LABC: Stage III breast cancer, excluding inflammatory breast cancer (reported separately due to distinct clinical presentation/behavior)
T3: Primary invasive tumor > 5 cm
T4: Tumor any size with direct extension to skin &/or chest wall; invasion of dermis alone does not qualify as T4 (requires skin ulceration &/or skin nodules)
N2: Matted axillary nodes; ipsilateral internal mammary nodes in absence of axillary metastasis
N3: Ipsilateral metastatic infra- or supraclavicular nodes or clinically apparent (includes imaging) internal mammary nodes and axillary nodes
Anatomic stage IIIA: T0-2N2M0 or T3N1-2M0
Anatomic stage IIIB: T4N0-2M0
Prognostic staging considers tumor grade and receptor status, may better predict outcome
Pectoralis muscle invasion should be reported but is not classified as chest wall invasion
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Nuclear Medicine Findings
Image-Guided Biopsy
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Pan H et al: Palliative local surgery for locally advanced breast cancer depending on hormone receptor status in elderly patients. Clin Breast Cancer. 19(1):e247-e260, 2019
Altundag K: Locally advanced non-inflammatory breast cancer may be misdiagnosed as inflammatory breast cancer. Eur J Surg Oncol. 44(8):1280, 2018
Everett AS et al: The evolving role of postmastectomy radiation therapy. Surg Clin North Am. 98(4):801-17, 2018
Gajjala SR et al: Whole-body 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) for staging locally advanced breast cancer: a prospective study from a tertiary cancer centre in south India. Indian J Med Res. 147(3):256-62, 2018
Tanić M et al: Molecular signature of response to preoperative radiotherapy in locally advanced breast cancer. Radiat Oncol. 13(1):193, 2018
Vondeling GT et al: Burden of early, advanced and metastatic breast cancer in The Netherlands. BMC Cancer. 18(1):262, 2018
Wang M et al: Evaluation of the prognostic stage in the 8th edition of the American Joint Committee on Cancer in locally advanced breast cancer: An analysis based on SEER 18 database. Breast. 37:56-63, 2018
Yee C et al: Radiotherapy for patients with unresected locally advanced breast cancer. Ann Palliat Med. 7(4):373-84, 2018
Grimm LJ et al: Can breast cancer molecular subtype help to select patients for preoperative MR imaging? Radiology. 274(2):352-8, 2015
Mazilu L et al: Optimizing the indication for breast-conservative surgery (BCS) in patients with locally-advanced breast cancer. Chirurgia (Bucur). 108(4):478-81, 2013
Berg WA et al: Breast cancer: comparative effectiveness of positron emission mammography and MR imaging in presurgical planning for the ipsilateral breast. Radiology. 258(1):59-72, 2011
Edge SB et al: AJCC Cancer Staging Handbook. 7th ed. New York: Springer, 2011
Loo CE et al: Magnetic resonance imaging response monitoring of breast cancer during neoadjuvant chemotherapy: relevance of breast cancer subtype. J Clin Oncol. 29(6):660-6, 2011
Niikura N et al: Initial staging impact of fluorodeoxyglucose positron emission tomography/computed tomography in locally advanced breast cancer. Oncologist. 16(6):772-82, 2011
Prat A et al: Practical implications of gene-expression-based assays for breast oncologists. Nat Rev Clin Oncol. 9(1):48-57, 2011
Chung A et al: Axillary staging in the neoadjuvant setting. Ann Surg Oncol. 17(9):2401-10, 2010
Partridge SC et al: Association between serial dynamic contrast-enhanced MRI and dynamic 18F-FDG PET measures in patients undergoing neoadjuvant chemotherapy for locally advanced breast cancer. J Magn Reson Imaging. 32(5):1124-31, 2010
Zhang YJ et al: Clinically apparent internal mammary nodal metastasis in patients with advanced breast cancer: incidence and local control. Int J Radiat Oncol Biol Phys. 77(4):1113-9, 2010
Whitman GJ et al: Workup and staging of locally advanced breast cancer. Semin Radiat Oncol. 19(4):211-21, 2009
Houssami N et al: Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 26(19):3248-58, 2008
Newman EA et al: Sentinel lymph node biopsy performed after neoadjuvant chemotherapy is accurate in patients with documented node-positive breast cancer at presentation. Ann Surg Oncol. 14(10):2946-52, 2007
Rosen EL et al: FDG PET, PET/CT, and breast cancer imaging. Radiographics. 27 Suppl 1:S215-29, 2007
Rouzier R et al: Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res. 11(16):5678-85, 2005
Berg WA et al: Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 233(3):830-49, 2004
Londero V et al: Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy. Eur Radiol. 14(8):1371-9, 2004
Lønning PE et al: Microarrays in primary breast cancer--lessons from chemotherapy studies. Endocr Relat Cancer. 8(3):259-63, 2001
Herrada J et al: Relative value of physical examination, mammography, and breast sonography in evaluating the size of the primary tumor and regional lymph node metastases in women receiving neoadjuvant chemotherapy for locally advanced breast carcinoma. Clin Cancer Res. 3(9):1565-9, 1997
Related Anatomy
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Abbreviations
Locally advanced breast cancer (LABC)
Definitions
LABC: Stage III breast cancer, excluding inflammatory breast cancer (reported separately due to distinct clinical presentation/behavior)
T3: Primary invasive tumor > 5 cm
T4: Tumor any size with direct extension to skin &/or chest wall; invasion of dermis alone does not qualify as T4 (requires skin ulceration &/or skin nodules)
N2: Matted axillary nodes; ipsilateral internal mammary nodes in absence of axillary metastasis
N3: Ipsilateral metastatic infra- or supraclavicular nodes or clinically apparent (includes imaging) internal mammary nodes and axillary nodes
Anatomic stage IIIA: T0-2N2M0 or T3N1-2M0
Anatomic stage IIIB: T4N0-2M0
Prognostic staging considers tumor grade and receptor status, may better predict outcome
Pectoralis muscle invasion should be reported but is not classified as chest wall invasion
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Nuclear Medicine Findings
Image-Guided Biopsy
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Pan H et al: Palliative local surgery for locally advanced breast cancer depending on hormone receptor status in elderly patients. Clin Breast Cancer. 19(1):e247-e260, 2019
Altundag K: Locally advanced non-inflammatory breast cancer may be misdiagnosed as inflammatory breast cancer. Eur J Surg Oncol. 44(8):1280, 2018
Everett AS et al: The evolving role of postmastectomy radiation therapy. Surg Clin North Am. 98(4):801-17, 2018
Gajjala SR et al: Whole-body 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) for staging locally advanced breast cancer: a prospective study from a tertiary cancer centre in south India. Indian J Med Res. 147(3):256-62, 2018
Tanić M et al: Molecular signature of response to preoperative radiotherapy in locally advanced breast cancer. Radiat Oncol. 13(1):193, 2018
Vondeling GT et al: Burden of early, advanced and metastatic breast cancer in The Netherlands. BMC Cancer. 18(1):262, 2018
Wang M et al: Evaluation of the prognostic stage in the 8th edition of the American Joint Committee on Cancer in locally advanced breast cancer: An analysis based on SEER 18 database. Breast. 37:56-63, 2018
Yee C et al: Radiotherapy for patients with unresected locally advanced breast cancer. Ann Palliat Med. 7(4):373-84, 2018
Grimm LJ et al: Can breast cancer molecular subtype help to select patients for preoperative MR imaging? Radiology. 274(2):352-8, 2015
Mazilu L et al: Optimizing the indication for breast-conservative surgery (BCS) in patients with locally-advanced breast cancer. Chirurgia (Bucur). 108(4):478-81, 2013
Berg WA et al: Breast cancer: comparative effectiveness of positron emission mammography and MR imaging in presurgical planning for the ipsilateral breast. Radiology. 258(1):59-72, 2011
Edge SB et al: AJCC Cancer Staging Handbook. 7th ed. New York: Springer, 2011
Loo CE et al: Magnetic resonance imaging response monitoring of breast cancer during neoadjuvant chemotherapy: relevance of breast cancer subtype. J Clin Oncol. 29(6):660-6, 2011
Niikura N et al: Initial staging impact of fluorodeoxyglucose positron emission tomography/computed tomography in locally advanced breast cancer. Oncologist. 16(6):772-82, 2011
Prat A et al: Practical implications of gene-expression-based assays for breast oncologists. Nat Rev Clin Oncol. 9(1):48-57, 2011
Chung A et al: Axillary staging in the neoadjuvant setting. Ann Surg Oncol. 17(9):2401-10, 2010
Partridge SC et al: Association between serial dynamic contrast-enhanced MRI and dynamic 18F-FDG PET measures in patients undergoing neoadjuvant chemotherapy for locally advanced breast cancer. J Magn Reson Imaging. 32(5):1124-31, 2010
Zhang YJ et al: Clinically apparent internal mammary nodal metastasis in patients with advanced breast cancer: incidence and local control. Int J Radiat Oncol Biol Phys. 77(4):1113-9, 2010
Whitman GJ et al: Workup and staging of locally advanced breast cancer. Semin Radiat Oncol. 19(4):211-21, 2009
Houssami N et al: Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 26(19):3248-58, 2008
Newman EA et al: Sentinel lymph node biopsy performed after neoadjuvant chemotherapy is accurate in patients with documented node-positive breast cancer at presentation. Ann Surg Oncol. 14(10):2946-52, 2007
Rosen EL et al: FDG PET, PET/CT, and breast cancer imaging. Radiographics. 27 Suppl 1:S215-29, 2007
Rouzier R et al: Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res. 11(16):5678-85, 2005
Berg WA et al: Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 233(3):830-49, 2004
Londero V et al: Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy. Eur Radiol. 14(8):1371-9, 2004
Lønning PE et al: Microarrays in primary breast cancer--lessons from chemotherapy studies. Endocr Relat Cancer. 8(3):259-63, 2001
Herrada J et al: Relative value of physical examination, mammography, and breast sonography in evaluating the size of the primary tumor and regional lymph node metastases in women receiving neoadjuvant chemotherapy for locally advanced breast carcinoma. Clin Cancer Res. 3(9):1565-9, 1997
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