Metaplastic breast carcinoma: a clinical-pathologic study of 97 cases with subset analysis of response to neoadjuvant chemotherapy

• Published in: Modern pathology 2019-06, Vol.32 (6), p.807-816
• Main Authors: Han, Min, Salamat, Arsalan, Zhu, Li, Zhang, Huina, Clark, Beth Z., Dabbs, David J., Carter, Gloria J., Brufsky, Adam M., Jankowitz, Rachel C., Puhalla, Shannon L., Johnson, Ronald R., Soran, Atilla, Steiman, Jennifer G., McAuliffe, Priscilla F., Diego, Emilia J., Bhargava, Rohit
• Format: Article
• Language: English
• Subjects: 13/1; 631/67/1347; 692/308/409; Adult; Aged; Biopsy; Breast cancer; Breast carcinoma; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Chemotherapy; Chemotherapy, Adjuvant; Female; Humans; Laboratory Medicine; Lymph nodes; Lymphatic system; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Pathology; Prognosis; Survival; Treatment Outcome
• ISSN: 0893-3952; 1530-0285
• DOI: 10.1038/s41379-019-0208-x

Metaplastic breast carcinoma is a rare heterogeneous category of breast cancer, often associated with a poor prognosis. Clinical-pathologic studies with respect to varied morphologic subtypes are lacking. There is also a dearth of studies assessing the response of metaplastic breast carcinoma to neoadjuvant chemotherapy. Cases of metaplastic breast carcinoma diagnosed between 2007 and 2017 were identified. Various clinical-pathologic variables were tested for association with survival. Patients who underwent neoadjuvant chemotherapy were assessed for pathologic response. Median age at diagnosis with metaplastic breast carcinoma was 64 years. With a median follow-up of 39 months, 26 patients (27%) recurred (24 distant and 2 loco-regional). The overall survival rate of the cohort was 66% (64/97). A number of variables were associated with survival in univariable analysis; however, in multivariable analysis, only lymph node status and tumor size (pT3 vs. pT1/2) were significantly associated with all survival endpoints: recurrence-free survival, distant recurrence-free survival, overall survival and breast cancer-specific survival. Twenty-nine of 97 (30%) patients with metaplastic breast carcinoma received neoadjuvant chemotherapy. Five (17%) patients achieved pathologic complete response. Matrix-producing morphology was associated with higher probability of achieving pathologic complete response ( p  = 0.027). Similar to other breast cancer subtypes, tumor size and lymph node status are prognostic in metaplastic carcinomas. The pathologic complete response rate of metaplastic breast carcinoma in our cohort was 17%, higher than previously reported. Although the matrix-producing subtype was associated with pathologic complete response, there was no survival difference with respect to tumor subtypes.