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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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Zhu K, Sui Y, Zhu M, Gao Y, Yuan Y, Sun P, Meng L, Dai J, Li Z. Development and validation of a nomogram for predicting lymph node metastasis in ductal carcinoma in situ with microinvasion: A SEER population-based study. PLoS One 2024; 19:e0301057. [PMID: 38557552 PMCID: PMC10984531 DOI: 10.1371/journal.pone.0301057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Ductal carcinoma in situ with microinvasion (DCIS-MI) is a special type of breast cancer. It is an invasive lesion less than 1.0 mm in size related to simple ductal carcinoma in situ (DCIS). Lymph node metastasis (LNM) in DCIS-MI often indicates a poor prognosis. Therefore, the management of lymph nodes plays a vital role in the treatment strategy of DCIS-MI. Since DCIS-MI is often diagnosed by postoperative paraffin section and immunohistochemical detection, to obtain the best clinical benefits for such patients, we aim to establish and verify a nomogram to predict the possibility of lymph node metastasis in DCIS-MI patients and help preoperative or intraoperative clinical decision-making. METHODS A retrospective analysis of patients with DCIS-MI in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2019 was performed. The study cohort was randomly divided into a training cohort and a validation cohort at a ratio of 7:3. The risk factors were determined by univariate and multivariate logistic regression analyses in the training cohort, and a nomogram was constructed. The receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the nomogram in the training set and validation set. An independent data cohort was obtained from the Shanghai Jiao Tong University Breast Cancer Database (SJTU-BCDB) for external validation. RESULTS This study included 3951 female patients from SEER with DCIS-MI, including 244 patients with regional lymph node metastasis, accounting for 6.18% of the total. An independent test set of 323 patients from SJTU-BCDB was used for external validation. According to the multifactorial logistic regression analysis results, age at diagnosis, ethnicity, grade, and surgical modality were included in the prediction model. The areas under the ROC curves (AUCs) were 0.739 (95% CI: 0.702~0.775), 0.732 (95% CI: 0.675~0.788), and 0.707 (95%CI: 0.607-0.807) in the training, validation and external test groups, suggesting that the column line graphs had excellent differentiation. The calibration curves slope was close to 1, and the model's predicted values were in good agreement with the actual values. The DCA curves showed good clinical utility. CONCLUSION In this study, we constructed accurate and practical columnar maps with some clinical benefit to predict the likelihood of lymph node metastasis in patients with postoperatively diagnosed DCIS-MI and provide a reference value for specifying treatment strategies.
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Affiliation(s)
- Kaijun Zhu
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, P. R. China
| | - Yuan Sui
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, P. R. China
| | - Mingliao Zhu
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, P. R. China
| | - Yuan Gao
- Department of Breast and Thyroid Surgery, Shaoxing People’s Hospital, The First Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, People’s Republic of China
| | - Ying Yuan
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, P. R. China
| | - Pujian Sun
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, P. R. China
| | - Liwei Meng
- Department of Breast and Thyroid Surgery, Shaoxing People’s Hospital, The First Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, People’s Republic of China
| | - Jiangfeng Dai
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
| | - Zhian Li
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
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Rich BS, Dicken BJ, Billmire DF, Weil BR, Ross J, Fallahazad N, Krailo M, Shaikh F, Frazier AL, Hazard FK, Nuño MM. Characterizing Lymphovascular Invasion in Pediatric and Adolescent Malignant Ovarian Nongerminomatous Germ Cell Tumors: A Report from the Children's Oncology Group. J Pediatr Surg 2023; 58:2399-2404. [PMID: 37699777 PMCID: PMC10872999 DOI: 10.1016/j.jpedsurg.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Lymphovascular invasion (LVI) has been identified as a poor prognostic factor for a variety of tumors; however, its significance in malignant ovarian germ cell tumors (MOGCT) in pediatric and adolescent patients is not well described. We aim to clarify the significance of LVI in the subset of patients with nongerminomatous MOGCT. METHODS Records of patients 0-20 years of age with MOGCT enrolled on Children's Oncology Group study AGCT0132 were reviewed. Patients with documented presence or absence of LVI in either institutional or central review pathology reports were included. RESULTS Of 130 patients with MOGCTs, 83 patients had of the presence or absence of LVI documented in their pathology report. 42/83 patients (50.6%) were found to have LVI present. The estimated odds of having LVI was higher in patients with stage II and III disease, 11 years and older and with the presence of choriocarcinoma. Event-free survival (EFS) and overall survival (OS) remained high in patients with LVI. Approximately 50% of patients with a documented LVI status in either institutional pathology report or central review were found to have LVI. CONCLUSIONS The presence of LVI was higher in tumors with adverse risk factors including higher stage and age greater than 11 years. While LVI was not associated with EFS or OS in the intermediate risk group, further work is necessary to determine the effect of LVI on long-term disease-free survival. We, therefore, recommend routinely incorporating LVI status into institutional pathology reports for pediatric and adolescent patients with MOGCT. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA.
| | - Bryan J Dicken
- Division of Pediatric Surgery, University of Alberta, Edmonton Canada
| | - Deborah F Billmire
- Division of Pediatric Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brent R Weil
- Division of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Ross
- Department of Urology, Department of Pediatrics, Rush Medical College, Chicago, IL, USA
| | - Negar Fallahazad
- Children's Oncology Group, Public Health Institute, Monrovia, CA, USA
| | - Mark Krailo
- Children's Oncology Group, Public Health Institute, Monrovia, CA, USA; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Furqan Shaikh
- Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center Harvard Medical School, Boston, MA, USA
| | - Florette K Hazard
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michelle M Nuño
- Children's Oncology Group, Public Health Institute, Monrovia, CA, USA; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Huang Z, Chen X, Jiang N, Hu S, Hu C. A clinical radiomics nomogram preoperatively to predict ductal carcinoma in situ with microinvasion in women with biopsy-confirmed ductal carcinoma in situ: a preliminary study. BMC Med Imaging 2023; 23:118. [PMID: 37679713 PMCID: PMC10483851 DOI: 10.1186/s12880-023-01092-5] [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: 01/02/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE To predict ductal carcinoma in situ with microinvasion (DCISMI) based on clinicopathologic, conventional breast magnetic resonance imaging (MRI), and dynamic contrast enhanced MRI (DCE-MRI) radiomics signatures in women with biopsy-confirmed ductal carcinoma in situ (DCIS). METHODS Eighty-six women with eighty-seven biopsy-proven DCIS who underwent preoperative MRI and underwent surgery were retrospectively identified. Clinicopathologic, conventional MRI, DCE-MRI radiomics, combine (based on conventional MRI and DCE-MRI radiomics), traditional (based on clinicopathologic and conventional MRI) and mixed (based on clinicopathologic, conventional MRI and DCE-MRI radiomics) models were constructed by logistic regression (LR) with a 3-fold cross-validation, all evaluated using receiver operating characteristic (ROC) curve analysis. A clinical radiomics nomogram was then built by incorporating the Radiomics score, significant clinicopathologic and conventional MRI features of mixed model. RESULTS The area under the curves (AUCs) of clinicopathologic, conventional MRI, DCE-MRI radiomics, traditional, combine, and mixed model were 0.76 (95% confidence interval [CI] 0.59-0.94), 0.77 (95%CI 0.59-0.95), 0.74 (95%CI 0.55-0.93), 0.87 (95%CI 0.73-1), 0.8 (95%CI 0.63-0.96), and 0.93 (95%CI 0.84-1) in the validation cohort, respectively. The clinical radiomics nomogram based on mixed model showed higher AUCs than both clinicopathologic and DCE-MRI radiomics models in training/test (all P < 0.05) set and showed the greatest overall net benefit for upstaging according to decision curve analysis (DCA). CONCLUSION A nomogram constructed by combining clinicopathologic, conventional MRI features and DCE-MRI radiomics signatures may be useful in predicting DCISMI from DICS preoperatively.
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Affiliation(s)
- Zhou Huang
- Department of Radiology, the First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Gusu District, Suzhou City, Jiangsu Province, 215006, PR China
| | - Xue Chen
- Department of Radiology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou City, Jiangsu Province, 215002, PR China
| | - Nan Jiang
- Department of Radiology, the First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Gusu District, Suzhou City, Jiangsu Province, 215006, PR China
| | - Su Hu
- Department of Radiology, the First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Gusu District, Suzhou City, Jiangsu Province, 215006, PR China
| | - Chunhong Hu
- Department of Radiology, the First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Gusu District, Suzhou City, Jiangsu Province, 215006, PR China.
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Lin Y, Zhang Y, Fang H, Hu Q, Duan H, Zhang L, Pang D. Survival and clinicopathological significance of blood vessel invasion in operable breast cancer: a systematic review and meta-analysis. Jpn J Clin Oncol 2023; 53:35-45. [PMID: 36156086 DOI: 10.1093/jjco/hyac149] [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: 12/22/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Lymphovascular invasion, including lymphatic-vessel invasion and blood-vessel invasion, plays an important role in distant metastases. The metastatic pattern of blood-vessel invasion may differ from that of lymphatic-vessel invasion. However, its prognostic significance in breast cancer remains controversial. We evaluated the role of blood-vessel invasion in the prognosis of operable breast-cancer patients and its association with clinicopathological characteristics. METHODS We systematically searched EMBASE, PubMed, the Cochrane Library and Web of Science for studies in English through December 2020. Disease-free survival, overall survival and cancer-specific survival were the primary outcomes. Pooled hazard ratios and 95% confidence intervals were assessed using a random-effects model. RESULTS Twenty-seven studies involving 7954 patients were included. Blood-vessel invasion occurred in 20.4% of tumor samples. Pooled results showed significant associations of blood-vessel invasion with worse disease-free survival (hazard ratio = 1.82; 95% confidence interval = 1.43-2.31) and overall survival (hazard ratio = 1.86; 95% confidence interval = 1.16-2.99) in multivariate analyses. The results of the univariate analyses were similar. Among the clinicopathological factors, blood-vessel invasion was associated with larger tumor size, lymph-node metastasis, nonspecific invasive type, higher histological grade, estrogen receptor-negative breast cancer, human epidermal growth factor receptor 2-positive breast cancer and lymphatic-vessel invasion. In the lymph-node-negative subgroup analyses, the presence of blood-vessel invasion led to poorer disease-free survival (hazard ratio = 2.46; 95%confidence interval = 1.64-3.70) and overall survival (hazard ratio = 2.94; 95%confidence interval = 1.80-4.80). CONCLUSIONS We concluded that blood-vessel invasion is an independent predictor of poor prognosis in operable breast cancer and is associated with aggressive clinicopathological features. Breast-cancer patients with blood-vessel invasion require more aggressive treatments after surgery.
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Affiliation(s)
- Yingxin Lin
- Department of Breast Cancer Oncology, The Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong, P. R. China
| | - Yuehua Zhang
- Department of Pathology, The Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong, P. R. China
| | - Huiqiong Fang
- Department of Pathology, The Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong, P. R. China
| | - Qian Hu
- Department of Breast Cancer Oncology, The Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong, P. R. China
| | - Haibo Duan
- Department of Breast Cancer Oncology, The Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong, P. R. China
| | - Liangyun Zhang
- Department of Pathology, The Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong, P. R. China
| | - Danmei Pang
- Department of Breast Cancer Oncology, The Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong, P. R. China
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Hong M, Fan S, Yu Z, Gao C, Fang Z, Du L, Wang S, Chen X, Xu M, Zhou C. Evaluating Upstaging in Ductal Carcinoma In Situ Using Preoperative
MRI‐Based
Radiomics. J Magn Reson Imaging 2022. [DOI: 10.1002/jmri.28539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Minping Hong
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology Jiaxin TCM Hospital Affiliated to Zhejiang Chinese Medical University Zhejiang China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
| | - Sijia Fan
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
- Department of Radiology, Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine Zhejiang China
| | - Zhexuan Yu
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
| | - Chen Gao
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
| | - Zhen Fang
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
| | - Liang Du
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
- Department of Radiology Hangzhou TCM Hospital of Zhejiang Chinese Medical University Zhejiang China
| | - Shiwei Wang
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
| | - Xiaobo Chen
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
| | - Maosheng Xu
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
| | - Changyu Zhou
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
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Shen L, Jiang T, Tang P, Ge H, You C, Peng W. Comprehensive quantitative malignant risk prediction of pure grouped amorphous calcifications: clinico-mammographic nomogram. Quant Imaging Med Surg 2022; 12:2672-2683. [PMID: 35502394 PMCID: PMC9014145 DOI: 10.21037/qims-21-797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/03/2022] [Indexed: 01/18/2024]
Abstract
BACKGROUND Pure grouped amorphous calcifications are classified as Breast Imaging Reporting and Data System (BI-RADS) category 4B suspicious calcifications and recommended for biopsy. However, the biopsies often reveal benign findings, especially in screening mammograms (92.4-97.2%). METHODS Mammograms of 699 pure grouped amorphous calcifications with final pathological results were analyzed in this retrospective study. The maximum span (MS) of the group of calcifications and the MS of the parallel/vertical direction of the mammary duct (MPS/MVS) were measured, and the MPS to MVS ratio was calculated. Based on the MS and ratio, 2 prediction nomograms with other clinic-mammographic features were developed. The discrimination performance of the models was assessed and compared by the area under the receiver operating characteristic curve (AUC). Scatterplots were created to determine the cutoff values with fewer misdiagnoses of malignant calcifications and fewer false positives. RESULTS Ultimately, 2 prediction models were successfully developed based on the 4 risk factors of age, purpose of the mammogram, whether multiple or single calcifications, and the MS [odds ratio (OR) =1.06, P=0.02]/ratio (OR =6.05, P<0.001). Both models had good discrimination. The ratio model performed better than the MS model in the training cohort (AUC of 0.875 and 0.834, respectively, P=0.003) and validation cohort (AUC 0.908 and 0.867, respectively, P=0.047). For the group with probably benign calcifications (as detected by the ratio nomogram), the malignancy rates were 2.7% [95% confidence interval (CI): 1.00% to 6.53%] and 1.19% (95% CI: 0.06% to 7.37%) in the training and validation cohorts, respectively, and 44.12% and 47.70% of benign biopsies were detected in the training and validation cohorts, respectively. CONCLUSIONS The clinico-mammographic quantitative malignancy risk prediction nomogram showed favorable discrimination and calibration performance. The ratio model showed better diagnostic efficiency than the MS model, and identified >40% of benign biopsies.
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Affiliation(s)
- Lijuan Shen
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingting Jiang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Pengzhou Tang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huijuan Ge
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Chao You
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Identification of patients with ductal carcinoma in situ at high risk of postoperative upstaging: A comprehensive review and an external (un)validation of predictive models developed. Eur J Obstet Gynecol Reprod Biol 2022; 271:7-14. [DOI: 10.1016/j.ejogrb.2022.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/30/2021] [Accepted: 01/27/2022] [Indexed: 12/17/2022]
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Paik PS, Paik NS, Lee ES, Choi JE, Jeong J, Youn HJ, Yoon CI, Bae SY, Yoo TK. Low incidence of lymph node metastasis in patients with microinvasive breast cancer: a Korean nationwide study. Ann Surg Treat Res 2022; 102:306-312. [PMID: 35800998 PMCID: PMC9204023 DOI: 10.4174/astr.2022.102.6.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/26/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Microinvasive breast cancer (MIBC) is an invasive carcinoma with a tumor dimension not exceeding 1 mm. Owing to its low incidence, the rate of axillary node metastasis and its management are not well established. The aim of this study was to assess the incidence of lymph node metastasis (LNM) and identify variables associated with LNM, as well as to evaluate the need for axillary staging in MIBC patients by analyzing nationwide data. Methods The Korean Breast Cancer Society registry was searched to identify MIBC patients diagnosed between January 1996 and April 2020. Patients without neoadjuvant chemotherapy experiences, systemic metastasis, and missing or discordant data were eligible for the analysis. The incidence rate of LNM was determined, and variables associated with LNM were identified by multivariable regression analysis. Results Of 2,427 MIBC patients identified, 98 (4.0%) had LNM and 12 (0.5%) had N2/3 disease. Type of breast operation (odds ratio [OR], 2.093; 95% confidence interval [CI], 1.332–3.290; P = 0.001), age (OR, 2.091; 95% CI, 1.326–3.298; P = 0.002), hormone receptor status (OR, 2.220; 95% CI, 1.372–3.594; P = 0.001), and lymphovascular invasion (OR, 11.143; 95% CI, 6.354–19.540; P < 0.001) were significantly related to LNM. Conclusion The incidence of LNM in MIBC patients was only 4.0% in our study, suggesting that de-escalation of axillary surgical interventions could be carefully considered. The indications for axillary staging should be individualized considering tumor volume, age, hormone receptor status, and lymphovascular invasion to improve the quality of life of MIBC survivors.
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Affiliation(s)
- Pill Sun Paik
- Department of Surgery, Bucheon St. Mary’s Hospital, Bucheon, Korea
| | - Nam Sun Paik
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Eun Sook Lee
- Department of Surgery, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jung Eun Choi
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jo Youn
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, Korea
| | - Chang Ik Yoon
- Department of Surgery, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Soo Youn Bae
- Department of Surgery, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Tae-Kyung Yoo
- Department of Surgery, Breast Cancer Center, Asan Medical Center, Seoul, Korea
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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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11
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Shen L, Ma X, Jiang T, Shen X, Yang W, You C, Peng W. Malignancy Risk Stratification Prediction of Amorphous Calcifications Based on Clinical and Mammographic Features. Cancer Manag Res 2021; 13:235-245. [PMID: 33469367 PMCID: PMC7811441 DOI: 10.2147/cmar.s286269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose To explore the potential factors influencing the malignancy risk of amorphous calcifications and establish a predictive nomogram for malignancy risk stratification. Patients and Methods Consecutive mammograms from January 2013 to December 2018 were retrospectively reviewed. Traditional clinical features were recorded, and mammographic features were estimated according to the 5th BI-RADS. Included calcifications were randomly divided into the training and validation cohorts. A nomogram was developed to graphically predict the risk of malignancy (risk) based on stepwise multivariate logistic regression analysis. The discrimination and calibration performance of the model were assessed in both the training and validation cohorts. Results Finally, 1018 amorphous calcifications with final pathological results in 907 women were identified with a malignancy rate of 28.4% (95% CI: 25.7%, 31.3%). The malignancy rates of subgroups divided by the distribution of calcifications, quantity of calcifications, age, menopausal status and family history of cancer were significantly different. There were 712 cases and 306 cases in the training and validation cohorts. The prediction nomogram was finally developed based on four risk factors, including age and distribution, maximum diameter and quantity of calcifications. The AUC of the nomogram was 0.799 (95% CI: 0.761, 0.836) in the training cohort and 0.795 (95% CI: 0.738, 0.852) in the validation cohort. Conclusion On mammography, the distribution, maximum diameter and quantity of calcifications are independent predictors of malignant amorphous calcifications and can be easily obtained in the clinic. The nomogram developed in this study for individualized malignancy risk stratification of amorphous calcifications shows good discrimination performance.
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Affiliation(s)
- Lijuan Shen
- Shanghai Institute of Medical Imaging, Shanghai, People's Republic of China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Xiaowen Ma
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Tingting Jiang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Xigang Shen
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Wentao Yang
- Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Chao You
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
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12
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Kariri YA, Aleskandarany MA, Joseph C, Kurozumi S, Mohammed OJ, Toss MS, Green AR, Rakha EA. Molecular Complexity of Lymphovascular Invasion: The Role of Cell Migration in Breast Cancer as a Prototype. Pathobiology 2020; 87:218-231. [PMID: 32645698 DOI: 10.1159/000508337] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/30/2020] [Indexed: 12/24/2022] Open
Abstract
Lymphovascular invasion (LVI) is associated with poor outcome in breast cancer (BC); however, its underlying mechanisms remain ill-defined. LVI in BC develops through complex molecular pathways involving not only the interplay with the surrounding microenvironment along with endothelial cells lining the lymphovascular spaces but also changes in the malignant epithelial cells with the acquisition of more invasive and migration abilities. In this review, we focus on the key features that enable tumour cell detachment from the primary niche, their migration and interaction with the surrounding microenvironment as well as the crosstalk with the vascular endothelial cells, which eventually lead to intravasation of tumour cells and LVI. Intravascular tumour cell survival and migration, their distant site extravasation, stromal invasion and growth are part of the metastatic cascade. Cancer cell migration commences with loss of tumour cells' cohesion initiating the invasion and migration processes which are usually accompanied by the accumulation of specific cellular and molecular changes that enable tumour cells to overcome the blockades of the extracellular matrix, spread into surrounding tissues and interact with stromal cells and immune cells. Thereafter, tumour cells migrate further via interacting with lymphovascular endothelial cells to penetrate the vessel wall leading ultimately to intravasation of cancer cells. Exploring the potential factors influencing cell migration in LVI can help in understanding the underlying mechanisms of LVI to identify targeted therapy in BC.
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Affiliation(s)
- Yousif A Kariri
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham, Nottingham, United Kingdom.,Faculty of Applied Medical Science, Shaqra University, Riyadh, Saudi Arabia.,Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, Nottingham, United Kingdom
| | - Mohammed A Aleskandarany
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham, Nottingham, United Kingdom
| | - Chitra Joseph
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham, Nottingham, United Kingdom
| | - Sasagu Kurozumi
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham, Nottingham, United Kingdom
| | - Omar J Mohammed
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, Nottingham, United Kingdom
| | - Michael S Toss
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham, Nottingham, United Kingdom
| | - Andrew R Green
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham, Nottingham, United Kingdom.,Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, Nottingham, United Kingdom
| | - Emad A Rakha
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham, Nottingham, United Kingdom,
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