Breast Cancer Research and Treatment

, Volume 93, Issue 3, pp 199–205 | Cite as

Tubular Carcinoma of the Breast: a Retrospective Analysis and Review of the Literature

  • Timothy Sullivan
  • Rita Abi Raad
  • Saveli Goldberg
  • Sherif I. Assaad
  • Michele Gadd
  • Barbara L. Smith
  • Simon N. Powell
  • Alphonse G. Taghian

Abstract

Background. The favorable prognosis associated with tubular carcinoma of the breast has led some studies to propose less aggressive treatments for patients with this disease. This study aims to address the extent of therapy needed for tubular patients.

Methods. A retrospective review identified 73 cases of tubular carcinoma treated at the Massachusetts General Hospital between 1980 and 2002. Primary treatment was conservative surgery (CS) plus radiation therapy (RT) in 67%, CS without RT in 18%, and mastectomy in 15%. Median follow-up time was 90.5 months. The published literature of 529 conservatively treated tubular carcinomas was reviewed along with the 62 conservative cases from this series.

Results. No patients developed distant metastasis or died from this disease. Local failure occurred in three (4%) of the cases, after 13, 84 and 121 months. All three had initially been treated with CS  + RT. Five cases were node-positive, three of which were associated with a primary tumor smaller than 1 cm. Thirteen women, with a median age of 74, were treated by CS without RT and none recurred. A literature review showed that adjuvant RT reduces local failure following CS for tubular carcinoma.

Conclusions. Tubular carcinoma is associated with an excellent prognosis, but long-term follow-up is essential for detecting local failures and a small primary tumor size does not preclude nodal involvement. Adjuvant RT reduces the incidence of local failure following CS for tubular carcinoma, however, elderly women treated by CS may have a very low risk of local recurrence without adjuvant RT.

Key words

breast cancer elderly local failure radiation therapy tubular 

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References

  1. 1.
    Cooper, H, Patchefsky, A, Krall, R 1978Tubular carcinoma of the breastCancer4223342342PubMedGoogle Scholar
  2. 2.
    Rescigno, J, Schiff, PB 1997Tubular carcinoma: Analysis of 1623 patients from the SEER database (Abstr.)Breast Cancer Res. Treat4640Google Scholar
  3. 3.
    Diab, SG, Clark, GM, Osborne, CK, Libby, A, Allred, DC, Elledge, RM 1999Tumor Characteristics and Clinical Outcome of Tubular and Mucinous Breast CarcinomasJ Clin Oncol1714421448PubMedGoogle Scholar
  4. 4.
    Weiss, MC, Fowble, BL, Solin, LJ, Yeh, IT, Schultz, DJ 1992Outcome of conservative therapy for invasive breast cancer by histologic subtypeInt J Radiat Oncol Biol Phys23941947PubMedGoogle Scholar
  5. 5.
    Kader, HA, Jackson, J, Mates, D, Andersen, S, Hayes, M, Olivotto, IA 2001Tubular carcinoma of the breast: A population-based study of nodal metastases at presentation and of patterns of relapseBreast J7813CrossRefPubMedGoogle Scholar
  6. 6.
    Thurman, SA, Schnitt, SJ, Connolly, JL, Gelman, R, Silver, B, Harris, JR, Recht, A 2004Outcome after breast-conserving therapy for patients with stage I or II mucinous, medullary, or tubular breast carcinomaInt J Radiat Oncol Biol Phys59159CrossRefGoogle Scholar
  7. 7.
    Leonard C, Chen B, Tenny C, Howell K, Jennings L, Norton L, Aarestad N, Sedlacek S. Clinical implications of axillary dissections for tubular carcinoma of the breast in a community setting (Abstr.). Proc Am Soc Clin Oncol 15, 1996Google Scholar
  8. 8.
    Cabral, AH, Recine, M, Paramo, JC, McPhee, MM, Poppiti, R, Mesko, TW 2003Tubular carcinoma of the breast: An institutional experience and review of the literatureBreast J9298301CrossRefPubMedGoogle Scholar
  9. 9.
    Kitchen, PRB, Smith, HJ, Henderson, MA, Goldhirsch, A, Castiglione-Gertsch, M, Coates, AS, Gusterson, B, Brown, RW, Gelber, RD, Collins, JP 2001Tubular carcinoma of the breast: Prognosis and response to adjuvant systemic therapyANZ J Surg712731CrossRefPubMedGoogle Scholar
  10. 10.
    Winchester, DJ, Sahin, AA, Tucker, SL, Singletary, SE 1996Tubular carcinoma of the breast. Predicting axillary nodal metastases and recurrenceAnn Surg223342347CrossRefPubMedGoogle Scholar
  11. 11.
    Peters, GN, Wolff, M, Haagensen, CD 1981Tubular carcinoma of the breast. Clinical pathologic correlations based on 100 casesAnn Surg193138149PubMedGoogle Scholar
  12. 12.
    Carstens, PH, Greenberg, RA, Francis, D, Lyon, H 1985Tubular carcinoma of the breast. A long term follow-upHistopathology9271280PubMedGoogle Scholar
  13. 13.
    Papadatos, G, Rangan, AM, Psarianos, T, Ung, O, Taylor, R, Boyages, J 2001Probability of axillary node involvement in patients with tubular carcinoma of the breastBr J Surg88860864CrossRefPubMedGoogle Scholar
  14. 14.
    Arias E: United States life tables, 2001. National vital statistics reports; vol. 52 no. 14. Hyattsville, Maryland: National Center for Health Statistics, 2004Google Scholar
  15. 15.
    Fein, DA, Fowble, BL, Hanlon, AL, Hooks, MA, Hoffman, JP, Sigurdson, ER, Jardines, LA, Eisenberg, BL 1997Identification of women with T1–T2 breast cancer at low risk of positive axillary nodesJ Surg Oncol653439CrossRefPubMedGoogle Scholar
  16. 16.
    Krag, D, Weaver, D, Ashikaga, T, Moffat, F, Klimberg, VS, Shriver, C, Feldman, S, Kusminsky, R, Gadd, M, Kuhn, J, Harlow, S, Beitsch, P, Whitworth, P, Foster, R, Dowlatshahi, K 1998The sentinel node in breast cancer – A multicenter validation studyN Engl J Med339941946CrossRefPubMedGoogle Scholar
  17. 17.
    Fisher, B, Anderson, S, Bryant, J, Margolese, RG, Deutsch, M, Fisher, ER, Jeong, J-H, Wolmark, N 2002Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancerN Engl J Med34712331241CrossRefPubMedGoogle Scholar
  18. 18.
    Fisher, B, Bryant, J, Dignam, JJ, Wickerham, DL, Mamounas, EP, Fisher, ER, Margolese, RG, Nesbitt, L, Paik, S, Pisansky, TM, Wolmark, N 2002Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or lessJ Clin Oncol2041414149CrossRefPubMedGoogle Scholar
  19. 19.
    Veronesi, U, Salvadori, B, Luini, A, Greco, M, Saccozzi, R, Vecchio, M, Mariani, L, Zurrida, S, Rilke, F 1995Breast conservation is a safe method in patients with small cancer of the breast: Long-term results of three randomized trials of 1973 patientsEur J Cancer31A15741581CrossRefPubMedGoogle Scholar
  20. 20.
    Early Breast Cancer Trialists Collaborative Group1995Effects of radiotherapy and surgery in early breast cancer: An overview of the randomized trialsN Engl J Med33314441455Google Scholar
  21. 21.
    Early Breast Cancer Trialists Collaborative Group2000Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trialsLancet35517571770Google Scholar
  22. 22.
    Clark, RM, Whelan, T, Levine, M, Roberts, R, Willan, A, McCulloch, P, Lipa, M, Wilkinson, RH, Mahoney, LJ 1996Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer: an update. Ontario Clinical Oncology GroupJ Natl Cancer Inst8816591664PubMedGoogle Scholar
  23. 23.
    Fisher, ER, Anderson, S, Tan-Chiu, E, Fisher, B, Eaton, L, Wolmark, N 2001Fifteen-year prognostic discriminants for invasive breast carcinoma: National Surgical Adjuvant Breast and Bowel Project Protocol-06Cancer9116791687CrossRefPubMedGoogle Scholar
  24. 24.
    Borger, JH, Kemperman, H, Hart, A, Peterse, H, Dongen, J, Bartelink, H 1994Risk factors in breast conservation therapyJ Clin Onc12653660Google Scholar
  25. 25.
    Elkhuizen, PH, Vijver, MJ, Hermans, J, Zonderland, HM, Velde, CJ, Leer, JW 1998Local recurrence after breast-conserving therapy for invasive breast cancer: High incidence in young patients and association with poor survival.Int J Radiat Oncol Biol Phys40859867CrossRefPubMedGoogle Scholar
  26. 26.
    Liljegren, G, Lindgren, A, Bergh, J, Nordgren, H, Tabar, L, Holmberg, L 1997Risk factors for local recurrence after conservative treatment in stage I breast cancer. Definition of a subgroup not requiring radiotherapyAnn Oncol8235241CrossRefPubMedGoogle Scholar
  27. 27.
    Benhaim, DI, Lopchinsky, R, Tartter, PI 2000Lumpectomy with tamoxifen as primary treatment for elderly women with early-stage breast cancerAm J Surg180162166CrossRefPubMedGoogle Scholar
  28. 28.
    Gruenberger, T, Gorlitzer, M, Soliman, T, Rudas, M, Mittlboeck, M, Gnant, M, Reiner, A, Teleky, B, Seitz, W, Jakesz, R 1998It is possible to omit postoperative irradiation in a highly selected group of elderly breast cancer patientsBreast Cancer Res Treat503746CrossRefPubMedGoogle Scholar
  29. 29.
    Veronesi, U, Marubini, E, Mariani, L, Galimberti, V, Luini, A, Veronesi, P, Salvadori, B, Zucali, R 2001Radiotherapy after breast-conserving surgery in small breast carcinoma: Long-term results of a randomized trialAnn Oncol1210032001CrossRefGoogle Scholar
  30. 30.
    Hughes, KS, Schnaper, LA, Berry, D, Cirrincione, C, McCormick, B, Shank, B, Wheeler, J, Champion, LA, Smith, TJ, Smith, BL, Shapiro, C, Muss, HB, Winer, E, Hudis, C, Wood, W, Sugarbaker, D, Henderson, IC, Norton, L, Cancer, , Leukemia Group, B 2004Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast CancerN Engl J Med351971977CrossRefPubMedGoogle Scholar
  31. 31.
    Fyles, AW, McCready, DR, Manchul, LA, Trudeau, ME, Merante, P, Pintilie, M, Weir, LM, Olivotto, IA 2004Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancerN Engl J Med351963970CrossRefPubMedGoogle Scholar
  32. 32.
    McBoyle, M, Razek, H, Carter, J, Helmer, S 1997Tubular carcinoma of the breast: an institutional reviewAm Surg63639644PubMedGoogle Scholar
  33. 33.
    Haffty, BG, Perrotta, PL, Ward, B, Moran, M, Beinfield, M, McKhann, C, Fischer, D, Carter, D 1997Conservatively treated breast cancer: outcome by histologic subtypeBreast J3714Google Scholar
  34. 34.
    Tobon, H, Salazar, H 1977Tubular carcinoma of the breast. Clinical, histological, and ultrastructural observationsArch Pathol Lab Med101310316PubMedGoogle Scholar
  35. 35.
    Oberman, HA, Fidler, WJ 1979Tubular carcinoma of the breastAm J Surg Pathol3387395PubMedGoogle Scholar
  36. 36.
    Deos, PH, Norris, HJ 1982Well-differentiated (tubular) carcinoma of the breast. A clinicopathologic study of 145 pure and mixed casesAm J Clin Pathol7817PubMedGoogle Scholar
  37. 37.
    McDivitt, RW, Boyce, W, Gersell, D 1982Tubular carcinoma of the breast. Clinical and pathological observations concerning 135 casesAm J Surg Pathol6401411PubMedGoogle Scholar
  38. 38.
    Schnitt, SJ, Hayman, J, Gelman, R, Eberlein, TJ, Love, SM, Mayzel, K, Osteen, RT, Nixon, AJ, Pierce, S, Connolly, JL, Cohen, P, Schneider, L, Silver, B, Recht, A, Harris, JR 1996A prospective study of conservative surgery alone in the treatment of selected patients with stage I breast cancerCancer7710941100CrossRefPubMedGoogle Scholar
  39. 39.
    Bradford, WZ, Christensen, WN, Fraser, H, Cloninger, TE 1998Treatment of pure tubular carcinoma of the breastBreast J4437440CrossRefGoogle Scholar
  40. 40.
    Holland, DW, Boucher, LD, Mortimer, JE 2001Tubular breast cancer experience at Washington University: A review of the literatureClin Breast Cancer2210214PubMedGoogle Scholar
  41. 41.
    Livi, L, Paiar, F, Meldolesi, E, Talamonti, C, Simontacchi, G, Detti, B, Salerno, S, Bianchi, S, Cardona, G, Biti, GP 2005Tubular carcinoma of the breast: Outcome and loco-regional recurrence in 307 patientsEur J Surg Oncol31912CrossRefPubMedGoogle Scholar
  42. 42.
    Forrest, AP, Stewart, HJ, Everington, D, Prescott, RJ, McArdle, CS, Harnett, AN, Smith, DC, George, WD 1996Randomized controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish trialLancet348708713CrossRefPubMedGoogle Scholar
  43. 43.
    Renton, S, Gazet, JC, Ford, HT, Corbishley, C, Sutcliffe, R. 1996The importance of the resection margin in conservative surgery for breast cancerEur J Surg Oncol221722CrossRefPubMedGoogle Scholar
  44. 44.
    Liljegren, G, Holmberg, L, Bergh, J, Lindgren, A, Tabar, L, Nordgren, H, Adami, HO 199910-year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: A randomized trialJ Clin Oncol1723262333PubMedGoogle Scholar
  45. 45.
    Malmstrom, P, Holmberg, L, Anderson, H, Mattsson, J, Jonsson, PE, Tennvall-Nittby, L, Balldin, G, Loven, L, Svensson, JH, Ingvar, C 2003Breast conservation surgery, with and without radiotherapy, in women with lymph node-negative breast cancer: A randomised clinical trial in a population with access to public mammography screeningEur J Cancer3916901697CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Timothy Sullivan
    • 1
  • Rita Abi Raad
    • 1
  • Saveli Goldberg
    • 1
  • Sherif I. Assaad
    • 1
  • Michele Gadd
    • 2
  • Barbara L. Smith
    • 2
  • Simon N. Powell
    • 1
  • Alphonse G. Taghian
    • 1
  1. 1.Department of Radiation OncologyHarvard Medical SchoolBostonUSA
  2. 2.Department of Surgical Oncology, Massachusetts General Hospital Cancer CenterHarvard Medical SchoolBostonUSA
  3. 3.Department of Radiation OncologyMassachusetts General HospitalBostonUSA

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