Breast edema and Peau d'Orange: a hypothesis for redefining pT4b and pT4d

Female breast cancer accounted for an estimated 2.3 million new cases in 2022, ranking second in global cancer incidence [1]. Although it disseminates to multiple organs, involvement of certain sites, such as the ovary, remains infrequent [2].Anatomic disease extent is a principal determinant of prognosis, and its formal classification gave rise to the tumor, node, and metastasis (TNM) system, developed in Paris during the 1940s and 1950s in conjunction with the Union for International Cancer Control (UICC)[3]. In the system of the American Joint Committee on Cancer (AJCC) and the UICC, clinical TNM is assigned at diagnosis, before any treatment is applied, whereas pathological TNM follows surgical excision and rests on histopathological findings, biopsy alone being inadequate for this purpose [3],[4].