Breast Cancer Research and Treatment

, Volume 94, Issue 1, pp 17–23 | Cite as

Assessment of Breast Cancer Tumor Size Depends on Method, Histopathology and Tumor Size Itself*

  • K. Heusinger
  • C. Löhberg
  • M. P. Lux
  • T. Papadopoulos
  • K. Imhoff
  • R. Schulz-Wendtland
  • M. W. Beckmann
  • P. A. FaschingEmail author


Purpose.Mammography (MG), breast (BU) and axillary ultrasound (AU), and clinical examination (CE) are commonly used for clinical staging. These different methods were compared in order to assess the accuracy of clinical tumor staging (cT).

Method.About 503 breast cancer (BC) patients were prospectively measured by MG, ultrasound and clinical examination. Pearson’s correlation to pathological tumor size (pT) was tested and the deviation of MG, BU and CE to pT was analyzed in subgroups defined by pT, grading (G), estrogen receptor (ER), progesteron receptor (PR), proliferation (MIB-1) and HER2/neu. Association of AU to pN was examined by χ2-test. Receiver operating characteristics (ROC) were used to test the prediction of a pT > 2 cm.

Results.Mammography correlated best with pT (r = 0.752). Mammography (mean (MG) = 2.17 cm) overestimated tumors in size (mean (pT) = 2.04 cm) rather than ultrasound (mean (BU) = 1.86 cm) and clinical examination (mean (cT) = 1.70 cm). pT of invasive ductal BC could be estimated significantly better than pT of invasive lobular BC. Smaller tumors were better to assess than larger ones. Tumors with a grading G1 were easier to estimate than tumors with G2/3. Best predictor of a pT > 2 cm was the mammography with an area under the curve of 0.876. The combination of all three modalities by linear regression performed even better with an AUC of 0.906.

Conclusions.The dimension of invasive ductal carcinomas, small and low grading tumors is significantly better to estimate. Concerning treatment decisions, we propose a combination of all three modalities, as the best predictive value was seen for the complementary use of mammography, ultrasound and clinical examination.

Key words

accuracy breast cancer clinical staging mammography tumor size ultrasound 


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  1. 1.
    Beckmann, MW, Nestle-Kraemling, C, Lux, MP, Klemt, D, Schroer, B, Goecke, TO, Niederacher, D, Fasching, PA 2001Das Familiäre Mammakarzinom-Syndrom: prädiktive genetische Testung, Beratung und BetreuungMed Welt12385390Google Scholar
  2. 2.
    Beckmann, MW, Fasching, PA, Weiss, JM, Magener, A, Ortmann, O 2003Update primäres Mammakarzinom 2003Geburtshilfe Frauenheilkd04R66R91Google Scholar
  3. 3.
    Fisher, B, Bryant, J, Wolmark, N, Mamounas, E, Brown, A, Fisher, ER, Wickerham, DL, Begovic, M, DeCillis, A, Robidoux, A, Margolese, RG, Cruz, AB,Jr., Hoehn, JL, Lees, AW, Dimitrov, NV, Bear, HD 1998Effect of preoperative chemotherapy on the outcome of women with operable breast cancerJ Clin Oncol1626722685PubMedGoogle Scholar
  4. 4.
    Minckwitz, G, Costa, SD, Eiermann, W, Blohmer, JU, Tulusan, AH, Jackisch, C, Kaufmann, M 1999Maximized reduction of primary breast tumor size using preoperative chemotherapy with doxorubicin and docetaxelJ Clin Oncol1719992005PubMedGoogle Scholar
  5. 5.
    Bonadonna, G, Valagussa, P, Brambilla, C, Ferrari, L, Moliterni, A, Terenziani, M, Zambetti, M 1998Primary chemotherapy in operable breast cancer: eight-year experience at the Milan Cancer InstituteJ Clin Oncol1693100PubMedGoogle Scholar
  6. 6.
    Fisher, B, Brown, A, Mamounas, E, Wieand, S, Robidoux, A, Margolese, RG, Cruz, AB, ,Jr., Fisher, ER, Wickerham, DL, Wolmark, N, DeCillis, A, Hoehn, JL, Lees, AW, Dimitrov, NV 1997Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18J Clin Oncol1524832493PubMedGoogle Scholar
  7. 7.
    Hage, JA, Velde, CJ, Julien, JP, Tubiana-Hulin, M, Vandervelden, C, Duchateau, L 2001Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902J Clin Oncol1942244237PubMedGoogle Scholar
  8. 8.
    Scholl, SM, Fourquet, A, Asselain, B, Pierga, JY, Vilcoq, JR, Durand, JC, Dorval, T, Palangie, T, Jouve, M, Beuzeboc, P,  et al. 1994Neoadjuvant versus adjuvant chemotherapy in premenopausal patients with tumours considered too large for breast conserving surgery: preliminary results of a randomised trial: S6Eur J Cancer30A645652CrossRefPubMedGoogle Scholar
  9. 9.
    Kaufmann, M, Minckwitz, G, Smith, R, Valero, V, Gianni, L, Eiermann, W, Howell, A, Costa, SD, Beuzeboc, P, Untch, M, Blohmer, JU, Sinn, HP, Sittek, R, Souchon, R, Tulusan, AH, Volm, T, Senn, HJ 2003International expert panel on the use of primary (preoperative) systemic treatment of operable breast cancer: review and recommendationsJ Clin Oncol2126002608CrossRefPubMedGoogle Scholar
  10. 10.
    Hieken, TJ, Harrison, J, Herreros, J, Velasco, JM 2001Correlating sonography, mammography, and pathology in the assessment of breast cancer sizeAm J Surg182351354CrossRefPubMedGoogle Scholar
  11. 11.
    Snelling, JD, Abdullah, N, Brown, G, King, DM, Moskovic, E, Gui, GP 2004Measurement of tumour size in case selection for breast cancer therapy by clinical assessment and ultrasoundEur J Surg Oncol3059CrossRefPubMedGoogle Scholar
  12. 12.
    Zeggelink, WF, Deurloo, EE, Bartelink, H, Rutgers, EJ, Gilhuijs, KG 2003Reproducibility of the assessment of tumor extent in the breast using multiple image modalitiesMed Phys3029192926CrossRefPubMedGoogle Scholar
  13. 13.
    Fredriksson, I, Liljegren, G, Palm-Sjovall, M, Arnesson, LG, Emdin, SO, Fornander, T, Lindgren, A, Nordgren, H, Idvall, I, Holmqvist, M, Holmberg, L, Frisell, J 2003Risk factors for local recurrence after breast-conserving surgeryBr J Surg9010931102CrossRefPubMedGoogle Scholar
  14. 14.
    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 randomised trials on 1,973 patientsEur J Cancer31A15741579CrossRefPubMedGoogle Scholar
  15. 15.
    Goldhirsch, A, Wood, WC, Gelber, RD, Coates, AS, Thurlimann, B, Senn, HJ 2003Meeting highlights: updated international expert consensus on the primary therapy of early breast cancerJ Clin Oncol2133573365CrossRefPubMedGoogle Scholar
  16. 16.
    Fornage, BD, Toubas, O, Morel, M 1987Clinical, mammographic, and sonographic determination of preoperative breast cancer sizeCancer60765771PubMedGoogle Scholar
  17. 17.
    Tresserra, F, Feu, J, Grases, PJ, Navarro, B, Alegret, X, Fernandez-Cid, A 1999Assessment of breast cancer size: sonographic and pathologic correlationJ Clin Ultrasound27485491CrossRefPubMedGoogle Scholar
  18. 18.
    Forouhi, P, Walsh, JS, Anderson, TJ, Chetty, U 1994Ultrasonography as a method of measuring breast tumour size and monitoring response to primary systemic treatmentBr J Surg81223225PubMedGoogle Scholar
  19. 19.
    Davis, PL, Staiger, MJ, Harris, KB, Ganott, MA, Klementaviciene, J, McCarty, KS,Jr., Tobon, H 1996Breast cancer measurements with magnetic resonance imaging, ultrasonography, and mammographyBreast Cancer Res Treat3719CrossRefPubMedGoogle Scholar
  20. 20.
    Skaane, P, Skjorten, F 1999Ultrasonographic evaluation of invasive lobular carcinomaActa Radiol40369375PubMedGoogle Scholar
  21. 21.
    McNeil, BJ, Keller, E, Adelstein, SJ 1975Primer on certain elements of medical decision makingN Engl J Med293211215PubMedCrossRefGoogle Scholar
  22. 22.
    Yang, WT, Lam, WW, Cheung, H, Suen, M, King, WW, Metreweli, C 1997Sonographic, magnetic resonance imaging, and mammographic assessments of preoperative size of breast cancerJ Ultrasound Med16791797PubMedGoogle Scholar
  23. 23.
    Finlayson, CA, MacDermott, TA 2000Ultrasound can estimate the pathologic size of infiltrating ductal carcinomaArch Surg1351589CrossRefPubMedGoogle Scholar
  24. 24.
    Herrada, J, Iyer, RB, Atkinson, EN, Sneige, N, Buzdar, AU, Hortobagyi, GN 1997Relative value of physical examination, mammography, and breast sonography in evaluating the size of the primary tumor and regional lymph node metastases in women receiving neoadjuvant chemotherapy for locally advanced breast carcinomaClin Cancer Res315651569PubMedGoogle Scholar
  25. 25.
    Skaane, P, Sager, EM, Olsen, JB, Abdelnoor, M, Berger, A, Wolff, PA, Kullmann, G 1999Diagnostic value of ultrasonography in patients with palpable mammographically noncalcified breast tumorsActa Radiol40163168PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • K. Heusinger
    • 1
  • C. Löhberg
    • 1
  • M. P. Lux
    • 1
  • T. Papadopoulos
    • 2
  • K. Imhoff
    • 2
  • R. Schulz-Wendtland
    • 3
  • M. W. Beckmann
    • 1
  • P. A. Fasching
    • 1
    Email author
  1. 1.Department of Gynecology and ObstetricsUniversity Hospital ErlangenErlangenGermany
  2. 2.Department of PathologyUniversity of ErlangenErlangenGermany
  3. 3.Institute of Diagnostic RadiologyUniversity of ErlangenErlangenGermany

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