The evolving role of radiofrequency ablation therapy of breast lesions

BACKGROUND

The potential for radiofrequency ablation (RFA) therapy is an area of increasing interest in the context of breast conserving therapy for breast cancer. This non surgical technique potentially provides a non invasive, cosmetically pleasing result that is preferable to surgeon and patient.

MATERIALS AND METHODS

A literature review was carried out facilitated by PubMed and Medline databases. Cross referencing of the obtained articles was used to identify other relevant studies. A total of 17 studies were reviewed.

RESULTS

RFA is emerging as a promising treatment for breast cancer. Pilot and phase II studies have shown RFA to be effective at ablation with few complications or adverse effects experienced by patients. However, complete ablation of tumours is still not achieved in all patients.

CONCLUSION

RFA represents a promising therapeutic modality for breast lesions. However, there is a clear need for further research and refinement of the procedure before it can be offered as a therapeutic alternative to surgical excision for operable breast cancer.

Surgical excision for B3 breast lesions diagnosed by vacuum-assisted core biopsy

The aim of this retrospective study was to assess whether open surgical excision is required following a B3 diagnosis on 11-gauge vacuum-assisted core biopsy (VACB) of radiologically indeterminate breast lesions.

PATIENTS AND METHODS

Twenty-four women with a histological diagnosis of the B3 category on VACB of radiologically indeterminate breast lesions were identified over a 3-year period. The VACB procedure was performed under stereotactic (n=21), ultrasound (n=2) or magnetic resonance imaging (MRI) (n=1) guidance using the Suros system. Nineteen patients underwent open surgical excision. The remaining 5 patients who had 'complete' removal of the radiological abnormality using VACB under ultrasound (n=2, papilloma) or stereotactic (n=4, atypical ductal hyperplasia) guidance were followed up clinically and radiologically.

RESULTS

The median patient age was 49 years. The disease status in three patients was upgraded to ductal carcinoma in situ at open surgical excision. The VACB showed atypical lobular hyperplasia in these 3 patients, associated with microcalcification (n=2) or mass lesion (n=1). No single case of upgrading to invasive breast cancer was identified in our series. The remaining patients (16 out of 19) had a benign biopsy. The upgrade to malignancy was significantly associated with the presence of atypical lobular hyperplasia, a BI-RADS category of 4 and incomplete removal of the radiological abnormality by VACB. After a mean follow-up of 18 months, no malignancy was detected in the 5 patients who did not undergo open surgical biopsy.

CONCLUSION

Open surgical excision is strongly recommended for atypical lobular hyperplasia identified in VACB specimens. VACB can be a safe alternative to surgery in the treatment of B3 lesions in selected cases, providing thorough multidisciplinary discussion has taken place.

Evidence of a tumour suppressor function for DLEC1 in human breast cancer

DLEC1 (deleted in lung and oesophageal cancer), located on 3p22.3, is a candidate tumour suppressor gene in lung, esophageal, and renal cancer. The aim of this study was determine whether the mRNA expression levels of DLEC1 were consistent with a tumour suppressive function.

MATERIALS AND METHODS

A total of 153 samples were analysed. The levels of transcription of DLEC1 were determined using quantitative PCR and normalised against (CK19). Transcript levels within breast cancer specimens were compared to normal background tissues.

RESULTS

Levels of transcription were lower [corrected] in tumour samples compared to adjacent non cancerous tissue (ANCT) samples but this was not statistically significant (median 0.167 vs. 0.03; p=0.138). DLEC1 expression levels were significantly lower in samples from patients who developed metastasis, local recurrence, or died of breast cancer when compared to those who were disease free for >10 years (p=0.041).

DISCUSSION

These findings are consistent with a possible tumour suppressor function of DLEC1 in breast cancer.

Gene Transcripts in the Tumor Suppressor Region of Chromosome 3 (3p21)

Background:There is increasing evidence that the short arm of chromosome 3 has a tumour suppressor region that has been associated with permanent growth arrest of tumour cells. We have identified 9 closely related genes in this region (CCDC12, KLH9, KLH18, MYL3, NBEAL2, PTPN23, SCAP, SETD2, and TESSP2) located which could be possible candidates for tumour suppressor genes (TSG).Our objective was to determine, using quantitative PCR, whether the mRNA expression levels of these genes were consistent with a tumour suppressive function in human breast cancer.Methods:A total of 153 samples were analysed. The levels of transcription of all 9 genes were determined using quantitative PCR and normalized against (CK19).Transcript levels within breast cancer specimens were compared with non-cancerous breast tissue and analyzed against conventional pathological parameters and clinical outcome over a 10 year follow-up period.Results:Quantification of CCDC12, KLH9, KLH18, MYL3, NBEAL2, PTPN23, and SCAP mRNA expression after CK19 normalisation showed no statistically significant difference between malignant and normal breast tissue (p=0.23, 0.46, 0.3, 0.141, 0.8, 0.696, and 0.11 respectively). The mRNA expression of TESSP2 was higher in normal samples compared with malignant lesions (347 vs. 35, p=0.0061) but showed no significant associations with clinical outcome.The levels of SETD2 mRNA were significantly lower in malignant samples (406 vs. 17, p=0.0345) and decreased with increasing tumour stage. SETD2 expression levels were significantly lower in samples from patients who developed metastasis, local recurrence, or died from breast cancer when compared to those who were disease free for > 10 years (p=0.041).Conclusion:These findings are consistent with a possible tumour suppressor function of SETD2 in human breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6139.

Suppressors of Cytokine Signaling and Their Role in Human Breast Cancer

BACKGROUND:Suppressors of cytokine signaling (SOCS) are important negative feedback regulators of the JAK/STAT signaling pathway, and have been recently investigated for their role in the development of different cancers. In this study, we examined the expression of SOCS 1-7 genes in normal and breast cancer tissue and correlated this with several clinico-pathological and prognostic factors.PATIENTS AND METHODS:SOCS 1-7 mRNA extraction and reverse transcription were performed on breast cancer tissue samples (n= 127) and normal background breast tissue (n= 31). Transcript levels of expression were determined using real-time PCR and analyzed against TNM stage, tumour grade and clinical outcome over a 10 year follow-up period.RESULTS:SOCS 1,4,5,6 and 7 expression decreased with increased TNM stage (TNM1 vs. TNM3 p= 0.039, TNM1 vs. TNM4 p= 0.016, TNM1 vs. TNM3 p= 0.012 and TNM1 vs. TNM3 p= 0.044 respectively). SOCS 2 and 3 expression decreased with increased Nottingham Prognostic Index (NPI) (NPI1 vs. NPI3 p=0.033 and NPI2 vs. NPI3 p=0.041 respectively). SOCS-7 expression decreased with higher tumour grade (Grade 3 vs. Grade 2 p=0.037). After a median follow up period of 10 years, we found higher levels of SOCS 1, 2 and 7 expression among those patients who remained disease-free compared to those who developed local recurrence (p= 0.0073, p= 0.021 and p= 0.039 respectively). Similarly, we found higher levels of SOCS 2, 4 and 7 expression in those who remained disease-free compared to those who developed distant recurrence (p= 0.022, p=0.024 and p= 0.033 respectively). Patients who remained disease-free had higher levels of SOCS 1 and 2 expression compared to those who died from breast cancer (p= 0.02 and p=0.033 respectively). The disease free survival (DFS) and overall survival (OS) curves showed that higher levels of SOCS 1, 3 and 7 were significant predictors of higher DFS (p=0.015, p=0.024 and p=0.03 respectively) and OS (p=0.005, p=0.013 and p= 0.035 respectively). Higher levels of SOCS 4 were significant in predicting better OS (p=0.007) but not DFS.CONCLUSIONHigher mRNA expression levels of SOCS 1, 3, 4 and 7 are significantly associated with earlier tumour stage and better clinical outcomes in human breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3157.

Oncological Outcome and Patient's Satisfaction of Skin-Sparing Mastectomy and Immediate Breast Reconstruction: A Prospective Observational Study

INTRODUCTION: The management of early breast cancer with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) is not based on evidence from randomised controlled trials. The purpose of this study is to evaluate the oncological safety, post-operative morbidity and patients' satisfaction with SSM and IBR using the latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis. METHODS: One hundred and twenty five consecutive women underwent 137 SSMs with IBR (12 bilateral), using the LD flap plus implant (n=85) or implant alone (n=42), indications included breast cancer (n=130)and prophylaxis (n=7). Most tumours (99.2%) were Tis, T1, or T2 and only one tumour was T3 stage. Nipple reconstruction was performed in 69 patients, using a small local flap technique (n=61), nipple sharing (n=6), free skin graft (n=1) or Monocryl mesh (n=1). Thirty patients underwent contra-lateral surgery in order to optimise symmetry, including 19 augmentations and 11 mastopexy/reduction mammoplasties. Patient satisfaction with the outcome of surgery was assessed on a linear visual analogue scale ranging from 0 (not satisfied) to 10 (most satisfied). RESULTS: There was no local recurrence (LR) after a mean follow-up of 33.2 months (range=3-98 months). Overall survival was 99.2%, seven patients developed distant disease and one patient died of metastatic breast cancer. No case of partial or total LD flap loss was observed. Morbidities included infection, requiring implant removal in two patients and one patient developed marginal ischaemia of the skin envelope. Significant capsule formation, requiring capsulotomy, was observed in 87% of patients who had either PMR or prior RT compared with 13% for those who did not have RT. Eighty two (65.6%) of 125 patients completed the questionnaire with a median satisfaction scores of 9 (range=5-10). CONCLUSION: SSM with IBR is associated with low morbidity, high levels of patient satisfaction and is oncologically safe for T(is), T1 and T2 tumours without extensive skin involvement.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3113.

The mRNA expression of SETD2 in human breast cancer: correlation with clinico-pathological parameters

Background

SET domain containing protein 2 (SETD2) is a histone methyltransferase that is involved in transcriptional elongation.

There is evidence that SETD2 interacts with p53 and selectively regulates its downstream genes. Therefore, it could be implicated in the process of carcinogenesis. Furthermore, this gene is located on the short arm of chromosome 3p and we previously demonstrated that the 3p21.31 region of chromosome 3 was associated with permanent growth arrest of breast cancer cells. This region includes closely related genes namely: MYL3, CCDC12, KIF9, KLHL18 and SETD2. Based on the biological function of these genes, SETD2 is the most likely gene to play a tumour suppressor role and explain our previous findings.

Our objective was to determine, using quantitative PCR, whether the mRNA expression levels of SETD2 were consistent with a tumour suppressive function in breast cancer. This is the first study in the literature to examine the direct relationship between SETD2 and breast cancer.

Methods

A total of 153 samples were analysed.

The levels of transcription of SETD2 were determined using quantitative PCR and normalized against (CK19).

Transcript levels within breast cancer specimens were compared to normal background tissues and analyzed against conventional pathological parameters and clinical outcome over a 10 year follow-up period.

Results

The levels of SETD2 mRNA were significantly lower in malignant samples (p = 0.0345) and decreased with increasing tumour stage.

SETD2 expression levels were significantly lower in samples from patients who developed metastasis, local recurrence, or died of breast cancer when compared to those who were disease free for > 10 years (p = 0.041).

Conclusion

This study demonstrates a compelling trend for SETD2 transcription levels to be lower in cancerous tissues and in patients who developed progressive disease. These findings are consistent with a possible tumour suppressor function of this gene in breast cancer.

Expression of MDA7/IL-24 human breast cancer and the molecular impact

Abstract #2060

INTRODUCTION. MDA-7 (melanoma differentiation associated gene-7), also known as IL-24, was initially identified from cancer cells and was found to be up-regulated in melanoma cells. Forced expression of MDA7 in cancer cells was found to be growth inhibitory. MDA7/IL-24 operates in cells via its receptor, MDA7R/IL-24R, which includes at least the IL-20Rα and IL-20Rβ complex and the IL-22R and IL20Rβ complex. The present study investigated the impact of MDA7 on the growth and motility of breast cancer cells and the clinical relevance of MDA7 expression in mammary tumour tissues.
 MATERIALS AND METHODS. Human breast cancer cell lines MDA MB-231 and MCF-7 were used for in vitro testing. The response of cancer cells to rhMDA7 in growth and cellular motility was determined using growth assay and ECIS (electric cell impedance sensing, and confirmed by wounding assay). Localisation of MDA7 in mammary issues was assessed using conventional immunohistochemical method. Levels of MDA7 transcript in fresh frozen breast tissues were determined using quantitative PCR analysis and analysed against clinical and pathological information.
 RESULTS. Recombinant human MDA-7 only had a marginal effect on the in vitro growth of the breast cancer cell lines used. However, rhMDA had a significant effect on the migration of breast cancer cells. Cells treated with rhMDA-7 showed a slower rate of migration (electrical resistance 80.1±24.3Ω), when compared with control cells (130±24.3Ω) (p=0.024). Normal mammary epithelial cells showed a good degree of staining of MDA-7, a staining greatly reduced in cancer cells. Using the Nottingham Prognostic Index as a predictor of prognosis, tumours from patients with poor prognosis showed a significantly lower level of MDA-7 transcript compared with tumours from those with good prognosis (p=0.049). A significant difference was seen between tumours from patients who died of breast cancer and tumours from patients who remained disease free (p=0.035), the later showing a higher levels of MDA7 transcript. Using the Kaplan-Meier survival analysis, it was revealed that low levels of MDA-7 were significantly correlated with a shorter disease free survival (mean survival for low level group 121.7 (108.5-134.9) months compared with high levels 140.4 (133.7 – 147.1, 95% CI) months, p=0.0287. ER positive tumours showed a lower but levels of MDA-7 expression compared with ER-negative tumours, although this was not statistically significant (p=0.094).
 CONCLUSIONS. MDA-7 is a potential regulator of cellular motility of breast cancer cells. The aberrant expression of the molecule is linked to the prognosis and long term survival of patients, indicating the potential clinical implication of MDA-7 in cancer therapies.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2060.

SATB1: a 'master genome organizer' in mammary carcinogenesis

Abstract #3070

Background: SATB1 is a nuclear protein that has been recently reported to be a 'genome organizer' that delinates specific epigenetic modifications at target gene loci, directly up-regulating metastasis-associated genes while down-regulating tumor-suppressor genes. This study aimed to examine the level of mRNA expression of SATB1 gene in normal and malignant breast tissue and correlate the level to the clinico-pathological parameters.
 Material and Methods: One hundred and fifteen breast cancer tissue and 31 normal breast tissues were analyzed. Levels of transcription of SATB1 were determined using real-time quantitative PCR and were analyzed against TNM stage, nodal involvement, tumor grade and clinical outcome.
 Results: The levels of SATB1 mRNA were significantly higher in malignant compared with normal breast tissue (p=0.0167). The expression of SATB1 mRNA was demonstrated to increase with increasing TNM stage (TNM1 vs. TNM2, p=0.0264; TNM2 vs. TNM3, p=0.024) and increasing tumor grade (grade 1 vs. grade 3, p=0.017; grade 2 vs. grade 3, p=0.0437; grade 1 vs. grade 2&3, p=0.021). After a median follow up of 10 years, there was a trend for tumors with higher SATB1 expression levels to be associated with shorter overall survival times.
 Discussion: These results are consistent with the notion that SATB1 acts as the 'master genome organizer' in tumorigenesis of human breast cancer.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3070.

Evidence of a tumour suppressive function of E2F1 gene in human breast cancer

BACKGROUND

The E2F family of transcription factors are key regulators of genes involved in cell cycle progression, cell fate determination, DNA damage repair and apoptosis. E2F1 is unique in that it contributes both to the control of cellular proliferation and cellular death. Furthermore, unlike other E2Fs, E2F1 responds to various cellular stresses. This study aimed to examine the level of mRNA expression of E2F1 gene in normal and malignant breast tissue and correlate the level of expression to tumour stage.

MATERIALS AND METHODS

One hundred and twenty-seven breast cancer tissue and 33 normal tissues were analyzed. Levels of transcription of E2F1 were determined using real-time quantitative PCR, normalized against CK19. Levels of expression were analyzed against TNM stage, nodal involvement, tumour grade and distant metastasis.

RESULTS

The levels of E2F1 mRNA were lower in malignant tissues. They declined further with increasing TNM stage. This became statistically significant when TNM stages 3 and 4 were compared to TNM stages 1 and 2 disease (TNM1 vs. TNM3 p = 0.032; TNM1 vs. TNM4 p = 0.032; TNM2 vs. TNM3 p = .019; TNM2 vs. TNM4 p = 0.021). The levels of E2F1 also fell with increasing tumour grade, when comparing grade 2 and 3 with grade 1, however, the differences were not statistically significant.

CONCLUSION

These results are highly suggestive of the role of E2F1 as a tumour suppressive gene in human breast cancer.

The utility of MRI for the screening and staging of breast cancer

INTRODUCTION & BACKGROUND

Contrast-enhanced magnetic resonance imaging (MRI) of the breast has been recently introduced as a potential clinical tool for the detection, diagnosis, staging and management of breast cancer. In this article, we consider the established and evolving roles of MRI with particular reference to screening in high risk women and staging of the primary tumour. Controversies are discussed in the context of the tumour biology and natural history of breast cancer.

METHODS

Articles were identified by searches of PubMed and MEDLINE up to October 2007.

RESULTS

Contrast-enhanced MRI is an effective tool for screening women at high risk of breast cancer. However, randomized trials have yet to demonstrate a reduction in mortality. MRI can also facilitate local staging, in particular, the evaluation of ipsilateral multicentric or multifocal lesions and synchronous contralateral disease which may be 'missed' by conventional imaging. However, efficacy with respect to clinically relevant and patient oriented end-points has yet to be addressed in the context of clinical trials.

CONCLUSIONS

In women at high risk of breast cancer, screening MRI should be used in conjunction with published guidelines. In women with newly diagnosed breast cancer, the utility of MRI is less clearly defined and should be restricted to selected cases within the multidisciplinary setting.

Mammographic breast density by area of residence: possible evidence of higher density in urban areas

OBJECTIVES

A comparison of mammographic breast densities of women living in London with those of women living in rural and suburban areas.

DESIGN AND METHODS

Using the standard four American College of Radiology Breast Imaging Reporting and Data System (BIRADS) categories of mammographic density, 318 mammograms of women from London and 654 mammograms of women from outside the capital aged 27-87 years who had received mammography at the Princess Grace Hospital, London, were assessed for density. The association between having any dense tissue and area of residence was assessed using both ordered and standard logistic regression, giving odds ratio estimates of relative risk of dense tissue adjusting for age.

RESULTS

Adjusting for age, London residents had significantly higher levels of density (OR = 1.32, 95% CI 1.04-1.70, p = 0.02). The major difference occurred in the age group 45-54 years and was most strongly manifested as a higher rate in London for density of 25% or more (BIRADS categories 2-4) as compared to almost entirely fatty (BIRADS 1) (OR = 2.22, 95% CI 1.05-4.68, p = 0.035).

CONCLUSION

The higher density is likely to be due to a different prevalence of risk factors in the London population. This study cannot ascertain the reason for the higher density in this urban population, but the result is a cause for concern given that screening uptake is lower in London. Increased attention to screening in urban areas and attention to screening quality for dense breast tissue might be prudent.

Cyclooxygenase-2 mRNA expression correlates with aromatase expression in human breast cancer

INTRODUCTION

The cyclooxygenase-2 (COX-2), responsible for the conversion of arachidonic acid into prostaglandin (PG) E2, is known to increase intracellular cAMP and estrogen production in malignant breast tissue. The aromatase enzyme complex is responsible for local production of estrogens in breast cancer. Increasing evidence supports a role for COX-2 in upregulation of aromatase activity. The aim of this study was to examine the relationship between COX-2 and aromatase mRNA expression in human breast cancer.

METHODS

A total of 160 breast samples (127 tumor tissues and 33 normal tissues) were analyzed. Levels of transcription were determined using real-time quantitative PCR. COX-2 and aromatase mRNA expression were normalized against CK19. Levels of expression of COX-2 were correlated with those of aromatase using Pearson's correlation method.

RESULTS

Levels of expression of COX-2/CK19 of both benign and malignant tissues were positively correlated with aromatase/CK19 transcript levels (correlation coefficient = +0.536, P < 0.0001). When we compared levels of expression of both genes in malignant samples only, there was a highly significant positive correlation (r = +0.611, P < 0.00001).

CONCLUSION

This study demonstrates a strong positive relationship between COX-2 and aromatase mRNA expression, and lends further support to the hypothesis that COX-2 is an upregulator of aromatase in breast tissue.