Abstract
BackgroundInvasive micropapillary carcinoma (IMPC) is an unusual and distinct subtype of invasive breast tumor with high propensity for regional lymph node metastases. This study was to identify risk factors accounting for IMPC of the breast and to develop a nomogram to preoperatively predict the probability of lymph node involvement.MethodsA retrospective review of the clinical and pathology records was performed in patients diagnosed with IMPC between 2003 and 2014 from Surveillance, Epidemiology, and End Results (SEER) database. The cohort was divided into training and validation sets. Training set comprised patients diagnosed between 2003 and 2009, while validation set included patients diagnosed thereafter. A logistic regression model was used to construct the nomogram in the training set and then varified in the validation set. Nomogram performance was quantified with respect to discrimination and calibration using R 3.4.1 software.ResultsOverall, 1407 patients diagnosed with IMPC were enrolled, of which 527 in training set and 880 in validation set. Logistic regression analysis indicated larger lesions, younger age at diagnosis, black ethnic and lack of hormone receptor expression were significantly related to regional nodes involvement. The AUC of the nomogram was 0.735 (95% confidential interval (CI) 0.692 to 0.777), demonstrating a good prediction performance. Calibration curve for the nomogram was plotted and the slope was close to 1, which demonstrated excellent calibration of the nomogram. The performance of the nomogram was further validated in the validation set, with AUC of 0.748 (95% CI 0.701 to 0.767).ConclusionsThe striking difference between IMPC and IDC remains the increased lymph node involvement in IMPC and therefore merits aggressive treatment. The nomogram based on the clinicalpathologic parameters was established, which could accurately preoperatively predict regional lymph node status. This nomogram would facilitate evaluating lymph node state preoperatively and thus treatment decision-making of individual patients.
Highlights
Invasive micropapillary carcinoma (IMPC) is an unusual and distinct subtype of invasive breast tumor with high propensity for regional lymph node metastases
In 2003 World Health Organization (WHO) guidelines for histologic classification of tumors of the breast, IMPC was considered as a rare subtype of invasive breast carcinoma, accounting for approximately 2% to 8% of all breast cancers [3]
The data released from the SEER database did not require informed patient consent because cancer is a reportable disease in every state in the US
Summary
Invasive micropapillary carcinoma (IMPC) is an unusual and distinct subtype of invasive breast tumor with high propensity for regional lymph node metastases. This study was to identify risk factors accounting for IMPC of the breast and to develop a nomogram to preoperatively predict the probability of lymph node involvement. Invasive micropapillary carcinoma (IMPC) of the breast was first described by Fisher et al in 1980 [1], and defined by Siriaunkgul and Tavassoli in1993 [2]. In 2003 World Health Organization (WHO) guidelines for histologic classification of tumors of the breast, IMPC was considered as a rare subtype of invasive breast carcinoma, accounting for approximately 2% to 8% of all breast cancers [3]. Axillary lymph node metastasis is one of the most important prognostic determinants for patients with breast cancer. Preoperative assessment of lymph node involvement has become an essential issue with respect to determining the need for neoadjuvant therapy and aiding in axillary lymph nodes dissection decision making or other alternative treatment options
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