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Ann Surg. Feb 1989; 209(2): 249–253.
PMCID: PMC1493899

Treatment and survival of female patients with nonpalpable breast carcinoma.


Since 1971, 151 nonpalpable breast cancers (100 invasive carcinomas, 39 in situ ductal carcinomas, and twelve lobular carcinomas in situ) have been diagnosed and treated at the St. Radboud University Hospital. Of the 100 clinically occult invasive carcinomas, 53 had pathologic diameters of more than 10 mm, 29 were of sizes between 6 and 10 mm, and 18 were tumors of 5 mm or less. Residual tumor outside the "excisional" biopsy cavity was encountered in 76 of the 118 mastectomy specimens (64.4%) fully capable of evaluation. Invasive residual tumor would have been left behind in 34 of 86 mastectomy specimens (39.5%). Of 27 axillas studied, no patient with in situ carcinoma had evidence of axillary lymph node metastases. Invasive carcinoma, however, showed axillary lymph node involvement in 7.7% of mastectomy specimens when the size of the primary tumor was not more than 5 mm, in 12.5% when the size was between 6 and 10 mm, and in 29.5% when the primary tumor was more than 10 mm in diameter. The 10-year recurrence-free survival (RFS) of patients with clinically occult invasive carcinomas greater than 10 mm in size was 71.9% and differed significantly from the 90.9% for patients with the invasive tumors less than or equal to 5 mm, as well as from the 100% RFS of patients with invasive tumors of between 6 and 10 mm and noninvasive tumors. Although the 10-year RFS was 92.6% for the patients with negative axillary nodes and 80.0% for the patients with positive axillary nodes, this difference did not reach statistical significance. However, the disease-specific overall survival after 10 years was significantly different between node-negative patients (96.4%) and node-positive patients (78.8%). Multivariate analysis disclosed that the relationship between size of the primary tumor and RFS was independent of the presence of axillary lymph node metastases. In conclusion, the validity of the concept of minimal breast cancer has been re-enforced. However, the results of this study suggest that the upper limit of the original definition of minimal breast cancer is too narrow and should be extended, so that, apart from the noninvasive tumors--regardless of their size--all invasive tumors having a maximum diameter less than or equal to 10 mm should be regarded as minimal breast cancers.

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Selected References

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  • Rodes ND, Lopez MJ, Pearson DK, Blackwell CW, Lankford HD. The impact of breast cancer screening on survival. A 5- to 10-year follow-up study. Cancer. 1986 Feb 1;57(3):581–585. [PubMed]
  • Letton AH, Mason EM. Routine breast screening. Survival after 10.5 years follow-up. Ann Surg. 1986 May;203(5):470–473. [PMC free article] [PubMed]
  • Tinnemans JG, Wobbes T, Hendriks JH, van der Sluis RF, Lubbers EJ, de Boer HH. Localization and excision of nonpalpable breast lesions. A surgical evaluation of three methods. Arch Surg. 1987 Jul;122(7):802–806. [PubMed]
  • Tinnemans JG, Wobbes T, Holland R, Hendriks JH, van der Sluis RF, Lubbers EJ, de Boer HH. Mammographic and histopathologic correlation of nonpalpable lesions of the breast and the reliability of frozen section diagnosis. Surg Gynecol Obstet. 1987 Dec;165(6):523–529. [PubMed]
  • Egan RL. Multicentric breast carcinomas: clinical-radiographic-pathologic whole organ studies and 10-year survival. Cancer. 1982 Mar 15;49(6):1123–1130. [PubMed]
  • Holland R, Veling SH, Mravunac M, Hendriks JH. Histologic multifocality of Tis, T1-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer. 1985 Sep 1;56(5):979–990. [PubMed]
  • Tinnemans JG, Wobbes T, van der Sluis RF, Lubbers EJ, de Boer HH. Multicentricity in nonpalpable breast carcinoma and its implications for treatment. Am J Surg. 1986 Mar;151(3):334–338. [PubMed]
  • Wanebo HJ, Huvos AG, Urban JA. Proceedings: Treatment of minimal breast cancer. Cancer. 1974 Feb;33(2):349–357. [PubMed]
  • Frazier TG, Copeland EM, Gallager HS, Paulus DD, Jr, White EC. Prognosis and treatment in minimal breast cancer. Am J Surg. 1977 Jun;133(6):697–701. [PubMed]
  • Peters TG, Donegan WL, Burg EA. Minimal breast cancer: a clinical appraisal. Ann Surg. 1977 Dec;186(6):704–710. [PMC free article] [PubMed]
  • Nevin JE, Pinzón G, Morán TJ, Baggerly JT. Minimal breast carcinoma. Am J Surg. 1980 Mar;139(3):357–359. [PubMed]
  • Bedwani R, Vana J, Rosner D, Schmitz RL, Murphy GP. Management and survival of female patients with "minimal" breast cancer: as observed in the long-term and short-term surveys of the American College of Surgeons. Cancer. 1981 Jun 15;47(12):2769–2778. [PubMed]
  • Beahrs OH, Smart CR. Diagnosis of minimal breast cancers in the BCDDP: the 66 questionable cases. Cancer. 1979 Mar;43(3):848–850. [PubMed]
  • Lundgren B. Observations on growth rate of breast carcinomas and its possible implications for lead time. Cancer. 1977 Oct;40(4):1722–1725. [PubMed]
  • Shwartz M. Estimates of lead time and length bias in a breast cancer screening program. Cancer. 1980 Aug 15;46(4):844–851. [PubMed]
  • Holland R, Mravunac M, Hendriks JH, Bekker BV. So-called interval cancers of the breast. Pathologic and radiologic analysis of sixty-four cases. Cancer. 1982 Jun 15;49(12):2527–2533. [PubMed]
  • Schwartz GF, Feig SA, Rosenberg AL, Patchefsky AS, Schwartz AB. Staging and treatment of clinically occult breast cancer. Cancer. 1984 Mar 15;53(6):1379–1384. [PubMed]
  • Haagensen CD, Lane N, Lattes R, Bodian C. Lobular neoplasia (so-called lobular carcinoma in situ) of the breast. Cancer. 1978 Aug;42(2):737–769. [PubMed]
  • Ashikari R, Hajdu SI, Robbins GF. Intraductal carcinoma of the breast. (1960-1969). Cancer. 1971 Nov;28(5):1182–1187. [PubMed]
  • Rosen PP. Axillary lymph node metastases in patients with occult noninvasive breast carcinoma. Cancer. 1980 Sep 1;46(5):1298–1306. [PubMed]
  • Verbeek AL, Hendriks JH, Holland R, Mravunac M, Sturmans F, Day NE. Reduction of breast cancer mortality through mass screening with modern mammography. First results of the Nijmegen project, 1975-1981. Lancet. 1984 Jun 2;1(8388):1222–1224. [PubMed]
  • Collette HJ, Day NE, Rombach JJ, de Waard F. Evaluation of screening for breast cancer in a non-randomised study (the DOM project) by means of a case-control study. Lancet. 1984 Jun 2;1(8388):1224–1226. [PubMed]
  • Tabár L, Fagerberg CJ, Gad A, Baldetorp L, Holmberg LH, Gröntoft O, Ljungquist U, Lundström B, Månson JC, Eklund G, et al. Reduction in mortality from breast cancer after mass screening with mammography. Randomised trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet. 1985 Apr 13;1(8433):829–832. [PubMed]

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