Clinicopathological and Radiological Features with Long Term Follow Up of Metaplastic Carcinoma Breast in India.

Gopal Puri,Anita Dhar,Sandeep Mathur,Anurag Srivastava,Smriti Hari,Kamal Kataria,Sarada Khadka,Piyush Ranjan,Kush Lohani

doi:10.31557/apjcp.2021.22.11.3483

Abstract

Objective:Metaplastic breast carcinoma (MBC) is a heterogeneous group of invasive carcinomas with squamous and/or mesenchymal differentiation. Because of their rare occurrence, the information regarding the clinical behaviour of metaplastic carcinomas is limited. The purpose of our study was to delineate the clinicopathological and radiological features, treatment outcomes, prognostic factors, and survival of patients with MBC. Methods:Ambispective observational study with prospective recruitment was done from 1st January 2019 to 31st August 2020. Retrospective data included between 1st January 2009 and 31st December 2018. In the retrospective group surgical database of our department was searched and those with MBC diagnosis on post-operative histopathology recruited. In prospective group patients with MBC on core biopsy were followed and those operated were included. The patients followed up at our breast cancer clinic (BCC) and their demographic, clinical, pathological radiological and treatment details noted. Results:Forty patients formed the study population. The mean age of the patents was 42 years. Ipsilateral axillary lymph node metastasis was present in 22.5%. The pathological median tumor size was 5.4 (range 2.1 to 22 cm). The most common differentiation was cartilaginous (35%) followed by squamous (32.5%). The most common mammographic grading was BIRADS 4 (Breast Imaging Reporting and Data system). Magnetic resonance imaging was T2 hyperintense with peripheral rim enhancement and restriction on DWI. The median overall (OS) and disease-free survival (DFS) was 42 and 40 months, respectively. Fifteen patients (37.5%) had disease related mortality. A subgroup analysis revealed that, type of differentiation, histopathology and tumor size > 5cm affected both OS and DFS significantly. Conclusion:Metaplastic breast cancer in our setup presents in young patients with aggressive large tumors at a higher stage and diverse histopathology and with comparable overall and disease-free survival. The histological subtype, tumor differentiation and tumor size are prognostic factors.

Highlights

The incidence of Metaplastic Breast Carcinoma (MBC) is 0.2%-5% of all invasive breast cancers (Lakhani et al, 2012)
The surgical database of our department was searched for the term metaplastic carcinoma and the patients with confirmed post-operative histopathological report were recruited in the retrospective group
This study presents clinical features, outcomes, and prognostic factors of forty patients of Metaplastic breast carcinoma (MBC), managed at our tertiary care institute

Summary

Introduction

The incidence of Metaplastic Breast Carcinoma (MBC) is 0.2%-5% of all invasive breast cancers (Lakhani et al, 2012). Metaplastic breast cancer is a diverse group of invasive carcinomas with squamous with or without mesenchymal differentiation. The clinical presentation of these cancers, in hindsight, reveal aggressively fast-growing, large tumors with paradoxically less rates of axillary metastasis at diagnosis (Alam et al, 2003; Lai et al.,2013). They are notorious to metastasise to the lungs among other organs. The present study was designed to evaluate overall survival, disease free survival, clinical outcomes and prognostic factors of patients with histologically diagnosed MBC

Materials and Methods

Results

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Discussion