TUBULAR CARCINOMA OF THE BREAST - AN INSTITUTIONAL REVIEW

Tubular carcinoma of the breast is a rare, but distinct, well-differen tiated histologic subtype of invasive carcinoma, known for its favorab le prognosis. Review of the literature reveals controversy relative to the frequency of tubular carcinoma, the mammographic appearance, the incidence of lymph node metastases, and the need for axillary node dis section. In consideration of these variables and because of the concer n that this type of breast cancer was being surgically overtreated, th is review was undertaken. Through the use of our tumor registry, a ret rospective review of patients with invasive breast cancer was carried out from January 1984 to September 1995. Of 1483 total cases of invasi ve breast carcinoma, 22 (1.5%) had a diagnosis of pure tubular carcino ma (>90% tubular component), The mean age was 58 years (range, 37-80). In 14 patients, the lesion was detected solely by mammography with a mean size of 1.0 cm (range, 0.5-1.5 cm). The mean pathologic tumor siz e was 1.2 cm (range, 0.5-2.9 cm). The mean number of nodes, in 22 axil lary specimens, was 19 (range, 8-30). In one patient, there was lymph node metastasis to a single node (4.5% incidence), which demonstrated tubular characteristics. Presently, 18 of the patients are alive and d isease free, with a mean follow-up of 3.5 years (range, 4 months to 9 years). Our study confirms the low incidence of pure tubular carcinoma , 1.5 per cent, with the lesions being small, 1.2 cm in mean size. The mammographic lesions had no unique features that would distinguish tu bular from other invasive carcinomas. With the small tumor size and th e overall excellent prognosis, these patients are ideal candidates for breast preservation. Most importantly, the review did demonstrate tha t even in pure tubular breast carcinoma, lymph node metastases, though rare, can occur.