Tubular carcinoma of the breast: axillary involvement and prognostic factors Vivienne Lea,* Laurence Gluch,*† Catherine W. Kennedy,† Hugh Carmalt*† and David Gillett† *Concord Repatriation Hospital, Sydney, New South Wales, Australia and †The Strathfield Breast Centre, Sydney, New South Wales, Australia Key words axillary metastasis, prognosis, tubular breast carcinoma. Correspondence Dr Vivienne Lea, Concord Repatriation Hospital, Hospital Road, Concord, NSW 2139, Australia. Email: vivienne.lea@gmail.com V. Lea MBBS; L. Gluch MBBCh, FRACS; C. W. Kennedy RMRA; H. Carmalt MBBS, FRACS; D. Gillett MBBS, FRACS. Accepted for publication 22 June 2014. doi: 10.1111/ans.12791 Abstract Background: Tubular carcinoma (TC) of the breast has a very favourable prognosis. The role for axillary staging in small TC was questioned. This study investigated the frequency of axillary metastases and prognostic factors in pure TC of the breast. It involved a retrospective review of prospectively collected data. Methods: A consecutive series of patients presenting to The Strathfield Breast Centre (TSBC) between 1988 and 2011 were reviewed. Only pure TC was included. Infor- mation collected included demographics, surgery, pathology, adjuvant therapy and survival. Results: Pure TC accounted for 146 out of 6110 cases of operable breast cancer. Ninety-five per cent were node negative (micrometastases and isolated tumour cells excluded). Ninety-eight per cent of those with known oestrogen receptor status were oestrogen receptor positive. Median tumour size was 10 mm (range 1–52 mm). Ten- year survival was 97%. Twelve per cent of patients had more than one tumour (either ipsilateral or contralateral). Eight patients had recurrent disease. All were node nega- tive. Three of these patients died of their disease. Conclusion: Axillary metastases are uncommon in pure TC. Recurrent disease is not readily predicted by tumour size or node status. Introduction Tubular carcinoma (TC) of the breast is a well-differentiated variant of infiltrating ductal carcinoma characterized by orderly tubule for- mation. TCs are often detected on screening mammograms and are consequently usually small and impalpable. 1 They have generally been regarded as uncommon, however rising use of mammographic screening is likely to increase their detection. 2,3 Controversy remains regarding the frequency of axillary metastases and the role of sen- tinel node biopsy in patients with TC. The aim of this review was to examine the frequency of axillary node metastases and to analyse factors influencing the long-term prognosis of patients with TC. Methods A consecutive series of patients presenting to The Strathfield Breast Centre (TSBC) between 1988 and 2011 were reviewed. Data were collected from the prospective database that had been established by the Centre when it was established. 4,5 Data collected included demographics, work-up, extent of surgery, pathology, adjuvant therapy, and recurrence and survival data. All pathology was staged using the American Joint Committee on Cancer (AJCC) criteria 6 from definitive operative histol- ogy. As part of the review of the database only pure TC were included, mixed tubulolobular cases have been excluded. Follow-up continued to the end of 2012 and was carried out by the treating surgeon or by contact with the patients’ general practitioner. All patients have had follow-up ranging between 6 months and 23 years (median 8 years). The time and site of any recurrence were documented, as was any further treatment. Any diagnosis of cancer in the contralateral breast was recorded. The date and cause of death or last review were documented to obtain survival data. Survival curves and rates were calculated by the actuarial methods of Kaplan–Meier. Results Pure TC accounted for 146 out of 6110 cases of operable breast cancer in the database (2.39%). All patients were female. Table 1 summarizes patient and tumour characteristics at the time of primary surgery. The patient age range was from 36 to 94 years (median 57 years). One hundred and thirty-seven cases were grade 1, three were grade 2 and for six cases, the grade was not reported. The median ORIGINAL ARTICLE ANZJSurg.com © 2014 Royal Australasian College of Surgeons ANZ J Surg •• (2014) ••–••