1
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Mangla B, Mittal P, Kumar P, Javed S, Ahsan W, Aggarwal G. Development of erlotinib-loaded nanotransferosomal gel for the topical treatment of ductal carcinoma in situ. Nanomedicine (Lond) 2024; 19:855-874. [PMID: 38440976 DOI: 10.2217/nnm-2023-0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Aims: This study was aimed to formulate erlotinib (ERL)-loaded transferosomal gel (ERL@TG) intended for topical application for the treatment of ductal carcinoma in situ. Materials & methods: The optimized process involved a thin-film hydration method to generate ERL-loaded transferosomes (ERL@TFS), which was incorporated into a carbopol gel matrix to generate ERL@TG. The optimized formulation was characterized in vitro followed by cytotoxicity evaluation on MCF-7 breast cancer cell lines and acute toxicity and skin irritation studies was performed in vivo. Results: In a comparative assessment against plain ERL, ERL@TG displayed enhanced efficacy against MCF-7 cell lines, reflected in considerably lower IC50 values with an enhanced safety profile. Conclusion: Optimized ERL@TG was identified as a promising avenue for addressing ductal carcinoma in situ breast cancer.
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Affiliation(s)
- Bharti Mangla
- Centre for Advanced Formulation & Technology, Delhi Pharmaceutical Sciences and Research University, New Delhi, 110017, India
| | - Priya Mittal
- Centre for Advanced Formulation & Technology, Delhi Pharmaceutical Sciences and Research University, New Delhi, 110017, India
| | - Pankaj Kumar
- Centre for Advanced Formulation & Technology, Delhi Pharmaceutical Sciences and Research University, New Delhi, 110017, India
| | - Shamama Javed
- Department of Pharmaceutics, College of Pharmacy, Jazan University, PO box no. 114, Jazan, Saudi Arabia
| | - Waquar Ahsan
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jazan University, PO box no. 114, Jazan, Saudi Arabia
| | - Geeta Aggarwal
- Centre for Advanced Formulation & Technology, Delhi Pharmaceutical Sciences and Research University, New Delhi, 110017, India
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2
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Alaeikhanehshir S, Schmitz RSJM, van den Belt-Dusebout AW, van Duijnhoven FH, Verschuur E, van Seijen M, Schaapveld M, Lips EH, Wesseling J. The effects of contemporary treatment of DCIS on the risk of developing an ipsilateral invasive Breast cancer (iIBC) in the Dutch population. Breast Cancer Res Treat 2024; 204:61-68. [PMID: 37964135 PMCID: PMC10806034 DOI: 10.1007/s10549-023-07168-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE To assess the effects of contemporary treatment of ductal carcinoma in situ (DCIS) on the risk of developing an ipsilateral invasive breast cancer (iIBC) in the Dutch female population. METHODS Clinical data was obtained from the Netherlands Cancer Registry (NCR), a nationwide registry of all primary malignancies in the Netherlands integrated with the data from PALGA, the Dutch nationwide network and registry of histo- and cytopathology in the Netherlands, on all women in the Netherlands treated for primary DCIS from 2005 to 2015, resulting in a population-based cohort of 14.419 women. Cumulative iIBC incidence was assessed and associations of DCIS treatment type with subsequent iIBC risk were evaluated by multivariable Cox regression analyses. RESULTS Ten years after DCIS diagnosis, the cumulative incidence of iIBC was 3.1% (95% CI: 2.6-3.5%) in patients treated by breast conserving surgery (BCS) plus radiotherapy (RT), 7.1% (95% CI: 5.5-9.1) in patients treated by BCS alone, and 1.6% (95% CI: 1.3-2.1) in patients treated by mastectomy. BCS was associated with a significantly higher risk for iIBC compared to BCS + RT during the first 5 years after treatment (HR 2.80, 95% CI: 1.91-4.10%). After 5 years of follow-up, the iIBC risk declined in the BCS alone group but remained higher than the iIBC risk in the BCS + RT group (HR 1.73, 95% CI: 1.15-2.61). CONCLUSIONS Although absolute risks of iIBC were low in patients treated for DCIS with either BCS or BCS + RT, risks remained higher in the BCS alone group compared to patients treated with BCS + RT for at least 10 years after DCIS diagnosis.
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MESH Headings
- Female
- Humans
- Breast Neoplasms/epidemiology
- Breast Neoplasms/therapy
- Breast Neoplasms/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Mastectomy/methods
- Mastectomy, Segmental/methods
- Incidence
- Neoplasm Recurrence, Local/surgery
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Ductal, Breast/etiology
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Affiliation(s)
- Sena Alaeikhanehshir
- Division of Molecular Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, Netherlands
- Department of Surgical Oncology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Renée S J M Schmitz
- Division of Molecular Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, Netherlands
| | - Alexandra W van den Belt-Dusebout
- Division of Molecular Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, Netherlands
| | - Frederieke H van Duijnhoven
- Department of Surgical Oncology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | - Maartje van Seijen
- Division of Molecular Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, Netherlands
| | - Michael Schaapveld
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Esther H Lips
- Division of Molecular Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, Netherlands.
- Department of Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
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3
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Pan J, Huang X, Yang S, Ouyang F, Ouyang L, Wang L, Chen M, Zhou L, Du Y, Chen X, Deng L, Hu Q, Guo B. The added value of apparent diffusion coefficient and microcalcifications to the Kaiser score in the evaluation of BI-RADS 4 lesions. Eur J Radiol 2023; 165:110920. [PMID: 37320881 DOI: 10.1016/j.ejrad.2023.110920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To explore the added value of combining microcalcifications or apparent diffusion coefficient (ADC) with the Kaiser score (KS) for diagnosing BI-RADS 4 lesions. METHODS This retrospective study included 194 consecutive patients with 201 histologically verified BI-RADS 4 lesions. Two radiologists assigned the KS value to each lesion. Adding microcalcifications, ADC, or both these criteria to the KS yielded KS1, KS2, and KS3, respectively. The potential of all four scores to avoid unnecessary biopsies was assessed using the sensitivity and specificity. Diagnostic performance was evaluated by the area under the curve (AUC) and compared between KS and KS1. RESULTS The sensitivity of KS, KS1, KS2, and KS3 ranged from 77.1% to 100.0%.KS1 yielded significantly higher sensitivity than other methods (P < 0.05), except for KS3 (P > 0.05), most of all, when assessing NME lesions. For mass lesions, the sensitivity of these four scores was comparable (p > 0.05). The specificity of KS, KS1, KS2, and KS3 ranged from 56.0% to 69.4%, with no statistically significant differences(P > 0.05), except between KS1 and KS2 (p < 0.05).The AUC of KS1 (0.877) was significantly higher than that of KS (0.837; P = 0.0005), particularly for assessing NME (0.847 vs 0.713; P < 0.0001). CONCLUSION KS can stratify BI-RADS 4 lesions to avoid unnecessary biopsies. Adding microcalcifications, but not adding ADC, as an adjunct to KS improves diagnostic performance, particularly for NME lesions. ADC provides no additional diagnostic benefit to KS. Thus, only combining microcalcifications with KS is most conducive to clinical practice.
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Affiliation(s)
- Jialing Pan
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Xiyi Huang
- Department of Clinical Laboratory, Lecong Hospital of Shunde, Foshan, Guangdong, China
| | - Shaomin Yang
- Department of Radiology, Lecong Hospital of Shunde, Foshan, Guangdong, China
| | - Fusheng Ouyang
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Lizhu Ouyang
- Department of Ultrasound, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Liwen Wang
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Ming Chen
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Lanni Zhou
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Yongxing Du
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Xinjie Chen
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Lingda Deng
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Qiugen Hu
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China.
| | - Baoliang Guo
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China.
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4
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Magnoni F, Bianchi B, Corso G, Alloggio EA, Di Silvestre S, Abruzzese G, Sacchini V, Galimberti V, Veronesi P. Ductal Carcinoma In Situ (DCIS) and Microinvasive DCIS: Role of Surgery in Early Diagnosis of Breast Cancer. Healthcare (Basel) 2023; 11:healthcare11091324. [PMID: 37174866 PMCID: PMC10177838 DOI: 10.3390/healthcare11091324] [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: 03/05/2023] [Revised: 04/20/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Advances in treatments, screening, and awareness have led to continually decreasing breast cancer-related mortality rates in the past decades. This achievement is coupled with early breast cancer diagnosis. Ductal carcinoma in situ (DCIS) and microinvasive breast cancer have increasingly been diagnosed in the context of mammographic screening. Clinical management of DCIS is heterogenous, and the clinical significance of microinvasion in DCIS remains elusive, although microinvasive DCIS (DCIS-Mi) is distinct from "pure" DCIS. Upfront surgery has a fundamental role in the overall treatment of these breast diseases. The growing number of screen-detected DCIS diagnoses with clinicopathological features of low risk for local recurrence (LR) allows more conservative surgical options, followed by personalised adjuvant radiotherapy plans. Furthermore, studies are underway to evaluate the validity of surgery omission in selected low-risk categories. Nevertheless, the management, the priority of axillary surgical staging, and the prognosis of DCIS-Mi remain the subject of debate, demonstrating how the paucity of data still necessitates adequate studies to provide conclusive guidelines. The current scientific scenario for DCIS and DCIS-Mi surgical approach consists of highly controversial and diversified sources, which this narrative review will delineate and clarify.
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Affiliation(s)
- Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy
- European Cancer Prevention Organization (ECP), 20141 Milan, Italy
| | - Beatrice Bianchi
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy
| | - Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy
- European Cancer Prevention Organization (ECP), 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Erica Anna Alloggio
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy
| | - Susanna Di Silvestre
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy
| | - Giuliarianna Abruzzese
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy
| | - Virgilio Sacchini
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Viviana Galimberti
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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5
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Smith JC, Sheltzer JM. Genome-wide identification and analysis of prognostic features in human cancers. Cell Rep 2022; 38:110569. [PMID: 35354049 DOI: 10.1016/j.celrep.2022.110569] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/30/2022] [Accepted: 03/03/2022] [Indexed: 12/12/2022] Open
Abstract
Clinical decisions in cancer rely on precisely assessing patient risk. To improve our ability to identify the most aggressive malignancies, we constructed genome-wide survival models using gene expression, copy number, methylation, and mutation data from 10,884 patients. We identified more than 100,000 significant prognostic biomarkers and demonstrate that these genomic features can predict patient outcomes in clinically ambiguous situations. While adverse biomarkers are commonly believed to represent cancer driver genes and promising therapeutic targets, we show that cancer features associated with shorter survival times are not enriched for either oncogenes or for successful drug targets. Instead, the strongest adverse biomarkers represent widely expressed cell-cycle and housekeeping genes, and, correspondingly, nearly all therapies directed against these features have failed in clinical trials. In total, our analysis establishes a rich resource for prognostic biomarker analysis and clarifies the use of patient survival data in preclinical cancer research and therapeutic development.
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Affiliation(s)
- Joan C Smith
- Yale University School of Medicine, New Haven, CT 06511, USA; Google, Inc., New York, NY 10011, USA
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6
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Preneoplastic Low-Risk Mammary Ductal Lesions (Atypical Ductal Hyperplasia and Ductal Carcinoma In Situ Spectrum): Current Status and Future Directions. Cancers (Basel) 2022; 14:cancers14030507. [PMID: 35158775 PMCID: PMC8833401 DOI: 10.3390/cancers14030507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 02/04/2023] Open
Abstract
Intraepithelial mammary ductal neoplasia is a spectrum of disease that varies from atypical ductal hyperplasia (ADH), low-grade (LG), intermediate-grade (IG), to high-grade (HG) ductal carcinoma in situ (DCIS). While ADH has the lowest prognostic significance, HG-DCIS carries the highest risk. Due to widely used screening mammography, the number of intraepithelial mammary ductal neoplastic lesions has increased. The consequence of this practice is the increase in the number of patients who are overdiagnosed and, therefore, overtreated. The active surveillance (AS) trials are initiated to separate lesions that require active treatment from those that can be safely monitored and only be treated when they develop a change in the clinical/radiologic characteristics. At the same time, the natural history of these lesions can be evaluated. This review aims to evaluate ADH/DCIS as a spectrum of intraductal neoplastic disease (risk and histomorphology); examine the controversies of distinguishing ADH vs. DCIS and the grading of DCIS; review the upgrading for both ADH and DCIS with emphasis on the variation of methods of detection and the definitions of upgrading; and evaluate the impact of all these variables on the AS trials.
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7
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Park KW, Kim SW, Han H, Park M, Han BK, Ko EY, Choi JS, Cho EY, Cho SY, Ko ES. Ductal carcinoma in situ: a risk prediction model for the underestimation of invasive breast cancer. NPJ Breast Cancer 2022; 8:8. [PMID: 35031626 PMCID: PMC8760307 DOI: 10.1038/s41523-021-00364-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/29/2021] [Indexed: 11/09/2022] Open
Abstract
Patients with a biopsy diagnosis of ductal carcinoma in situ (DCIS) may be diagnosed with invasive breast cancer after excision. We evaluated the preoperative clinical and imaging predictors of DCIS that were associated with an upgrade to invasive carcinoma on final pathology and also compared the diagnostic performance of various statistical models. We reviewed the medical records; including mammography, ultrasound (US), and magnetic resonance imaging (MRI) findings; of 644 patients who were preoperatively diagnosed with DCIS and who underwent surgery between January 2012 and September 2018. Logistic regression and three machine learning methods were applied to predict DCIS underestimation. Among 644 DCIS biopsies, 161 (25%) underestimated invasive breast cancers. In multivariable analysis, suspicious axillary lymph nodes (LNs) on US (odds ratio [OR], 12.16; 95% confidence interval [CI], 4.94-29.95; P < 0.001) and high nuclear grade (OR, 1.90; 95% CI, 1.24-2.91; P = 0.003) were associated with underestimation. Cases with biopsy performed using vacuum-assisted biopsy (VAB) (OR, 0.42; 95% CI, 0.27-0.65; P < 0.001) and lesion size <2 cm on mammography (OR, 0.45; 95% CI, 0.22-0.90; P = 0.021) and MRI (OR, 0.29; 95% CI, 0.09-0.94; P = 0.037) were less likely to be upgraded. No significant differences in performance were observed between logistic regression and machine learning models. Our results suggest that biopsy device, high nuclear grade, presence of suspicious axillary LN on US, and lesion size on mammography or MRI were independent predictors of DCIS underestimation.
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Affiliation(s)
- Ko Woon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seon Woo Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Heewon Han
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Minsu Park
- Department of Information and Statistics, Chungnam National University, Daejeon, Republic of Korea
| | - Boo-Kyung Han
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Young Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Soo Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Yoon Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Youn Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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8
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Hatton A, Heriot N, Zalcberg J, Ayton D, Evans J, Roder D, Chua BH, Hersch J, Lippey J, Fox J, Saunders C, Mann GB, Synnot J, Bell RJ. Factors involved in treatment decision making for women diagnosed with ductal carcinoma in situ: A qualitative study. Breast 2021; 60:123-130. [PMID: 34624754 PMCID: PMC8503564 DOI: 10.1016/j.breast.2021.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Whilst some of the diversity in management of women with ductal carcinoma in situ (DCIS) may be explained by tumour characteristics, the role of patient preference and the factors underlying those preferences have been less frequently examined. We have used a descriptive qualitative study to explore treatment decisions for a group of Australian women diagnosed with DCIS through mammographic screening. Semi-structured telephone interviews were performed with 16 women diagnosed with DCIS between January 2012 and December 2018, recruited through the LifePool dataset (a subset of BreastScreen participants who have agreed to participate in research). Content analysis using deductive coding identified three themes: participants did not have a clear understanding of their diagnosis or prognosis; reported involvement in decision making about management varied; specific factors including the psychosexual impact of mastectomy and perceptions of radiotherapy, could act as barriers or facilitators to specific decisions about treatment. The treatment the women received was not simply determined by the characteristics of their disease. Interaction with the managing clinician was pivotal, however many other factors played a part in individual decisions. Recognising that decisions are not purely a function of disease characteristics is important for both women with DCIS and the clinicians who care for them.
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Affiliation(s)
- Amy Hatton
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Natalie Heriot
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - John Zalcberg
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia; Medical Oncology Unit, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, 3004, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | | | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Australia
| | - Boon H Chua
- Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Jolyn Hersch
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Jocelyn Lippey
- Department of Surgery University of Melbourne, Australia
| | - Jane Fox
- Department of Surgery Monash University, Monash Health Clayton Road Clayton Victoria, Australia
| | - Christobel Saunders
- Department of Surgery, School of Medicine, University of Western Australia, Australia
| | - G Bruce Mann
- Department of Surgery University of Melbourne, Australia
| | - Jane Synnot
- Consumer Representative Breast Cancer Network Australia, Australia
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.
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9
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Brock EJ, Jackson RM, Boerner JL, Li Q, Tennis MA, Sloane BF, Mattingly RR. Sprouty4 negatively regulates ERK/MAPK signaling and the transition from in situ to invasive breast ductal carcinoma. PLoS One 2021; 16:e0252314. [PMID: 34048471 PMCID: PMC8162601 DOI: 10.1371/journal.pone.0252314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/13/2021] [Indexed: 12/16/2022] Open
Abstract
Breast ductal carcinoma in situ (DCIS) is a non-obligate precursor of invasive ductal carcinoma (IDC). It is still unclear which DCIS will become invasive and which will remain indolent. Patients often receive surgery and radiotherapy, but this early intervention has not produced substantial decreases in late-stage disease. Sprouty proteins are important regulators of ERK/MAPK signaling and have been studied in various cancers. We hypothesized that Sprouty4 is an endogenous inhibitor of ERK/MAPK signaling and that its loss/reduced expression is a mechanism by which DCIS lesions progress toward IDC, including triple-negative disease. Using immunohistochemistry, we found reduced Sprouty4 expression in IDC patient samples compared to DCIS, and that ERK/MAPK phosphorylation had an inverse relationship to Sprouty4 expression. These observations were reproduced using a 3D culture model of disease progression. Knockdown of Sprouty4 in MCF10.DCIS cells increased ERK/MAPK phosphorylation as well as their invasive capability, while overexpression of Sprouty4 in MCF10.CA1d IDC cells reduced ERK/MAPK phosphorylation, invasion, and the aggressive phenotype exhibited by these cells. Immunofluorescence experiments revealed reorganization of the actin cytoskeleton and relocation of E-cadherin back to the cell surface, consistent with the restoration of adherens junctions. To determine whether these effects were due to changes in ERK/MAPK signaling, MEK1/2 was pharmacologically inhibited in IDC cells. Nanomolar concentrations of MEK162/binimetinib restored an epithelial-like phenotype and reduced pericellular proteolysis, similar to Sprouty4 overexpression. From these data we conclude that Sprouty4 acts to control ERK/MAPK signaling in DCIS, thus limiting the progression of these premalignant breast lesions.
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MESH Headings
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Intraductal, Noninfiltrating/genetics
- Carcinoma, Intraductal, Noninfiltrating/metabolism
- Cell Line, Tumor
- Cells, Cultured
- Female
- Humans
- Immunoblotting
- Immunohistochemistry
- Intracellular Signaling Peptides and Proteins/genetics
- Intracellular Signaling Peptides and Proteins/metabolism
- Mitogen-Activated Protein Kinase 1/genetics
- Mitogen-Activated Protein Kinase 1/metabolism
- Mitogen-Activated Protein Kinase 3/genetics
- Mitogen-Activated Protein Kinase 3/metabolism
- Nerve Tissue Proteins/genetics
- Nerve Tissue Proteins/metabolism
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Affiliation(s)
- Ethan J. Brock
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United states of America
| | - Ryan M. Jackson
- Department of Pharmacology, Wayne State University School of Medicine, Detroit, MI, United states of America
| | - Julie L. Boerner
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United states of America
| | - Quanwen Li
- Department of Pharmacology, Wayne State University School of Medicine, Detroit, MI, United states of America
| | - Meredith A. Tennis
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United states of America
| | - Bonnie F. Sloane
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United states of America
- Department of Pharmacology, Wayne State University School of Medicine, Detroit, MI, United states of America
| | - Raymond R. Mattingly
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United states of America
- Department of Pharmacology, Wayne State University School of Medicine, Detroit, MI, United states of America
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10
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Pure Ductal Carcinoma In Situ of the Breast: Analysis of 270 Consecutive Patients Treated in a 9-Year Period. Cancers (Basel) 2021; 13:cancers13030431. [PMID: 33498737 PMCID: PMC7865419 DOI: 10.3390/cancers13030431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/19/2021] [Indexed: 11/27/2022] Open
Abstract
Simple Summary Ductal carcinoma in situ (DCIS) accounts for 20 to 25% of all breast cancers and its incidence of progression to invasive ductal carcinoma is at least 13 to 50%. The aim of our retrospective observational analysis is to review the issues of this histological type of cancer. We confirmed in a wide population of 270 consecutive patients who underwent surgery in a single institute that the management of DCIS can be difficult and particularly complex. There are many variables to be taken into consideration such as the choice of the diagnostic and bioptical technique. This delicate management must be carried out in specialized centres such as Breast Units involving multiple professional figures to define and guarantee the best possible treatment for each patient. Abstract Introduction: Ductal carcinoma in situ (DCIS) is an intraductal neoplastic proliferation of epithelial cells that are confined within the basement membrane of the breast ductal system. This retrospective observational analysis aims at reviewing the issues of this histological type of cancer. Materials and methods: Patients treated for DCIS between 1 January 2009 and 31 December 2018 were identified from a retrospective database. The patients were divided into two groups of 5 years each, the first group including patients treated from 2009 to 2013, and the second group including patients treated from 2014 to 2018. Once the database was completed, we performed a statistical analysis to see if there were significant differences among the 2 periods. Statistical analyses were performed using GraphPad Prism software for Windows, and the level of significance was set at p < 0.05. Results: 3586 female patients were treated for breast cancer over the 9-year study period (1469 patients from 2009 to 2013 and 2117 from 2014 to 2018), of which 270 (7.53%) had pure DCIS in the final pathology. The median age of diagnosis was 59-year-old (range 36–86). In the first period, 81 (5.5%) women out of 1469 had DCIS in the final pathology, in the second, 189 (8.9%) out of 2117 had DCIS in the final pathology with a statistically significant increase (p = 0.0001). From 2009 to 2013, only 38 (46.9%) were in stage 0 (correct DCIS diagnosis) while in the second period, 125 (66.1%) were included in this stage. The number of patients included in clinical stage 0 increased significantly (p = 0.004). In the first period, 48 (59.3%) specimen margins were at a greater or equal distance than 2 mm (negative margins), between 2014 and 2018; 137 (72.5%) had negative margins. Between 2014 and 2018 the number of DCIS patients with positive margins decreased significantly (p = 0.02) compared to the first period examined. The mastectomies number increased significantly (p = 0.008) between the 2 periods, while the sentinel lymph node biopsy (SLNB) numbers had no differences (p = 0.29). For both periods analysed all the 253 patients who underwent the follow up are currently living and free of disease. We have conventionally excluded the 17 patients whose data were lost. Conclusion: The choice of the newest imaging techniques and the most suitable biopsy method allows a better pre-operative diagnosis of the DCIS. Surgical treatment must be targeted to the patient and a multidisciplinary approach discussed in the Breast Unit centres.
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Mills MN, Russo NW, Nanda RH, Wilson JP, Altoos TA, Caldwell DL, Stout LL, Dube S, Blumencranz PW, Allen KG, Diaz R. Management of ductal carcinoma in situ with accelerated partial breast irradiation brachytherapy: Implications for guideline expansion. Brachytherapy 2020; 20:345-352. [PMID: 33317964 DOI: 10.1016/j.brachy.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Accelerated partial breast irradiation (APBI) for patients with ductal carcinoma in situ (DCIS) is controversial, and the suitability criteria from the American Brachytherapy Society (ABS), American Society of Therapeutic Radiology and Oncology (ASTRO), and the European Society for Radiotherapy and Oncology (GEC-ESTRO) have important differences. METHODS AND MATERIALS This is a single-institution retrospective review of 169 consecutive patients with DCIS who underwent lumpectomy followed by APBI intracavitary brachytherapy from 2003 to 2018. Outcomes, including overall survival, recurrence-free survival (RFS), ipsilateral breast tumor recurrence, and distant metastasis, were estimated with the Kaplan-Meier method. RESULTS The median followup time was 62.5 months. Median age was 66 years (47-89 years). The majority of patients had estrogen receptor-positive disease (89%). Fifty patients (30%) had Grade 3 disease. Of the 142 patients with adequate pathology interpretation, 91 and 108 cases had margins ≥ 3 mm and ≥2 mm, respectively. Most patients (72%) were prescribed and started endocrine therapy. Of the patients evaluable for ABS criteria (N = 130), 97 met the suitability criteria. Of the patients evaluable for ASTRO criteria (N = 129), 42 were deemed cautionary and 33 were deemed unsuitable. Of the patients evaluable for GEC-ESTRO criteria (N = 143), 141 cases were at intermediate risk and two were at high risk. Five-year ipsilateral breast tumor recurrence, RFS, and overall survival were 0.6%, 97.7%, and 97.2%, respectively. The ABS, ASTRO, and GEC-ESTRO criteria failed to significantly predict for RFS. CONCLUSIONS These results, although limited by short-term followup, indicate that expansion of the eligibility criteria of APBI for patients with DCIS should be considered.
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Affiliation(s)
- Matthew N Mills
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Nicholas W Russo
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Ronica H Nanda
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jason P Wilson
- Comprehensive Breast Cancer Center of Tampa Bay, Morton Plant Hospital, Clearwater, FL
| | | | | | - Lisa L Stout
- Lykes Radiation Pavilion, Morton Plant Hospital, Clearwater, FL
| | - Scott Dube
- Lykes Radiation Pavilion, Morton Plant Hospital, Clearwater, FL
| | - Peter W Blumencranz
- Comprehensive Breast Cancer Center of Tampa Bay, Morton Plant Hospital, Clearwater, FL
| | - Kathleen G Allen
- Comprehensive Breast Cancer Center of Tampa Bay, Morton Plant Hospital, Clearwater, FL
| | - Roberto Diaz
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
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12
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Lamb LR, Lehman CD, Oseni TO, Bahl M. Ductal Carcinoma In Situ (DCIS) at Breast MRI: Predictors of Upgrade to Invasive Carcinoma. Acad Radiol 2020; 27:1394-1399. [PMID: 31699638 DOI: 10.1016/j.acra.2019.09.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 01/24/2023]
Abstract
RATIONALE AND OBJECTIVES To determine the upgrade rate of magnetic resonance imaging (MRI)-detected ductal carcinoma in situ (DCIS) and to identify patient, imaging, and pathologic features that may predict the risk of upgrade. MATERIALS AND METHODS Medical chart review from January 2007 to December 2016 identified 60 patients with 61 cases of MRI-detected DCIS and negative mammographic evaluations within 1 year prior to the MRI. Imaging and pathology reports were reviewed. Standard statistical tests, including Student's t-tests and chi-square tests, were used to compare patient, imaging, and pathologic features between the cases of DCIS that did and did not upgrade to invasive carcinoma at surgery. RESULTS Over a 10-year period, 60 patients (mean age 52 years, range 30-76 years) were diagnosed with 61 cases of MRI-detected DCIS. Two-thirds of DCIS cases were detected on MRI examinations that were performed for purposes of high-risk screening (67.2%, 41/61). MRI features that led to the DCIS diagnosis were nonmass enhancement in 78.7% (48/61), enhancing mass in 16.4% (10/61), nonmass enhancement and enhancing mass in 3.3% (2/61), and enhancing focus in 1.6% (1/61). Thirteen cases (21.3%, 13/61) were upgraded to invasive ductal carcinoma at surgery. DCIS cases that upgraded were larger on MRI (40 mm vs 17 mm, p < 0.01) and more likely to be associated with comedonecrosis at biopsy (38.5% [5/13] vs 6.3% [3/48], p < 0.01). CONCLUSION The upgrade rate of MRI-detected DCIS to invasive ductal carcinoma at surgery is 21.3%. Features that are associated with upgrade include large size on MRI and the presence of comedonecrosis at biopsy.
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Affiliation(s)
- Leslie R Lamb
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, WAC 240, Boston, MA 02114
| | - Constance D Lehman
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, WAC 240, Boston, MA 02114
| | - Tawakalitu O Oseni
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts
| | - Manisha Bahl
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, WAC 240, Boston, MA 02114.
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13
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Yang L, Lu D, Lai Y, Shen M, Yu Q, Lei T, Pu T, Bu H. Prognostic Score-Based Stratification Analysis Reveals Universal Benefits of Radiotherapy on Lowering the Risk of Ipsilateral Breast Event for Ductal Carcinoma In Situ Patients with Different Risk Levels. Ann Surg Oncol 2020; 28:975-984. [PMID: 32794031 DOI: 10.1245/s10434-020-09003-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/21/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND We aimed to analyze the effects of radiotherapy (RT) on the incidence rate of ipsilateral breast event (IBE) in ductal carcinoma in situ (DCIS) patients with lumpectomy after being stratified by prognostic score. METHODS We identified DCIS patients who received lumpectomy, from the Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2015. Cumulative incidence functions for competing risk were used to evaluate the effects of RT on IBE risk over time. Three multivariate regression models (weighted, non-weighted, and Fine-Gray) were applied to compare the IBE risk between the RT and non-RT groups after stratifying patients by prognostic score. RESULTS Overall, 72,623 DCIS patients were identified from the SEER database and 49,206 (66.8%) patients received RT. During the follow-up period (ranging from 7 to 347 months), the cumulative probability of invasive and in situ IBE was significantly lower in the RT group than in the non-RT group (p < 0.001). After being stratified by prognostic score, the weighted IBE incidence rate increased as the risk level increased (p < 0.050). In multivariate regression models, RT lowered the IBE incidence rate by at least 30% in low-, moderate-, and high-risk DCIS (p < 0.010). In particular, the in situ and invasive IBE incidence rate decreased by over 50% in low-risk DCIS with RT (p < 0.001). CONCLUSIONS RT is associated with a lowered IBE incidence rate in DCIS patients, regardless of the assigned risk levels for patients. The significant reduction in the IBE incidence rate in low-risk DCIS patients also indicates the potential benefits for recommending RT to such a patient population in clinical practice.
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Affiliation(s)
- Libo Yang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Transplant Engineering and Immunology, Ministry of Health, West China Hospital, Sichuan University, Chengdu, China
| | - Dongli Lu
- Department of Life Sciences, Imperial College London, London, UK
| | - Yutian Lai
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mengjia Shen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Transplant Engineering and Immunology, Ministry of Health, West China Hospital, Sichuan University, Chengdu, China
| | - Qiuxiao Yu
- Department of Pathology, Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Ting Lei
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Transplant Engineering and Immunology, Ministry of Health, West China Hospital, Sichuan University, Chengdu, China
| | - Tianjie Pu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Transplant Engineering and Immunology, Ministry of Health, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Bu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China. .,Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China. .,Key Laboratory of Transplant Engineering and Immunology, Ministry of Health, West China Hospital, Sichuan University, Chengdu, China.
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Kim G, Mikhael PG, Oseni TO, Bahl M. Ductal carcinoma in situ on digital mammography versus digital breast tomosynthesis: rates and predictors of pathologic upgrade. Eur Radiol 2020; 30:6089-6098. [PMID: 32591884 DOI: 10.1007/s00330-020-07021-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/15/2020] [Accepted: 06/08/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare upgrade rates of ductal carcinoma in situ (DCIS) on digital mammography (DM) versus digital breast tomosynthesis (DBT) and identify patient, imaging, and pathological features associated with upgrade risk. METHODS A retrospective review was performed of 318 women (mean 59 years, range 37-89) with screening-detected DCIS from 2007 to 2011 (DM group) and from 2013 to 2016 (DBT group). Comparisons made between DM and DBT groups using the unpaired t test and chi-square test include detection rates of DCIS, upgrade rates to invasive cancer, and pathological features of DCIS and upgraded cases. Patient, imaging, and pathological features associated with upgrade were also determined. P values < 0.05 were considered significant. RESULTS There was no significant difference in detection rates of DCIS between DM and DBT groups (0.9 versus 1.0 per 1000 examinations, p = 0.45). Upgrade rates of DCIS to invasive cancer in DM and DBT groups were similar (17.3% versus 16.8%, p = 0.90), despite significant differences in pathological features of DCIS between DM and DBT groups (including nuclear grade, comedonecrosis, and progesterone receptor status [p ≤ 0.01]). Among upgraded cases, a higher proportion were high-grade invasive cancers with DBT (36.7% versus 9.5%, p = 0.03). In both groups, ultrasound-guided (versus stereotactic) biopsy was associated with higher upgrade risk (p ≤ 0.03). CONCLUSIONS There was no significant difference in detection rates or upgrade rates of DCIS on DM versus DBT; however, upgraded cases were more likely to be high grade with DBT, suggesting possible differences in tumor biology between cancers with DM and DBT. In both DM and DBT groups, biopsy modality was associated with upgrade risk. KEY POINTS • Detection rates and upgrade rates of ductal carcinoma in situ (DCIS) on digital mammography (DM) versus digital breast tomosynthesis (DBT) are similar. • A higher proportion of upgraded cases were high-grade invasive cancers with DBT than DM, suggesting possible differences in tumor biology between cancers that are detected with DM and DBT. • With both DM and DBT, ultrasound-guided biopsy (versus stereotactic biopsy) was associated with a higher risk of upgrade.
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Affiliation(s)
- Geunwon Kim
- Department of Radiology, Division of Breast Imaging, Massachusetts General Hospital, 55 Fruit Street, WAC 240, Boston, MA, 02114, USA
| | - Peter G Mikhael
- Department of Radiology, Division of Breast Imaging, Massachusetts General Hospital, 55 Fruit Street, WAC 240, Boston, MA, 02114, USA
| | - Tawakalitu O Oseni
- Department of Surgery, Division of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Manisha Bahl
- Department of Radiology, Division of Breast Imaging, Massachusetts General Hospital, 55 Fruit Street, WAC 240, Boston, MA, 02114, USA.
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15
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Agahozo MC, Berghuis SAM, van den Broek E, Koppert LB, Obdeijn IM, van Deurzen CHM. Radioactive Seed Versus Wire-Guided Localization for Ductal Carcinoma in Situ of the Breast: Comparable Resection Margins. Ann Surg Oncol 2020; 27:5296-5302. [PMID: 32578065 PMCID: PMC7669767 DOI: 10.1245/s10434-020-08744-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Indexed: 12/26/2022]
Abstract
Background There are currently two widely used methods for preoperative localization of ductal carcinoma in situ (DCIS) of the breast: wire-guided localization (WGL) and radioactive seed localization (RSL). Several studies compared these localization techniques in small cohorts. Objective The aim of this study was to compare the surgical resection margin status between RSL and WGL in a large national cohort of patients with DCIS. Patients and Methods We included patients from the Dutch Pathology Registry who underwent breast-conserving surgery for DCIS by either RSL (n = 1851) or WGL (n = 2187) between 2009 and 2019. Several clinicopathological characteristics were compared between these two groups, including resection margin status and number of re-excisions.
Results Patients undergoing RSL were younger (p = 0.014) and were more often diagnosed with a large DCIS (p = 0.013), high grade DCIS (p < 0.001) and comedonecrosis (p < 0.001) compared with patients undergoing WGL. There was no significant difference in resection margin status between both groups (p = 0.089) and the number of re-excisions (p = 0.429). However, in case of re-excision, patients in the RSL group were more often treated with breast-conserving surgery (p = 0.029). Conclusion In this large national cohort study of patients with DCIS, we demonstrated that there was no difference in resection margin status between both procedures, or in the number of re-excisions, but patients in the RSL group were more often treated with breast-conserving therapy in case of a re-excision.
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Affiliation(s)
- Marie Colombe Agahozo
- Department of Pathology, Erasmus MC Cancer Institute Rotterdam, Rotterdam, The Netherlands.
| | - Sofie A M Berghuis
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | | | - Linetta B Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Inge-Marie Obdeijn
- Department of Radiology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Ductal Carcinoma In Situ of the Breast: An Update with Emphasis on Radiological and Morphological Features as Predictive Prognostic Factors. Cancers (Basel) 2020; 12:cancers12030609. [PMID: 32155777 PMCID: PMC7139619 DOI: 10.3390/cancers12030609] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 12/19/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) shows overlapping epidemiology with invasive ductal carcinoma of the breast, sharing similar risk factorssuch as age, mammographic density, family history, and hormonal therapy as well as genetic factors such as BRCA1/BRCA2, histotypes, and molecular subtypes such as luminal A and B, HER2 enriched, and basal-type, thus suggesting its potential precursor role. A small percentage of patients with a history of DCIS die without a documented intermediate diagnosis of invasive breast carcinoma (IBC). The increased risk of death is usually associated with ipsilateral recurrence such as IBC. The slightly variable incidence of DCIS in different countries is mainly due to a different diffusion of mammographic screening and variability of the risk factors. The majority of DCIS lesions are not palpable lesions, which can be only radiologically detected because of the association with microcalcifications. Mammography is a highly sensitive diagnostic procedure for detecting DCIS with microcalcifications, while magnetic resonance imaging (MRI) is considered more sensitive to detect DCIS without calcifications and/or multifocal lesions. The aim of the present overview was to focus on the clinical, radiological, and pathological features of DCIS of the breast, with an emphasis on the practical diagnostic approach, predictive prognostic factors, and therapeutic options.
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17
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Alghamdi SA, Krishnamurthy K, Garces Narvaez SA, Algashaamy KJ, Aoun J, Reis IM, Recine MA, Jorda M, Poppiti RJ, Gomez-Fernandez CR. Low-Grade Ductal Carcinoma In Situ. Am J Clin Pathol 2020; 153:360-367. [PMID: 31769792 DOI: 10.1093/ajcp/aqz179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES We aimed to determine the interobserver reproducibility in diagnosing low-grade ductal carcinoma in situ (DCIS). We also aimed to compare the interobserver variability using a proposed two-tiered grading system as opposed to the current three-tiered system. METHODS Three expert breast pathologists and one junior pathologist identified low-grade DCIS from a set of 300 DCIS slides. Months later, participants were asked to grade the 300 cases using the standard three-tiered system. RESULTS Using the two-tiered system, interobserver agreement among breast pathologists was considered moderate (κ = 0.575). The agreement was similar (κ = 0.532) with the junior pathologist included. Using the three-tiered system, pathologists' agreement was poor (κ = 0.235). CONCLUSIONS Pathologists' reproducibility on diagnosing low-grade DCIS showed moderate agreement. Experience does not seem to influence reproducibility. Our proposed two-tiered system of low vs nonlow grade, where the intermediate grade is grouped in the nonlow category has shown improved concordance.
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Affiliation(s)
| | | | | | | | - Jessica Aoun
- University of Miami/Jackson Health System, Miami, FL
| | - Isildinha M Reis
- Department of Public Health Sciences, University of Miami, Miami, FL
| | - Monica A Recine
- Mount Sinai Medical Center of Florida, Miami Beach
- Herbert Wertheim College of Medicine, Florida International University, Miami
| | - Merce Jorda
- Department of Public Health Sciences, University of Miami, Miami, FL
- Miller School of Medicine, University of Miami, Miami, FL
| | - Robert J Poppiti
- Mount Sinai Medical Center of Florida, Miami Beach
- Herbert Wertheim College of Medicine, Florida International University, Miami
| | - Carmen R Gomez-Fernandez
- Department of Public Health Sciences, University of Miami, Miami, FL
- Miller School of Medicine, University of Miami, Miami, FL
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Chen G, Ding XF, Pressley K, Bouamar H, Wang B, Zheng G, Broome LE, Nazarullah A, Brenner AJ, Kaklamani V, Jatoi I, Sun LZ. Everolimus Inhibits the Progression of Ductal Carcinoma In Situ to Invasive Breast Cancer Via Downregulation of MMP9 Expression. Clin Cancer Res 2019; 26:1486-1496. [PMID: 31871301 DOI: 10.1158/1078-0432.ccr-19-2478] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/06/2019] [Accepted: 12/16/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE We evaluated the role of everolimus in the prevention of ductal carcinoma in situ (DCIS) to invasive ductal carcinoma (IDC) progression. EXPERIMENTAL DESIGN The effects of everolimus on breast cancer cell invasion, DCIS formation, and DCIS progression to IDC were investigated in a 3D cell culturing model, intraductal DCIS xenograft model, and spontaneous MMTV-Her2/neu mouse model. The effect of everolimus on matrix metalloproteinase 9 (MMP9) expression was determined with Western blotting and IHC in these models and in patients with DCIS before and after a window trial with rapamycin. Whether MMP9 mediates the inhibition of DCIS progression to IDC by everolimus was investigated with knockdown or overexpression of MMP9 in breast cancer cells. RESULTS Everolimus significantly inhibited the invasion of human breast cancer cells in vitro. Daily intragastric treatment with everolimus for 7 days significantly reduced the number of invasive lesions from intraductal DCIS foci and inhibited DCIS progression to IDC in the MMTV-Her2/neu mouse mammary tumor model. Mechanistically, everolimus treatment decreased the expression of MMP9 in the in vitro and in vivo models, and in breast tissues from patients with DCIS treated with rapamycin for 1 week. Moreover, overexpression of MMP9 stimulated the invasion, whereas knockdown of MMP9 inhibited the invasion of breast cancer cell-formed spheroids in vitro and DCIS in vivo. Knockdown of MMP9 also nullified the invasion inhibition by everolimus in vitro and in vivo. CONCLUSIONS Targeting mTORC1 can inhibit DCIS progression to IDC via MMP9 and may be a potential strategy for DCIS or early-stage IDC therapy.
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Affiliation(s)
- Guang Chen
- Department of Cell Systems and Anatomy, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas. .,Department of Pharmacology, School of Medicine, Taizhou University, Taizhou, Zhejiang, China
| | - Xiao-Fei Ding
- Department of Cell Systems and Anatomy, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Laboratory for Biological Medicine, School of Medicine, Taizhou University, Taizhou, Zhejiang, China
| | - Kyle Pressley
- Department of Cell Systems and Anatomy, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Hakim Bouamar
- Department of Cell Systems and Anatomy, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Bingzhi Wang
- Department of Cell Systems and Anatomy, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Guixi Zheng
- Department of Cell Systems and Anatomy, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Larry E Broome
- Department of Cell Systems and Anatomy, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Alia Nazarullah
- Department of Pathology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Andrew J Brenner
- Department of Medicine, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Virginia Kaklamani
- Department of Medicine, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ismail Jatoi
- Department of Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Lu-Zhe Sun
- Department of Cell Systems and Anatomy, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
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Krischer B, Forte S, Singer G, Kubik-Huch RA, Leo C. Stereotactic Vacuum-Assisted Breast Biopsy in Ductal Carcinoma in situ: Residual Microcalcifications and Intraoperative Findings. Breast Care (Basel) 2019; 15:386-391. [PMID: 32982649 DOI: 10.1159/000502944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 08/27/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose The question of overtreatment of ductal carcinoma in situ (DCIS) was raised because a significant proportion of especially low-grade DCIS lesions never progress to invasive cancer. The rationale for the present study was to analyze the value of stereotactic vacuum-assisted biopsy (VAB) for complete removal of DCIS, focusing on the relationship between the absence of residual microcalcifications after stereotactic VAB and the histopathological diagnosis of the definitive surgical specimen. Patients and Methods Data of 58 consecutive patients diagnosed with DCIS by stereotactic VAB in a single breast center between 2012 and 2017 were analyzed. Patient records from the hospital information system were retrieved, and mammogram reports and images as well as histopathology reports were evaluated. The extent of microcalcifications before and after biopsy as well as the occurrence of DCIS in biopsy and definitive surgical specimens were analyzed and correlated. Results There was no correlation between the absence of residual microcalcifications in the post-biopsy mammogram and the absence of residual DCIS in the final surgical specimen (p = 0.085). Upstaging to invasive cancer was recorded in 4 cases (13%) but occurred only in the group that had high-grade DCIS on biopsy. Low-grade DCIS was never upgraded to high-grade DCIS in the definitive specimen. Conclusions The radiological absence of microcalcifications after stereotactic biopsy does not rule out residual DCIS in the final surgical specimen. Since upstaging to invasive cancer is seen in a substantial proportion of high-grade DCIS, the surgical excision of high-grade DCIS should remain the treatment of choice.
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Affiliation(s)
- Benedict Krischer
- Department of Gynecology, Breast Center, Kantonsspital Baden, Baden, Switzerland
| | - Serafino Forte
- Department of Radiology, Kantonsspital Baden, Baden, Switzerland
| | - Gad Singer
- Department of Pathology, Kantonsspital Baden, Baden, Switzerland
| | | | - Cornelia Leo
- Department of Gynecology, Breast Center, Kantonsspital Baden, Baden, Switzerland
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van Seijen M, Lips EH, Thompson AM, Nik-Zainal S, Futreal A, Hwang ES, Verschuur E, Lane J, Jonkers J, Rea DW, Wesseling J. Ductal carcinoma in situ: to treat or not to treat, that is the question. Br J Cancer 2019; 121:285-292. [PMID: 31285590 PMCID: PMC6697179 DOI: 10.1038/s41416-019-0478-6] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 12/27/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) now represents 20-25% of all 'breast cancers' consequent upon detection by population-based breast cancer screening programmes. Currently, all DCIS lesions are treated, and treatment comprises either mastectomy or breast-conserving surgery supplemented with radiotherapy. However, most DCIS lesions remain indolent. Difficulty in discerning harmless lesions from potentially invasive ones can lead to overtreatment of this condition in many patients. To counter overtreatment and to transform clinical practice, a global, comprehensive and multidisciplinary collaboration is required. Here we review the incidence of DCIS, the perception of risk for developing invasive breast cancer, the current treatment options and the known molecular aspects of progression. Further research is needed to gain new insights for improved diagnosis and management of DCIS, and this is integrated in the PRECISION (PREvent ductal Carcinoma In Situ Invasive Overtreatment Now) initiative. This international effort will seek to determine which DCISs require treatment and prevent the consequences of overtreatment on the lives of many women affected by DCIS.
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Affiliation(s)
- Maartje van Seijen
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Esther H Lips
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alastair M Thompson
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Serena Nik-Zainal
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Andrew Futreal
- Department of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Comprehensive Cancer Center, Durham, NC, USA
| | | | - Joanna Lane
- Health Cluster Net, Amsterdam, The Netherlands
| | - Jos Jonkers
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Oncode Institute, Amsterdam, The Netherlands
| | - Daniel W Rea
- Department of Medical Oncology, University of Birmingham, Birmingham, UK
| | - Jelle Wesseling
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
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Hanna WM, Parra-Herran C, Lu FI, Slodkowska E, Rakovitch E, Nofech-Mozes S. Ductal carcinoma in situ of the breast: an update for the pathologist in the era of individualized risk assessment and tailored therapies. Mod Pathol 2019; 32:896-915. [PMID: 30760859 DOI: 10.1038/s41379-019-0204-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 12/30/2022]
Abstract
Ductal carcinoma in situ (DCIS) is a neoplastic proliferation of mammary ductal epithelial cells confined to the ductal-lobular system, and a non-obligate precursor of invasive disease. While there has been a significant increase in the diagnosis of DCIS in recent years due to uptake of mammography screening, there has been little change in the rate of invasive recurrence, indicating that a large proportion of patients diagnosed with DCIS will never develop invasive disease. The main issue for clinicians is how to reliably predict the prognosis of DCIS in order to individualize patient treatment, especially as treatment ranges from surveillance only, breast-conserving surgery only, to breast-conserving surgery plus radiotherapy and/or hormonal therapy, and mastectomy with or without radiotherapy. We conducted a semi-structured literature review to address the above issues relating to "pure" DCIS. Here we discuss the pathology of DCIS, risk factors for recurrence, biomarkers and molecular signatures, and disease management. Potential mechanisms of progression from DCIS to invasive cancer and problems faced by clinicians and pathologists in diagnosing and treating this disease are also discussed. Despite the tremendous research efforts to identify accurate risk stratification predictors of invasive recurrence and response to radiotherapy and endocrine therapy, to date there is no simple, well-validated marker or group of variables for risk estimation, particularly in the setting of adjuvant treatment after breast-conserving surgery. Thus, the standard of care to date remains breast-conserving surgery plus radiotherapy, with or without hormonal therapy. Emerging tools, such as pathologic or biologic markers, may soon change such practice. Our review also includes recent advances towards innovative treatment strategies, including targeted therapies, immune modulators, and vaccines.
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Affiliation(s)
- Wedad M Hanna
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, E432-2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| | - Carlos Parra-Herran
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, E432-2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Fang-I Lu
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, E432-2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Elzbieta Slodkowska
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, E432-2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Eileen Rakovitch
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, E432-2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Sharon Nofech-Mozes
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, E432-2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
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Van Bockstal MR, Agahozo MC, Koppert LB, van Deurzen CHM. A retrospective alternative for active surveillance trials for ductal carcinoma in situ of the breast. Int J Cancer 2019; 146:1189-1197. [PMID: 31018242 PMCID: PMC7004157 DOI: 10.1002/ijc.32362] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/25/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022]
Abstract
Ductal carcinoma in situ (DCIS) of the breast is a nonobligate precursor of invasive breast cancer, accounting for 20 % of screen-detected breast cancers. Little is known about the natural progression of DCIS because most patients undergo surgery upon diagnosis. Many DCIS patients are likely being overtreated, as it is believed that only around 50 % of DCIS will progress to invasive carcinoma. Robust prognostic markers for progression to invasive carcinoma are lacking. In the past, studies have investigated women who developed a recurrence after breast-conserving surgery (BCS) and compared them with those who did not. However, where there is no recurrence, the patient has probably been adequately treated. The present narrative review advocates a new research strategy, wherein only those patients with a recurrence are studied. Approximately half of the recurrences are invasive cancers, and half are DCIS. So-called "recurrences" are probably most often the result of residual disease. The new approach allows us to ask: why did some residual DCIS evolve to invasive cancers and others not? This novel strategy compares the group of patients that developed in situ recurrence with the group of patients that developed invasive recurrence after BCS. The differences between these groups could then be used to develop a robust risk stratification tool. This tool should estimate the risk of synchronous and metachronous invasive carcinoma when DCIS is diagnosed in a biopsy. Identification of DCIS patients at low risk for developing invasive carcinoma will individualize future therapy and prevent overtreatment.
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Affiliation(s)
- Mieke R Van Bockstal
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marie C Agahozo
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Smith JC, Sheltzer JM. Systematic identification of mutations and copy number alterations associated with cancer patient prognosis. eLife 2018; 7:e39217. [PMID: 30526857 PMCID: PMC6289580 DOI: 10.7554/elife.39217] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/12/2018] [Indexed: 02/06/2023] Open
Abstract
Successful treatment decisions in cancer depend on the accurate assessment of patient risk. To improve our understanding of the molecular alterations that underlie deadly malignancies, we analyzed the genomic profiles of 17,879 tumors from patients with known outcomes. We find that mutations in almost all cancer driver genes contain remarkably little information on patient prognosis. However, CNAs in these same driver genes harbor significant prognostic power. Focal CNAs are associated with worse outcomes than broad alterations, and CNAs in many driver genes remain prognostic when controlling for stage, grade, TP53 status, and total aneuploidy. By performing a meta-analysis across independent patient cohorts, we identify robust prognostic biomarkers in specific cancer types, and we demonstrate that a subset of these alterations also confer specific therapeutic vulnerabilities. In total, our analysis establishes a comprehensive resource for cancer biomarker identification and underscores the importance of gene copy number profiling in assessing clinical risk.
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The importance of early detection of calcifications associated with breast cancer in screening. Breast Cancer Res Treat 2017; 167:451-458. [PMID: 29043464 PMCID: PMC5790861 DOI: 10.1007/s10549-017-4527-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/27/2017] [Indexed: 11/02/2022]
Abstract
PURPOSE The aim of this study was to assess how often women with undetected calcifications in prior screening mammograms are subsequently diagnosed with invasive cancer. METHODS From a screening cohort of 63,895 women, exams were collected from 59,690 women without any abnormalities, 744 women with a screen-detected cancer and a prior negative exam, 781 women with a false positive exam based on calcifications, and 413 women with an interval cancer. A radiologist identified cancer-related calcifications, selected by a computer-aided detection system, on mammograms taken prior to screen-detected or interval cancer diagnoses. Using this ground truth and the pathology reports, the sensitivity for calcification detection and the proportion of lesions with visible calcifications that developed into invasive cancer were determined. RESULTS The screening sensitivity for calcifications was 45.5%, at a specificity of 99.5%. A total of 68.4% (n = 177) of cancer-related calcifications that could have been detected earlier were associated with invasive cancer when diagnosed. CONCLUSIONS Screening sensitivity for detection of malignant calcifications is low. Improving the detection of these early signs of cancer is important, because the majority of lesions with detectable calcifications that are not recalled immediately but detected as interval cancer or in the next screening round are invasive at the time of diagnosis.
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26
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Groen EJ, Elshof LE, Visser LL, Rutgers EJT, Winter-Warnars HA, Lips EH, Wesseling J. Finding the balance between over- and under-treatment of ductal carcinoma in situ (DCIS). Breast 2017; 31:274-283. [DOI: 10.1016/j.breast.2016.09.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/19/2016] [Accepted: 09/01/2016] [Indexed: 12/21/2022] Open
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Denis M, Gregory A, Bayat M, Fazzio RT, Whaley DH, Ghosh K, Shah S, Fatemi M, Alizad A. Correlating Tumor Stiffness with Immunohistochemical Subtypes of Breast Cancers: Prognostic Value of Comb-Push Ultrasound Shear Elastography for Differentiating Luminal Subtypes. PLoS One 2016; 11:e0165003. [PMID: 27776153 PMCID: PMC5077080 DOI: 10.1371/journal.pone.0165003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/04/2016] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The purpose of our study is to correlate quantitatively measured tumor stiffness with immunohistochemical (IHC) subtypes of breast cancer. Additionally, the influence of prognostic histologic features (cancer grade, size, lymph node status, and histological type and grade) to the tumor elasticity and IHC profile relationship will be investigated. METHODS Under an institutional review board (IRB) approved protocol, B-mode ultrasound (US) and comb-push ultrasound shear elastography (CUSE) were performed on 157 female patients with suspicious breast lesions. Out of 157 patients 83 breast cancer patients confirmed by pathology were included in this study. The association between CUSE mean stiffness values and the aforementioned prognostic features of the breast cancer tumors were investigated. RESULTS Our results demonstrate that the most statistically significant difference (p = 0.0074) with mean elasticity is tumor size. When considering large tumors (size ≥ 8mm), thus minimizing the statistical significance of tumor size, a significant difference (p< 0.05) with mean elasticity is obtained between luminal A of histological grade I and luminal B (Ki-67 > 20%) subtypes. CONCLUSION Tumor size is an independent factor influencing mean elasticity. The Ki-67 proliferation index and histological grade were dependent factors influencing mean elasticity for the differentiation between luminal subtypes. Future studies on a larger group of patients may broaden the clinical significance of these findings.
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Affiliation(s)
- Max Denis
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Adriana Gregory
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Mahdi Bayat
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Robert T Fazzio
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Dana H Whaley
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Karthik Ghosh
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, 55905, United States of America
| | - Sejal Shah
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Azra Alizad
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, United States of America.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, United States of America.,Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, 55905, United States of America
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29
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Pang JMB, Gorringe KL, Fox SB. Ductal carcinoma in situ - update on risk assessment and management. Histopathology 2016; 68:96-109. [PMID: 26768032 DOI: 10.1111/his.12796] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/31/2015] [Indexed: 12/20/2022]
Abstract
Ductal carcinoma in situ (DCIS) accounts for ~20-25% of breast cancers. While DCIS is not life-threatening, it may progress to invasive carcinoma over time, and treatment intended to prevent invasive progression may itself cause significant morbidity. Accurate risk assessment is therefore necessary to avoid over- or undertreatment of an individual patient. In this review we will outline the evidence for current management of DCIS, discuss approaches to DCIS risk assessment and challenges facing identification of novel DCIS biomarkers.
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Affiliation(s)
- Jia-Min B Pang
- Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia.,Department of Pathology, University of Melbourne, Melbourne, Vic., Australia
| | - Kylie L Gorringe
- Department of Pathology, University of Melbourne, Melbourne, Vic., Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic., Australia.,Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia
| | - Stephen B Fox
- Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia.,Department of Pathology, University of Melbourne, Melbourne, Vic., Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic., Australia
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Sánchez-Céspedes R, Millán Y, Guil-Luna S, Reymundo C, Espinosa de Los Monteros A, Martín de Las Mulas J. Myoepithelial cells in canine mammary tumours. Vet J 2015; 207:45-52. [PMID: 26639832 DOI: 10.1016/j.tvjl.2015.10.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 10/07/2015] [Accepted: 10/10/2015] [Indexed: 02/05/2023]
Abstract
Mammary tumours are the most common neoplasms of female dogs. Compared to mammary tumours of humans and cats, myoepithelial (ME) cell involvement is common in canine mammary tumours (CMT) of any subtype. Since ME cell involvement in CMT influences both histogenetic tumour classification and prognosis, correct identification of ME cells is important. This review describes immunohistochemical methods for identification of canine mammary ME cells used in vivo. In addition, phenotypic and genotypic methods to isolate ME cells for in vitro studies to analyse tumour-suppressor protein production and gene expression are discussed. The contribution of ME cells to both histogenetic classifications and the prognosis of CMT is compared with other species and the potential use of ME cells as a method to identify carcinoma in situ is discussed.
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Affiliation(s)
| | - Yolanda Millán
- Department of Comparative Pathology, University of Córdoba, 14014 Córdoba, Spain
| | - Silvia Guil-Luna
- Department of Comparative Pathology, University of Córdoba, 14014 Córdoba, Spain
| | - Carlos Reymundo
- Department of Pathology, University of Córdoba, 14071 Córdoba, Spain
| | - Antonio Espinosa de Los Monteros
- Unit of Histology and Animal Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, 35413 Las Palmas, Spain
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Immunostaining of ∆Np63 (using the p40 antibody) is equal to that of p63 and CK5/6 in high-grade ductal carcinoma in situ of the breast. Virchows Arch 2015; 467:67-70. [PMID: 25850754 DOI: 10.1007/s00428-015-1766-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 02/23/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
As a result of breast cancer screening programs, high-grade ductal carcinoma in situ (DCIS) of the breast is diagnosed more often. Frequently, a DCIS diagnosis can only be made using immunohistochemical stains to visualize the myoepithelial layer in order to assess microinvasion. Standard markers for myoepithelial cells are CK5/6 and p63. An isoform of the latter, ∆Np63, is recognized by a recently developed antibody, p40. Here, we compare the standard myoepithelial markers CK5/6 and p63 with p40. We immunostained full sections of tissue samples of 35 high-grade DCIS and compared the staining pattern of CK5/6, p63 and p40 in tumour tissue and in normal glands. Staining patterns of myoepithelial cells for p63 and p40 were similar in terms of the percentage of stained nuclei. In all cases, p63 was strongly expressed, while this was the case for p40 in 31 (89%) and moderately in 4 (11%) cases. All but one case (97%) showed a similar percentage of stained myoepithelial cells in comparing CK5/6 and p40 staining. CK5/6 expression was heterogeneous and strong/moderate/weak in 60, 34 and 6 % respectively. Compared to surrounding normal glands, staining of myoepithelial cells for all three markers in the neoplastic lesion was attenuated. In high-grade DCIS, p40 staining is highly specific for myoepithelial cells. Its staining pattern and intensity are equal to p63, which opens up its use for daily practice. Staining with p40 is less heterogeneous than that for CK5/6.
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Au FWF, Ghai S, Lu FI, Moshonov H, Crystal P. Quantitative shear wave elastography: correlation with prognostic histologic features and immunohistochemical biomarkers of breast cancer. Acad Radiol 2015; 22:269-77. [PMID: 25666048 DOI: 10.1016/j.acra.2014.10.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/15/2014] [Accepted: 10/21/2014] [Indexed: 12/19/2022]
Abstract
RATIONALE AND OBJECTIVES To correlate prognostic histologic features and immunohistochemical biomarkers of breast cancer with quantitative shear wave elastography (SWE) parameters. MATERIALS AND METHODS B-mode ultrasound (US) and SWE were performed before core biopsy on 72 cancers in 68 patients. Mean cancer size was determined from US. Histologic grade, lymph node status, lymphovascular invasion (LVI), histologic type, and immunohistochemical biomarkers (estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 [HER2]) were determined from surgical pathology reports. Correlation between these features and quantitative SWE parameters (mean elasticity [E mean], maximum elasticity [E max], and elasticity ratio [E ratio]) was made. RESULTS There was significant correlation of mean cancer size with E mean, E max, and E ratio (correlation, 0.492, 0.500, and 0.435, respectively; all P < .001). Lymph node involvement was associated with significantly higher E max (P = .040). LVI was associated with significantly higher E mean, E max, and E ratio (P = .002, .004, and .042, respectively). There was no significant correlation of histologic grade with SWE parameters. HER2+ cancers were associated with significantly higher E ratio (P = .030). In multivariate analysis, only mean cancer size was significantly correlated with E mean and E max (P < .001). CONCLUSIONS There was significant correlation of cancer size with SWE parameters. There was significant correlation of lymph node status and LVI with SWE, but only on univariate analysis. SWE has the potential to provide prognostic information of breast cancer in a noninvasive manner, but further study is required.
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Affiliation(s)
- Frederick Wing-Fai Au
- Joint Department of Medical Imaging, University of Toronto, Toronto General Hospital, 585 University Avenue East, NCSB 1C-571, Toronto, Ontario, Canada M5G2N2.
| | - Sandeep Ghai
- Joint Department of Medical Imaging, University of Toronto, Toronto General Hospital, 585 University Avenue East, NCSB 1C-571, Toronto, Ontario, Canada M5G2N2
| | - Fang-I Lu
- Department of Pathology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Hadas Moshonov
- Joint Department of Medical Imaging, University of Toronto, Toronto General Hospital, 585 University Avenue East, NCSB 1C-571, Toronto, Ontario, Canada M5G2N2
| | - Pavel Crystal
- Joint Department of Medical Imaging, University of Toronto, Toronto General Hospital, 585 University Avenue East, NCSB 1C-571, Toronto, Ontario, Canada M5G2N2
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Blinded double reading yields a higher programme sensitivity than non-blinded double reading at digital screening mammography: A prospected population based study in the south of The Netherlands. Eur J Cancer 2015; 51:391-9. [DOI: 10.1016/j.ejca.2014.12.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/06/2014] [Accepted: 12/11/2014] [Indexed: 11/20/2022]
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Histopathological characterization of ductal carcinoma in situ (DCIS) of the breast according to HER2 amplification status and molecular subtype. Virchows Arch 2014; 465:275-89. [PMID: 24973889 DOI: 10.1007/s00428-014-1609-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/15/2014] [Accepted: 06/16/2014] [Indexed: 12/29/2022]
Abstract
This study aimed to characterize ductal carcinoma in situ (DCIS) according to human epidermal growth factor receptor 2 (HER2) amplification status and molecular subtype. In addition, we performed a detailed HER2 and CEP17 copy number analysis and we assessed the impact of recent changes in the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines on HER2 immunohistochemical (IHC) scores in DCIS. Nuclear grade, extensive comedonecrosis, stromal architecture, stromal inflammation, and progesterone receptor (PR) expression were significantly associated with HER2 amplification status. In multivariate analysis, stromal inflammation and extensive comedonecrosis were the only two features that remained significantly related to HER2 amplification status. The recent changes in ASCO/CAP guidelines resulted in significant upgrading of HER2 IHC score. Remarkably, about one in five non-amplified DCIS presented a 3+ IHC score, regardless of the scoring method. The biological significance of this phenomenon is presently unknown. After categorization according to molecular subtype, luminal A DCIS mainly presented histopathological features associated with good prognosis, whereas luminal B/HER2+ and HER2+ categories displayed a more aggressive phenotype. Overall, our results demonstrate that HER2-amplified DCIS constitute a clearly distinct subgroup which is characterized by histopathological features associated with poor prognosis. Further studies are required to elucidate the biological significance of a 3+ IHC score in non-amplified DCIS, as well as its mechanism.
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Butt S, Butt T, Jirström K, Hartman L, Amini RM, Zhou W, Wärnberg F, Borgquist S. The target for statins, HMG-CoA reductase, is expressed in ductal carcinoma-in situ and may predict patient response to radiotherapy. Ann Surg Oncol 2014; 21:2911-9. [PMID: 24777857 DOI: 10.1245/s10434-014-3708-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients with ductal carcinoma-in-situ (DCIS) are currently not prescribed adjuvant systemic treatment after surgery and radiotherapy. Prediction of DCIS patients who would benefit from radiotherapy is warranted. Statins have been suggested to exert radio-sensitizing effects. The target for cholesterol-lowering statins is HMG-CoA reductase (HMGCR), the rate-limiting enzyme in the mevalonate pathway. The aim of this study was to examine HMGCR expression in DCIS and study its treatment predictive value. METHODS A population-based cohort including 458 women diagnosed with primary DCIS between 1986 and 2004 were followed until November 2011 to study long-term survival. Tumor tissue microarrays were constructed, and immunohistochemical analyses were performed to detect cytoplasmic protein expression of HMGCR. The association between DCIS HMGCR expression and invasive breast cancer recurrence-free survival (RFSinv) and overall survival (OS) was analyzed by Kaplan-Meier curves, log rank test, and Cox proportional hazard analysis. RESULTS HMGCR was strongly expressed in 24 % of the assessed DCIS samples, moderately expressed in 46 %, and weakly expressed in 23 %; no expression was detected in 7 % of the samples. During the follow-up time (median 13.8 years), 61 patients were diagnosed with an invasive breast cancer recurrence, and 80 patients died. A crude analysis showed no survival benefit from radiotherapy. However, patients with strong HMGCR expression showed an improved RFSinv (log rank, p = 0.03) and OS (log rank, p = 0.04) after radiotherapy. No statistically significant interaction was observed for HMGCR and radiotherapy (RFSinv p = 0.69 and OS p = 0.29). CONCLUSIONS This study demonstrates HMGCR expression in DCIS and suggests HMGCR as a predictive marker of response to postoperative radiotherapy in DCIS, although the test for interaction was nonsignificant. Future DCIS studies addressing the potential of statin treatment targeting HMGCR are warranted.
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Affiliation(s)
- Salma Butt
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden,
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Nation-wide data on screening performance during the transition to digital mammography: Observations in 6 million screens. Eur J Cancer 2013; 49:3517-25. [DOI: 10.1016/j.ejca.2013.06.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/15/2013] [Accepted: 06/19/2013] [Indexed: 11/19/2022]
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