were used to evaluate the breast cancer survival experience in a representative sample of women from the United States. Actuarial (life table) methods were used to investigate the 5-year relative survival rates in cases with known operative/pathologic axillary lymph node status and primary tumor diameter. Survival rates varied from 45.5% for tumor diameters equal to or greater than 5 cm with positive axillary nodes to 96.3% for tumors less than 2 cm and with no involved nodes. The relation between tumor size and lymph node status was investigated in detail. Tumor diameter and lymph node status were found to act as independent but additive prognostic indicators. As tumor size increased, survival decreased regardless of lymph node status; and as lymph node involvement increased, survival status also decreased regardless of tumor size. A linear relation was found between tumor diameter and the percent of cases with positive lymph node involvement. The results of our analyses suggest that disease progression to distant sites does not occur exclusively via the axillary lymph nodes, but rather that lymph node status serves as an indicator of the tumor's ability to spread.
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              Prognostic significance of Nottingham histologic grade in invasive breast carcinoma.

              The three strongest prognostic determinants in operable breast cancer used in routine clinical practice are lymph node (LN) stage, primary tumor size, and histologic grade. However, grade is not included in the recent revision of the TNM staging system of breast cancer as its value is questioned in certain settings. This study is based on a large and well-characterized consecutive series of operable breast cancer (2,219 cases), treated according to standard protocols in a single institution, with a long-term follow-up (median, 111 months) to assess the prognostic value of routine assessment of histologic grade using Nottingham histologic grading system. Histologic grade is strongly associated with both breast cancer-specific survival (BCSS) and disease-free survival (DFS) in the whole series as well as in different subgroups based on tumor size (pT1a, pT1b, pT1c, and pT2) and LN stages (pN0 and pN1 and pN2). Differences in survival were also noted between different individual grades (1, 2, and 3). Multivariate analyses showed that histologic grade is an independent predictor of both BCSS and DFS in operable breast cancer as a whole as well as in all studied subgroups. Histologic grade, as assessed by the Nottingham grading system, provides a strong predictor of outcome in patients with invasive breast cancer and should be incorporated in breast cancer staging systems.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                jbpml
                Jornal Brasileiro de Patologia e Medicina Laboratorial
                J. Bras. Patol. Med. Lab.
                Sociedade Brasileira de Patologia Clínica (Rio de Janeiro )
                1678-4774
                August 2015
                : 51
                : 4
                : 252-257
                Affiliations
                [1 ] Universidade Federal do Ceará Brazil
                [2 ] Universidade de Fortaleza Brazil
                Article
                S1676-24442015000400252
                10.5935/1676-2444.20150042
                dd2a5ec7-70cf-4130-ab7f-47bc3d73ecb3

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1676-2444&lng=en
                Categories
                MEDICAL LABORATORY TECHNOLOGY
                MEDICINE, RESEARCH & EXPERIMENTAL
                PATHOLOGY

                Pathology,Medicine,Clinical chemistry
                breast neoplasms,neoplasias da mama,patologia cirúrgica,distribuição por idade,surgical pathology,age distribution

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