DTCs in breast cancer: clinical research and practice

Bone Marrow Synoptic Reporting for Hematologic Neoplasms: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center

CONTEXT

-There is ample evidence from the solid tumor literature that synoptic reporting improves accuracy and completeness of relevant data. No evidence-based guidelines currently exist for synoptic reporting for bone marrow samples.

OBJECTIVE

-To develop evidence-based recommendations to standardize the basic components of a synoptic report template for bone marrow samples.

DESIGN

-The College of American Pathologists Pathology and Laboratory Quality Center convened a panel of experts in hematopathology to develop recommendations. A systematic evidence review was conducted to address 5 key questions. Recommendations were derived from strength of evidence, open comment feedback, and expert panel consensus.

RESULTS

-Nine guideline statements were established to provide pathology laboratories with a framework by which to develop synoptic reporting templates for bone marrow samples. The guideline calls for specific data groups in the synoptic section of the pathology report; provides a list of evidence-based parameters for key, pertinent elements; and addresses ancillary testing.

CONCLUSION

-A framework for bone marrow synoptic reporting will improve completeness of the final report in a manner that is clear, succinct, and consistent among institutions.

Trastuzumab monotherapy for bone marrow metastasis of breast cancer: A case report

The current study presents the case of a 41-year-old female patient who received modified radical mastectomy and adjuvant chemotherapy and radiotherapy for infiltrating ductal cancer of the left breast. The pathological stage of the disease was IIA. In addition, the patient was negative for the estrogen and progesterone receptors, and human epidermal growth factor receptor-2 gene amplification was identified. At one year following surgery, the patient presented with severe pancytopenia and pain at multiple sites all over the body. Furthermore, the patient’s Eastern Cooperative Oncology Group performance status score was 3 and numeric rating scale pain score was 8. The bone marrow puncture indicated bone marrow metastatic cancer, and the positron emission tomography/computed tomography (CT) indicated multiple internal organ metastases and osseous metastasis. Chemotherapy treatment posed great risks due to the patient’s poor performance status and severe bone marrow suppression. Therefore, trastuzumab monotherapy was administered at a loading dose of 8 mg/kg and a maintenance dose of 6 mg/kg every three weeks. Following four doses of trastuzumab treatment, the patient’s performance status significantly improved and the peripheral blood cell counts had returned to within the normal ranges. Taxol was added to the trastuzumab treatment and seven cycles were completed. No metastatic cancer cells were found in the subsequent bone marrow smear test; however, CT showed metastatic foci in the left lung. Furthermore, the enlarged lymph nodes had subsided and the tumor in the right appendix region had decreased in size by 50%. The patient’s disease condition was maintained stable for 11 months.

Associations between tumor vascularization assessed by in vivo DCE-MRI and the presence of disseminated tumor cells in bone marrow in breast cancer patients at the time of diagnosis

PURPOSE

To explore possible associations between in vivo pharmacokinetic dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters and the presence of disseminated tumor cells (DTCs) in bone marrow in breast cancer patients at the time of diagnosis.

MATERIALS AND METHODS

Thirty-seven women with breast cancer (stage T2-4N0-1M0) were included. Patients were classified as DTC+ if one or more DTCs were detected by immunocytochemistry. DCE-MRI was acquired with a radial 3D T1 -weighted spoiled gradient echo sequence with k-space weighted image contrast. K(trans), kep, and ve were calculated using the extended Tofts model and a population-derived arterial input function. The nonparametric Mann-Whitney U-test was used to compare the histogram distributions of the pharmacokinetic parameters for the DTC+ and the DTC- patients.

RESULTS

DTCs were detected in 7 of the 37 patients (19%). In DTC+ patients, the distribution of tumor K(trans) and kep were significantly (P < 0.01) more shifted towards lower values than in DTC- patients.

CONCLUSION

An association between vascular dependent pharmacokinetic DCE-MRI parameters and the presence of DTCs were found. Compared to DTC- patients, DTC+ patients had poorer perfusion and permeability, indicative of hypoxia. Thus, pharmacokinetic parameters might be surrogate biomarkers of metastatic potential and future relapse.