Background: Multifocal (MF) and multicentric (MC) breast cancers, defined by the presence of multiple synchronous tumor foci within the same breast, present important diagnostic, therapeutic, and prognostic challenges. Historically considered a contraindication for breast-conserving therapy (BCT), advances in imaging, surgical techniques, and adjuvant therapy have reshaped management strategies. Methods: A narrative literature review was conducted through PubMed, Web of Science, and Scopus, prioritizing ISI-indexed articles published within the last 10–15 years. More than 55 relevant studies, including systematic reviews, meta-analyses, and large cohorts, were analyzed to evaluate epidemiology, pathological features, imaging modalities, treatment outcomes, and prognosis of MF/MC breast cancers. Results: The reported incidence of MF/MC breast cancers ranges from 10% to 24%, increasing when MRI or whole-organ pathology is applied. MRI can detect otherwise occult additional foci in up to 30% of patients, improving staging accuracy but raising concerns of overdiagnosis. MF/MC presentation is strongly associated with lobular histology, younger age at diagnosis, and higher rates of axillary involvement—nodal positivity is observed in up to 45% of MF/MC cases versus 28% in unifocal tumors. Pathological analyses demonstrate frequent clonal origin of MF lesions, whereas MC lesions may represent independent primaries, occasionally with receptor heterogeneity that alters systemic therapy selection. From a prognostic perspective, older series suggested shorter breast cancer-specific survival (e.g., median 154 vs. 204 months for MF/MC vs. unifocal disease), and higher local recurrence with BCT. However, contemporary analyses, including a 2022 meta-analysis of 15,703 patients, demonstrated no significant difference in overall or disease-free survival once adjusted for tumor size and nodal status. Local recurrence remains slightly higher with BCT in MF/MC (5.6% vs. 4.2%), but outcomes are equivalent to mastectomy when radiotherapy is appropriately delivered. Five-year survival in early-stage MF/MC exceeds 90% with guideline-concordant multimodal therapy. Conclusions: MF/MC breast cancers represent a biologically heterogeneous entity. Optimal outcomes rely on precise imaging, complete excision, tailored systemic therapy, and multidisciplinary management, with increasing acceptance of breast conservation in selected patients.
背景：多灶性（MF）与多中心性（MC）乳腺癌定义为同一乳房内存在多个同步肿瘤病灶，其诊断、治疗及预后均面临重要挑战。历史上曾被视为保乳治疗（BCT）的禁忌证，但随着影像学、外科技术和辅助治疗的进步，其治疗策略已发生转变。方法：通过PubMed、Web of Science和Scopus数据库进行叙述性文献综述，优先选取近10至15年内发表的ISI索引文献。共分析超过55项相关研究，包括系统综述、荟萃分析及大型队列研究，以评估MF/MC乳腺癌的流行病学、病理特征、影像学方法、治疗结果及预后。结果：文献报道的MF/MC乳腺癌发病率在10%至24%之间，应用MRI或全器官病理检查时检出率更高。MRI可在高达30%的患者中发现其他隐匿病灶，虽提高了分期准确性，但也引发过度诊断的担忧。MF/MC表现与小叶组织学类型、诊断年龄较轻及腋窝淋巴结转移率较高密切相关——MF/MC病例的淋巴结阳性率可达45%，而单灶肿瘤仅为28%。病理分析显示MF病灶常为克隆起源，而MC病灶可能代表独立原发灶，偶见受体异质性从而影响全身治疗方案选择。从预后角度看，早期研究提示MF/MC乳腺癌特异性生存期较短（例如中位生存期154个月 vs. 单灶肿瘤204个月），且BCT后局部复发率更高。然而，当代分析（包括2022年一项涉及15,703例患者的荟萃分析）表明，在调整肿瘤大小和淋巴结状态后，总生存期或无病生存期均无显著差异。MF/MC患者接受BCT后局部复发率仍略高（5.6% vs. 4.2%），但规范放疗后疗效与乳房切除术相当。早期MF/MC乳腺癌接受指南推荐的多模式治疗后，五年生存率超过90%。结论：MF/MC乳腺癌具有生物学异质性。最佳疗效依赖于精准影像评估、完整病灶切除、个体化全身治疗及多学科协作管理，保乳治疗在经选择患者中的接受度正逐步提高。
Multicentric and Multifocal Breast Tumors—Narrative Literature Review
肿瘤(癌症)患者之家