Diagnosis of 'early', 'minimal' and impalpable breast carcinoma

Abstract

'Early breast carcinoma' is a clinical term which has been traditionally used to describe in situ carcinoma and stage 1 tumours, 2 cm or less in diameter, which are confined to the breast, with no metastasis. Currently, however, there seems to be no accepted definition and different authors use the term to cover different stages of the disease. In this respect, out of four recent articles dealing with early breast cancer two included stage 1 tumours with or without lymph node metastasis, 23 one included stage 1 and 2 tumours, ~ and one defined early cancers as all technically resectable tumours? No wonder many pathologists and clinicians avoid using this term especially as it also implies a temporal relationship between time and tumour size which may not always be the case. 6 On the other hand, the term 'minimal breast cancer ' is now gaining wide acceptance. 7 It is used to designate forms of breast carcinoma which are thought to have a high curable rate. Originally these included all cases of ductal and lobular carcinoma in situ as well as cases of invasive ductal and lobular carcinomas which did not measure more than 0.5 cm in maximum dimension? Later, it was suggested, and widely accepted, 7 that the upper limit for the size of minimal invasive tumours should extend to 1.0 cm and to exclude all cases with lymph node metastasis. These suggestions were based on a detailed study of the long-term behaviour of 16 894 breast carcinomas of different sizes in which no significant difference was noted between tumours measuring 0.5 cm or less and those measuring 0.6--1.0 cm, but a significant difference in behaviour was noted between axillary node positive and negative tumours measuring 1.0 cm or less. 9