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Yao MX, Li L, Ye WT, Liu Y, Wang Y, Zhu W, Liang CH. Multimodal Imaging Features and Prognosis of Metaplastic Breast Carcinoma. Acad Radiol 2024; 31:2205-2213. [PMID: 38030514 DOI: 10.1016/j.acra.2023.10.017] [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: 08/01/2023] [Revised: 09/13/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023]
Abstract
RATIONALE AND OBJECTIVES Metaplastic breast carcinoma (MBC) is an infrequent malignancy with an unfavorable prognosis, and there is a paucity of research on the multimodal imaging features of MBC. This study aimed to provide a comprehensive analysis of the multimodal imaging features, clinicopathological characteristics, and prognosis of MBC. MATERIALS AND METHODS A total of 36 patients with histologically confirmed MBC from 2012 to 2021 were included in the study. We analyzed the pre-treatment multimodal imaging features, including mammography, ultrasonography (US), and magnetic resonance imaging (MRI), as well as clinicopathology and prognosis of MBC. Follow-up data included local recurrence, distant metastasis, and overall survival (OS) rate. RESULTS MBC patients had a median age of 51 years at diagnosis. The most common histologic subtype was squamous cell carcinoma, with 86.1% of MBC being histological grade 3 and triple negative. The most common mammographic findings were irregular shape, non-calcification, and high density. The predominant US findings included irregular shape, parallel orientation, posterior acoustic enhancement, and hypoecho. On MRI, most masses exhibited irregular shape, spiculate margin, heterogeneous enhancement, Type II time intensity curve, and diffusion restriction on diffusion weighted images determined by apparent diffusion coefficient. According to breast imaging reporting and data system, mammography suggested malignancy in 50% of cases, US indicated a moderate to high suspicion of malignancy in 77.8% of cases, MRI revealed malignancy in all cases. At a median follow-up time of 48 months (range, 8-122 months) for 35 MBC patients, the local recurrence, distant metastasis, and OS rates were 11.4%, 28.6%, and 67.4%, respectively. CONCLUSION The benign features of MBC on mammography and US may cause misinterpretation. However, the inclusion of malignant features observed on MRI can improve diagnostic accuracy.
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Affiliation(s)
- Meng-Xia Yao
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Yuexiu District, Guangzhou, 510080, China (M.X.Y., Y.L., Y.W., W.Z.)
| | - Lian Li
- Department of Ultrasound, Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Baiyun District, Guangzhou, 510515, China (L.L.)
| | - Wei-Tao Ye
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China (W.T.Y., C.H.L.)
| | - Yu Liu
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Yuexiu District, Guangzhou, 510080, China (M.X.Y., Y.L., Y.W., W.Z.)
| | - Yin Wang
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Yuexiu District, Guangzhou, 510080, China (M.X.Y., Y.L., Y.W., W.Z.)
| | - Wu Zhu
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Yuexiu District, Guangzhou, 510080, China (M.X.Y., Y.L., Y.W., W.Z.)
| | - Chang-Hong Liang
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China (W.T.Y., C.H.L.).
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Sarfraz Z, Sarfraz A, Mehak O, Akhund R, Bano S, Aftab H. Racial and socioeconomic disparities in triple-negative breast cancer treatment. Expert Rev Anticancer Ther 2024; 24:107-116. [PMID: 38436305 DOI: 10.1080/14737140.2024.2326575] [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: 08/09/2023] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Triple-negative breast cancer (TNBC) continues to be a significant concern, especially among minority populations, where treatment disparities are notably pronounced. Addressing these disparities, especially among African American women and other minorities, is crucial for ensuring equitable healthcare. AREAS COVERED This review delves into the continuum of TNBC treatment, noting that the standard of care, previously restricted to chemotherapy, has now expanded due to emerging clinical trial results. With advances like PARP inhibitors, immunotherapy, and antibody-drug conjugates, a more personalized treatment approach is on the horizon. The review highlights innovative interventions tailored for minorities, such as utilizing technology like text messaging, smartphone apps, and targeted radio programming, coupled with church-based behavioral interventions. EXPERT OPINION Addressing TNBC treatment disparities demands a multifaceted approach, blending advanced medical treatments with culturally sensitive community outreach. The potential of technology, especially in the realm of promoting health awareness, is yet to be fully harnessed. As the field progresses, understanding and integrating the socio-economic, biological, and access-related challenges faced by minorities will be pivotal for achieving health equity in TNBC care.
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Affiliation(s)
- Zouina Sarfraz
- Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Azza Sarfraz
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan
| | - Onaiza Mehak
- Department of Medicine, Aziz Fatimah Medical and Dental College, Faisalabad, Pakistan
| | - Ramsha Akhund
- Department of Surgery, University of Alabama at Birmingham, Tuscaloosa, AL, USA
| | - Shehar Bano
- Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Hinna Aftab
- Department of Medicine, CMH Lahore Medical College, Lahore, Pakistan
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Akrida I, Mulita F, Plachouri KM, Benetatos N, Maroulis I, Papadaki H. Epithelial to mesenchymal transition (EMT) in metaplastic breast cancer and phyllodes breast tumors. Med Oncol 2023; 41:20. [PMID: 38104042 DOI: 10.1007/s12032-023-02259-4] [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: 08/28/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023]
Abstract
Epithelial-mesenchymal transition (EMT), a transdifferentiation program whereby epithelial cells acquire mesenchymal phenotype, is essential during embryonic development. EMT has also been implicated in cancer progression by conferring migratory and metastatic potential, as well as cell plasticity and stem cell like traits, to cancer cells. Metaplastic breast carcinoma (MBC) is a rare aggressive type of breast cancer characterized by the presence of heterologous elements, typically by the existence of epithelial and mesenchymal components. Phyllodes tumors (PTs) are uncommon fibroepithelial neoplasms consisting of epithelial and mesenchymal elements. Although various hypotheses have been proposed on the pathogenesis of these biphasic tumors, there is growing evidence supporting the theory that PTs and MBC could both correlate with cancer related EMT. This review summarizes the existing literature on the emerging role of EMT in the pathogenesis of MBC and PTs. Both malignant PTs and MBC are characterized by poor prognosis. Therefore, several anti-EMT targeting strategies such as blocking upstream signaling pathways, targeting the molecular drivers of EMT and targeting mesenchymal cells and the extracellular matrix, could potentially represent a promising therapeutic approach for patients suffering from these aggressive neoplasms.
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Affiliation(s)
- Ioanna Akrida
- Department of General Surgery, University General Hospital of Patras, Rion, Greece.
- Department of Anatomy-Histology-Embryology, University of Patras Medical School, Rion, Greece.
- Department of Surgery, Department of Anatomy-Histology-Embryology, School of Medicine, University of Patras, 26504, Rion, Greece.
| | - Francesk Mulita
- Department of General Surgery, University General Hospital of Patras, Rion, Greece
| | | | - Nikolaos Benetatos
- Department of General Surgery, University General Hospital of Patras, Rion, Greece
| | - Ioannis Maroulis
- Department of General Surgery, University General Hospital of Patras, Rion, Greece
| | - Helen Papadaki
- Department of Anatomy-Histology-Embryology, University of Patras Medical School, Rion, Greece
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Chartier S, Brochard C, Martinat C, Coussy F, Feron JG, Kirova Y, Cottu P, Marchiò C, Vincent-Salomon A. TROP2, androgen receptor, and PD-L1 status in histological subtypes of high-grade metaplastic breast carcinomas. Histopathology 2023; 82:664-671. [PMID: 36527253 DOI: 10.1111/his.14852] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
AIMS High-grade metaplastic breast carcinoma (HG-MBC) is a rare subtype of invasive breast carcinoma, mostly triple-negative. Metaplastic carcinomas are less responsive to neoadjuvant chemotherapy and are associated with a worse outcome than invasive carcinomas of no special type. METHODS Clinicopathological characteristics and immunophenotype were retrospectively assessed in a series of 65 patients diagnosed with HG-MBC between 2005 and 2017 at the Curie Institute (antibody panel: oestrogen receptor [ER], progesterone receptor [PR], androgen receptor [AR], human epidermal growth factor receptor 2 [HER2], programmed death ligand-1 [PD-L1], and trophoblast cell surface antigen 2 [TROP2]). RESULTS The median age at diagnosis was 59.5 years. Six (9%) patients had metastatic disease at diagnosis. Among the nonmetastatic patients receiving neoadjuvant therapy, 26% (5/19) achieved pathological complete response. Most tumours were pT1/pT2 (77%) and 12% were pN+. Histological subtypes (mixed, squamous, mesenchymal, and spindle cell) were 40%, 35.5%, 15.5%, and 9%, respectively. Tumour-infiltrating lymphocytes were low or moderate except when squamous differentiation was present. Most tumours were triple-negative (92%). AR and TROP2 were positive in 34% and 85% of the cases, respectively. PD-L1 was positive in tumour cells in 18% (cutoff: 1% of positive tumour cells) of the cases and in tumour-infiltrating immune cells in 40% (cutoff: 1% of tumour area) of the cases. Notably, spindle cell and mesenchymal metaplastic breast carcinomas were mostly PDL1-negative. Lastly, 21 (32.3%) cases were HER2-low, all being HER2 1+, with no HER2 2+. CONCLUSION Metaplastic breast carcinoma could benefit from tailored therapeutic strategies adapted to the phenotypic specificities of histological subtypes.
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Affiliation(s)
- Suzanne Chartier
- Department of Pathology, Hôpital Bicêtre, APHP, Université Paris Saclay, Le Kremlin-Bicêtre, France.,Department of Pathology, Institut Curie, Paris, France
| | | | | | - Florence Coussy
- Department of Medical Oncology, Institut Curie, Paris, France
| | | | - Youlia Kirova
- Department of Radiotherapy, Institut Curie, Paris, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Caterina Marchiò
- Department of Medical Sciences, University of Turin, Italy.,Pathology Unit, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Italy
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Chen L, Yang F, Chen S, Tai J. Mechanisms on chemotherapy resistance of colorectal cancer stem cells and research progress of reverse transformation: A mini-review. Front Med (Lausanne) 2022; 9:995882. [PMID: 36172536 PMCID: PMC9510709 DOI: 10.3389/fmed.2022.995882] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Tumor recurrence and chemotherapy resistance are mainly responsible for poor prognosis in colorectal cancer (CRC) patients. Cancer stem cell (CSC) has been identified in many solid tumors, including CRC. Additionally, CSC cannot be completely killed during chemotherapy and develops resistance to chemotherapeutic drugs, which is the main reason for tumor recurrence. This study reviews the main mechanisms of CSC chemotherapy resistance in CRC, including activation of DNA damage checkpoints, epithelial-mesenchymal transition (EMT), inhibition of the overexpression of antiapoptotic regulatory factors, overexpression of ATP-binding cassette (ABC) transporters, maintenance of reactive oxygen species (ROS) levels, and the dormant state of CSC. Advances in research to reverse chemotherapy resistance are also discussed. Our study can provide the promising potential for eliminating CSC and preventing tumor progression for CRC treatment.
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Affiliation(s)
- Lei Chen
- Department of Colorectal and Anal Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Funing Yang
- Pediatric Outpatient Clinic, First Hospital of Jilin University, Changchun, China
| | - Si Chen
- Department of Colorectal and Anal Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Jiandong Tai
- Department of Colorectal and Anal Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
- *Correspondence: Jiandong Tai
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