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Breast
Treatment
Focused Issues in Treatment
Metastatic Breast Cancer
Metastatic Breast Cancer
Jessica W. T. Leung, MD; Wei Tse Yang, MBBS
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Metastatic breast cancer (MBC)

            • Definitions

              • Stage IV: Distant metastases, spread beyond breast and ipsilateral nodes; TNM classification (M1)
              • De devo MBC = stage IV at initial presentation
              • Recurrent MBC = stages I, II, or III at initial presentation, with recurrence at distant sites

            IMAGING

            • Radiographic Findings

              • Mammographic Findings

                • Ultrasonographic Findings

                  • CT Findings

                    • MR Findings

                      • Nuclear Medicine Findings

                        • Image-Guided Biopsy

                          • Imaging Recommendations

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                • Staging, Grading, & Classification

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            Selected References

                                            1. Pons-Tostivint E et al: Survival impact of locoregional treatment of the primary tumor in de novo metastatic breast cancers in a large multicentric cohort study: A propensity score-matched analysis. Ann Surg Oncol. 26(2):356-365, 2019
                                            2. Gogate A et al: An updated systematic review of the cost-effectiveness of therapies for metastatic breast cancer. Breast Cancer Res Treat. ePub, 2019
                                            3. Bai XM et al: Long-term outcomes and prognostic analysis of percutaneous radiofrequency ablation in liver metastasis from breast cancer. Int J Hyperthermia. 35(1):183-93, 2019
                                            4. New Global Cancer Data: GLOBOCAN 2018. https://www.uicc.org/new-global-cancer-data-globocan-2018. Accessed January 11, 2019
                                            5. Begg CB et al: Contralateral breast cancers: Independent cancers or metastases? Int J Cancer. 142(2):347-356, 2018
                                            6. Begg CB et al: Contralateral breast cancers: Independent cancers or metastases? Int J Cancer. 142(2):347-356, 2018
                                            7. Caswell-Jin JL et al: Change in Survival in Metastatic Breast Cancer with Treatment Advances: Meta-Analysis and Systematic Review. JNCI Cancer Spectr. 2(4):pky062, 2018
                                            8. Caswell-Jin JL et al: Change in Survival in Metastatic Breast Cancer with Treatment Advances: Meta-Analysis and Systematic Review. JNCI Cancer Spectr. 2(4):pky062, 2018
                                            9. Szekely B et al: Immunological differences between primary and metastatic breast cancer. Ann Oncol. ePub, 2018
                                            10. Szekely B et al: Immunological differences between primary and metastatic breast cancer. Ann Oncol. ePub, 2018
                                            11. Xiao W et al: Primary tumor resection in stage IV breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol. ePub, 2018
                                            12. Xiao W et al: Primary tumor resection in stage IV breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol. ePub, 2018
                                            13. Yararbas U et al: The value of 18F-FDG PET/CT imaging in breast cancer staging. Bosn J Basic Med Sci. 18(1):72-79, 2018
                                            14. Yararbas U et al: The value of 18F-FDG PET/CT imaging in breast cancer staging. Bosn J Basic Med Sci. 18(1):72-79, 2018
                                            15. Lower EE et al: Discordance of the estrogen receptor and HER-2/neu in breast cancer from primary lesion to first and second metastatic site. Breast Cancer (Dove Med Press). 9:515-520, 2017
                                            16. Lower EE et al: Discordance of the estrogen receptor and HER-2/neu in breast cancer from primary lesion to first and second metastatic site. Breast Cancer (Dove Med Press). 9:515-520, 2017
                                            17. Mariotto AB et al: Estimation of the Number of Women Living with Metastatic Breast Cancer in the United States. Cancer Epidemiol Biomarkers Prev. 26(6):809-815, 2017
                                            18. Mariotto AB et al: Estimation of the Number of Women Living with Metastatic Breast Cancer in the United States. Cancer Epidemiol Biomarkers Prev. 26(6):809-815, 2017
                                            19. Sugihara T et al: Bone metastases from breast cancer: associations between morphologic CT patterns and glycolytic activity on PET and bone scintigraphy as well as explorative search for influential factors. Ann Nucl Med. 31(10):719-725, 2017
                                            20. Sugihara T et al: Bone metastases from breast cancer: associations between morphologic CT patterns and glycolytic activity on PET and bone scintigraphy as well as explorative search for influential factors. Ann Nucl Med. 31(10):719-725, 2017
                                            21. Groheux D et al: ¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer. J Nucl Med. 57 Suppl 1:17S-26S, 2016
                                            22. Groheux D et al: ¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer. J Nucl Med. 57 Suppl 1:17S-26S, 2016
                                            23. Taghipour M et al: FDG Avidity and Tumor Burden: Survival Outcomes for Patients With Recurrent Breast Cancer. AJR Am J Roentgenol. 206(4):846-55, 2016
                                            24. Taghipour M et al: FDG Avidity and Tumor Burden: Survival Outcomes for Patients With Recurrent Breast Cancer. AJR Am J Roentgenol. 206(4):846-55, 2016
                                            25. Alkner S et al: Contralateral breast cancer can represent a metastatic spread of the first primary tumor: determination of clonal relationship between contralateral breast cancers using next-generation whole genome sequencing. Breast Cancer Res. 17:102, 2015
                                            26. Alkner S et al: Contralateral breast cancer can represent a metastatic spread of the first primary tumor: determination of clonal relationship between contralateral breast cancers using next-generation whole genome sequencing. Breast Cancer Res. 17:102, 2015
                                            27. Chikarmane SA et al: Metastatic patterns of breast cancer subtypes: what radiologists should know in the era of personalized cancer medicine. Clin Radiol. 70(1):1-10, 2015
                                            28. Chikarmane SA et al: Metastatic patterns of breast cancer subtypes: what radiologists should know in the era of personalized cancer medicine. Clin Radiol. 70(1):1-10, 2015
                                            29. Son SH et al: Whole-Body Metabolic Tumor Volume, as Determined by (18)F-FDG PET/CT, as a Prognostic Factor of Outcome for Patients With Breast Cancer Who Have Distant Metastasis. AJR Am J Roentgenol. 205(4):878-85, 2015
                                            30. Son SH et al: Whole-Body Metabolic Tumor Volume, as Determined by (18)F-FDG PET/CT, as a Prognostic Factor of Outcome for Patients With Breast Cancer Who Have Distant Metastasis. AJR Am J Roentgenol. 205(4):878-85, 2015
                                            31. Gold LS et al: Imaging Techniques for Treatment Evaluation for Metastatic Breast Cancer. Rockville (MD): Agency for Healthcare Research and Quality (US). Report No.: 14-EHC044-EF, 2014
                                            32. Gold LS et al: Imaging Techniques for Treatment Evaluation for Metastatic Breast Cancer. Rockville (MD): Agency for Healthcare Research and Quality (US). Report No.: 14-EHC044-EF, 2014
                                            33. Rong J et al: Comparison of (18)FDG PET-CT and bone scintigraphy for detection of bone metastases in breast cancer patients. A meta-analysis. Surg Oncol. 22(2):86-91, 2013
                                            34. Rong J et al: Comparison of (18)FDG PET-CT and bone scintigraphy for detection of bone metastases in breast cancer patients. A meta-analysis. Surg Oncol. 22(2):86-91, 2013
                                            35. Niikura N et al: FDG-PET/CT compared with conventional imaging in the detection of distant metastases of primary breast cancer. Oncologist. 16(8):1111-9, 2011
                                            36. Niikura N et al: FDG-PET/CT compared with conventional imaging in the detection of distant metastases of primary breast cancer. Oncologist. 16(8):1111-9, 2011
                                            37. Edge SB et al: Cancer Staging Handbook From the AJCC Cancer Staging Manual. 7th ed. Chicago: Springer. 417-60, 2010
                                            38. Edge SB et al: Cancer Staging Handbook From the AJCC Cancer Staging Manual. 7th ed. Chicago: Springer. 417-60, 2010
                                            39. Dawood S et al: Survival differences among women with de novo stage IV and relapsed breast cancer. Ann Oncol. 21(11):2169-74, 2010
                                            40. Dawood S et al: Survival differences among women with de novo stage IV and relapsed breast cancer. Ann Oncol. 21(11):2169-74, 2010
                                            41. Carlson RW et al: Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 7(2):122-92, 2009
                                            42. Carlson RW et al: Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 7(2):122-92, 2009
                                            43. NCCN. NCCN Clinical practice guidelines in oncology. In Winn R: Jenkintown, PA: National Comprehensive Cancer Network; 2008
                                            44. NCCN. NCCN Clinical practice guidelines in oncology. In Winn R: Jenkintown, PA: National Comprehensive Cancer Network; 2008
                                            45. Harris L et al: American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 25(33):5287-312, 2007
                                            46. Harris L et al: American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 25(33):5287-312, 2007
                                            47. Buyse M et al: Validation and clinical utility of a 70-gene prognostic signature for women with node-negative breast cancer. J Natl Cancer Inst. 98(17):1183-92, 2006
                                            48. Buyse M et al: Validation and clinical utility of a 70-gene prognostic signature for women with node-negative breast cancer. J Natl Cancer Inst. 98(17):1183-92, 2006
                                            49. Braun S et al: A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med. 353(8):793-802, 2005
                                            50. Braun S et al: A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med. 353(8):793-802, 2005
                                            51. Buzdar AU et al: Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol. 23(16):3676-85, 2005
                                            52. Buzdar AU et al: Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol. 23(16):3676-85, 2005
                                            53. Moon YW et al: Neoadjuvant chemotherapy with infusional 5-fluorouracil, adriamycin and cyclophosphamide (iFAC) in locally advanced breast cancer: an early response predicts good prognosis. Ann Oncol. 16(11):1778-85, 2005
                                            54. Moon YW et al: Neoadjuvant chemotherapy with infusional 5-fluorouracil, adriamycin and cyclophosphamide (iFAC) in locally advanced breast cancer: an early response predicts good prognosis. Ann Oncol. 16(11):1778-85, 2005
                                            55. van't Veer LJ et al: Gene expression profiling of breast cancer: a new tumor marker. J Clin Oncol. 23(8):1631-5, 2005
                                            56. van't Veer LJ et al: Gene expression profiling of breast cancer: a new tumor marker. J Clin Oncol. 23(8):1631-5, 2005
                                            57. Cristofanilli M et al: Circulating tumor cells, disease progression, and survival in metastatic breast cancer. N Engl J Med. 351(8):781-91, 2004
                                            58. Cristofanilli M et al: Circulating tumor cells, disease progression, and survival in metastatic breast cancer. N Engl J Med. 351(8):781-91, 2004
                                            59. Paik S et al: A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 351(27):2817-26, 2004
                                            60. Paik S et al: A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 351(27):2817-26, 2004
                                            61. Thor A: A revised staging system for breast cancer. Breast J. 10 Suppl 1:S15-8, 2004
                                            62. Thor A: A revised staging system for breast cancer. Breast J. 10 Suppl 1:S15-8, 2004
                                            63. Zangheri B et al: PET/CT and breast cancer. Eur J Nucl Med Mol Imaging. 31 Suppl 1:S135-42, 2004
                                            64. Zangheri B et al: PET/CT and breast cancer. Eur J Nucl Med Mol Imaging. 31 Suppl 1:S135-42, 2004
                                            65. Systemic treatment of early breast cancer by hormonal et al: 133 randomised trials involving 31,000 recurrences and 24,000 deaths among 75,000 women. Early Breast Cancer Trialists' Collaborative Group. Lancet. 339(8785):71-85, 1992
                                            66. Systemic treatment of early breast cancer by hormonal et al: 133 randomised trials involving 31,000 recurrences and 24,000 deaths among 75,000 women. Early Breast Cancer Trialists' Collaborative Group. Lancet. 339(8785):71-85, 1992
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Metastatic breast cancer (MBC)

                                                      • Definitions

                                                        • Stage IV: Distant metastases, spread beyond breast and ipsilateral nodes; TNM classification (M1)
                                                        • De devo MBC = stage IV at initial presentation
                                                        • Recurrent MBC = stages I, II, or III at initial presentation, with recurrence at distant sites

                                                      IMAGING

                                                      • Radiographic Findings

                                                        • Mammographic Findings

                                                          • Ultrasonographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Nuclear Medicine Findings

                                                                  • Image-Guided Biopsy

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Staging, Grading, & Classification

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      Selected References

                                                                                      1. Pons-Tostivint E et al: Survival impact of locoregional treatment of the primary tumor in de novo metastatic breast cancers in a large multicentric cohort study: A propensity score-matched analysis. Ann Surg Oncol. 26(2):356-365, 2019
                                                                                      2. Gogate A et al: An updated systematic review of the cost-effectiveness of therapies for metastatic breast cancer. Breast Cancer Res Treat. ePub, 2019
                                                                                      3. Bai XM et al: Long-term outcomes and prognostic analysis of percutaneous radiofrequency ablation in liver metastasis from breast cancer. Int J Hyperthermia. 35(1):183-93, 2019
                                                                                      4. New Global Cancer Data: GLOBOCAN 2018. https://www.uicc.org/new-global-cancer-data-globocan-2018. Accessed January 11, 2019
                                                                                      5. Begg CB et al: Contralateral breast cancers: Independent cancers or metastases? Int J Cancer. 142(2):347-356, 2018
                                                                                      6. Begg CB et al: Contralateral breast cancers: Independent cancers or metastases? Int J Cancer. 142(2):347-356, 2018
                                                                                      7. Caswell-Jin JL et al: Change in Survival in Metastatic Breast Cancer with Treatment Advances: Meta-Analysis and Systematic Review. JNCI Cancer Spectr. 2(4):pky062, 2018
                                                                                      8. Caswell-Jin JL et al: Change in Survival in Metastatic Breast Cancer with Treatment Advances: Meta-Analysis and Systematic Review. JNCI Cancer Spectr. 2(4):pky062, 2018
                                                                                      9. Szekely B et al: Immunological differences between primary and metastatic breast cancer. Ann Oncol. ePub, 2018
                                                                                      10. Szekely B et al: Immunological differences between primary and metastatic breast cancer. Ann Oncol. ePub, 2018
                                                                                      11. Xiao W et al: Primary tumor resection in stage IV breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol. ePub, 2018
                                                                                      12. Xiao W et al: Primary tumor resection in stage IV breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol. ePub, 2018
                                                                                      13. Yararbas U et al: The value of 18F-FDG PET/CT imaging in breast cancer staging. Bosn J Basic Med Sci. 18(1):72-79, 2018
                                                                                      14. Yararbas U et al: The value of 18F-FDG PET/CT imaging in breast cancer staging. Bosn J Basic Med Sci. 18(1):72-79, 2018
                                                                                      15. Lower EE et al: Discordance of the estrogen receptor and HER-2/neu in breast cancer from primary lesion to first and second metastatic site. Breast Cancer (Dove Med Press). 9:515-520, 2017
                                                                                      16. Lower EE et al: Discordance of the estrogen receptor and HER-2/neu in breast cancer from primary lesion to first and second metastatic site. Breast Cancer (Dove Med Press). 9:515-520, 2017
                                                                                      17. Mariotto AB et al: Estimation of the Number of Women Living with Metastatic Breast Cancer in the United States. Cancer Epidemiol Biomarkers Prev. 26(6):809-815, 2017
                                                                                      18. Mariotto AB et al: Estimation of the Number of Women Living with Metastatic Breast Cancer in the United States. Cancer Epidemiol Biomarkers Prev. 26(6):809-815, 2017
                                                                                      19. Sugihara T et al: Bone metastases from breast cancer: associations between morphologic CT patterns and glycolytic activity on PET and bone scintigraphy as well as explorative search for influential factors. Ann Nucl Med. 31(10):719-725, 2017
                                                                                      20. Sugihara T et al: Bone metastases from breast cancer: associations between morphologic CT patterns and glycolytic activity on PET and bone scintigraphy as well as explorative search for influential factors. Ann Nucl Med. 31(10):719-725, 2017
                                                                                      21. Groheux D et al: ¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer. J Nucl Med. 57 Suppl 1:17S-26S, 2016
                                                                                      22. Groheux D et al: ¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer. J Nucl Med. 57 Suppl 1:17S-26S, 2016
                                                                                      23. Taghipour M et al: FDG Avidity and Tumor Burden: Survival Outcomes for Patients With Recurrent Breast Cancer. AJR Am J Roentgenol. 206(4):846-55, 2016
                                                                                      24. Taghipour M et al: FDG Avidity and Tumor Burden: Survival Outcomes for Patients With Recurrent Breast Cancer. AJR Am J Roentgenol. 206(4):846-55, 2016
                                                                                      25. Alkner S et al: Contralateral breast cancer can represent a metastatic spread of the first primary tumor: determination of clonal relationship between contralateral breast cancers using next-generation whole genome sequencing. Breast Cancer Res. 17:102, 2015
                                                                                      26. Alkner S et al: Contralateral breast cancer can represent a metastatic spread of the first primary tumor: determination of clonal relationship between contralateral breast cancers using next-generation whole genome sequencing. Breast Cancer Res. 17:102, 2015
                                                                                      27. Chikarmane SA et al: Metastatic patterns of breast cancer subtypes: what radiologists should know in the era of personalized cancer medicine. Clin Radiol. 70(1):1-10, 2015
                                                                                      28. Chikarmane SA et al: Metastatic patterns of breast cancer subtypes: what radiologists should know in the era of personalized cancer medicine. Clin Radiol. 70(1):1-10, 2015
                                                                                      29. Son SH et al: Whole-Body Metabolic Tumor Volume, as Determined by (18)F-FDG PET/CT, as a Prognostic Factor of Outcome for Patients With Breast Cancer Who Have Distant Metastasis. AJR Am J Roentgenol. 205(4):878-85, 2015
                                                                                      30. Son SH et al: Whole-Body Metabolic Tumor Volume, as Determined by (18)F-FDG PET/CT, as a Prognostic Factor of Outcome for Patients With Breast Cancer Who Have Distant Metastasis. AJR Am J Roentgenol. 205(4):878-85, 2015
                                                                                      31. Gold LS et al: Imaging Techniques for Treatment Evaluation for Metastatic Breast Cancer. Rockville (MD): Agency for Healthcare Research and Quality (US). Report No.: 14-EHC044-EF, 2014
                                                                                      32. Gold LS et al: Imaging Techniques for Treatment Evaluation for Metastatic Breast Cancer. Rockville (MD): Agency for Healthcare Research and Quality (US). Report No.: 14-EHC044-EF, 2014
                                                                                      33. Rong J et al: Comparison of (18)FDG PET-CT and bone scintigraphy for detection of bone metastases in breast cancer patients. A meta-analysis. Surg Oncol. 22(2):86-91, 2013
                                                                                      34. Rong J et al: Comparison of (18)FDG PET-CT and bone scintigraphy for detection of bone metastases in breast cancer patients. A meta-analysis. Surg Oncol. 22(2):86-91, 2013
                                                                                      35. Niikura N et al: FDG-PET/CT compared with conventional imaging in the detection of distant metastases of primary breast cancer. Oncologist. 16(8):1111-9, 2011
                                                                                      36. Niikura N et al: FDG-PET/CT compared with conventional imaging in the detection of distant metastases of primary breast cancer. Oncologist. 16(8):1111-9, 2011
                                                                                      37. Edge SB et al: Cancer Staging Handbook From the AJCC Cancer Staging Manual. 7th ed. Chicago: Springer. 417-60, 2010
                                                                                      38. Edge SB et al: Cancer Staging Handbook From the AJCC Cancer Staging Manual. 7th ed. Chicago: Springer. 417-60, 2010
                                                                                      39. Dawood S et al: Survival differences among women with de novo stage IV and relapsed breast cancer. Ann Oncol. 21(11):2169-74, 2010
                                                                                      40. Dawood S et al: Survival differences among women with de novo stage IV and relapsed breast cancer. Ann Oncol. 21(11):2169-74, 2010
                                                                                      41. Carlson RW et al: Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 7(2):122-92, 2009
                                                                                      42. Carlson RW et al: Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 7(2):122-92, 2009
                                                                                      43. NCCN. NCCN Clinical practice guidelines in oncology. In Winn R: Jenkintown, PA: National Comprehensive Cancer Network; 2008
                                                                                      44. NCCN. NCCN Clinical practice guidelines in oncology. In Winn R: Jenkintown, PA: National Comprehensive Cancer Network; 2008
                                                                                      45. Harris L et al: American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 25(33):5287-312, 2007
                                                                                      46. Harris L et al: American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 25(33):5287-312, 2007
                                                                                      47. Buyse M et al: Validation and clinical utility of a 70-gene prognostic signature for women with node-negative breast cancer. J Natl Cancer Inst. 98(17):1183-92, 2006
                                                                                      48. Buyse M et al: Validation and clinical utility of a 70-gene prognostic signature for women with node-negative breast cancer. J Natl Cancer Inst. 98(17):1183-92, 2006
                                                                                      49. Braun S et al: A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med. 353(8):793-802, 2005
                                                                                      50. Braun S et al: A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med. 353(8):793-802, 2005
                                                                                      51. Buzdar AU et al: Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol. 23(16):3676-85, 2005
                                                                                      52. Buzdar AU et al: Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol. 23(16):3676-85, 2005
                                                                                      53. Moon YW et al: Neoadjuvant chemotherapy with infusional 5-fluorouracil, adriamycin and cyclophosphamide (iFAC) in locally advanced breast cancer: an early response predicts good prognosis. Ann Oncol. 16(11):1778-85, 2005
                                                                                      54. Moon YW et al: Neoadjuvant chemotherapy with infusional 5-fluorouracil, adriamycin and cyclophosphamide (iFAC) in locally advanced breast cancer: an early response predicts good prognosis. Ann Oncol. 16(11):1778-85, 2005
                                                                                      55. van't Veer LJ et al: Gene expression profiling of breast cancer: a new tumor marker. J Clin Oncol. 23(8):1631-5, 2005
                                                                                      56. van't Veer LJ et al: Gene expression profiling of breast cancer: a new tumor marker. J Clin Oncol. 23(8):1631-5, 2005
                                                                                      57. Cristofanilli M et al: Circulating tumor cells, disease progression, and survival in metastatic breast cancer. N Engl J Med. 351(8):781-91, 2004
                                                                                      58. Cristofanilli M et al: Circulating tumor cells, disease progression, and survival in metastatic breast cancer. N Engl J Med. 351(8):781-91, 2004
                                                                                      59. Paik S et al: A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 351(27):2817-26, 2004
                                                                                      60. Paik S et al: A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 351(27):2817-26, 2004
                                                                                      61. Thor A: A revised staging system for breast cancer. Breast J. 10 Suppl 1:S15-8, 2004
                                                                                      62. Thor A: A revised staging system for breast cancer. Breast J. 10 Suppl 1:S15-8, 2004
                                                                                      63. Zangheri B et al: PET/CT and breast cancer. Eur J Nucl Med Mol Imaging. 31 Suppl 1:S135-42, 2004
                                                                                      64. Zangheri B et al: PET/CT and breast cancer. Eur J Nucl Med Mol Imaging. 31 Suppl 1:S135-42, 2004
                                                                                      65. Systemic treatment of early breast cancer by hormonal et al: 133 randomised trials involving 31,000 recurrences and 24,000 deaths among 75,000 women. Early Breast Cancer Trialists' Collaborative Group. Lancet. 339(8785):71-85, 1992
                                                                                      66. Systemic treatment of early breast cancer by hormonal et al: 133 randomised trials involving 31,000 recurrences and 24,000 deaths among 75,000 women. Early Breast Cancer Trialists' Collaborative Group. Lancet. 339(8785):71-85, 1992