Abstract P3-01-06: Sentinel lymph node biopsy after NACT: Results of a validation study in large/locally advanced breast cancer patients

Background:

Sentinel lymph node biopsy (SLNB) is the current standard of care for surgical staging of clinically node negative axilla (N0) early breast cancer patients undergoing primary surgery. SLN- identification rate (IR) of 90% and SLN- false negative rate (FNR) of 10% are considered minimum acceptable indices for SLNB. Its role in staging axillae in patients undergoing post-NACT surgery is somewhat unclear. In India, and most low-and-middle income countries, large operable breast cancers (LOBC) and locally advanced breast cancers (LABC) constitute a large proportion of breast cancer patients treated. These patients are usually are treated with NACT, followed by surgery and radiation therapy. In a prospective validation SLNB study, we investigated the accuracy of SLNB in staging post-NACT N0 axilla in a patient cohort that were LOBC or LABC at the time of initial presentation.

Methods:

Hundred consenting non-inflammatory LOBC/LABC patients (mean age 49.3+8.6; index stage T3,N0-1=21; T4b,N0-1=33; T1-3,N2a=24; T4b,N2a=22) who were N0 after NACT at time of surgery (Breast conservation surgery in 19, Mastectomy in 81) were included. Majority had Infiltrating ductal carcinoma (n=87), and grade II/III tumors (n=93); 45 were hormone receptor positive (+), 29 had HR negative (-) HER2(+); and 26 had triple negative breast cancer on IHC sub-typing. Commonest NACT regimen used was Anthracycline followed by taxanes in 83. SLNB was performed using low-cost methylene-blue and 99mTc-Antimony-colloid, which were produced in-house using well standardized protocols, with clearance of the institutional ethics committee. Irrespective of the SLN histology, a complete axillary dissection (ALND) was carried out in all. SLN-IR and SLN-FNR were calculated, comparing the histological status of the SLN and the ALND specimen. Factors predicting non-identified SLN and false negative SLN were evaluated in uni-variate and multi-variate analysis.

Results:

With a combination of methylene blue dye and radiopharmaceutical, the SLN-IR was 81%. Mean number of SLN removed was 2.4+/-1.02. Mean number of nodes removed at ALND was 13.3+/-2.2. SLN-IR varied significantly (p<0.05) per index stage, and were- 90.4% in T3,N0-1; 84.4% in T4b,N0-1; 83.3% in T1-3,N2a; and 63.6% in T4bN2a. The FNR was 17.3% for the whole cohort. FNR varied significantly (p<0.05) per index stage, and were- 8.3% in T3,N0-1; 14.9% in T4b,N0-1; 22.2% in T1-3,N2a; and 30% in T4bN2a. Factors found predictive of non-identified SLN were tumor stage T4b, nodal stage N2a, extra-nodal spread, and LVI. Factors found predictive of FNR SLN were tumor stage T4b, nodal stage N2a, and extra-nodal spread.

Conclusions:

Considering SLN-IR of 90% and SLN-FNR of 10% as acceptable standards, SLNB in post-NACT N0 patients undergoing surgery was not found robust in staging the axilla, with the exception of patients with index stage T3,N0-1 who had SLN-IR of 90.4% and SLN-FNR of 8.3%. Patients with (pre-NACT) skin involvement(T4b), matted axillary nodes(N2a) and LVI are fraught with high-risk of non-identification and false-negative SLNB.

Citation Format: Agarwal G, Gambhir S, Lal P, Rajan S, Krishnani N, Mishra A, SabaRetnam M, Agarwal A, Chand G, Verma AK, Mishra SK, Kumari N, Agrawal V, Kheruka SC. Sentinel lymph node biopsy after NACT: Results of a validation study in large/locally advanced breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-06.

Management of Acute Pulmonary Embolism: Consensus Statement for Indian Patients

Pulmonary embolism (PE) is an important cause of morbidity and mortality among hospitalized patients. Although the exact epidemiology of PE is not known in India, Some of the studies show that more frequently it is missed and not managed appropriately leading to significant cardiovascular morbidity and mortality. Justification and purpose: Indian guidelines for the diagnosis and treatment of acute PE are not yet formulated. The objective of this consensus statement is to propose a diagnostic and management approach for acute PE in India.

PROCESS

A working group of 15 experts in the management of acute PE (cardiologists, pulmonologist, haematologist, emergency specialist and intensivists). This consensus statement makes recommendations for diagnosis and management for PE based on literature review, including Indian data.

Effect of orally administered soy milk fermented with Lactobacillus plantarum LAB12 and physical exercise on murine immune responses

Probiotics are live microorganisms that confer health benefits through the gastrointestinal microbiota. This nutritional supplement may benefit athletes who undergo rigorous training by maintaining their gastrointestinal functions and overall health. In this study the influence of moderate physical exercise using a graded treadmill exercise, alone or in combination with the consumption of a soy product fermented with Lactobacillus plantarum LAB12 (LAB12), on tumour necrosis factor alpha (TNF-α) responses was investigated in a murine model. Male BALB/c mice were randomly divided into four groups of six mice each (control, exercise alone, LAB12 and LAB12 + exercise). Mice treated with the potential probiotic LAB12 were orally gavaged for 42 days. At autopsy, blood and spleen from the animals were collected. The splenocytes were cultured in the presence of a mitogen, concanavalin A (Con A). The amount of TNF-α produced by the Con A-stimulated splenocytes was quantified using ELISA, while their proliferation was determined using the [(3)H]-thymidine incorporation method. This study shows that LAB12-supplemented and exercise-induced mice showed marked increase (P<0.05) in cell proliferation compared to the control animals. TNF-α production was suppressed (P<0.05) in the LAB12 group compared to the untreated mice. These results demonstrate that supplementation with LAB12 has immunomodulatory effects, under conditions of moderate physical exercise, which may have implications for human athletes. Further investigation in human trials is warranted to confirm and extrapolate these findings.

Generation and characterization of neutralizing monoclonal antibodies against baculo-expressed HPV 16 VLPs

Human papillomavirus (HPV) is the well-known second most cause of cervical cancer in women worldwide. According to the WHO survey, 70% of the total cervical cancers are associated with types HPV 16 and 18. Presently used prophylactic vaccine for HPV contains mainly capsid protein of L1 virus like particles (VLPs). Correct folding of VLPs and display of neutralizing epitopes are the major constraint for VLP-based vaccines. Further, monoclonal antibodies (mAbs) play a vital role in developing therapeutics and diagnostics. mAbs are also useful for the demonstration of VLP conformation, virus typing and product process assessment as well. In the present study, we have explored the usefulness of mAbs generated against sf-9 expressed HPV 16 VLPs demonstrated as type-specific and conformational dependent against HPV 16 VLPs by ELISA. High affinity and high pseudovirion neutralization titer of mAbs indicated their potential for the development of prophylactic vaccines for HPV. Also, the type-specific and conformational reactivity of the mAbs to HPV 16 VLPs in sf-9 cells by immunofluorescence assay proved their diagnostic potential.

Development of anti-bovine IgA single chain variable fragment and its application in diagnosis of foot-and-mouth disease

Recombinant antibody fragments like single chain variable fragments (scFvs) represent an attractive yet powerful alternative to immunoglobulins and hold great potential in the development of clinical diagnostic/therapeutic reagents. Structurally, scFvs are the smallest antibody fragments capable of retaining the antigen-binding capacity of whole antibodies and are composed of an immunoglobulin (Ig) variable light (VL) and variable heavy (VH) chain joined by a flexible polypeptide linker. In the present study, we constructed a scFv against bovine IgA from a hybridoma cell line IL-A71 that secretes a monoclonal antibody against bovine IgA using recombinant DNA technology. The scFv was expressed in Escherichia coli and purified using immobilized metal affinity chromatography (IMAC). The binding activity and specificity of the scFv was established by its non-reactivity toward other classes of immunoglobulins as determined by enzyme-linked immunosorbent assay (ELISA) and immunoblot analysis. Kinetic measurement of the scFv indicated that the recombinant antibody fragment had an affinity in picomolar range toward purified IgA. Furthermore, the scFv was used to develop a sensitive ELISA for the detection of foot and mouth disease virus (FMDV) carrier animals.

Preparation and storage stability of retort processed Chettinad chicken

Chettinad chicken was prepared using boneless meat derived from spent hen and boiler breeder packed in retort pouches (250 g) and processed in retort at the product temperature of 121.1 °C and the corresponding F0 value of 5.2. The product was stored at ambient temperature (35 ± 2 °C) up to 180 days. The sensory scores for texture of the Chettinad chicken prepared from spent hen and broiler breeder meat decreased significantly however the scores were rated very acceptable even on 180th day. The thiobarbituric acid (TBA), tyrosine values and acid value increased gradually during storage but E. coli, Salmonella spp, Clostridium spp, Staphylococci spp, Streptococci spp, yeast and mould could not be detected during the entire storage period. The cost of production of Chettinad chicken (250 g) prepared from spent hen meat and broiler breeder meat was Rs.37 and Rs.50, respectively. It was concluded that the retort processed Chettinad chicken prepared from spent hen and broiler breeder meat can be safely stored up to 180 days at ambient temperature.

Multidisciplinary decisions in breast cancer: does the patient receive what the team has recommended?

BACKGROUND

A multidisciplinary team (MDT) approach to breast cancer management is the gold standard. The aim is to evaluate MDT decision making in a modern breast unit.

METHODS

All referrals to the breast MDT where breast cancer was diagnosed from 1 July 2009 to 30 June 2011 were included. Multidisciplinary team decisions were compared with subsequent patient management and classified as concordant or discordant.

RESULTS

Over the study period, there were 3230 MDT decisions relating to 705 patients. Overall, 91.5% (2956 out of 3230) of decisions were concordant, 4.5% (146 out of 3230), were discordant and 4% (128 out of 3230) had no MDT decision. Of 146 discordant decisions, 26 (17.8%) were considered 'unjustifiable' as there was no additional information available after the MDT to account for the change in management. The remaining 120 discordant MDT decisions were considered 'justifiable', as management was altered due to patient choice (n=61), additional information available after MDT (n=54) or MDT error (n=5).

CONCLUSION

The vast majority of MDT decisions are implemented. Management alteration was most often due to patient choice or additional information available after the MDT. A minority of management alterations were 'unjustifiable' and the authors recommend that any patient whose treatment is subsequently changed should have MDT rediscussion prior to treatment.

Near-room-temperature colossal magnetodielectricity and multiglass properties in partially disordered La2NiMnO6

We report magnetic, dielectric, and magnetodielectric responses of the pure monoclinic bulk phase of partially disordered La2NiMnO6, exhibiting a spectrum of unusual properties and establish that this compound is an intrinsically multiglass system with a large magnetodielectric coupling (8%-20%) over a wide range of temperatures (150-300 K). Specifically, our results establish a unique way to obtain colossal magnetodielectricity, independent of any striction effects, by engineering the asymmetric hopping contribution to the dielectric constant via the tuning of the relative-spin orientations between neighboring magnetic ions in a transition-metal oxide system. We discuss the role of antisite (Ni-Mn) disorder in emergence of these unusual properties.

Comparison of PCR based marker systems for genetic analysis in different cultivars of mango

Native diversity is well represented in northern and eastern parts of India for mango. We evaluated three important polymerase chain reaction (PCR) based marker techniques viz., random amplified polymorphic DNA (RAPD), inter simple sequence repeat (ISSR) and directed amplified mini satellite DNA (DAMD) and examined their suitability for depicting genetic relationships and discrimination among closely related group of 46 mango varieties grown in the different agro-ecological zones in Uttar Pradesh, Bihar and West Bengal. Nine RAPD, eleven ISSR and four DAMD primers generated 110, 160 and 43 discrete fragments, respectively, accounting for polymorphism of 87.3, 79.83 and 83.72%, respectively. Cumulative analysis of these markers resulted in comprehensive UPGMA based dendrogram where in native mangoes representing important breeding lines and varieties from Uttar Pradesh fall more or less in separate cluster, while Bihar and West Bengal cultivars represent genetically different lineage forming distinct separate cluster. The prime focus on the study was towards identification of genetic variability that warrants establishing origin and molecular evolution of mango cultivars of eastern and northern India because they are the rich gene pool for conservation. Highest diversity index (DI) and polymorphic information content (PIC) values were found in DAMD indicating it to be more informative than others. Similarly, high effective multiplex ratio (EMR) and marker index (MI) were recorded by ISSR reflecting ability to simultaneously detect a large number of bands. The study accomplished establishing genetic relationship and also DNA fingerprint development. The data is also useful for mapping studies for gene identification.

Congenital infiltrating lipomatosis of the face with exophytic temporomandibular joint ankylosis: a case report and review of the literature

Congenital infiltrating lipomatosis of the face (CIL-F) is a rare lipomatous lesion with diffuse fatty infiltration of tissues and hyperplasia of underlying bone. We report clinical and CT findings in an unusual case of CIL-F presenting with progressive hemifacial asymmetry, manifesting as severely restricted mouth opening owing to exophytic temporomandibular joint ankylosis. The role of imaging in diagnosis is presented with a review of the literature. Differential diagnosis of CIL-F and its exclusion as a cause of hemifacial hyperplasia are also discussed.

Antifungal activity of Aegle marmelos (L.) Correa (Rutaceae) leaf extract on dermatophytes

OBJECTIVE

To evaluate the in vitro antifungal activity of Aegle marmelos leaf extracts and fractions on the clinical isolates of dermatophytic fungi like Trichophyton mentagrophytes, Trichophyton rubrum, Microsporum canis, Microsporum gypseum and Epidermophyton floccosum.

METHODS

The minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of various extracts and fractions of the leaves of Aegle marmelos were measured using method of National Committee for Clinical Laboratory Standards (NCCLS).

RESULTS

Aegle marmelos leaf extracts and fractions were found to have fungicidal activity against various clinical isolates of dermatophytic fungi. The MIC and MFC was found to be high in water and ethyl alcohol extracts and methanol fractions (200µg/mL) against dermatophytic fungi studied.

CONCLUSIONS

Aegle marmelos leaf extracts significantly inhibites the growth of all dermatophytic fungi studied. If this activity is confirmed by in vivo studies and if the compound is isolated and identified, it could be a remedy for dermatophytosis.

A Validated RP-HPLC Method for Simultaneous Estimation of Nebivolol and Hydrochlorothiazide in Tablets

A simple, selective, rapid, precise and economical reverse phase high pressure liquid chromatographic method has been developed for the simultaneous estimation of nebivolol and hydrochlorthiazide from pharmaceutical formulation. Phenomenex Gemini C₁₈ (25 cm×4.6 mm i.d., 5 μ) column with a mobile phase consisting of acetonitrile: 50mM ammonium acetate (adjusted to pH 3.5 using orthophosphoric acid) (70:30 v/v) at a flow rate of 1.0 ml/min was used. Detection was carried out at 254 nm. Probenecid was used as an internal standard. The retention times of probenecid, nebivolol and hydrochlorthiazide were 13.05, 3.32 and 4.25 min, respectively. The developed method was validated in terms of accuracy, precision, linearity, limit of detection, limit of quantitation and solution stability. The proposed method can be used for the estimation of these drugs in combined dosage forms.