251
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Classification of Breast Cancer. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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252
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Solid Carcinoma of the Canine Mammary Gland: a Histological Type or Tumour Cell Arrangement? J Comp Pathol 2022; 190:1-12. [DOI: 10.1016/j.jcpa.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/28/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022]
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253
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Hai L, Feng Y, Zhao J, Tang Q, Wang X, Cao X, Xiao C. An Improved Nomogram to Reduce False-Positive Biopsy Rates of Breast Imaging Reporting and Data System Ultrasonography Category 4A Lesions. Cancer Control 2022; 29:10732748221122703. [PMID: 37735939 PMCID: PMC9478716 DOI: 10.1177/10732748221122703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The NCCN clinical guidelines recommended core needle biopsy for breast lesions classified as Breast Imaging Reporting and Data System (BI-RADS) 4, while category 4A lesions are only 2-10% likely to be malignant. Thus, a large number of biopsies of BI-RADS 4A lesions were ultimately determined to be benign, and those unnecessary biopsies may incur additional costs and pains. However, it is important to emphasize that the current risk prediction model focuses primarily on the details and complex risk features of US or MG findings, which may be difficult to apply in order to benefit from the model. To stratify and manage BI-RADS 4A lesions effectively and efficiently, a more effective and practical predictive model must be developed. METHODS We retrospectively analyzed 465 patients with BI-RADS ultrasonography (US) category 4A lesions, diagnosed between January 2019 and July 2019 in Tianjin Medical University Cancer Institute and Hospital and National Clinical Research Center for Cancer. Univariate and multivariate logistic regression analyses were conducted to identify risk factors. To stratify and predict the malignancy of BI-RADS 4A lesions, a nomogram combining the risk factors was constructed based on the multivariate logistic regression results. In order to determine the predictive performance of our predictive model, we used the concordance index (C-index), calibration curve, and receiver operating characteristic (ROC), and the decision curve analysis (DCA) to assess the clinical benefits. RESULTS Based on our analysis, 16.3% (76 out of 465) of patients were pathologically diagnosed with malignant lesions, while 83.6% (389 out of 465) were diagnosed with benign lesions. According to univariate and multivariate logistic regression analysis, age (OR = 3.414, 95%CI:1.849-6.303), nipple discharge (OR = .326, 95%CI:0.157-.835), palpable lesions (OR = 1.907, 95%CI:1.004-3.621), uncircumscribed margin (US) (OR = 1.732, 95%CI:1.033-2.905), calcification (mammography, MG) (OR = 2.384, 95%CI:1.366-4.161), BI-RADS(MG) (OR = 5.345, 95%CI:2.934-9.736) were incorporated into the predictive nomogram (C-index = .773). There was good agreement between the predicted risk and the observed probability of recurrence. Furthermore, we determined that 153 was the best cutoff score for distinguishing between patients in the low- and high-risk groups. Malignant lesions were significantly more prevalent in high-risk patients than in low-risk patients. CONCLUSION Based on clinical, US, and MG features, we present a predictive nomogram to reliably predict the malignancy risk of BI-RADS(US) 4A lesions, which may assist clinicians in the selection of patients at low risk of malignancy and reduce the number of false-positive biopsies.
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Affiliation(s)
- Linyue Hai
- The First Department of Breast
Cancer, Tianjin Medical University Cancer Institute &
Hospital, National Clinical Research Center for Cancer, Tianjin,
China
- Key Laboratory of Cancer Prevention
and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center
for Cancer, Tianjin, China
- Key Laboratory of Breast Cancer
Prevention and Therapy, Tianjin Medical
University, Ministry of Education, Tianjin, China
| | - Youqin Feng
- The First Department of Breast
Cancer, Tianjin Medical University Cancer Institute &
Hospital, National Clinical Research Center for Cancer, Tianjin,
China
- Key Laboratory of Cancer Prevention
and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center
for Cancer, Tianjin, China
- Key Laboratory of Breast Cancer
Prevention and Therapy, Tianjin Medical
University, Ministry of Education, Tianjin, China
| | - Jingjing Zhao
- The First Department of Breast
Cancer, Tianjin Medical University Cancer Institute &
Hospital, National Clinical Research Center for Cancer, Tianjin,
China
- Key Laboratory of Cancer Prevention
and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center
for Cancer, Tianjin, China
- Key Laboratory of Breast Cancer
Prevention and Therapy, Tianjin Medical
University, Ministry of Education, Tianjin, China
| | - Qiang Tang
- The First Department of Breast
Cancer, Tianjin Medical University Cancer Institute &
Hospital, National Clinical Research Center for Cancer, Tianjin,
China
- Key Laboratory of Cancer Prevention
and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center
for Cancer, Tianjin, China
- Key Laboratory of Breast Cancer
Prevention and Therapy, Tianjin Medical
University, Ministry of Education, Tianjin, China
| | - Xuefei Wang
- The First Department of Breast
Cancer, Tianjin Medical University Cancer Institute &
Hospital, National Clinical Research Center for Cancer, Tianjin,
China
- Key Laboratory of Cancer Prevention
and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center
for Cancer, Tianjin, China
- Key Laboratory of Breast Cancer
Prevention and Therapy, Tianjin Medical
University, Ministry of Education, Tianjin, China
| | - Xuchen Cao
- The First Department of Breast
Cancer, Tianjin Medical University Cancer Institute &
Hospital, National Clinical Research Center for Cancer, Tianjin,
China
- Key Laboratory of Cancer Prevention
and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center
for Cancer, Tianjin, China
- Key Laboratory of Breast Cancer
Prevention and Therapy, Tianjin Medical
University, Ministry of Education, Tianjin, China
| | - Chunhua Xiao
- The First Department of Breast
Cancer, Tianjin Medical University Cancer Institute &
Hospital, National Clinical Research Center for Cancer, Tianjin,
China
- Key Laboratory of Cancer Prevention
and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center
for Cancer, Tianjin, China
- Key Laboratory of Breast Cancer
Prevention and Therapy, Tianjin Medical
University, Ministry of Education, Tianjin, China
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254
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Tan XJ, Mustafa N, Mashor MY, Rahman KSA. Automated knowledge-assisted mitosis cells detection framework in breast histopathology images. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:1721-1745. [PMID: 35135226 DOI: 10.3934/mbe.2022081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Based on the Nottingham Histopathology Grading (NHG) system, mitosis cells detection is one of the important criteria to determine the grade of breast carcinoma. Mitosis cells detection is a challenging task due to the heterogeneous microenvironment of breast histopathology images. Recognition of complex and inconsistent objects in the medical images could be achieved by incorporating domain knowledge in the field of interest. In this study, the strategies of the histopathologist and domain knowledge approach were used to guide the development of the image processing framework for automated mitosis cells detection in breast histopathology images. The detection framework starts with color normalization and hyperchromatic nucleus segmentation. Then, a knowledge-assisted false positive reduction method is proposed to eliminate the false positive (i.e., non-mitosis cells). This stage aims to minimize the percentage of false positive and thus increase the F1-score. Next, features extraction was performed. The mitosis candidates were classified using a Support Vector Machine (SVM) classifier. For evaluation purposes, the knowledge-assisted detection framework was tested using two datasets: a custom dataset and a publicly available dataset (i.e., MITOS dataset). The proposed knowledge-assisted false positive reduction method was found promising by eliminating at least 87.1% of false positive in both the dataset producing promising results in the F1-score. Experimental results demonstrate that the knowledge-assisted detection framework can achieve promising results in F1-score (custom dataset: 89.1%; MITOS dataset: 88.9%) and outperforms the recent works.
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Affiliation(s)
- Xiao Jian Tan
- Centre for Multimodal Signal Processing, Department of Electrical and Electronic Engineering, Faculty of Engineering and Technology, Tunku Abdul Rahman University College (TARUC), Jalan Genting Kelang, Setapak 53300, Kuala Lumpur, Malaysia
| | - Nazahah Mustafa
- Biomedical Electronic Engineering Programme, Faculty of Electronic Engineering Technology, Universiti Malaysia Perlis (UniMAP) 02600 Arau, Perlis, Malaysia
| | - Mohd Yusoff Mashor
- Biomedical Electronic Engineering Programme, Faculty of Electronic Engineering Technology, Universiti Malaysia Perlis (UniMAP) 02600 Arau, Perlis, Malaysia
| | - Khairul Shakir Ab Rahman
- Department of Pathology, Hospital Tuanku Fauziah 01000 Jalan Tun Abdul Razak Kangar Perlis, Malaysia
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255
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Accardo G, Capobianco AM, Torre GL, Thodas A, Marino G, Sisti LG, Vita G. Adenoid cystic carcinoma of the breast and intraoperative electron radiotherapy: single case report and review of literature. Future Oncol 2021; 18:871-881. [PMID: 34904444 DOI: 10.2217/fon-2021-0860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) of the breast is a very rare neoplasm. It presents a triple-negative phenotype in most cases, but its prognosis is generally considered to be better than other breast cancers with the same immunohistochemical pattern. Due to its controversial features, no data are available in the literature regarding a consensus approach for ACC treatment, especially for subtypes with worse prognosis like solid basaloid ACC. We present for the first time a rare case of ACC with multifocal presentation treated with breast-conservative surgery and intraoperative electron radiotherapy, thus supporting this treatment of ACC in selected patients like young women affected by the solid basaloid variant who commonly present a worse prognosis. In this case, no local or systemic recurrence was detected after 30 months of follow-up.
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Affiliation(s)
- Giuseppe Accardo
- Department of Breast Surgery, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Alba Ml Capobianco
- Head of Multidisciplinary Oncology Unit, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Giuseppe La Torre
- Department of Breast Surgery, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Alexios Thodas
- Department of Breast Surgery, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Graziella Marino
- Department of Breast Surgery, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Leuconoe Grazia Sisti
- Center for Global Health Research and studies and Department of Public Health, Section of Hygiene, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Giulia Vita
- Department of Pathology, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
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256
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Cui H, Zhao D, Han P, Zhang X, Fan W, Zuo X, Wang P, Hu N, Kong H, Peng F, Wang Y, Tian J, Zhang L. Predicting Pathological Complete Response After Neoadjuvant Chemotherapy in Advanced Breast Cancer by Ultrasound and Clinicopathological Features Using a Nomogram. Front Oncol 2021; 11:718531. [PMID: 34888231 PMCID: PMC8650158 DOI: 10.3389/fonc.2021.718531] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/20/2021] [Indexed: 12/26/2022] Open
Abstract
Background and Aims Prediction of pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) for breast cancer is critical for surgical planning and evaluation of NAC efficacy. The purpose of this project was to assess the efficiency of a novel nomogram based on ultrasound and clinicopathological features for predicting pCR after NAC. Methods This retrospective study included 282 patients with advanced breast cancer treated with NAC from two centers. Patients received breast ultrasound before NAC and after two cycles of NAC; and the ultrasound, clinicopathological features and feature changes after two cycles of NAC were recorded. A multivariate logistic regression model was combined with bootstrapping screened for informative features associated with pCR. Then, we constructed two nomograms: an initial-baseline nomogram and a two-cycle response nomogram. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were analyzed. The C-index was used to evaluate predictive accuracy. Results Sixty (60/282, 21.28%) patients achieved pCR. Triple-negative breast cancer (TNBC) and HER2-amplified types were more likely to obtain pCR. Size shrinkage, posterior acoustic pattern, and elasticity score were identified as independent factors by multivariate logistic regression. In the validation cohort, the two-cycle response nomogram showed better discrimination than the initial-baseline nomogram, with the C-index reaching 0.79. The sensitivity, specificity, and NPV of the two-cycle response nomogram were 0.77, 0.77, and 0.92, respectively. Conclusion The two-cycle response nomogram exhibited satisfactory efficiency, which means that the nomogram was a reliable method to predict pCR after NAC. Size shrinkage after two cycles of NAC was an important in dependent factor in predicting pCR.
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Affiliation(s)
- Hao Cui
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dantong Zhao
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Peng Han
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xudong Zhang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Fan
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaoxuan Zuo
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Panting Wang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Nana Hu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hanqing Kong
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fuhui Peng
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ying Wang
- Department of General Surgery, The Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiawei Tian
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lei Zhang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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257
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Wong YM, Jagmohan P, Goh YG, Putti TC, Ow SGW, Thian YL, Pillay P. Infiltrative pattern of metastatic invasive lobular breast carcinoma in the abdomen: a pictorial review. Insights Imaging 2021; 12:181. [PMID: 34894297 PMCID: PMC8665916 DOI: 10.1186/s13244-021-01120-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022] Open
Abstract
Invasive lobular carcinoma (ILC) has a greater tendency to metastasize to the peritoneum, retroperitoneum, and gastrointestinal (GI) tract as compared to invasive carcinoma of no special type (NST). Like primary ILC in the breast, ILC metastases are frequently infiltrative and hypometabolic, rather than mass forming and hypermetabolic in nature. This renders them difficult to detect on conventional and metabolic imaging studies. As a result, intra-abdominal ILC metastases are often detected late,
with patients presenting with clinical complications such as liver failure, hydronephrosis, or bowel obstruction. In patients with known history of ILC, certain imaging features are very suggestive of infiltrative metastatic ILC. These include retroperitoneal or peritoneal nodularity and linitis plastica appearance of the bowel. Recognition of linitis plastica on imaging should prompt deep or repeat biopsies. In this pictorial review, the authors aim to familiarize readers with imaging features and pitfalls for evaluation of intra-abdominal metastatic ILC. Awareness of these will allow the radiologist to assess these patients with a high index of suspicion and aid detection of metastatic disease. Also, this can direct histopathology and immunohistochemical staining to obtain the correct diagnosis in suspected metastatic disease.
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Affiliation(s)
- Ying Mei Wong
- Department of Diagnostic Imaging, National University Hospital, Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore.
| | - Pooja Jagmohan
- Department of Diagnostic Imaging, National University Hospital, Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore
| | - Yong Geng Goh
- Department of Diagnostic Imaging, National University Hospital, Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore
| | - Thomas Choudary Putti
- Department of Pathology, National University of Singapore, National University Hospital, Kent Ridge Road, Singapore, 119074, Singapore
| | - Samuel Guan Wei Ow
- Department of Hematology-Oncology, National University Cancer Institute and Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
| | - Yee Liang Thian
- Department of Diagnostic Imaging, National University Hospital, Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore
| | - Premilla Pillay
- Department of Diagnostic Imaging, National University Hospital, Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore
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258
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Dudgeon SN, Wen S, Hanna MG, Gupta R, Amgad M, Sheth M, Marble H, Huang R, Herrmann MD, Szu CH, Tong D, Werness B, Szu E, Larsimont D, Madabhushi A, Hytopoulos E, Chen W, Singh R, Hart SN, Sharma A, Saltz J, Salgado R, Gallas BD. A Pathologist-Annotated Dataset for Validating Artificial Intelligence: A Project Description and Pilot Study. J Pathol Inform 2021; 12:45. [PMID: 34881099 PMCID: PMC8609287 DOI: 10.4103/jpi.jpi_83_20] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/23/2021] [Accepted: 03/16/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose: Validating artificial intelligence algorithms for clinical use in medical images is a challenging endeavor due to a lack of standard reference data (ground truth). This topic typically occupies a small portion of the discussion in research papers since most of the efforts are focused on developing novel algorithms. In this work, we present a collaboration to create a validation dataset of pathologist annotations for algorithms that process whole slide images. We focus on data collection and evaluation of algorithm performance in the context of estimating the density of stromal tumor-infiltrating lymphocytes (sTILs) in breast cancer. Methods: We digitized 64 glass slides of hematoxylin- and eosin-stained invasive ductal carcinoma core biopsies prepared at a single clinical site. A collaborating pathologist selected 10 regions of interest (ROIs) per slide for evaluation. We created training materials and workflows to crowdsource pathologist image annotations on two modes: an optical microscope and two digital platforms. The microscope platform allows the same ROIs to be evaluated in both modes. The workflows collect the ROI type, a decision on whether the ROI is appropriate for estimating the density of sTILs, and if appropriate, the sTIL density value for that ROI. Results: In total, 19 pathologists made 1645 ROI evaluations during a data collection event and the following 2 weeks. The pilot study yielded an abundant number of cases with nominal sTIL infiltration. Furthermore, we found that the sTIL densities are correlated within a case, and there is notable pathologist variability. Consequently, we outline plans to improve our ROI and case sampling methods. We also outline statistical methods to account for ROI correlations within a case and pathologist variability when validating an algorithm. Conclusion: We have built workflows for efficient data collection and tested them in a pilot study. As we prepare for pivotal studies, we will investigate methods to use the dataset as an external validation tool for algorithms. We will also consider what it will take for the dataset to be fit for a regulatory purpose: study size, patient population, and pathologist training and qualifications. To this end, we will elicit feedback from the Food and Drug Administration via the Medical Device Development Tool program and from the broader digital pathology and AI community. Ultimately, we intend to share the dataset, statistical methods, and lessons learned.
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Affiliation(s)
- Sarah N Dudgeon
- Division of Imaging Diagnostics and Software Reliability, Office of Science and Engineering Laboratories, Center for Devices and Radiologic Health, United States Food and Drug Administration, White Oak, MD, USA
| | - Si Wen
- Division of Imaging Diagnostics and Software Reliability, Office of Science and Engineering Laboratories, Center for Devices and Radiologic Health, United States Food and Drug Administration, White Oak, MD, USA
| | | | - Rajarsi Gupta
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Mohamed Amgad
- Department of Pathology, Northwestern University, Chicago, IL, USA
| | - Manasi Sheth
- Division of Biostatistics, Center for Devices and Radiologic Health, United States Food and Drug Administration, White Oak, MD, USA
| | - Hetal Marble
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard Huang
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Markus D Herrmann
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | - Evan Szu
- Arrive Bio, San Francisco, CA, USA
| | - Denis Larsimont
- Department of Pathology, Institute Jules Bordet, Brussels, Belgium
| | - Anant Madabhushi
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, USA
| | | | - Weijie Chen
- Division of Imaging Diagnostics and Software Reliability, Office of Science and Engineering Laboratories, Center for Devices and Radiologic Health, United States Food and Drug Administration, White Oak, MD, USA
| | - Rajendra Singh
- Northwell Health and Zucker School of Medicine, New York, NY, USA
| | - Steven N Hart
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ashish Sharma
- Department of Biomedical Informatics, Emory University, Atlanta, GA, USA
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Roberto Salgado
- Division of Research, Peter Mac Callum Cancer Centre, Melbourne, Australia.,Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
| | - Brandon D Gallas
- Division of Imaging Diagnostics and Software Reliability, Office of Science and Engineering Laboratories, Center for Devices and Radiologic Health, United States Food and Drug Administration, White Oak, MD, USA
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259
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Thennavan A, Beca F, Xia Y, Recio SG, Allison K, Collins LC, Tse GM, Chen YY, Schnitt SJ, Hoadley KA, Beck A, Perou CM. Molecular analysis of TCGA breast cancer histologic types. CELL GENOMICS 2021; 1. [PMID: 35465400 DOI: 10.1016/j.xgen.2021.100067] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Breast cancer is classified into multiple distinct histologic types, and many of the rarer types have limited characterization. Here, we extend The Cancer Genome Atlas Breast Cancer (TCGA-BRCA) dataset with additional histologic type annotations, in a total of 1063 breast cancers. We analyze this extended dataset to define transcriptomic and genomic profiles of six rare special histologic types: cribriform, micropapillary, mucinous, papillary, metaplastic, and invasive carcinoma with medullary pattern. We show the broader applicability of our constructed special histologic type gene signatures in the TCGA Pan-Cancer Atlas dataset with a predictive model that detects mucinous histologic type across cancers of other organ systems. Using a normal mammary cell differentiation score analysis, we order histologic types into a continuum from stem cell-like to luminal progenitor-like to mature luminal-like. Finally, we classify TCGA-BRCA into 12 consensus groups based on integrated genomic and histological features. We present a rich openly accessible resource of histologic and genomic characterization of TCGA-BRCA to enable studies of the range of breast cancers.
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Affiliation(s)
- Aatish Thennavan
- Oral and Craniofacial Biomedicine Program, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Francisco Beca
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Youli Xia
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Susana Garcia Recio
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Kimberly Allison
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura C Collins
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Yunn-Yi Chen
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, CA, 94143, USA
| | - Stuart J Schnitt
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA 02115, USA
| | - Katherine A Hoadley
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | - Charles M Perou
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Department of Pathology & Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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260
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Forooshani MK, Scarpitta R, Fanelli GN, Miccoli M, Naccarato AG, Scatena C. Is it time to consider the Androgen receptor as a therapeutic target in breast cancer? Anticancer Agents Med Chem 2021; 22:775-786. [PMID: 34852747 DOI: 10.2174/1871520621666211201150818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/15/2021] [Accepted: 09/02/2021] [Indexed: 11/22/2022]
Abstract
Breast cancer (BC) is a heterogeneous disease and the most prevalent malignant tumor in women worldwide. The majority of BC cases are positive for estrogen receptor (ER) and progesterone receptor (PgR), both known to be involved in cancer pathogenesis, progression, and invasion. In line with this, hormonal deprivation therapy appears to be a useful tool and an effective treatment for these BC subtypes. Unfortunately, prognosis among patients with hormone-negative tumors or therapy-refractory and metastatic patients remains poor. Novel biomarkers are urgently needed in order to predict the course of the disease, make better therapy decisions and improve the overall survival of patients. In this respect, the androgen receptor (AR), a member of the hormonal nuclear receptor superfamily and ER and PgR, emerges as an interesting feature widely expressed in human BCs. Despite the advances, the precise tumorigenic mechanism of AR and the role of its endogenous ligands are yet not well-understood. In this review, we aim to elaborate on the prognostic impact of AR expression and current AR-targeting approaches based on previous studies investigating AR's role in different BC subtypes.
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Affiliation(s)
- Melika Kooshki Forooshani
- Division of Pathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa. Italy
| | - Rosa Scarpitta
- Division of Pathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa. Italy
| | - Giuseppe Nicolò Fanelli
- Division of Pathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa. Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa. Italy
| | - Antonio Giuseppe Naccarato
- Division of Pathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa. Italy
| | - Cristian Scatena
- Division of Pathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa. Italy
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261
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Shetat OMM, Moustafa AFI, Zaitoon S, Fahim MII, Mohamed G, Gomaa MM. Added value of contrast-enhanced spectral mammogram in assessment of suspicious microcalcification and grading of DCIS. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00554-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Abstract
Background
Breast microcalcifications are one of the most difficult mammographic findings to assess. The purpose of this study is to assess the ability of contrast-enhanced spectral mammography in the assessment of suspicious microcalcification and in predicting the grade of DCIS.
Methods
Three hundred and forty cases with suspicious microcalcification were reviewed in this study. We excluded 160 cases associated with masses. We enrolled 180 cases for analysis of suspicious microcalcification on mammograms with no underlying masses. We reviewed the microcalcification for their morphology, distribution, and associated pathological enhancement according to BI-RADS lexicon with pathology results reviewed and classified into benign and malignant which subdivided into low, intermediate, or high-grade DCIS or invasive carcinoma.
Results
Three hundred and forty cases with suspicious microcalcification were reviewed in this study. We excluded 160 cases associated with masses. Forty-five of 180 cases were benign, and 135/180 cases were malignant. Twenty-five of 135 cases were diagnosed as invasive breast carcinomas while 110/135 were ductal carcinoma in situ. From the latter, 110 patients with DCIS, 22/110 cases were low grade, 11/110 cases were intermediate grade, and 77/110 cases were high grade (44 with micro-invasion). A total of 25 invasive carcinomas showed pathological non-mass enhancement, 76/77 cases of high-grade DCIS, and 6/11 cases of intermediate-grade DCIS. No abnormal enhancement appeared with benign entities, low-grade DCIS, and 5/11 cases of intermediate DCIS. The diagnostic performance of CESM in anticipation of high grade in DCIS patients was sensitivity of 98%, specificity of 81.8%, and accuracy of 93.1%. CESM sensitivity, specificity, and accuracy in prediction of invasiveness or high-grade DCIS were 98.5%, 81.8%, and 87.5%, respectively.
Conclusion
CESM can provide a fundamental contribution in the evaluation of suspicious microcalcification as high-grade DCIS or invasive component can present by non-mass enhancement, but enhancement paucity is favorable to diagnose benign lesion or non-invasive/low-grade DCIS.
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Zhao D, Fu X, Rohr J, Wang Y, Li M, Zhang X, Qin J, Xu M, Li C, Sun G, Wang Z, Guo S. Poor histologic tumor response after adjuvant therapy in basal-like HER2-positive breast carcinoma. Pathol Res Pract 2021; 228:153677. [PMID: 34775151 DOI: 10.1016/j.prp.2021.153677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 12/21/2022]
Abstract
AIMS HER2-positive breast carcinomas are all treated with first-line anti-HER2 therapy. However, immunohistochemical and molecular profiling demonstrates significant heterogeneity among HER2-positive carcinomas. Basal-like HER2-positive breast carcinomas are poorly differentiated from pure HER2-positive breast carcinomas. MATERIALS AND METHODS Seventy-five patients with HER2-positive, ER- and PR-negative breast carcinomas who received anti-HER2 based neoadjuvant therapy were retrospectively analyzed. Thirty-seven cases were classified as basal-like HER2-positive breast carcinoma with any positivity for CK5/6, and thirty-eight cases were classified as pure HER2-positive breast carcinoma with completely negativity for CK5/6. The clinicopathological features and tumor responses after neoadjuvant therapy and outcomes were analyzed. RESULTS Compared to non-basal HER2-positive breast carcinoma, basal-like HER2-positive breast carcinoma showed distinctive histologic features including poor differentiation and syncytial tumor cells with pushing, invasive borders and a significantly higher proportion of apocrine metaplasia. They also demonstrated significantly higher histologic grade; 18/37 (48.6%) of basal-like carcinomas were grade 3, whereas only 5/38 (13.2%) of non-basal carcinomas were grade 3 (p = 0.001), Furthermore, basal-like HER2-positive breast carcinomas were more likely to be positive or completely negative for p53 (p = 0.009), and demonstrated a higher percentage of TP53 mutation (p = 0.17). These tumors were less responsive to anti-HER2 based neoadjuvant therapy, with Miller-Payne grades 1-3 higher than pure HER2-positive breast carcinoma (25/37 [67.6%] vs 16/38 [42.1%]), and the percentage of grade 4-5 was lower (12/37 [32.4%] vs 22/38 [57.9%]; p = 0.027). CONCLUSIONS Basal-like HER2-positive breast carcinoma has distinctive clinicopathological features and less histologic tumor response after neoadjuvant therapy. There is urgent need to recognize basal-like HER2-positive breast carcinoma to be treated precisely.
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Affiliation(s)
- Danhui Zhao
- Department of Pathology, the First Affinity Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Xin Fu
- Department of Pathology, the First Affinity Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Joseph Rohr
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, 68105, NE, USA
| | - Yingmei Wang
- Department of Pathology, the First Affinity Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Mingyang Li
- Department of Pathology, the First Affinity Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Xiuming Zhang
- Department of Pathology, the First Affinity Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Junhui Qin
- Department of Pathology, the First Affinity Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Mengwei Xu
- Department of Pathology, the First Affinity Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Chao Li
- Department of Pathology, the First Affinity Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Guorui Sun
- Department of Pathology, the First Affinity Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Zhe Wang
- Department of Pathology, the First Affinity Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China.
| | - Shuangping Guo
- Department of Pathology, the First Affinity Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China.
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263
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Barron M, Asaad A, Idaewor P, Rasheed N, Saad Abdalla Al-Zawi A. Breast Apocrine Carcinoma Detected Incidentally as Axillary Lymphadenopathy in a CT Scan. Cureus 2021; 13:e18523. [PMID: 34754678 PMCID: PMC8569647 DOI: 10.7759/cureus.18523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/25/2022] Open
Abstract
Breast apocrine cell pathology varieties include benign papilloma, non-high-grade apocrine ductal carcinoma in situ (DCIS), and breast invasive apocrine carcinoma (BAC). BAC is a rare type of invasive breast cancer and is histologically distinguished by large-sized cells with copious eosinophilic granular cytoplasm, round nuclei, and prominent nucleoli. Its prognosis is similar to breast invasive ductal carcinoma, of no special type (IDC-NST), when matched for tumour stage and histological grade. In this paper, we report the case of a 75-year-old lady presenting with apocrine carcinoma of the left breast diagnosed at the stage of mediastinal lymph node metastasis.
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Affiliation(s)
- Marina Barron
- Emergency Department, South West Acute Hospital, Enniskillen, GBR
| | - Amira Asaad
- Research Unit, University College London, London, GBR
| | - Philip Idaewor
- Cellular Pathology/Histopathology, Basildon and Thurrock University Hospital, Basildon, GBR
| | - Noreen Rasheed
- Breast Radiology, Basildon and Thurrock University Hospital, Basildon, GBR
| | - Abdalla Saad Abdalla Al-Zawi
- General and Breast Surgery, Mid and South Essex University Hospital Group, Basildon, GBR.,General and Breast Surgery, Basildon and Thurrock University Hospital, Basildon, GBR.,General and Breast Surgery, Anglia Ruskin University, Chelmsford, GBR
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264
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Bartley CM, Parikshak NN, Ngo TT, Alexander JA, Zorn KC, Alvarenga BA, Kang MK, Pedriali M, Pleasure SJ, Wilson MR. Case Report: A False Negative Case of Anti-Yo Paraneoplastic Myelopathy. Front Neurol 2021; 12:728700. [PMID: 34744969 PMCID: PMC8570369 DOI: 10.3389/fneur.2021.728700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/16/2021] [Indexed: 11/22/2022] Open
Abstract
The development of autoimmune antibody panels has improved the diagnosis of paraneoplastic neurological disorders (PNDs) of the brain and spinal cord. Here, we present a case of a woman with a history of breast cancer who presented with a subacute sensory ataxia that progressed over 18 months. Her examination and diagnostic studies were consistent with a myelopathy. Metabolic, infectious, and autoimmune testing were non-diagnostic. However, she responded to empirical immunosuppression, prompting further workup for an autoimmune etiology. An unbiased autoantibody screen utilizing phage display immunoprecipitation sequencing (PhIP-Seq) identified antibodies to the anti-Yo antigens cerebellar degeneration related protein 2 like (CDR2L) and CDR2, which were subsequently validated by immunoblot and cell-based overexpression assays. Furthermore, CDR2L protein expression was restricted to HER2 expressing tumor cells in the patient's breast tissue. Recent evidence suggests that CDR2L is likely the primary antigen in anti-Yo paraneoplastic cerebellar degeneration, but anti-Yo myelopathy is poorly characterized. By immunostaining, we detected neuronal CDR2L protein expression in the murine and human spinal cord. This case demonstrates the diagnostic utility of unbiased assays in patients with suspected PNDs, supports prior observations that anti-Yo PND can be associated with isolated myelopathy, and implicates CDR2L as a potential antigen in the spinal cord.
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Affiliation(s)
- Christopher M Bartley
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Neelroop N Parikshak
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Thomas T Ngo
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jessa A Alexander
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, United States
| | - Bonny A Alvarenga
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Min K Kang
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Massimo Pedriali
- Operative Unit of Surgical Pathology, Azienda Ospedaliera-Universitaria, Ferrara, Italy
| | - Samuel J Pleasure
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Michael R Wilson
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
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265
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Rana MK, Rana APS, Khera U. Expression of p53 and p16 in Carcinoma Breast Tissue: Depicts Prognostic Significance or Coincidence. Cureus 2021; 13:e19395. [PMID: 34925997 PMCID: PMC8654126 DOI: 10.7759/cureus.19395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
Breast cancer remains the most common malignancy among the Indian female population. The p16 and p53 genes are frequently mutated in breast cancer. Therefore, we aimed to evaluate the prognostic significance of p16 and p53 overexpression in breast cancer and their correlation with various traditional prognostic parameters. Total of 100 confirmed cases of breast cancers were selected. Patients who underwent chemotherapy treatment were excluded from the study. Estrogen receptor (ER), progesterone receptor (PR), and Her2neu immunohistochemistry were performed. The p16 and p53 immunohistochemistry was performed on all cases and association with various clinicopathologic parameters was determined. The mean age of carcinoma breast was 53.3+11.6 with age ranging from 28 to 82 years. On histopathological examination, 93% of cases were of invasive ductal cell carcinoma (IDC) with majority of grade I (43%). Only 14% of cases showed positive p53 expression and 19% of cases showed positive p16 expression. P16 was seen in a very significant correlation with p53 expression in all breast carcinoma cases (<0.002). p53 expression showed a positively significant (<0.05) correlation with age and grade III. The p16 expression was seen significantly correlated with low mitotic activity index (MAI) only. The p53 over-expression was seen in worse prognostic factors such as high tumor grade, Her2neu and triple-negative expression suggested its potential role in pathogenesis of carcinoma breast. In addition, high expression of p16 seen in low mitotic count and Her2neu expression also emphasized the role of this biomarker and recommends further molecular-based research.
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266
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Al-Ansari MM, AlMalki RH, Dahabiyeh LA, Abdel Rahman AM. Metabolomics-Microbiome Crosstalk in the Breast Cancer Microenvironment. Metabolites 2021; 11:metabo11110758. [PMID: 34822416 PMCID: PMC8619468 DOI: 10.3390/metabo11110758] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 12/23/2022] Open
Abstract
Breast cancer, the most frequent cancer diagnosed among females, is associated with a high mortality rate worldwide. Alterations in the microbiota have been linked with breast cancer development, suggesting the possibility of discovering disease biomarkers. Metabolomics has emerged as an advanced promising analytical approach for profiling metabolic features associated with breast cancer subtypes, disease progression, and response to treatment. The microenvironment compromises non-cancerous cells such as fibroblasts and influences cancer progression with apparent phenotypes. This review discusses the role of metabolomics in studying metabolic dysregulation in breast cancer caused by the effect of the tumor microenvironment on multiple cells such as immune cells, fibroblasts, adipocytes, etc. Breast tumor cells have a unique metabolic profile through the elevation of glycolysis and the tricarboxylic acid cycle metabolism. This metabolic profile is highly sensitive to microbiota activity in the breast tissue microenvironment. Metabolomics shows great potential as a tool for monitoring metabolic dysregulation in tissue and associating the findings with microbiome expression.
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Affiliation(s)
- Mysoon M. Al-Ansari
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (M.M.A.-A.); (R.H.A.)
- Department of Molecular Oncology, Cancer Biology & Experimental Therapeutics Section, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh 11211, Saudi Arabia
| | - Reem H. AlMalki
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (M.M.A.-A.); (R.H.A.)
- Department of Molecular Oncology, Cancer Biology & Experimental Therapeutics Section, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh 11211, Saudi Arabia
| | - Lina A. Dahabiyeh
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Jordan, Amman 11942, Jordan;
| | - Anas M. Abdel Rahman
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Zahrawi Street, Al Maather, Riyadh 11211, Saudi Arabia
- Department of Biochemistry and Molecular Medicine, College of Medicine, Al Faisal University, Riyadh 11533, Saudi Arabia
- Correspondence:
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267
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Sajjadi E, Venetis K, Piciotti R, Gambini D, Blundo C, Runza L, Ferrero S, Guerini-Rocco E, Fusco N. Combined analysis of PTEN, HER2, and hormone receptors status: remodeling breast cancer risk profiling. BMC Cancer 2021; 21:1152. [PMID: 34706703 PMCID: PMC8555186 DOI: 10.1186/s12885-021-08889-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/19/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Phosphatase and tensin homolog (PTEN) loss is associated with tumorigenesis, tumor progression, and therapy resistance in breast cancer. However, the clinical value of PTEN as a biomarker in these patients is controversial. We sought to determine whether the benefit of traditional biomarkers testing is improved by the analysis of PTEN status for the identification of high-risk breast cancer. METHODS A cohort of 608 patients with breast cancer was included in this study. Based on the expression on the neoplastic cells compared to the normal internal controls by immunohistochemistry (IHC), cases were classified as PTEN-low (PTEN-L) or PTEN-retained (PTEN-WT). The former constituted the study group, while the latter the control group. Analysis of gene expression was performed on publicly available genomic data and included 4265 patients from the METABRIC and MSK cohorts retrieved from cBioPortal. The Shapiro-Wilk test was used to analyze the normal distributions of continuous variables. Relationships between PTEN status and the clinicopathologic and molecular features of the patient population were assessed using Fisher's exact test or Chi-squared/Wilcoxon rank-sum test. Survival curves were built according to the Kaplan-Meier method. RESULTS Alteration in PTEN status was significantly different at protein and gene levels, where the reduced protein expression was observed in 280/608 cases (46.1%) from our group, while genetic aberrations in only 315/4265 (7.4%) cases of the METABRIC and MSK cohorts. PTEN-L tumors were significantly enriched for hormone receptors (HR) and HER2 negativity (n = 48, 17.1%) compared to PTEN-WT tumors (n = 22, 6.7%; p = 0.0008). Lack of HR with or without HER2 overexpression/amplification was significantly associated with worse overall survival (OS) in PTEN-L but not in PTEN-WT breast cancers (p < .0001). Moreover, PTEN-L protein expression but not gene alterations was related to the outcome, in terms of both OS and disease-free survival (p = 0.002). CONCLUSIONS The combined analysis of PTEN, HER2, and HR status offers relevant information for a more precise risk assessment of patients with breast cancer.
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Affiliation(s)
- Elham Sajjadi
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Konstantinos Venetis
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Roberto Piciotti
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Donatella Gambini
- Division of Medical Oncology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Concetta Blundo
- Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Letterio Runza
- Division of Pathology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Stefano Ferrero
- Division of Pathology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Via della Commenda 10, 20122, Milan, Italy
| | - Elena Guerini-Rocco
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy.
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268
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Peneş NO, Pop AL, Borş RG, Varlas VN. Large borderline phyllodes breast tumor related to histopathology, diagnosis, and treatment management - case report. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 62:283-288. [PMID: 34609433 PMCID: PMC8597354 DOI: 10.47162/rjme.62.1.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Breast phyllodes tumors (PTs) are uncommon tumors with a biphasic fibroepithelial component, characterized by rapid development in middle-aged women. A correct preoperative diagnosis after Tru-Cut biopsy allows for proper surgical planning. The treatment of choice remains surgery (wide local excision or mastectomy) with or without breast reconstruction, depending on the size and histopathological (HP) nature of the tumor. We reported a case of a 50-year-old woman with a large PT in her left breast, measuring 11/10 cm. Preoperative HP examination revealed biphasic proliferation, with the appearance of benign PT. The patient underwent a left mastectomy, with a favorable postoperative evolution. The final HP diagnosis was borderline PT, with areas of lipomatous metaplasia. After three months, breast reconstruction was performed. The therapeutic management of large PTs continues to be a challenge for pathologists and surgeons. Due to the increased frequency of local recurrence and HP progression to malignancies, the treatment of choice for these patients is mastectomy, without lymphadenectomy.
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Affiliation(s)
- Nicolae Ovidiu Peneş
- Department of Clinical Laboratory, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; ,
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269
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Díaz-Delgado J, Douglas P, Stoneburg S, Cirqueira C, Gomez G. Invasive mammary carcinoma in a black-handed spider monkey (Ateles geoffroyi). J Med Primatol 2021; 50:332-334. [PMID: 34585387 DOI: 10.1111/jmp.12543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/01/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
Mammary neoplasia is rare in nonhuman primates other than macaques; records in New World primates are exceedingly rare. We report the pathologic and immunohistochemical features of an invasive carcinoma no special type with neuroendocrine differentiation in a captive, black-handed spider monkey (Ateles geoffroyi).
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Affiliation(s)
- J Díaz-Delgado
- Texas A&M Veterinary Medical Diagnostic Laboratory, College Station, Texas, USA
| | - P Douglas
- Little Rock Zoo, Little Rock, Arkansas, USA
| | | | - C Cirqueira
- Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, Brazil
| | - G Gomez
- Texas A&M Veterinary Medical Diagnostic Laboratory, College Station, Texas, USA
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270
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Ibrahim A, Lashen A, Toss M, Mihai R, Rakha E. Assessment of mitotic activity in breast cancer: revisited in the digital pathology era. J Clin Pathol 2021; 75:365-372. [PMID: 34556501 DOI: 10.1136/jclinpath-2021-207742] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/06/2021] [Indexed: 11/04/2022]
Abstract
The assessment of cell proliferation is a key morphological feature for diagnosing various pathological lesions and predicting their clinical behaviour. Visual assessment of mitotic figures in routine histological sections remains the gold-standard method to evaluate the proliferative activity and grading of cancer. Despite the apparent simplicity of such a well-established method, visual assessment of mitotic figures in breast cancer (BC) remains a challenging task with low concordance among pathologists which can lead to under or overestimation of tumour grade and hence affects management. Guideline recommendations for counting mitoses in BC have been published to standardise methodology and improve concordance; however, the results remain less satisfactory. Alternative approaches such as the use of the proliferation marker Ki67 have been recommended but these did not show better performance in terms of concordance or prognostic stratification. The advent of whole slide image technology has brought the issue of mitotic counting in BC into the light again with more challenges to develop objective criteria for identifying and scoring mitotic figures in digitalised images. Using reliable and reproducible morphological criteria can provide the highest degree of concordance among pathologists and could even benefit the further application of artificial intelligence (AI) in breast pathology, and this relies mainly on the explicit description of these figures. In this review, we highlight the morphology of mitotic figures and their mimickers, address the current caveats in counting mitoses in breast pathology and describe how to strictly apply the morphological criteria for accurate and reliable histological grade and AI models.
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Affiliation(s)
- Asmaa Ibrahim
- Division of Cancer and Stem Cell, University of Nottingham, Nottingham, UK.,Department of Pathology, Suez Canal University, Ismailia, Egypt
| | - Ayat Lashen
- Division of Cancer and Stem Cell, University of Nottingham, Nottingham, UK.,Department of Pathology, Menoufia University, Shebin El-Kom, Egypt
| | - Michael Toss
- Division of Cancer and Stem Cell, University of Nottingham, Nottingham, UK
| | - Raluca Mihai
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Emad Rakha
- Division of Cancer and Stem Cell, University of Nottingham, Nottingham, UK .,Department of Pathology, Menoufia University, Shebin El-Kom, Egypt
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271
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Jovanovic DV, Mitrovic SL, Milosavljevic MZ, Ilic MB, Stankovic VD, Vuletic MS, Dimitrijevic Stojanovic MN, Milosev DB, Azanjac GL, Nedeljkovic VM, Radovanovic D. Breast Cancer and p16: Role in Proliferation, Malignant Transformation and Progression. Healthcare (Basel) 2021; 9:healthcare9091240. [PMID: 34575014 PMCID: PMC8468846 DOI: 10.3390/healthcare9091240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
The definition of new molecular biomarkers could provide a more reliable approach in predicting the prognosis of invasive breast cancers (IBC). The aim of this study is to analyze the expression of p16 protein in IBC, as well as its participation in malignant transformation. The study included 147 patients diagnosed with IBC. The presence of non-invasive lesions (NIL) was noted in each IBC and surrounding tissue. p16 expression was determined by reading the percentage of nuclear and/or cytoplasmic expression in epithelial cells of IBC and NIL, but also in stromal fibroblasts. Results showed that expression of p16 increases with the progression of cytological changes in the epithelium; it is significantly higher in IBC compared to NIL (p < 0.0005). Cytoplasmic p16 expression is more prevalent in IBC (76.6%), as opposed to nuclear staining, which is characteristic of most NIL (21.1%). There is a difference in p16 expression between different molecular subtypes of IBC (p = 0.025). In the group of p16 positive tumors, pronounced mononuclear infiltrates (p = 0.047) and increased expression of p16 in stromal fibroblasts (p = 0.044) were noted. In conclusion, p16 protein plays an important role in proliferation, malignant transformation, as well as in progression from NIL to IBC.
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Affiliation(s)
- Dalibor V. Jovanovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.V.J.); (M.B.I.); (V.D.S.); (M.S.V.); (M.N.D.S.)
| | - Slobodanka L. Mitrovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.V.J.); (M.B.I.); (V.D.S.); (M.S.V.); (M.N.D.S.)
- Correspondence: ; Tel.: +381-658080877
| | - Milos Z. Milosavljevic
- Department of Pathology, University Medical Centre Kragujevac, 34000 Kragujevac, Serbia; (M.Z.M.); (D.B.M.)
| | - Milena B. Ilic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.V.J.); (M.B.I.); (V.D.S.); (M.S.V.); (M.N.D.S.)
| | - Vesna D. Stankovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.V.J.); (M.B.I.); (V.D.S.); (M.S.V.); (M.N.D.S.)
| | - Milena S. Vuletic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.V.J.); (M.B.I.); (V.D.S.); (M.S.V.); (M.N.D.S.)
| | - Milica N. Dimitrijevic Stojanovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.V.J.); (M.B.I.); (V.D.S.); (M.S.V.); (M.N.D.S.)
| | - Danijela B. Milosev
- Department of Pathology, University Medical Centre Kragujevac, 34000 Kragujevac, Serbia; (M.Z.M.); (D.B.M.)
| | - Goran L. Azanjac
- Department of Plastic Surgery, University Medical Centre Kragujevac, 34000 Kragujevac, Serbia;
| | - Vladica M. Nedeljkovic
- Institute of Pathology, Faculty of Medicine, University in Pristina—Kosovska Mitrovica,38220 Kosovska Mitrovica, Serbia;
| | - Dragce Radovanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
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272
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Matute G, Barcenas L, Bautista C, Restrepo Ramirez CA, Llinas Quintero N. Tall Cell Carcinoma With Reversed Polarity of the Breast. Cureus 2021; 13:e16814. [PMID: 34522474 PMCID: PMC8424973 DOI: 10.7759/cureus.16814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/23/2022] Open
Abstract
Tall cell carcinoma with reversed polarity (TCCRP) of the breast is a rare entity with low potential for malignancy that exhibits some morphological similarities to the tall cell variant of papillary thyroid carcinoma. Immunohistochemical and molecular studies help establish the mammary origin of this neoplasm. Here, we describe the case of a 63-year-old woman with a finding of a nodular lesion during a screening mammogram, whose morphological findings and immunohistochemical studies confirmed the diagnosis of papillary high cell carcinoma with the reverse polarity of the mammary gland.
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Affiliation(s)
| | - Linda Barcenas
- Pathology and Laboratory Medicine, National University of Colombia, Bogotá, COL
| | - Carolina Bautista
- Pathology, Fundación Universitaria Ciencias de la Salud, Bogotá, COL
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273
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Bièche I, Coussy F, El-Botty R, Vacher S, Château-Joubert S, Dahmani A, Montaudon E, Reyes C, Gentien D, Reyal F, Ricci F, Nicolas A, Marchio C, Vincent-Salomon A, Laé M, Marangoni E. HRAS is a therapeutic target in malignant chemo-resistant adenomyoepithelioma of the breast. J Hematol Oncol 2021; 14:143. [PMID: 34496925 PMCID: PMC8424935 DOI: 10.1186/s13045-021-01158-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022] Open
Abstract
Malignant adenomyoepithelioma (AME) of the breast is an exceptionally rare form of breast cancer, with a significant metastatic potential. Chemotherapy has been used in the management of advanced AME patients, however the majority of treatments are not effective. Recent studies report recurrent mutations in the HRAS Q61 hotspot in small series of AMEs, but there are no preclinical or clinical data showing H-Ras protein as a potential therapeutic target in malignant AMEs. We performed targeted sequencing of tumours’ samples from new series of 13 AMEs, including 9 benign and 4 malignant forms. Samples from the breast tumour and the matched axillary metastasis of one malignant HRAS mutated AME were engrafted and two patient-derived xenografts (PDX) were established that reproduced the typical AME morphology. The metastasis-derived PDX was treated in vivo by different chemotherapies and a combination of MEK and BRAF inhibitors (trametinib and dabrafenib). All malignant AMEs presented a recurrent mutation in the HRAS G13R or G12S hotspot. Mutation of PIK3CA were found in both benign and malignant AMEs, while AKT1 mutations were restricted to benign AMEs. Treatment of the PDX by the MEK inhibitor trametinib, resulted in a marked anti-tumor activity, in contrast to the BRAF inhibitor and the different chemotherapies that were ineffective. Overall, these findings further expand on the genetic features of AMEs and suggest that patients carrying advanced HRAS-mutated AMEs could potentially be treated with MEK inhibitors.
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Affiliation(s)
- Ivan Bièche
- Genetics Department, Institut Curie, University of Paris, Paris, France.,Department of Diagnostic and Theranostic Medicine Paris, University of Paris, Paris, France.,INSERM U1016, Institut Cochin, Paris, France
| | - Florence Coussy
- Medical Oncology Department, Institut Curie, PSL Research University, Paris, France
| | - Rania El-Botty
- Translational Research Department, Institut Curie, PSL Research University, 26 Rue d'Ulm, 75005, Paris, France
| | - Sophie Vacher
- Genetics Department, Institut Curie, University of Paris, Paris, France.,Department of Diagnostic and Theranostic Medicine Paris, University of Paris, Paris, France
| | | | - Ahmed Dahmani
- Translational Research Department, Institut Curie, PSL Research University, 26 Rue d'Ulm, 75005, Paris, France
| | - Elodie Montaudon
- Translational Research Department, Institut Curie, PSL Research University, 26 Rue d'Ulm, 75005, Paris, France
| | - Cécile Reyes
- Translational Research Department, Institut Curie, PSL Research University, 26 Rue d'Ulm, 75005, Paris, France
| | - David Gentien
- Translational Research Department, Institut Curie, PSL Research University, 26 Rue d'Ulm, 75005, Paris, France
| | - Fabien Reyal
- Surgery Department, Institut Curie, PSL Research University, Paris, France.,INSERM U932, Immunity and Cancer, Institut Curie, Paris, France
| | - Francesco Ricci
- Medical Oncology Department, Institut Curie, PSL Research University, Paris, France
| | - André Nicolas
- Pathex, Institut Curie, PSL Research University, Paris, France
| | - Caterina Marchio
- Institut Curie, Pathology Department, PSL Research University, Paris, France.,Pathology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Marick Laé
- Pathology Department, Centre Henri Becquerel, INSERM U1245, Université Rouen Normandie, Rouen, France
| | - Elisabetta Marangoni
- Translational Research Department, Institut Curie, PSL Research University, 26 Rue d'Ulm, 75005, Paris, France.
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274
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An JK, Woo JJ, Kim EK, Kwak HY. Breast adenoid cystic carcinoma arising in microglandular adenosis: A case report and review of literature. World J Clin Cases 2021; 9:7579-7587. [PMID: 34616829 PMCID: PMC8464440 DOI: 10.12998/wjcc.v9.i25.7579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/13/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast adenoid cystic carcinoma (AdCC) is a rare invasive carcinoma composed of epithelial and myoepithelial cells. Microglandular adenosis (MGA) is a rare benign proliferative lesion consisting of small, uniform, and round glands formed by a single layer of epithelial cells and basement membrane without a myoepithelial cell layer. MGA may progress to atypical MGA and carcinoma arising in MGA. Among various invasive carcinomas from MGA, AdCC has been rarely reported. Here, we report a case of AdCC arising in MGA.
CASE SUMMARY A 59-year-old woman was diagnosed with a newly developed density on a routine mammogram. The density was similar to or slightly lower than that of the breast parenchyma. Sonography showed an irregular mass with a slightly higher echo than that of fat. Magnetic resonance imaging showed an irregular mass with a similar T1 signal intensity and a slightly higher T2 signal intensity compared to muscles or the breast parenchyma. The lesion showed heterogeneous internal enhancement with an initially slow and delayed persistent enhancing pattern. Microscopically, the tumor was composed of invasive AdCC, in situ AdCC, and MGA. AdCC is composed of basaloid and ductal epithelial cells forming cribriform or solid sheets, or haphazardly scattered small cribriform or tubular glands. MGA showed small glands with a single epithelial lining and retained lumen. S-100 staining was strongly positive in MGA area. The patient underwent breast-conserving surgery with sentinel lymph node biopsy.
CONCLUSION Breast AdCC arising in MGA showed unique imaging findings that was different from usual invasive cancer.
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Affiliation(s)
- Jin Kyung An
- Department of Radiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, South Korea
| | - Jeong Joo Woo
- Department of Radiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, South Korea
| | - Eun Kyung Kim
- Department of Pathology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, South Korea
| | - Hee Yong Kwak
- Department of Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, South Korea
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275
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The Prognostic Significance of MACC1 Expression in Breast Cancer and Its Relationship to Immune Cells in the Tumor Microenvironment and Patient Survival. ACTA ACUST UNITED AC 2021; 57:medicina57090934. [PMID: 34577857 PMCID: PMC8466860 DOI: 10.3390/medicina57090934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 01/07/2023]
Abstract
Breast cancer (BC) is one of the most prevalent malignancies among females worldwide. Globally, distant metastases were reported to be responsible for a large proportion of breast cancer-related deaths. The metastasis-associated colon cancer-1 (MACC1) gene was reported as a reliable biomarker for early detection of metastasis and prediction of prognosis of breast cancer. This study investigated the prognostic significance of MACC1 in breast cancer in relation to the clinicopathologic characteristics and patients’ survival. Furthermore, the possible correlation between MACC1 expression and the different immune cells in the tumor microenvironment was explored. MACC1 mRNA was identified using quantitative reverse transcription polymerase chain reaction in 120 breast cancer specimens and adjacent non-cancerous tissues. MACC1 mRNA expression was significantly higher in the cancerous relative to the non-cancerous tissues (p < 0.001). High MACC1 expression was significantly associated with poor prognostic parameters, such as larger tumor size, grade III tumors, positive nodal metastasis, lymphovascular invasion, stage III tumors, and elevated Ki-67 expression. Higher MACC1 mRNA levels were positively correlated with CD163+ tumor-associated macrophages (r = 0.614, p < 0.001), and were negatively correlated with CD56+ natural killer cells (r = −0.398, p < 0.001) and CD8+ cytotoxic T lymphocytes (r = −0.323, p < 0.001). MACC1 expression was associated with poor patient overall survival (OS) and progression-free survival (PFS) (p < 0.001). Multivariate analysis suggested that MACC1 expression and the presence of lymphovascular invasion could be independent prognostic indicators for breast cancer (p = 0.015 and 0.042, respectively). In conclusion, MACC1 is highly expressed in cancerous tissues and is significantly related to poor prognostic factors, overall survival, and progression-free survival. MACC1 may influence infiltration of the immune cells in the tumor microenvironment, enhance immune escape of tumor cells, and may serve as a reliable independent prognostic factor for breast cancer.
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276
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Dasman H, Harahap WA, Khambri D. Analysis Predictors of the Outcome of Adjuvant of Hormone Therapy on Estrogen Receptor-positive Breast Cancer in Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND: An existing study reported variation of the outcome of adjuvant hormone therapy on breast cancer.
AIM: This study aimed to examine predictors of the hormone therapy to the outcome of recurrence-free survival (RFS) of estrogen receptor-positive (ER+) breast cancer.
METHODS: In this cohort study, we followed up 219 eligible breast cancer patients with ER+ who had hormone therapy in 2017–2018. Age of patients, cancer stage, and various histopathology parameters were collected from the medical records, then we followed up with the patients within 2 years (2019–2020) to assess the RFS outcome. Bivariate analysis was conducted to assess the association between the clinicopathology parameters with RFS outcome. Multivariate analysis with logistic regression was also performed to see the dominant predictor. Mediation path analysis was also performed to determine the estimated effect of a predictor on the level of RFS and to see the visualization of the association of predictors with RFS.
RESULTS: Breast cancer RFS was 91.3% within 2 years of hormone therapy. The recurrent rate was only 8.7%, which most of them (68.4%) were local. There was no association of age, lymphovascular invasion (LVI), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status with RFS. Based on the molecular subtype, the RFS was better in luminal A (p = 0.045), and also better gradually in the lower stage (p = 0.001). Multivariate analysis shows that the cancer stage was the dominant predictor of the RFS outcome (p = 0.001) with OR = 4.271 (Exp[B] = 1.937–9.417). Mediation analysis also found that there was a positively associated molecular subtype with RFS through cancer stage mediation (r = 16.7%, p = 0.006) but no statistically significant association of age, LVI, PR, and HER2 status (p > 0.005).
CONCLUSION: Cancer stage is the main predictor of RFS of hormone therapy outcome. Luminal A is most also likely to have a better outcome of RFS, especially mediated by the lower stage.
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277
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Lashen A, Ibrahim A, Katayama A, Ball G, Mihai R, Toss M, Rakha E. Visual assessment of mitotic figures in breast cancer: a comparative study between light microscopy and whole slide images. Histopathology 2021; 79:913-925. [PMID: 34455620 DOI: 10.1111/his.14543] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/24/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Visual assessment of mitotic figures in breast cancer (BC) remains a challenge. This is expected to be more pronounced in the digital pathology era. This study aims to refine the criteria of mitotic figure recognition, particularly in whole slide images (WSI). METHOD AND RESULTS Haematoxylin and eosin (H&E)-stained BC sections (n = 506) were examined using light microscopy (LM) and WSI. A set of features for identifying mitosis in WSI and to distinguish true figures from mimickers was developed. Changes in the mitotic count between the two platforms was explored. Morphological features of mitoses were recorded separately, including absence of nuclear membrane, chromatin hairy-like projections, shape, cytoplasmic features, mitotic cell size and relationship to surrounding cells. Each mitotic phase has its own mimickers. Fifty-eight per cent of mitoses showed absent hairy-like projection in WSI; however, 89% retained their ragged nuclear border, which distinguished them from mimickers including apoptotic cells, lymphocytes and dark elongated hyperchromatic structures. Mitosis in WSI showed loss of fine details, and there was a 20% average reduction rate of mitotic counts when compared to the same area on LM. Using refined mitosis recognition criteria in WSI resulted in a twofold improvement of interobserver concordance. However, when compared to LM, 19% of cases were underscored in WSIs. CONCLUSIONS All morphological features of mitosis should be considered to enable recognition and differentiation from their mimickers, particularly in WSI, to ensure reliable BC grading. Refining mitotic cut-offs per specific area when using WSI, based on the degree of reduction and association with outcome, is warranted.
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Affiliation(s)
- Ayat Lashen
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | - Asmaa Ibrahim
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ayaka Katayama
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK.,Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Graham Ball
- John van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Raluca Mihai
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Michael Toss
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emad Rakha
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
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278
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Saridakis A, Berger ER, Harigopal M, Park T, Horowitz N, Le Blanc J, Zanieski G, Chagpar A, Greenup R, Golshan M, Lannin DR. Apocrine Breast Cancer: Unique Features of a Predominantly Triple-Negative Breast Cancer. Ann Surg Oncol 2021; 28:5610-5616. [DOI: 10.1245/s10434-021-10518-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/01/2021] [Indexed: 12/14/2022]
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279
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Cerimele F, Tagliati C, Salvatori F, Baldassarre S, Di Martino A, Calamita V, Pressanti GL, Mingliang Y, Giuseppetti GM, Giovagnoni A. Invasive ductal carcinoma mammographic findings: Correlation with age, breast composition and tumor size. Breast Dis 2021; 41:45-49. [PMID: 34397397 DOI: 10.3233/bd-201072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to identify the mammographic findings associated with malignancy in different age groups, taking into account breast composition (BC) and lesion size. METHODS Preoperative mammograms of 1023 invasive ductal carcinomas were retrospectively evaluated. According to the American College of Radiology Breast Imaging Reporting and Data System, cancer mammographic findings were classified as mass, calcifications, architectural distortion and asymmetry, and breasts were assessed as non-dense (A or B BC) and dense (C or D BC). Patient cohort was subdivided into three age groups (group 1: <50 years of age; group 2: between 50 and 69; group 3: ≥70 years of age). RESULTS Significant results of multinomial logistic regression were the association between mass and non-dense breast (p < 0.0001) and the association between mass and tumor size larger than 15 mm (p = 0.0049). CONCLUSIONS Mass finding of invasive ductal breast carcinoma is associated with breast composition and tumor size.
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Affiliation(s)
- Federico Cerimele
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | | | - Fabio Salvatori
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Silvia Baldassarre
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | | | | | | | - Ying Mingliang
- Department of Radiology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, China
| | - Gian Marco Giuseppetti
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Giovagnoni
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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280
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Establishment and characterization of NCC-MFS4-C1: a novel patient-derived cell line of myxofibrosarcoma. Hum Cell 2021; 34:1911-1918. [PMID: 34383271 DOI: 10.1007/s13577-021-00589-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/01/2021] [Indexed: 02/07/2023]
Abstract
Myxofibrosarcoma (MFS) is an aggressive sarcoma with a highly complex karyotype. Complete resection is the only curative treatment for MFS because it is refractory to chemotherapy. To improve clinical outcomes, it is critical to develop novel treatments for MFS. Although patient-derived cell lines play a key role in cancer research, only 12 MFS cell lines have been reported to date, and considering the diversity of the disease, more cell lines need to be established. Hence, in the present study, we established a novel MFS cell line, NCC-MFS4-C1, using a surgically resected tumor tissue from a patient with MFS. NCC-MFS4-C1 cells exhibited copy number alterations similar to those of the original tumors and showed constant proliferation, spheroid formation, and aggressive invasion. By screening a drug library, we found that actinomycin D, bortezomib, docetaxel, eribulin, and romidepsin significantly reduced the proliferation of NCC-MFS4-C1 cells. Therefore, the NCC-MFS4-C1 cell line may be a useful resource for researching MFS.
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281
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Effective Treatment for Primary Locally Aggressive Intermediate and Malignant Soft Tissue Tumors of the Breast. Int Surg 2021. [DOI: 10.9738/intsurg-d-21-00018.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
This study aimed to examine the rare locally aggressive intermediate tumors and malignant primary breast mesenchymal tumors in patients receiving surgical treatment.
Summary of background data
Locally aggressive intermediate tumors were subdivided into nonmetastasizing and rarely metastasizing, and the malignant group was subdivided as a single subgroup called able to metastasize. A retrospective examination of surgical notes and clinical charts was carried out reviewing gender, age, symptoms, duration of symptoms, tumor size, clinical presentation, radiation history, kind of surgery undergone, adjuvant radiotherapy, adjuvant chemotherapy, local recurrences, systemic metastases, and mortality.
Results
Mitotic index and Ki-67 were statistically different between locally aggressive and malignant groups (P < 0.001). One local recurrence occurred in only 1 patient diagnosed as dermatofibrosarcoma protuberans among all patients. None of the entities showed distant metastasis or mortality. In this result, clear margin of surgery in locally aggressive intermediate group and combination of surgery with radiation therapy in the malignant group was the most important determinant for the prospect of the patients with mean follow-up of 28 months.
Conclusion
The main treatment for localized mesenchymal breast tumors is surgery. When the disease is locally advanced or malignant with high mitotic index, radiotherapy with surgery is predominantly used. Targeted therapies are promising with the limited place of chemotherapy.
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282
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Masab M, Gross A, Flanagan M, Goldberg R, Malla M. Neuroendocrine Neoplasm of the Breast Presenting as a Liver Metastasis: A Rare Diagnostic Challenge. Cureus 2021; 13:e16860. [PMID: 34513437 PMCID: PMC8413109 DOI: 10.7759/cureus.16860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/05/2022] Open
Abstract
We present a case of a 58-year-old female who presented initially to an outside institution with abdominal pain and was diagnosed on liver biopsy with a well-differentiated neuroendocrine tumor of an unknown primary source. She was referred to our academic institution for a second opinion after disease progression on the initial chemotherapy regimen. Through additional evaluation, diagnostics, and multi-disciplinary tumor board discussion she was diagnosed with metastases from a well-differentiated neuroendocrine neoplasm of the breast (NENB). Consequently, her treatment plan was modified leading to significant clinical and radiological improvement.
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Affiliation(s)
- Muhammad Masab
- Hematology and Medical Oncology, West Virginia University, Morgantown, USA
| | - Alexander Gross
- Pathology and Laboratory Medicine, West Virginia University, Morgantown, USA
| | - Melina Flanagan
- Pathology and Laboratory Medicine, West Virginia University, Morgantown, USA
| | - Richard Goldberg
- Hematology and Medical Oncology, West Virginia University, Morgantown, USA
| | - Midhun Malla
- Hematology and Medical Oncology, West Virginia University, Morgantown, USA
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283
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Bikiewicz A, Banach M, von Haehling S, Maciejewski M, Bielecka‐Dabrowa A. Adjuvant breast cancer treatments cardiotoxicity and modern methods of detection and prevention of cardiac complications. ESC Heart Fail 2021; 8:2397-2418. [PMID: 33955207 PMCID: PMC8318493 DOI: 10.1002/ehf2.13365] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/24/2022] Open
Abstract
The most common cancer diagnosis in female population is breast cancer, which affects every year about 2.0 million women worldwide. In recent years, significant progress has been made in oncological therapy, in systemic treatment, and in radiotherapy of breast cancer. Unfortunately, the improvement in the effectiveness of oncological treatment and prolonging patients' life span is associated with more frequent occurrence of organ complications, which are side effects of this treatment. Current recommendations suggest a periodic monitoring of the cardiovascular system in course of oncological treatment. The monitoring includes the assessment of occurrence of risk factors for cardiovascular diseases in combination with the evaluation of the left ventricular systolic function using echocardiography and electrocardiography as well as with the analysis of the concentration of cardiac biomarkers. The aim of this review was critical assessment of the breast cancer therapy cardiotoxicity and the analysis of methods its detections. The new cardio-specific biomarkers in serum, the development of modern imaging techniques (Global Longitudinal Strain and Three-Dimensional Left Ventricular Ejection Fraction) and genotyping, and especially their combined use, may become a useful tool for identifying patients at risk of developing cardiotoxicity, who require further cardiovascular monitoring or cardioprotective therapy.
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Affiliation(s)
- Agata Bikiewicz
- Heart Failure Unit, Department of Cardiology and Congenital Diseases of AdultsPolish Mother's Memorial Hospital Research Institute (PMMHRI)Rzgowska 281/289Lodz93‐338Poland
- Department of Hypertension, Chair of Nephrology and HypertensionMedical University of LodzLodzPoland
| | - Maciej Banach
- Heart Failure Unit, Department of Cardiology and Congenital Diseases of AdultsPolish Mother's Memorial Hospital Research Institute (PMMHRI)Rzgowska 281/289Lodz93‐338Poland
- Department of Hypertension, Chair of Nephrology and HypertensionMedical University of LodzLodzPoland
| | - Stephan von Haehling
- Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), partner site GöttingenUniversity Medical Center Göttingen (UMG)GöttingenGermany
| | - Marek Maciejewski
- Department of Cardiology and Congenital Diseases of AdultsPolish Mother's Memorial Hospital Research Institute (PMMHRI)LodzPoland
| | - Agata Bielecka‐Dabrowa
- Heart Failure Unit, Department of Cardiology and Congenital Diseases of AdultsPolish Mother's Memorial Hospital Research Institute (PMMHRI)Rzgowska 281/289Lodz93‐338Poland
- Department of Hypertension, Chair of Nephrology and HypertensionMedical University of LodzLodzPoland
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Emens LA, Adams S, Cimino-Mathews A, Disis ML, Gatti-Mays ME, Ho AY, Kalinsky K, McArthur HL, Mittendorf EA, Nanda R, Page DB, Rugo HS, Rubin KM, Soliman H, Spears PA, Tolaney SM, Litton JK. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of breast cancer. J Immunother Cancer 2021; 9:e002597. [PMID: 34389617 PMCID: PMC8365813 DOI: 10.1136/jitc-2021-002597] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/17/2022] Open
Abstract
Breast cancer has historically been a disease for which immunotherapy was largely unavailable. Recently, the use of immune checkpoint inhibitors (ICIs) in combination with chemotherapy for the treatment of advanced/metastatic triple-negative breast cancer (TNBC) has demonstrated efficacy, including longer progression-free survival and increased overall survival in subsets of patients. Based on clinical benefit in randomized trials, ICIs in combination with chemotherapy for the treatment of some patients with advanced/metastatic TNBC have been approved by the United States (US) Food and Drug Administration (FDA), expanding options for patients. Ongoing questions remain, however, about the optimal chemotherapy backbone for immunotherapy, appropriate biomarker-based selection of patients for treatment, the optimal strategy for immunotherapy treatment in earlier stage disease, and potential use in histological subtypes other than TNBC. To provide guidance to the oncology community on these and other important concerns, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew upon the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for breast cancer, including diagnostic testing, treatment planning, immune-related adverse events (irAEs), and patient quality of life (QOL) considerations. The evidence-based and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers treating patients with breast cancer.
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Affiliation(s)
- Leisha A Emens
- Department of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sylvia Adams
- Perlmutter Cancer Center, New York University Langone, New York, New York, USA
| | - Ashley Cimino-Mathews
- Department of Pathology and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary L Disis
- Cancer Vaccine Institute, University of Washington, Seattle, Washington, USA
| | - Margaret E Gatti-Mays
- Pelotonia Institute for Immuno-Oncology, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Alice Y Ho
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin Kalinsky
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | | | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Breast Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Rita Nanda
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago Medicine Comprehensive Cancer Center, Chicago, Illinois, USA
| | - David B Page
- Earle A Chiles Research Institute, Portland, Oregon, USA
| | - Hope S Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Krista M Rubin
- Center for Melanoma, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Hatem Soliman
- Department of Breast Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Patricia A Spears
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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285
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Invasive lobular carcinoma mammographic findings: correlation with age, breast composition, and tumour size. Pol J Radiol 2021; 86:e353-e358. [PMID: 34322184 PMCID: PMC8297481 DOI: 10.5114/pjr.2021.107426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of this study was to evaluate mammographic findings associated with invasive lobular carcinoma in different age groups, taking into account breast composition and tumour size. Material and methods A total of 1023 invasive lobular carcinoma preoperative mammograms were evaluated. According to the American College of Radiology Breast Imaging Reporting and Data System, cancer mammographic findings were classified as mass, calcifications, architectural distortion, and asymmetry, and breasts were assessed as dense (C or D breast composition) or non-dense (A or B). The patient cohort was subdivided into 3 age groups (< 50, 50-69, ≥ 70 years of age). In order to make the size and age groups dichotomous variables and to perform multiple regression analysis, a cut-off of 10 mm was chosen for tumour size, and < 50-years-old and 50-69-years-old age groups were grouped together (< 70-years-old age group). Results Significant results of multivariate analysis were the association between mass finding and non-dense breasts and size ≥ 10 mm (p < 0.0001), between calcifications, and dense breasts, size < 10 mm and < 70-years-old age group (p < 0.0001), between distortion and < 70-years-old age group (p = 0.0366), and between asymmetry and ≥ 70-years-old age group (p = 0.0090). Conclusions Various mammographic findings are differently associated with age group, breast composition, and tumour size.
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286
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Loi S, Michiels S, Adams S, Loibl S, Budczies J, Denkert C, Salgado R. The journey of tumor-infiltrating lymphocytes as a biomarker in breast cancer: clinical utility in an era of checkpoint inhibition. Ann Oncol 2021; 32:1236-1244. [PMID: 34311075 DOI: 10.1016/j.annonc.2021.07.007] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/15/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022] Open
Abstract
In 2014, we described a method to quantify percentage of tumor-infiltrating lymphocytes (TILs) on hematoxylin and eosin-stained slides of breast cancer samples using light microscopy that could be performed easily by pathologists with no extra stains. The aim of detailing the method was to facilitate independent research groups replicating our prognostic findings using TIL quantity in early-stage breast cancers. A global working group of breast pathologists was convened to standardize, test reproducibility, and refine the method. A website was also established which allowed free training (www.tilsinbreastcancer.org). As a result of this work, TIL data have been collected in over 20 000 primary breast cancer samples worldwide and the robust associations with better prognoses in triple-negative breast cancer (TNBC) and HER2+ BC have been confirmed. This has resulted in the inclusion of the TIL biomarker in several international breast cancer guidelines as well as in national criteria for routine pathology reporting. TIL therefore represents the first biological prognostic biomarker for early-stage TNBCs, and here its prognostic effect is linear, with values of 30%-50% being suggested as suitable for use in potential chemotherapy de-escalation studies. The efficacy of immune checkpoint-targeted agents in breast cancer now provides direct evidence that host immune responses can modify tumor growth in some patients. With the recent granting of accelerated approvals for the first PD-1/PD-L1 targeting agents in early and advanced TNBC, our focus has now moved to investigating the clinical utility of TIL in the setting of immune checkpoint agents, with or without PD-L1 protein assessment. Emerging data suggest that TIL quantity can help clinicians identify patients with breast cancer who benefit most from PD-1/PD-L1 inhibition. In patients with advanced TNBC and HER2+ disease a TIL cut-off of 5% or 10%, with PD-L1 expression can define 'immune-enriched' tumors and currently seems to have the most clinical relevance in this context.
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Affiliation(s)
- S Loi
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
| | - S Michiels
- Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, University Paris-Saclay, Villejuif, France; Oncostat INSERM U1018, labeled Ligue Contre le Cancer, University Paris-Saclay, Villejuif, France
| | - S Adams
- Perlmutter Cancer Center, New York University School of Medicine, New York, USA
| | - S Loibl
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; German Breast Group, c/o GBG Forschungs GmbH, Frankfurt; Goethe University, Frankfurt
| | - J Budczies
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital Marburg (UK-GM), Marburg, Germany
| | - R Salgado
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
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287
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Bogach J, Shakeel S, Wright FC, Hong NJL. Phyllodes Tumors: A Scoping Review of the Literature. Ann Surg Oncol 2021; 29:446-459. [PMID: 34296360 DOI: 10.1245/s10434-021-10468-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Phyllodes tumors are rare tumors of the breast, with most literature being retrospective with limited guidelines on the management of these patients. Scoping review was performed to highlight themes and gaps in the available literature. METHODS A scoping review of the literature was performed as per PRISMA-ScR guidelines with titles, abstracts, and full texts reviewed in duplicate. Data were abstracted and summarized in categories of diagnostics, surgical management, adjuvant therapies, treatment of recurrence, and surveillance. Quality assessment was performed for each paper. RESULTS The search identified 4498 references, 434 full-text papers were reviewed, and 183 papers were included. Ultrasound, magnetic resonance imaging, and core needle biopsy are valuable preoperative diagnostics tools. Pathology reporting should include stromal overgrowth, stromal cellularity, nuclear atypia, mitotic rate, borders, and presence of heterologous elements. Ki67 may have a role in grading and prognosticating. Breast conservation is safe in all grades of phyllodes but may be associated with increased local recurrence in malignant phyllodes. Surgical margins should depend on grade. Axillary node positivity rate is very low, even with clinically enlarged lymph nodes. Adjuvant radiation is a useful tool to decrease local recurrence in malignant phyllodes tumors, tumors > 5 cm, age < 45 years, close margins, and breast conservation. There is no evidence supporting adjuvant chemotherapy. Recurrence can be managed with repeat wide excision; however, mastectomy is associated with lower re-recurrence. Surveillance protocols are variable in the literature. CONCLUSIONS There is heterogeneity in the literature on phyllodes tumors. Consensus guidelines based on the literature will help provide evidence-based care.
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Affiliation(s)
- Jessica Bogach
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Saad Shakeel
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicole J Look Hong
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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288
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Balachander GM, Kotcherlakota R, Nayak B, Kedaria D, Rangarajan A, Chatterjee K. 3D Tumor Models for Breast Cancer: Whither We Are and What We Need. ACS Biomater Sci Eng 2021; 7:3470-3486. [PMID: 34286955 DOI: 10.1021/acsbiomaterials.1c00230] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Three-dimensional (3D) models have led to a paradigm shift in disease modeling in vitro, particularly for cancer. The past decade has seen a phenomenal increase in the development of 3D models for various types of cancers with a focus on studying stemness, invasive behavior, angiogenesis, and chemoresistance of cancer cells, as well as contributions of its stroma, which has expanded our understanding of these processes. Cancer biology is moving into exploring the emerging hallmarks of cancer, such as inflammation, immune evasion, and reprogramming of energy metabolism. Studies into these emerging concepts have provided novel targets and treatment options such as antitumor immunotherapy. However, 3D models that can investigate the emerging hallmarks are few and underexplored. As commonly used immunocompromised mice and syngenic mice cannot accurately mimic human immunology, stromal interactions, and metabolism and require the use of prohibitively expensive humanized mice, there is tremendous scope to develop authentic 3D tumor models in these areas. Taking the specific case of breast cancer, we discuss the currently available 3D models, their applications to mimic signaling in cancer, tumor-stroma interactions, drug responses, and assessment of drug delivery systems and therapies. We discuss the lacunae in the development of 3D tumor models for the emerging hallmarks of cancer, for lesser-explored forms of breast cancer, and provide insights to develop such models. We discuss how the next generation of 3D models can provide a better mimic of human cancer modeling compared to xenograft models and the scope toward preclinical models and precision medicine.
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Affiliation(s)
- Gowri Manohari Balachander
- Centre for BioSystems Science and Engineering, Indian Institute of Science, Bangalore-560012, India.,Department of Physiology, Yong Loo Lin School of Medicine, National University Health System, MD9-04-11, 2 Medical Drive, Singapore 117593, Singapore
| | - Rajesh Kotcherlakota
- Department of Materials Engineering, Indian Institute of Science, Bangalore-560012, India
| | - Biswadeep Nayak
- Department of Materials Engineering, Indian Institute of Science, Bangalore-560012, India.,Department of Biomedical Engineering, Texas A&M University, College Station, Texas 77843, United States.,Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Bangalore-560012, India
| | - Dhaval Kedaria
- Department of Materials Engineering, Indian Institute of Science, Bangalore-560012, India
| | - Annapoorni Rangarajan
- Centre for BioSystems Science and Engineering, Indian Institute of Science, Bangalore-560012, India.,Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Bangalore-560012, India
| | - Kaushik Chatterjee
- Centre for BioSystems Science and Engineering, Indian Institute of Science, Bangalore-560012, India.,Department of Materials Engineering, Indian Institute of Science, Bangalore-560012, India
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289
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Boland PA, Ali Beegan A, Stokes M, Kell MR, Barry JM, O'Brien A, Walsh SM. Management and outcomes of phyllodes tumours - 10 year experience. Breast Dis 2021; 40:171-176. [PMID: 33749634 DOI: 10.3233/bd-201059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Phyllodes tumours represent 0.3-1% of breast tumours, typically presenting in women aged 35-55 years. They are classified into benign, borderline and malignant grades and exhibit a spectrum of features. There is significant debate surrounding the optimal management of phyllodes tumour, particularly regarding appropriate margins. METHODS This is a retrospective review of a prospectively maintained database of patients who underwent surgical management for phyllodes tumours in a single tertiary referral centre from 2007-2017. Patient demographics, tumour characteristics, surgical treatment and follow-up data were analysed. Tumour margins were classified as positive (0 mm), close (≤2 mm) and clear (>2 mm). RESULTS A total of 57 patients underwent surgical excision of a phyllodes tumour. The Mean age was 37.7 years (range: ages 14-91) with mean follow-up of 38.5 months (range: 0.5-133 months). There were 44 (77%) benign, 4 (7%) borderline and 9 (16%) malignant phyllodes cases. 54 patients had breast conserving surgery (BCS) and 3 underwent mastectomy. 30 (53%) patients underwent re-excision of margins. The final margin status was clear in 32 (56%), close in 13 (23%) and positive in 12 (21%). During follow-up, 4 patients were diagnosed with local recurrence (2 malignant, 1 borderline and 1 benign pathology on recurrence samples). CONCLUSION There are no clear guidelines for the surgical management and follow-up of phyllodes tumours. This study suggests that patients with malignant phyllodes and positive margins are more likely to develop local recurrence. There is a need for large prospective studies to guide the development of future guidelines.
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Affiliation(s)
- Patrick A Boland
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Azlena Ali Beegan
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Maurice Stokes
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Malcolm R Kell
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John M Barry
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Angela O'Brien
- Department of Breast Radiology, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Siun M Walsh
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
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290
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Loap P, Laki F, Beuzeboc P, Fourquet A, Kirova YM. Five-year outcomes in patients treated with surgery and radiotherapy for primary neuroendocrine neoplasm of the breast. Breast J 2021; 27:776-780. [PMID: 34196070 DOI: 10.1111/tbj.14264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Pierre Loap
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Fatima Laki
- Department of Surgery, Institut Curie, Paris, France
| | | | - Alain Fourquet
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Youlia M Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
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291
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Park NJY, Jeong JY, Park JY, Kim HJ, Park CS, Lee J, Park HY, Jung JH, Kim WW, Chae YS, Lee SJ, Kim WH. Peritumoral edema in breast cancer at preoperative MRI: an interpretative study with histopathological review toward understanding tumor microenvironment. Sci Rep 2021; 11:12992. [PMID: 34155253 PMCID: PMC8217499 DOI: 10.1038/s41598-021-92283-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 05/13/2021] [Indexed: 12/12/2022] Open
Abstract
Peritumoral edema (PE) of breast cancer at T2-weighted MR images is considered a poor prognostic sign and may represent the microenvironment surrounding the tumor; however, its histopathological mechanism remains unclear. The purpose of the study was to identify and describe detailed histopathological characteristics associated with PE at preoperative breast MRI in breast cancer patients. This retrospective study included breast cancer patients who had undergone preoperative MRI and surgery between January 2011 and December 2012. Two radiologists determined the presence of PE in consensus based on the signal intensity surrounding the tumor at T2-weighted images. The following detailed histopathological characteristics were reviewed by two breast pathologists using four-tiered grades; lymphovascular invasion, vessel ectasia, stromal fibrosis, growth pattern, and tumor budding. Tumor necrosis and tumor infiltrating lymphocytes were assessed using a percent scale. Baseline clinicopathological characteristics, including age and histologic grade, were collected. The associations between detailed histopathologic characteristics and PE were examined using multivariable logistic regression with odds ratio (OR) calculation. A total of 136 women (median age, 49 ± 9 years) were assessed; among them 34 (25.0%) had PE. After adjustment of baseline clinicopathological characteristics that were significantly associated with PE (age, T stage, N stage, histologic grade, and subtype, all Ps < 0.05), lymphovascular invasion (P = 0.009), vessel ectasia (P = 0.021), stromal fibrosis (P = 0.024), growth pattern (P = 0.036), and tumor necrosis (P < 0.001) were also associated with PE. In comparison with patients without PE, patients with PE were more likely to have a higher degree of lymphovascular invasion (OR, 2.9), vessel ectasia (OR, 3.3), stromal fibrosis (OR, 2.5), lesser degree of infiltrative growth pattern (OR, 0.4), and higher portion of tumor necrosis (OR, 1.4). PE of breast cancer at MRI is associated with detailed histopathological characteristics of lymphovascular invasion, vessel ectasia, stromal fibrosis, growth pattern, and tumor necrosis, suggesting a relevance for tumor microenvironment.
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Affiliation(s)
- Nora Jee-Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Ji Yun Jeong
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Ji Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Hye Jung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Chan Sub Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Jin Hyang Jung
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Wan Wook Kim
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Yee Soo Chae
- Department of Oncology/Hematology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Soo Jung Lee
- Department of Oncology/Hematology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Won Hwa Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea.
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292
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Fortunato A, Mallo D, Rupp SM, King LM, Hardman T, Lo JY, Hall A, Marks JR, Hwang ES, Maley CC. A new method to accurately identify single nucleotide variants using small FFPE breast samples. Brief Bioinform 2021; 22:6296507. [PMID: 34117742 PMCID: PMC8574974 DOI: 10.1093/bib/bbab221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 11/14/2022] Open
Abstract
Most tissue collections of neoplasms are composed of formalin-fixed and paraffin-embedded (FFPE) excised tumor samples used for routine diagnostics. DNA sequencing is becoming increasingly important in cancer research and clinical management; however it is difficult to accurately sequence DNA from FFPE samples. We developed and validated a new bioinformatic pipeline to use existing variant-calling strategies to robustly identify somatic single nucleotide variants (SNVs) from whole exome sequencing using small amounts of DNA extracted from archival FFPE samples of breast cancers. We optimized this strategy using 28 pairs of technical replicates. After optimization, the mean similarity between replicates increased 5-fold, reaching 88% (range 0-100%), with a mean of 21.4 SNVs (range 1-68) per sample, representing a markedly superior performance to existing tools. We found that the SNV-identification accuracy declined when there was less than 40 ng of DNA available and that insertion-deletion variant calls are less reliable than single base substitutions. As the first application of the new algorithm, we compared samples of ductal carcinoma in situ of the breast to their adjacent invasive ductal carcinoma samples. We observed an increased number of mutations (paired-samples sign test, P < 0.05), and a higher genetic divergence in the invasive samples (paired-samples sign test, P < 0.01). Our method provides a significant improvement in detecting SNVs in FFPE samples over previous approaches.
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Affiliation(s)
- Angelo Fortunato
- Arizona Cancer Evolution Center, Arizona State University, 1001 S. McAllister Ave., Tempe, AZ, 85287, USA.,Biodesign Center for Biocomputing, Security and Society, Arizona State University, 727 E. Tyler St., Tempe, AZ 85281 USA.,School of Life Sciences, Arizona State University, 427 East Tyler Mall, Tempe, AZ 85287, USA
| | - Diego Mallo
- Arizona Cancer Evolution Center, Arizona State University, 1001 S. McAllister Ave., Tempe, AZ, 85287, USA.,Biodesign Center for Biocomputing, Security and Society, Arizona State University, 727 E. Tyler St., Tempe, AZ 85281 USA.,School of Life Sciences, Arizona State University, 427 East Tyler Mall, Tempe, AZ 85287, USA
| | - Shawn M Rupp
- Arizona Cancer Evolution Center, Arizona State University, 1001 S. McAllister Ave., Tempe, AZ, 85287, USA.,Biodesign Center for Biocomputing, Security and Society, Arizona State University, 727 E. Tyler St., Tempe, AZ 85281 USA
| | | | | | - Joseph Y Lo
- Department of Radiology, Duke University, Durham, NC, USA
| | - Allison Hall
- Department of Pathology, Duke University, Durham, NC, USA
| | | | | | - Carlo C Maley
- Arizona Cancer Evolution Center, Arizona State University, 1001 S. McAllister Ave., Tempe, AZ, 85287, USA.,Biodesign Center for Biocomputing, Security and Society, Arizona State University, 727 E. Tyler St., Tempe, AZ 85281 USA.,School of Life Sciences, Arizona State University, 427 East Tyler Mall, Tempe, AZ 85287, USA
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293
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Atchison L, Hardy T, Mancl T, Quaranta BP, Madan A. Locally Advanced Primary Small Cell Carcinoma of the Breast: A Case Report and Review of Current Evidence. Case Rep Oncol 2021; 14:761-766. [PMID: 34177527 PMCID: PMC8215941 DOI: 10.1159/000515505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 12/22/2022] Open
Abstract
Small-cell breast carcinoma (SCBC) is a very rare type of aggressive breast cancer constituting less than 1% of all breast cancers. The WHO classification categorizes this tumor as small-cell neuroendocrine carcinoma, and its prognosis is usually worse as compared to invasive breast cancers. We report a 64-year-old Caucasian female who presented with a large fungating left breast mass. Biopsy of the mass revealed small-cell carcinoma of the breast, negative for all 3 receptors (estrogen, progesterone, and Her2/neu). Imaging studies were negative for distant metastasis. She was subsequently treated after multidisciplinary discussion utilizing neoadjuvant chemotherapy with platinum agents and etoposide, modified radical mastectomy with axillary lymph node dissection, and adjuvant radiation therapy. Since she has triple-negative small-cell breast cancer, she will be followed with active surveillance without hormonal therapy. With less than 100 cases reported and in the absence of evidence-based standard treatment guidelines, we have reviewed various case series reported in the literature. We further discuss various chemotherapy regimens used previously, adverse prognostic factors of breast neuroendocrine tumors, common receptor status, and genetic mutations found in SCBC.
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Affiliation(s)
- Linsey Atchison
- Department of Internal Medicine Residency, SOVAH, Danville, Virginia, USA
| | - Thomas Hardy
- Department of Pathology, SOVAH, Danville, Virginia, USA
| | - Tara Mancl
- Department of General Surgery, SOVAH, Danville, Virginia, USA
| | | | - Ankit Madan
- Department of Internal Medicine, Medical Oncology, SOVAH, Danville, Virginia, USA
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294
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Liu X, Huang X, Bai Y, Zhang Z, Jin T, Wu H, Liang Z. Next-generation sequencing revealed recurrent ZFPM1 mutations in encapsulated papillary carcinoma of the breast. NPJ Precis Oncol 2021; 5:42. [PMID: 34007008 PMCID: PMC8131604 DOI: 10.1038/s41698-021-00180-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 04/21/2021] [Indexed: 02/03/2023] Open
Abstract
Encapsulated papillary carcinoma (EPC) of the breast is a rare subtype of tumor. To date, the genetic abnormalities underlying EPC remain elusive. The purpose of this study was to gain further insight into EPC mutation profile. Forty-one EPCs diagnosed from 2015 to 2018 were included. Twenty-six EPCs were submitted to whole-exome sequencing (WES), and a 185 gene-targeted sequencing panel was designed to validate the results of the 26 EPCs that underwent WES and 15 additional cases. Recurrently mutated genes were further confirmed by Sanger sequencing. Our study revealed multiple recurrently mutated genes including PI3K-AKT-mTOR pathway genes (PIK3CA, AKT1, ULK1, MAP3K1, MAP2K4, RHOA, and PTEN) (27/41, 65.8%) and chromatin modification genes (ZFPM1, GATA3, CTCF, and KMT2C) (21/41, 51.2%) in EPC. Importantly, somatic ZFPM1 mutations existed in 9/41 (21.9%) of the EPCs. The frequency of ZFPM1 mutations in the EPCs was significantly higher than that of other tumor types. Of the nine ZFPM1 mutations, seven were frameshift mutations, and the remaining two were nonsense mutations. Moreover, a significant concurrence of ZFPM1 and PI3K-AKT-mTOR mutations were revealed in the EPCs. Of note, no TP53 mutations were detected in our EPCs, whereas it was detected in a considerable proportion of the luminal A invasive ductal carcinomas of no special type (IDC-NSTs) from TCGA. We reveal that recurrent somatic ZFPM1 mutation is characteristic of EPC and concurred with mutations in the PI3K-AKT-mTOR pathway. The distinctive genetic features of EPC might underlie its special histological structures and indolent behavior.
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Affiliation(s)
- Xuguang Liu
- Department of Pathology, Complex Severe and Rare Disease, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Huang
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yan Bai
- Department of Pathology, Complex Severe and Rare Disease, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiwen Zhang
- Department of Pathology, Complex Severe and Rare Disease, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tiefeng Jin
- Department of Pathology and Cancer Research Center, Yanbian University Medical College, Yanji, China
| | - Huanwen Wu
- Department of Pathology, Complex Severe and Rare Disease, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Zhiyong Liang
- Department of Pathology, Complex Severe and Rare Disease, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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295
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Erices-Leclercq M, Lubig S, Förster F, Förster R, Baldus S, Rudlowski C, Schröder L. Prognostic relevance of Ki67 expression in primary male breast cancer: determination of cut-off points by different evaluation methods and statistical examinations. J Cancer Res Clin Oncol 2021; 148:441-447. [PMID: 33991247 DOI: 10.1007/s00432-021-03623-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE 1% of all breast cancer cases occur in men. There are significant differences regarding clinical behaviour and genetic profiles between female (FBC) and male breast cancer (MBC). Parameters for decision-making on treatment and prognosis are derived from FBC. Ki67 has a high value as a prognostic and predictive factor in FBC, but accurate Ki67 cut-off points for MBC are missing. In this study, we aimed to evaluate adequate examination methods and reliable cut-off points for Ki67 to assess the highest prognostic value for patient's overall survival (OS). METHODS In this multicentric retrospective study, histological specimens were obtained from 104 male patients who were diagnosed and treated for primary invasive breast cancer. We applied three methods of Ki67 analysis: Tumor average scoring (TA), tumor border scoring (TB) and hot-spot scoring (HS). Calculated Ki67 cut-off points for each method were assessed as a threshold for patients' overall survival (OS). RESULTS Ki67 cut-off points were 13.5 for the TA group, 22.5 for the HS group and 17.5 for the TB group. Only Ki67 TA cut-off calculations demonstrated statistical significance (p = 0.04). Ki67 expression analysis of TA showed that more than 90% of patients with low Ki67 levels (< 13.5) were alive after 5-year follow-up. CONCLUSION Our findings demonstrate that determination of Ki67 expression in TA is the most reliable to define a cut-off point with high prognostic value. A Ki67 cut-off point of 13.5 shows highest statistical power to define luminal A subgroup and OS.
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Affiliation(s)
- Melanie Erices-Leclercq
- Department of Breast Cancer, Lutherian Hospital, Ferrenbergstr.24, 51465, Bergisch Gladbach, Germany
| | - Sabine Lubig
- Department of Breast Cancer, Lutherian Hospital, Ferrenbergstr.24, 51465, Bergisch Gladbach, Germany
| | - Frank Förster
- Department of Economical Sciences, University of Applied Sciences, Zwickau, Germany.,Outpatient Department of Gynecological Oncology and Palliative Care, Poliklinik GmbH, Chemnitz, Germany
| | - Robert Förster
- Institute for Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Stefan Baldus
- Institute for Pathology, Cytology and Molecular Pathology, Bergisch Gladbach, Germany
| | - Christian Rudlowski
- Department of Breast Cancer, Lutherian Hospital, Ferrenbergstr.24, 51465, Bergisch Gladbach, Germany. .,Medical Faculty, University Hospital Bonn, Bonn, Germany.
| | - Lars Schröder
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, Cologne, Germany
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296
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Lin S, Cao Y, Chen L, Chen M, Zhang S, Jia X. Contrast-enhanced ultrasound of breast fibromatosis: a case report. J Int Med Res 2021; 49:3000605211010619. [PMID: 33978517 PMCID: PMC8120548 DOI: 10.1177/03000605211010619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We herein present a rare case of breast fibromatosis, the contrast-enhanced ultrasonography (CEUS) findings of which we believe have never been described. The high similarity between the clinical and imaging manifestations of breast cancer makes its differential diagnosis difficult. In this report, we describe the CEUS findings of a less common type of fibromatosis, discuss the potential value of CEUS to differentiate it from malignant breast lesions, and briefly review the literature.
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Affiliation(s)
- Shanhong Lin
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Yong Cao
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Libin Chen
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Mei Chen
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Shengmin Zhang
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Xiupeng Jia
- Ningbo Clinical Pathological Diagnosis Center, Ningbo, China
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297
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Tian Y, Liu L, Chen L, Zhao S, Su R, Zhang W, Jiang A, Chen W, Ge F. Preoperative interventional artery embolization for the treatment of a giant malignant phyllodes tumor: A case report. Mol Clin Oncol 2021; 15:133. [PMID: 34055348 PMCID: PMC8138852 DOI: 10.3892/mco.2021.2295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 04/01/2021] [Indexed: 12/14/2022] Open
Abstract
Phyllodes tumors (PTs) are rare but complex fibroepithelial lesions of the breast. The present report describes an unusual case of a giant malignant PT with a rich blood supply treated with dominant blood supply internal thoracic artery interventional embolization before surgery. A 41-year-old woman without underlying systemic disease presented with a tumor >20 cm in diameter growing rapidly in the left breast. Radiological results indicated a giant circular tumor with a clear boundary occupying the whole breast, possible invasion of the major pectoralis muscle and several enlarged lymph nodes in the left axillary region. Computed tomography angiography showed a large mass with a rich and powerful blood vessel supply and preoperative interventional embolization was performed to block the internal thoracic artery. Three days after artery embolization, mastectomy and grade I axillary lymph node dissection were performed. The giant tumor measured 17x16x11 cm. The surgery successfully treated the pain and tumor necrosis and the patient received chemotherapy and local radiotherapy. No recurrence was found at the 14-month follow-up.
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Affiliation(s)
- Yue Tian
- No. 1 School of Clinical Medicine, Kunming Medical University, Kunming, Yunnan 650032, P.R. China.,First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Linlin Liu
- School of Forensic Medicine, Kunming Medical University, Kunming, Yunnan 650118, P.R. China
| | - Liang Chen
- First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Shengdi Zhao
- No. 1 School of Clinical Medicine, Kunming Medical University, Kunming, Yunnan 650032, P.R. China.,First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Ruijun Su
- No. 1 School of Clinical Medicine, Kunming Medical University, Kunming, Yunnan 650032, P.R. China.,First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Wenzhu Zhang
- No. 1 School of Clinical Medicine, Kunming Medical University, Kunming, Yunnan 650032, P.R. China.,First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Aimei Jiang
- No. 1 School of Clinical Medicine, Kunming Medical University, Kunming, Yunnan 650032, P.R. China.,First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Wenlin Chen
- The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650118, P.R. China
| | - Fei Ge
- First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
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298
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Hui T, Shang C, Yang L, Wang M, Li R, Song Z. Metformin improves the outcomes in Chinese invasive breast cancer patients with type 2 diabetes mellitus. Sci Rep 2021; 11:10034. [PMID: 33976288 PMCID: PMC8113316 DOI: 10.1038/s41598-021-89475-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/27/2021] [Indexed: 02/01/2023] Open
Abstract
Early reports indicate that metformin, a clinical drug administered to treat type 2 diabetes mellitus (T2DM), was found to be associated with a better prognosis of cancer. The objective of this study was retrospectively analyzed the effect of metformin on the outcomes of Chinese breast cancer patients with T2DM. A total of 3757 primary invasive breast cancer patients who underwent surgery from January 2010 to December 2013 were enrolled. According to the medication treatment, all the patients were divided as non-diabetes group, metformin group and insulin group. The follow-up data for disease-free survival (DFS) and overall survival (OS) were obtained from 3553 patients (median follow up of 85 months) and estimated with the Kaplan–Meier method followed by a log-rank test. Multivariate Cox proportional hazards regression model was applied. The results showed that there was a significant survival difference among non-diabetes group, metformin group and insulin group, 5-year DFS was 85.8%, 96.1%, 73.0%, and 5-year OS was 87.3%, 97.1%, 73.3% respectively (P < 0.05). Prognostic analysis showed metformin was significantly associated with better DFS and OS. Our results suggested that metformin may have a good effect on the survival of invasive breast cancer patients with T2DM.
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Affiliation(s)
- Tianli Hui
- Breast Center, Hebei Medical University Fourth Affiliated Hospital, No. 169 Tianshan Street, Shijiazhuang, 050035, China
| | - Chao Shang
- Breast Center, Hebei Medical University Fourth Affiliated Hospital, No. 169 Tianshan Street, Shijiazhuang, 050035, China
| | - Liu Yang
- Breast Center, Hebei Medical University Fourth Affiliated Hospital, No. 169 Tianshan Street, Shijiazhuang, 050035, China
| | - Meiqi Wang
- Breast Center, Hebei Medical University Fourth Affiliated Hospital, No. 169 Tianshan Street, Shijiazhuang, 050035, China
| | - Ruoyang Li
- Breast Center, Hebei Medical University Fourth Affiliated Hospital, No. 169 Tianshan Street, Shijiazhuang, 050035, China
| | - Zhenchuan Song
- Breast Center, Hebei Medical University Fourth Affiliated Hospital, No. 169 Tianshan Street, Shijiazhuang, 050035, China.
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299
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He Q, Xue S, Wa Q, He M, Feng S, Chen Z, Chen W, Luo X. Mining immune-related genes with prognostic value in the tumor microenvironment of breast invasive ductal carcinoma. Medicine (Baltimore) 2021; 100:e25715. [PMID: 33907159 PMCID: PMC8084029 DOI: 10.1097/md.0000000000025715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/02/2020] [Accepted: 03/30/2021] [Indexed: 12/21/2022] Open
Abstract
ABSTRACT The tumor microenvironment (TME) plays an important role in the development of breast cancer. Due to limitations in experimental conditions, the molecular mechanism of TME in breast cancer has not yet been elucidated. With the development of bioinformatics, the study of TME has become convenient and reliable.Gene expression and clinical feature data were downloaded from The Cancer Genome Atlas database and the Molecular Taxonomy of Breast Cancer International Consortium database. Immune scores and stromal scores were calculated using the Estimation of Stromal and Immune Cells in Malignant Tumor Tissues Using Expression Data algorithm. The interaction of genes was examined with protein-protein interaction and co-expression analysis. The function of genes was analyzed by gene ontology enrichment analysis, Kyoto Encyclopedia of Genes and Genomes analysis and gene set enrichment analysis. The clinical significance of genes was assessed with Kaplan-Meier analysis and univariate/multivariate Cox regression analysis.Our results showed that the immune scores and stromal scores of breast invasive ductal carcinoma (IDC) were significantly lower than those of invasive lobular carcinoma. The immune scores were significantly related to overall survival of breast IDC patients and both the immune and stromal scores were significantly related to clinical features of these patients. According to the level of immune/stromal scores, 179 common differentially expressed genes and 5 hub genes with prognostic value were identified. In addition, the clinical significance of the hub genes was validated with data from the molecular taxonomy of breast cancer international consortium database, and gene set enrichment analysis analysis showed that these hub genes were mainly enriched in signaling pathways of the immune system and breast cancer.We identified five immune-related hub genes with prognostic value in the TME of breast IDC, which may partly determine the prognosis of breast cancer and provide some direction for development of targeted treatments in the future.
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Affiliation(s)
- Qiang He
- Department of Cosmetic Plastic Surgery, Chengdu Second People's Hospital
| | | | - Qingbiao Wa
- Department of Cosmetic Plastic Surgery, Chengdu Second People's Hospital
| | - Mei He
- Department of Cosmetic Plastic Surgery, Chengdu Second People's Hospital
| | - Shuang Feng
- Department of Cosmetic Plastic Surgery, Chengdu Second People's Hospital
| | - Zhibing Chen
- Department of Cosmetic Plastic Surgery, Chengdu Second People's Hospital
| | - Wei Chen
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinrong Luo
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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300
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Trapani D, Gandini S, Corti C, Crimini E, Bellerba F, Minchella I, Criscitiello C, Tarantino P, Curigliano G. Benefit of adjuvant chemotherapy in patients with lobular breast cancer: A systematic review of the literature and metanalysis. Cancer Treat Rev 2021; 97:102205. [PMID: 33878560 DOI: 10.1016/j.ctrv.2021.102205] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 12/12/2022]
Abstract
The role of adjuvant chemotherapy (aCT) for patients with localized lobular breast cancer (ILC) is still controversial. It is unclear what is the magnitude of benefit of the CT in this setting. In this systematic review of the literature and metanalysis, we aimed to estimate the benefit of aCT in addition to the standard treatments in the early ILC setting. We identified the records by searching Medline, CENTRAL, Web of Science, SCOPUS, and Google Scholar, and the meeting proceeding of the principal oncology meetings of the last 10 years, with no language or time restriction. A research strategy was developed with mapped and MeSH terms. Studies on the clinical use of aCT reporting survival outcomes in the ILC setting were double-screened and tabulated. PRISMA methodology was used for data extraction and synthesis. We extracted information on the study design and setting, eligible population and population size, histology variants, menopausal status, treatment regimens, follow-up duration. Hazard ratios (HR) and 95% confidence interval (CI) were extracted and transformed into logHR and corresponding standard error to obtain the Summary HR (SHR). Heterogeneity (I2 statistics) and publication bias (Macaskill test) were tested; a random effect models provided by SAS Proc Mixed was used for data analysis. Sensitivity analysis was conducted to examine the impact of inclusion criteria on the summary results. Disease-free (DFS), overall (OS) and cancer-specific survival (BCSS) were the primary endpoints of the investigation. The systematic review and metanalysis included 38,387 patients across 8 clinical studies. aCT was not associated with an improvement of OS (SHR 0.99; 95%CI 0.86-1.14), with low heterogeneity (I2 = 28%) and no publication bias (p = 0.43). Sensitivity analysis resulted in unchanged conclusions. We did not perform a metanalysis of the DFS estimates, as only reported in 3 studies. The value of aCT in improving DFS was unconfirmed, consistently with the OS results. Our research did not confirm a certain role of aCT for patients with ILC. Research gaps were identified, warranting the development of prospective, controlled ad hoc investigations.
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Affiliation(s)
- D Trapani
- Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy
| | - S Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCSS, Milan, Italy
| | - C Corti
- Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy; Departement of Hematology and Oncology (DIPO), University of Milan, Milan, Italy
| | - E Crimini
- Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy; Departement of Hematology and Oncology (DIPO), University of Milan, Milan, Italy
| | - F Bellerba
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCSS, Milan, Italy
| | - I Minchella
- Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy
| | - C Criscitiello
- Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy; Departement of Hematology and Oncology (DIPO), University of Milan, Milan, Italy
| | - P Tarantino
- Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy; Departement of Hematology and Oncology (DIPO), University of Milan, Milan, Italy
| | - G Curigliano
- Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy; Departement of Hematology and Oncology (DIPO), University of Milan, Milan, Italy.
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