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Li X, Zhou C, Xu T, Ren Y, Li M, Shang J. Meta-analysis on axillary lymph node metastasis rate in ductal carcinoma in situ with microinvasion. Cancer Med 2024; 13:e7413. [PMID: 38925621 PMCID: PMC11199912 DOI: 10.1002/cam4.7413] [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: 02/06/2024] [Revised: 05/11/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE To address the question of axillary lymph node staging in ductal carcinoma in situ with microinvasion (DCIS-MI), we retrospectively evaluated axillary lymph nodes metastasis (ALNM) rate in a cohort of postsurgical DCIS-MI patients. By analyzing these data, we aimed to generate clinically relevant insights to inform treatment decision-making for this patient population. METHODS A systematic search was conducted on PubMed, Web of Science, Embase, The Cochrane Library, CNKI, Wanfang Database, Wipe, and China Biomedical Literature Database to identify relevant publications in any language. All the analyses were performed using Stata 16.0 software. RESULTS Among the 28 studies involving 8279 patients, the pooled analysis revealed an ALNM rate of 8% (95% CI, 7% to 10%) in patients with DCIS-MI. Furthermore, the rates of axillary lymph node macrometastasis, micrometastasis, and ITC in patients with DCIS-MI were 2% (95% CI, 2% to 3%), 3% (95% CI, 2% to 4%), and 2% (95% CI, 1% to 3%), respectively. Moreover, 13 studies investigated the non-sentinel lymph node (Non-SLN) metastasis rate, encompassing a total of 1236 DCIS-MI cases. The pooled analysis identified a Non-SLN metastasis rate of 33% (95% CI, 14% to 55%) in patients with DCIS-MI. CONCLUSION The SLNB for patients with DCIS-MI is justifiable and could provide a novel therapeutic basis for systemic treatment decisions.
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Affiliation(s)
- Xiongxiong Li
- Department of Breast SurgeryXi'an People's Hospital (Xi'an No. 4 Hospital)Xi'anChina
| | - Can Zhou
- Department of Breast SurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Ting Xu
- Department of Breast SurgeryXi'an People's Hospital (Xi'an No. 4 Hospital)Xi'anChina
| | - Yu Ren
- Department of Breast SurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Meng Li
- Department of Breast SurgeryXi'an People's Hospital (Xi'an No. 4 Hospital)Xi'anChina
| | - Jin Shang
- Department of Breast SurgeryXi'an People's Hospital (Xi'an No. 4 Hospital)Xi'anChina
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Ambrosini-Spaltro A, Di Donato F, Saragoni L, Cserni G, Rakha E, Foschini MP. Prognostic Markers of Microinvasive Breast Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15113007. [PMID: 37296968 DOI: 10.3390/cancers15113007] [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: 04/22/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: The prognostic factors of microinvasive (≤1 mm) breast carcinoma are not completely clear. The aim of this study was to perform a systematic review and meta-analysis to clarify these factors. (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was followed. Two databases were interrogated, PubMed and Embase, and papers in English were included to address this question. The selected studies were those that reported on female patients affected by microinvasive carcinoma, and on prognostic factors with a hazard ratio (HR) for disease-free survival (DFS) and overall survival (OS). (3) Results: In total, 618 records were identified. After removing duplicates (166), identification, and screening (336 by title and abstract alone, 116 by full text and eventual supplementary material), 5 papers were selected. Seven different meta-analyses were conducted in this study, all referring to DFS, analyzing the following prognostic factors: estrogen receptor, progesterone receptor, HER2 status, multifocality and grade of microinvasion, patient's age, and lymph node status. Only lymph node status was associated with prognosis and DFS (total number of cases: 1528; Z = 1.94; p = 0.05). The other factors examined did not significantly affect prognosis (p > 0.05). (4) Conclusions: Positive lymph node status significantly worsens prognosis in patients with microinvasive breast carcinoma.
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Affiliation(s)
| | - Francesco Di Donato
- Pathology Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- School of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40139 Bologna, Italy
| | - Luca Saragoni
- Pathology Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
- Department of Pathology, University of Szeged, 6725 Szeged, Hungary
| | - Emad Rakha
- Histopathology Department, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Maria Pia Foschini
- Unit of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, 40139 Bologna, Italy
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Prognostic significance of microinvasion with ductal carcinoma in situ of the breast: a meta-analysis. Breast Cancer Res Treat 2023; 197:245-254. [PMID: 36427119 PMCID: PMC9823049 DOI: 10.1007/s10549-022-06800-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Ductal carcinoma in situ (DCIS) associated with invasive carcinoma ≤ 1 mm in size is defined as DCIS with microinvasion (DCIS/microinvasion) rather than as invasive breast carcinoma. The number of patients with microinvasion accounts for < 1% of all breast cancer in published studies. As the numbers are limited, the prognostic significance of DCIS/microinvasion has not been clearly elucidated. This meta-analysis aimed to investigate the survival differences between patients with DCIS/microinvasion and those with pure DCIS. METHODS A meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was performed. We searched three electronic databases (MEDLINE, Cochrane Library, and EMBASE) and included observational studies published in English that contained survival details of patients with either DCIS or DCIS/microinvasion. RESULTS This study identified 26 studies that described the clinicopathological characteristics of patients in both the DCIS and DCIS/microinvasion groups. Survival differences were evaluated in 10 of 26 studies. Disease-free survival and loco-regional recurrence-free survival were significantly shorter in patients with DCIS/microinvasion than in those with DCIS (Hazard ratio, 1.52; 95% confidence interval, 1.11-2.08; p = 0.01 and hazard ratio, 2.53; 95% confidence interval, 1.45-4.41; p = 0.001, respectively). Both overall survival and distant metastasis-free survival tended to be shorter in patients with DCIS/microinvasion than in patients with DCIS (Hazard ratio, 1.63; 95% CI, 0.63-4.23; p = 0.31 and hazard ratio, 1.85; 95% confidence interval, 0.74-4.66; p = 0.19, respectively) but the difference was not statistically significant. CONCLUSION Our meta-analysis suggests that DCIS/microinvasion may display more aggressive biological and clinical behavior than pure DCIS, highlighting the potential need for closer follow-up and consideration of adjuvant treatment strategies in DCIS patients with microinvasive disease.
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Bertozzi S, Londero AP, Bulfoni M, Seriau L, Agakiza D, Pasqualucci A, Andretta M, Orsaria M, Mariuzzi L, Cedolini C. One-Step Nucleic Acid Amplification System in Comparison to the Intraoperative Frozen Section and Definitive Histological Examination Among Breast Cancer Patients: A Retrospective Survival Study. Front Oncol 2022; 12:847858. [PMID: 35664761 PMCID: PMC9158526 DOI: 10.3389/fonc.2022.847858] [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: 01/03/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Simple Summary Implementing intraoperative assessment of sentinel lymph nodes by one-step nucleic acid amplification in early breast cancer can reduce the surgical burden to the patient and the costs to the health system. However, only limited data are available in terms of long-term disease-free survival and overall survival. Therefore, this study aims to compare disease-free survival and overall survival between one-step nucleic acid amplification, frozen section, and definitive histology. These results could impact the healthcare community, adding further proof to the body of evidence supporting the broader adoption of this innovative technology that enables a safe reduction in patient surgical burden and healthcare costs. Background The one-step nucleic acid amplification (OSNA) system is a novel molecular technique, which consents to quick intraoperative detection of sentinel lymph node metastases by the amplification of cytokeratin 19 mRNA. Our study aims to evaluate the OSNA method in comparison with frozen section (FS) and definitive histological examination of the sentinel lymph node biopsy among early breast cancer patients considering disease-free survival (DFS) and overall survival (OS). Methods In this study, we included all women who underwent sentinel lymph node biopsy (SLNB) for breast cancers classified as TNM stage I and II in our center between January 2005 and January 2017, and the follow-up was collected up to January 2019. We divided patients among three groups based on SLNB evaluation: definitive histological examination, intra-operative FS, or OSNA. Results We included 2412 SLNBs: 727 by definitive histological examination, 697 by FS, and 988 by OSNA. Isolated tumor cells were found in 2.32% of cases, micrometastasis in 9.12%, and macrometastases in 13.64%. Surgical procedure duration was significantly shorter in OSNA than in FS (42.1 minutes ±5.1 vs. 70.1 minutes ±10.5, p <0.05). No significant differences have been observed among the three groups regarding OS, DSF, cumulative local, or distant metastases. In particular 5-year DFS was 96.38% in definitive histology (95% C.I. 95.02-97.75%), 96.37% in FS (95% C.I. 94.98-97.78%), and 96.51% in OSNA group (95% C.I. 95.32-97.72%). Conclusions No difference in OS and DFS was found comparing OSNA, FS, and definitive histology. Furthermore, reduced operative time was found in the OSNA group.
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Affiliation(s)
- Serena Bertozzi
- Breast Unit, University Hospital of Udine, Udine, Italy
- Ennergi Research, Lestizza, Italy
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Ambrogio P. Londero
- Ennergi Research, Lestizza, Italy
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, Genova, Italy
| | - Michela Bulfoni
- Institute of pathology, University Hospital of Udine, Udine, Italy
| | - Luca Seriau
- Breast Unit, University Hospital of Udine, Udine, Italy
| | - Diane Agakiza
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Alberto Pasqualucci
- Department of Surgical and Biomedical Science, University of Perugia, Perugia, Italy
- Rashid Hospital, Trauma and Emergency Center, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Maria Orsaria
- Institute of pathology, University Hospital of Udine, Udine, Italy
| | - Laura Mariuzzi
- Department of Medical Area (DAME), University of Udine, Udine, Italy
- Institute of pathology, University Hospital of Udine, Udine, Italy
| | - Carla Cedolini
- Breast Unit, University Hospital of Udine, Udine, Italy
- Ennergi Research, Lestizza, Italy
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5
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Londero AP, Bertozzi S, Cedolini C, Neri S, Bulfoni M, Orsaria M, Mariuzzi L, Uzzau A, Risaliti A, Barillari G. Incidence and Risk Factors for Venous Thromboembolism in Female Patients Undergoing Breast Surgery. Cancers (Basel) 2022; 14:cancers14040988. [PMID: 35205736 PMCID: PMC8870485 DOI: 10.3390/cancers14040988] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 01/04/2023] Open
Abstract
Albeit it does not have the highest venous thromboembolism (VTE) incidence compared to other neoplasms, breast cancer contributes to many VTE events because it is the most diagnosed tumor in women. We aim to analyze the occurrence and timing of VTE during the follow-up of patients who underwent breast surgery, the possible correlated factors, and the overall survival. This retrospective study included all female patients diagnosed with mammary pathology and surgically treated in our clinic between January 2002 and January 2012. Of 5039 women who underwent breast surgery, 1056 were found to have no evidence of malignancy, whereas 3983 were diagnosed with breast cancer. VTE rate resulted significantly higher in patients with invasive breast cancer than in women with benign breast disease or carcinoma in situ. Invasive cancers other than lobular or ductal were associated with a higher VTE rate. In addition, chronic hypertension, high BMI, cancer type, and evidence of metastasis turned out to be the most significant risk factors for VTE in women who underwent breast surgery. Moreover, VTE occurrence significantly impacted survival in invasive breast cancer patients. Compared to women with benign mammary pathology, VTE prevalence in women with breast cancer is significantly higher. The knowledge about the risk factors of VTE could be helpful as prognostic information, but also to eventually target preventive treatment strategies for VTE, as far as the co-existence of invasive breast cancer and VTE has a significantly negative impact on survival.
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Affiliation(s)
- Ambrogio P. Londero
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, Italy
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, Italy
- Correspondence: (A.P.L.); (S.B.)
| | - Serena Bertozzi
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, Italy
- Breast Unit, University Hospital of Udine, 33100 Udine, Italy;
- Correspondence: (A.P.L.); (S.B.)
| | - Carla Cedolini
- Breast Unit, University Hospital of Udine, 33100 Udine, Italy;
| | - Silvia Neri
- Clinic of Surgery, University Hospital of Udine, 33100 Udine, Italy; (S.N.); (A.R.)
| | - Michela Bulfoni
- Institute of Pathologic Anatomy, University Hospital of Udine, 33100 Udine, Italy; (M.B.); (M.O.); (L.M.)
| | - Maria Orsaria
- Institute of Pathologic Anatomy, University Hospital of Udine, 33100 Udine, Italy; (M.B.); (M.O.); (L.M.)
| | - Laura Mariuzzi
- Institute of Pathologic Anatomy, University Hospital of Udine, 33100 Udine, Italy; (M.B.); (M.O.); (L.M.)
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy;
| | - Alessandro Uzzau
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy;
| | - Andrea Risaliti
- Clinic of Surgery, University Hospital of Udine, 33100 Udine, Italy; (S.N.); (A.R.)
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy;
| | - Giovanni Barillari
- Center for Hemorrhagic and Thrombotic Diseases, ASUFC “Santa Maria della Misericordia”, 33100 Udine, Italy;
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Bertozzi S, Londero AP, Viola L, Orsaria M, Bulfoni M, Marzinotto S, Corradetti B, Baccarani U, Cesselli D, Cedolini C, Mariuzzi L. TFEB, SIRT1, CARM1, Beclin-1 expression and PITX2 methylation in breast cancer chemoresistance: a retrospective study. BMC Cancer 2021; 21:1118. [PMID: 34663249 PMCID: PMC8524961 DOI: 10.1186/s12885-021-08844-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 10/06/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Breast cancer chemoresistance is attributed to a wide variety of mechanisms, including autophagy. Transcription factor EB (TFEB) has been recently identified and characterized as one major regulator of autophagy and lysosomal genesis. OBJECTIVE This study aims to evaluate the prognostic impact of TFEB and its pathway in breast cancer chemoresistance. METHODS This retrospective study analyzes the expression of TFEB, CARM1, SIRT1, and Beclin-1 and the methylation of PITX2 in breast carcinoma. A group of breast cancer patients treated with chemotherapy, who relapsed within 12 months from treatment initiation, were compared to a sub-cohort of chemo-treated patients who did not recur within 12 months of follow-up. The expression of TFEB, CARM1, SIRT1, and Belcin-1 was analyzed using immunohistochemistry or RT-PCR on formalin-fixed paraffin-embedded samples. PITX2 methylation was tested with the diagnostic CE-marked kit Therascreen PITX2 RGQ PCR. In the final model, 136 cases of chemo-treated breast cancer were included. RESULTS A higher TFEB and Beclin-1 expression correlate with shorter survival in patients with chemo-treated invasive breast cancer (respectively HR 3.46, CI.95 1.27-9.47, p < 0.05 and 7.11, CI.95 2.54-19.9). TFEB, CARM1, and SIRT1 are positively correlated with Beclin-1. The protein expression of SIRT1 is significantly associated with TFEB and CARM1 so that a very low SIRT1 expression (lower than the first quartile of the H-score distribution) correlates with a low expression of TFEB and CARM1 and with longer survival. SIRT1 seems to have a lower H-score in the basal-like and HER2-enriched tumors than the luminal subtypes. Beclin-1 and TFEB seem to have a higher H-score in the basal-like and HER2-enriched tumors than the luminal subtypes. PITX2 methylation analysis was feasible only in 65% of the selected samples, but no significant differences between cases and controls were found, and there was also no correlation with the expression of the TFEB pathway. CONCLUSIONS TFEB, SIRT1, and Beclin-1 seem to have a potential prognostic significance in patients with chemo-treated breast cancer, likely because of their role in the regulation of autophagy. In addition, no correlation between TFEB and PITX2 methylation was found, likely because they perform two different roles within the autophagy process.
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Affiliation(s)
- Serena Bertozzi
- Breast Unit, DAME, University Hospital of Udine, Piazza Santa Maria della Misericordia, 15, 33100, Udine, Italy.
- Ennergi Research (non-profit organisation), 33050, Lestizza, UD, Italy.
| | - Ambrogio P Londero
- Ennergi Research (non-profit organisation), 33050, Lestizza, UD, Italy.
- Clinic of Obstetrics and Gynecology, University Hospital of Udine, Piazza Santa Maria della Misericordia, 15, 33100, Udine, Italy.
| | - Luigi Viola
- Department of Radiology & Radiotherapy, University of Campania "Luigi Vanvitelli", 80100, Naples, Italy
| | - Maria Orsaria
- Institute of Pathology, DAME, University Hospital of Udine, 33100, Udine, UD, Italy
| | - Michela Bulfoni
- Institute of Pathology, DAME, University Hospital of Udine, 33100, Udine, UD, Italy
| | - Stefania Marzinotto
- Institute of Pathology, DAME, University Hospital of Udine, 33100, Udine, UD, Italy
| | - Bruna Corradetti
- Department of Nanotechnology, Houston Methodist Hospital, Houston, TX, USA
| | - Umberto Baccarani
- Clinic of Surgery, DAME, University Hospital of Udine, 33100, Udine, UD, Italy
| | - Daniela Cesselli
- Institute of Pathology, DAME, University Hospital of Udine, 33100, Udine, UD, Italy
| | - Carla Cedolini
- Breast Unit, DAME, University Hospital of Udine, Piazza Santa Maria della Misericordia, 15, 33100, Udine, Italy
| | - Laura Mariuzzi
- Institute of Pathology, DAME, University Hospital of Udine, 33100, Udine, UD, Italy
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Li C, Yang Y, Wang J, Jin K, Yang Z, Yu X, Guo X, Chen X. Characteristics, prognosis, risk factors, and management of recently diagnosed ductal carcinoma in situ with microinvasion. Cancer Med 2021; 10:7203-7212. [PMID: 34547183 PMCID: PMC8525113 DOI: 10.1002/cam4.4263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/02/2021] [Accepted: 08/27/2021] [Indexed: 12/30/2022] Open
Abstract
Background Ductal carcinoma in situ with microinvasion (DCISM) represents ~1% of all breast cancer cases and is arguably a more aggressive subtype of ductal carcinoma in situ (DCIS). Lacking studies with a large population, the survival outcomes of DCISM are still poorly understood and the treatment recommendations remain controversial. This study aims to investigate the long‐term outcome of patients with DCISM, potential risk factors for their prognosis, and the difference of survival between patients treated with breast‐conserving surgery plus radiotherapy (BCT + RT) and mastectomy only. Methods In total, 1299 patients from 2008 to 2019 with DCISM were retrospectively retrieved. Clinicopathological features were analyzed. Subgroup analysis was conducted between patients who underwent BCT + RT and mastectomy only. Univariate and multivariate analyses were performed to identify prognostic factors for survival. Differences of survival between two groups were compared using the log‐rank test. Results Totally, 1286 patients had follow‐up information, the median follow‐up is 54.57 months, the 5‐year local–regional‐free survival (LRFS), distant metastasis‐free survival (DMFS), and overall survival (OS) were 98.6%, 97.1%, and 99.4%, respectively, two deaths were due to breast cancer. Multivariate analysis identified age <40 (p = 0.028) and close margin (≤2 mm) as independent negative prognostic factors for LRFS. No prognostic factors were identified for DMFS and OS. The 5‐year LRFS, DMFS, and OS of patients who had DCIS component ≥5 cm and underwent mastectomy without adjuvant radiotherapy were 100%, 98.4%, and 98.4%, respectively. After propensity score matching (PSM), no survival difference was observed between patients treated with BCT + RT or mastectomy only. Conclusions DCISM patients had a good survival, even those with DCIS component ≥5 cm. Patients aged <40 or with close margin (≤2 mm) had a poorer LRFS, but not DMFS or OS. BCT + RT is a feasible choice for DCISM patients.
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Affiliation(s)
- Chunyan Li
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yilan Yang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Jiangfeng Wang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Kairui Jin
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Zhaozhi Yang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Xiaoli Yu
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Xiaomao Guo
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Xingxing Chen
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
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Lai HW, Chang YL, Chen ST, Chang YJ, Wu WP, Chen DR, Kuo SJ, Liao CY, Wu HK. Revisit the practice of lymph node biopsy in patients diagnosed as ductal carcinoma in situ before operation: a retrospective analysis of 682 cases and evaluation of the role of breast MRI. World J Surg Oncol 2021; 19:263. [PMID: 34470633 PMCID: PMC8411510 DOI: 10.1186/s12957-021-02336-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background The optimal axillary lymph node (ALN) management strategy in patients diagnosed with ductal carcinoma in situ (DCIS) preoperatively remains controversial. The value of breast magnetic resonance imaging (MRI) to predict ALN metastasis pre-operative DCIS patients was evaluated. Methods Patients with primary DCIS with or without pre-operative breast MRI evaluation and underwent breast surgery were recruited from single institution. The value of breast MRI for ALN evaluation, predictors of breast and ALN surgeries, upgrade from DCIS to invasive cancer, and ALN metastasis were analyzed. Results A total of 682 cases with pre-operative diagnosis of DCIS were enrolled in current study. The rate of upgrade to invasive cancer were found in 34.2% of specimen, and this upgrade rate is 23% for patients who received breast conserving surgery and 40.7% for mastectomy (p < 0.01). Large pre-operative imaging tumor size and post-operative invasive component were risk factors to ALN metastasis. Breast MRI had 53.8% sensitivity, 77.8% specificity, 14.9% positive predictive value, 95.9% negative predictive value (NPV), and 76.2% accuracy to predict ALN metastasis in pre-OP DCIS patients. In MRI node-negative breast cancer patients with MRI tumor size < 3 cm, the NPV was 96.4%, and all these false-negative cases were N1. Pre-OP diagnosed DCIS patients with MRI tumor size < 3 cm and node negative suitable for BCS could safely omit SLNB if whole breast radiotherapy is to be performed. Conclusion Breast MRI had high NPV to predict ALN metastasis in pre-OP DCIS patients, which is useful and could be provided as shared decision-making reference.
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Affiliation(s)
- Hung-Wen Lai
- Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. .,Division of General Surgery, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. .,Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. .,Minimal Invasive Surgery Research Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. .,Tumor Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. .,Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Biomedical Imaging and Radiological Sciences, Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Chang Gung University College of Medicine, Taoyuan City, Taiwan. .,Division of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Yi-Lin Chang
- Division of General Surgery, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan
| | - Shou-Tung Chen
- Division of General Surgery, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan
| | - Yu-Jun Chang
- Center for Research and Epidemiology, Big Data Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan
| | - Wen-Pei Wu
- Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Radiology, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan
| | - Dar-Ren Chen
- Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,Division of General Surgery, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shou-Jen Kuo
- Division of General Surgery, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan
| | - Chiung-Ying Liao
- Department of Radiology, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan
| | - Hwa-Koon Wu
- Department of Radiology, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan
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Choi B, Jegatheeswaran L, Nakhoul M, Haria P, Srivastava R, Karki S, Lupi M, Patel V, Chakravorty A, Babu E. Axillary staging in ductal carcinoma in situ with microinvasion: A meta-analysis. Surg Oncol 2021; 37:101557. [PMID: 33819852 DOI: 10.1016/j.suronc.2021.101557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Ductal carcinoma in situ with microinvasion (DCISM); arguably a more aggressive subtype of DCIS, currently has variable recommendations governing its staging and management in the UK. As a result, there is ongoing controversy surrounding the most appropriate management of DCISM, in particular the need of axillary staging. METHOD A search was conducted on the databases MEDLINE and Embase using the keywords: breast, DCISM, microinvasion, "ductal carcinoma in situ with microinvasion", sentinel lymph node biopsy, SLNB, axillary staging was performed. 23 studies were selected for analysis. Primary outcome was the positivity of metastasis of lymph node; secondary outcome looked at characteristics of DCISM that may affect node positivity. RESULTS A total of 2959 patients were included. Significant heterogeneity was observed amongst the studies with regards to metastases (I2 = 61%; P < 0.01). Lymph node macrometastases was estimated to be 2%. Significant subgroup difference was not observed between SLNB technique and lymph node macrometastases (Q = 0.74; p = 0.69). Statistical significance was observed between the focality of the DCISM and lymph node macrometastases (Q = 8.71; p = 0.033). CONCLUSION Although histologically more advanced than DCIS, DCISM is not linked with higher rates of clinically significant metastasis to axillary lymph nodes. Survival rates are very similar to those seen in cases of DCIS. Current evidence suggests that axillary staging in cases of DCISM will not change their overall management, thus may only be an unnecessary and inconvenient additional intervention considering the majority of DCISM diagnoses are made from post-operative pathology samples. A multidisciplinary team approach evaluating pre-operative clinical and histological information to tailor the management specific to individual cases of DCISM would be a preferred approach than routine axillary staging.
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Affiliation(s)
- Byung Choi
- Department of Breast Surgery, The Hillingdon Hospital NHS Foundation Trust, London, UK.
| | | | | | - Payal Haria
- Department of Breast Surgery, The Hillingdon Hospital NHS Foundation Trust, London, UK
| | | | - Smriti Karki
- Department of Breast Surgery, The Hillingdon Hospital NHS Foundation Trust, London, UK
| | - Micol Lupi
- Department of Breast Surgery, The Hillingdon Hospital NHS Foundation Trust, London, UK
| | - Vishal Patel
- Department of Breast Surgery, The Hillingdon Hospital NHS Foundation Trust, London, UK
| | - Arunmoy Chakravorty
- Department of Breast Surgery, The Hillingdon Hospital NHS Foundation Trust, London, UK; AHERF, New Delhi, India
| | - Ekambaram Babu
- Department of Breast Surgery, The Hillingdon Hospital NHS Foundation Trust, London, UK
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Feng C, Zheng Q, Yang Y. Breast Microinvasive Carcinoma With Different Morphologies: Analysis of Clinicopathologic Features of 121 Cases. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2020; 14:1178223420948482. [PMID: 33088178 PMCID: PMC7543174 DOI: 10.1177/1178223420948482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 07/14/2020] [Indexed: 12/05/2022]
Abstract
Purpose: To investigate the clinicopathological features of patients with breast
microinvasive carcinoma (MI). Methods: The clinical data of 121 cases with breast MI were retrospectively collected.
The whole tumor in each case was stained with hematoxylin and eosin
(H&E) for pathological evaluation. The relationships among size of
tumor, histological grade, tumor-infiltrating lymphocytes (TILs), the number
of MIs, type of MI, and lymph node metastasis were analyzed. Results: It was revealed that 86% of the cases had high-grade ductal carcinoma in situ
(DCIS) and 63.6% had multiple MIs. The larger size of the tumors, the higher
the grade of DCIS, the more the number of MIs; 3.3% of cases had rich TILs
(lymphocyte/stroma > 30%) in the DCIS, and 26.5% had rich TILs in MIs.
The type A of MIs is characterized by single cells and small clusters of
solid cells. Tumor cells in type B of MIs can form glandular ducts. Formal
grading of microinvasive is challenging/impossible due to its limited size
precluding a representative mitotic count. But nuclear grade and tubule
(differentiation) grades can be reported. In addition, 72.7% of cases had
type A of MIs and 27.3% of cases had type B of MIs. Type B was found to be
highly accompanied by moderate-grade DCIS. Only 6.6% of patients with MI had
lymph node metastasis, which was mainly related to MIs with less TILs. Conclusion: Breast MI is easy to occur in high-grade DCIS, and multiple infiltration foci
may be observed in case with tumor size of higher than 3.5 cm. Microinvasive
carcinoma with poor TILs maybe a risk factor for lymph node metastasis in
patient with DCIS-Mi.
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Affiliation(s)
- ChangYin Feng
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - QiaoLing Zheng
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - YingHong Yang
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
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11
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Fan B, Pardo JA, Serres S, Alapati AC, Szewczyk J, Mele A, James TA. Role of Sentinel Lymph Node Biopsy in Microinvasive Breast Cancer. Ann Surg Oncol 2020; 27:4468-4473. [PMID: 32430750 DOI: 10.1245/s10434-020-08606-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Microinvasive ductal carcinoma (DCISM), defined as DCIS with a focus of invasive carcinoma ≤ 1 mm, can be managed similarly to pure DCIS; however, management of the axilla in DCISM has been a subject of debate. Reports in the literature differ on the utility and necessity of sentinel lymph node biopsy (SLNB) for DCISM. The aim of the present study was to identify risk factors for nodal disease in patients with DCISM, which can help develop a selective approach to SLNB in this patient population. METHODS The National Cancer Database was used to select patients with DCISM (pT1mi), diagnosed from 2012 to 2015, who underwent SLNB. Multivariable regression analysis was performed to determine associations between sentinel lymph node metastasis and relevant clinical variables. RESULTS Our cohort comprised of 2609 patients with pT1mi who underwent SLNB. Of these, 76 (2.9%) were found to have sentinel lymph node metastases on final pathology. Low/intermediate grade tumors were associated with decreased SLN metastasis (OR 0.50, CI 0.28-0.92). Age and receptor status of the tumor did not have a clear association in predicting SLN metastases. CONCLUSIONS The rate of sentinel node metastases in DCISM is low at only 2.9% in this national study. Tumor grade was identified as influencing the risk of SLN metastases. This information can factor into shared decision-making for SLNB in patients with DCISM.
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Affiliation(s)
- Betty Fan
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jaime A Pardo
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephanie Serres
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Amulya C Alapati
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joanne Szewczyk
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alessandra Mele
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ted A James
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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12
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Microinvasion: could it be sufficient diagnostic criteria for the optimal treatment decision? Breast Cancer Res Treat 2019; 176:717. [DOI: 10.1007/s10549-019-05269-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
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