Tumour location within the breast: Does tumour site have prognostic ability?

Seth Rummel

doi:10.3332/ecancer.2015.552

Abstract

IntroductionTumour location within the breast varies with the highest frequency in the upper outer quadrant (UOQ) and lowest frequency in the lower inner quadrant (LIQ). Whether tumour location is prognostic is unclear. To determine whether tumour location is prognostic, associations between tumour site and clinicopathological characteristics were evaluated.Materials and MethodsAll patients enrolled in the Clinical Breast Care Project whose tumour site—UOQ, upper inner quadrant (UIQ), central, LIQ, lower outer quadrant (LOQ)—was determined by a single, dedicated breast pathologist were included in this study. Patients with multicentric disease (n = 122) or tumours spanning multiple quadrants (n = 381) were excluded from further analysis. Clinicopathological characteristics were analysed using chi-square tests for univariate analysis with multivariate analysis performed using principal components analysis (PCA) and multiple logistic regression. Significance was defined as P < 0.05.ResultsOf the 980 patients with defined tumour location, 30 had bilateral disease. Tumour location in the UOQ (51.5%) was significantly higher than in the UIQ (15.6%), LOQ (14.2%), central (10.6%), or LIQ (8.1%). Tumours in the central quadrant were significantly more likely to have higher tumour stage (P = 0.003) and size (P < 0.001), metastatic lymph nodes (P < 0.001), and mortality (P = 0.011). After multivariate analysis, only tumour size and lymph node status remained significantly associated with survival.ConclusionsEvaluation of tumour location as a prognostic factor revealed that although tumours in the central region are associated with less favourable outcome, these associations are not independent of location but rather driven by larger tumour size. Tumours in the central region are more difficult to detect mammographically, resulting in larger tumour size at diagnosis and thus less favourable prognosis. Together, these data demonstrate that tumour location is not an independent prognostic factor.

Highlights

Tumour location within the breast varies with the highest frequency in the upper outer quadrant (UOQ) and lowest frequency in the lower inner quadrant (LIQ)
Tumours in the upper outer quadrant (UOQ), which is the most frequent site of tumour location, have been associated with improved survival compared to other quadrants [10, 11]; survival data for non-UOQ tumours have been mixed with findings demonstrating decreased survival for the lower inner quadrant (LIQ), and lower, medial or periareolar regions [12,13,14,15,16,17]
Two studies suggest that the frequency of tumours in the UOQ has increased over time [30, 31]; given the association of tumour in the UOQ with improved prognosis, these data would suggest a trend towards a reduction in breast cancer mortality

Summary

Introduction

Tumour location within the breast varies with the highest frequency in the upper outer quadrant (UOQ) and lowest frequency in the lower inner quadrant (LIQ). Materials and Methods: All patients enrolled in the Clinical Breast Care Project whose tumour site—UOQ, upper inner quadrant (UIQ), central, LIQ, lower outer quadrant (LOQ)—was determined by a single, dedicated breast pathologist were included in this study. Tumours in the central region are more difficult to detect mammographically, resulting in larger tumour size at diagnosis and less favourable prognosis Together, these data demonstrate that tumour location is not an independent prognostic factor. A number of pathological characteristics have been identified, which can be used as prognostic factors, including tumour size and grade, hormone receptor, HER2, and lymph node status [2, 3], which are all considered when predicting prognosis and determining the most effective treatment options. Other studies have found no association between tumour location and outcome [18,19,20]

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Conclusion