Breast Cancer-Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual

TP53 gene mutation in lymphoepithelioma‑like carcinoma of the breast with thyroid cancer: A case report

Globally, breast cancer is the most common malignancy among women and thyroid cancer is also one of the common cancer types among women. Patients with breast cancer exhibit a higher incidence of thyroid cancer than that noted in the general population. The exact mechanism of multiple tumors remains elusive. In the present study, the case of a patient with multiple tumors harboring gene mutation is reported. Specifically, a patient with lymphoepithelioma-like carcinoma of the breast (LELC-B) and thyroid cancer is described. It was hypothesized that the short interval between the onset of these two types of malignant tumor may be related to the TP53 gene mutation status of the patient. To date, a specific relationship between gene mutations and multiple tumors is yet to be determined. Therefore, additional studies are required to address this topic.

Patterns of Recurrence and Survival Outcomes of HER2-Low Expression in Early-Stage Breast Cancer

PURPOSE

To characterize site-specific recurrence patterns and survival outcomes of patients with human epidermal growth factor receptor 2 (HER2)-low breast cancer.

METHODS

This retrospective cohort study included patients diagnosed with early-stage breast cancer at a single institution in China from January 2010 to December 2020. Patterns of the first site of recurrence were compared between patients with HER2-low and HER2-0 tumors using competing risks regression analysis. Disease-free survival (DFS) and overall survival (OS) were evaluated using Kaplan-Meier method.

RESULTS

A total of 2055 patients were analyzed (median follow-up 52.3 months), comprising 1102 (53.6%) patients with HER2-low and 953 (46.4%) with HER2-0 tumors. Patients with HER2-0 tumors had a significantly higher 5-year cumulative incidence of visceral recurrence than those with HER2-low tumors (7.20% vs. 4.50%; P = .046), especially for the lung recurrence (4.16% vs. 2.81%; P = .044). In the hormone receptor (HoR)-positive subgroup, HER2-low patients had a significantly higher risk of local recurrence (10-year cumulative incidence rate, 7.58% vs. 2.61%; P = .013) but a relatively lower risk of contralateral breast cancer (10-year cumulative incidence rate, 0.90% vs. 4.53%; P = .044) compared with HER2-0 patients. Nevertheless, there were no significant differences between the HER2-0 and HER2-low patients regarding the time to all sites of recurrence after adjusting other potential risk factors (all P > .05), DFS (P = .763), and OS (P = .106).

CONCLUSION

Site-specific recurrence patterns differ between HER2-low and HER2-0 patients. However, it does not support that HER2-low breast cancer is a distinct prognostic subtype.

Nuclear morphological characterisation of lobular carcinoma variants: a morphometric study

BACKGROUND AND AIMS

Lobular carcinoma (LC) of the breast exhibits diverse morphology and clinical behaviour. The pleomorphic variant (pLC) displays distinct cytonuclear features and aggressiveness compared to the classic variant (cLC). However, diagnosing pLC remains subjective. This study aims to refine LC's cytonuclear features, focusing on pLC.

METHODS

Whole slide images of 59 LCs, including both in situ (LCIS) and invasive (ILC) lesions, were analysed. Nuclear measurements, including nuclear size and variability, were scored using QuPath image analysis software. For comparison, selected features were scored in normal cells (n = 10) and pleomorphism score-matched invasive breast carcinoma (IBC) of NST type (n = 33). Additional visual assessment of the pleomorphic ILC (pILC) cohort (n = 90) was conducted for cytomorphological features characterisation.

RESULTS

pILC demonstrated larger nuclear area and higher nuclear variability with abundance of cytoplasm than cILC. Compared to lymphocytes, pILC demonstrated a median area ranging from 2.7 to 4.7 times larger. Cut-off values for differentiating pILC from other ILC subtypes included median nuclear area > 48.2 μm2 and interquartile range (IQR) > 19.4, nuclear perimeter median > 25.2 μm and IQR > 5.3 and maximum diameter > 9.1 μm and IQR > 2.2. Multivariable logistic regression confirmed these parameters as independent predictors of pILC, with the maximum diameter being the most significant (P < 0.001). Visual assessment recognised two pILC subtypes: apocrine and non-apocrine. Apocrine variant showed nuclear roundness, pale vesicular chromatin patterns and prominent nucleoli, while non-apocrine variant exhibited greater nuclear size and shape variation.

CONCLUSIONS

Objective nuclear measurements, combined with cytoplasmic and architectural features, provide a robust framework for diagnosing LC subtypes, improving diagnostic accuracy and reproducibility.

Breast cancer staging with contrast-enhanced imaging. The benefits and drawbacks of MRI, CEM, and dedicated breast CT

Pretherapeutic breast cancer staging is pivotal for patient-centered disease management, guiding treatment stratification and assessing prognostic outcomes. Breast imaging plays a key role in both anatomic and prognostic staging by providing comprehensive insights into disease extent, localization, and tumor aggressiveness characteristics. To date, clinical image-based staging relies on conventional modalities such as digital mammography (DM), digital breast tomosynthesis (DBT), and ultrasound. Considering the phenotypic disparities of breast cancer and their relation to treatment response, other imaging techniques based on contrast-enhanced mechanisms, which highlight areas of increased neovascularity, appear indispensable in breast cancer staging. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) offers a comprehensive 3-dimensional assessment of extent of disease and characterization of lesions, capturing both morphological and functional aspects which are crucial for treatment and monitoring of the disease. Based on this established approach, contrast-enhanced x-ray-based techniques, with high spatial resolution, such as contrast-enhanced mammography (CEM) and dedicated contrast-enhanced breast computed tomography (dCEBCT), have emerged. This review outlines the current status, limitations, and ongoing challenges associated with each one contrast-enhanced imaging modality, while emphasis is given to key breast cancer manifestations and the optimal interpretation of their imaging phenotypes, in the current era of image-based (anatomic and prognostic) breast cancer staging.

Quantitative evaluation of axillary lymph nodes in breast cancer on dual-phase dual-energy CT by precise match with pathology

BackgroundIdentification of axillary lymph node (aLN) metastasis in breast cancer (BC) is important. Dual-energy computed tomography (DECT) is a promising innovation in the field of CT. However, its role in evaluating aLNs remains unclear.PurposeTo investigate the diagnostic performance of DECT in evaluating aLN metastasis in BC patients.Material and MethodsData were prospectively collected from treatment-naïve BC patients who underwent DECT for staging, ultrasound-guided biopsy for suspicious aLNs, and placement of tissue marker in the pathology-positive aLNs. Further cross-sectional imaging was performed preoperatively to locate the marker-labeled LN and help to identify the pathologically proven LN on DECT. Maximal short diameter (MSD) and 13 DECT parameters were measured on metastatic aLNs and contralateral normal aLNs. The univariate, least absolute shrinkage and selection operator and multivariable logistic regression were performed to find independent parameters for predicting metastasis. The diagnostic performance was assessed using receiver operating characteristics (ROC) analysis.ResultsA total of 76 axillary LNs (38 metastasized, 38 normal) from 38 patients were finally included. All DECT parameters showed significant difference between metastatic and normal LNs (all P < 0.001). Arterial enhancement fraction (AEF) and MSD were independent predictors of metastasis (P = 0.010 and 0.014, respectively). The area under the ROC curve (AUC) of AEF was the highest (0.967). The combined AUC of AEF and MSD was significantly higher than that of MSD alone (0.994 vs. 0.943; P = 0.025).ConclusionDECT is a promising tool for preoperative evaluation of aLNs in BC patients, with MSD and AEF having the best diagnostic performance.

Development and validation of a postoperative prognostic model for hormone receptor positive early stage breast cancer recurrence

Predicting recurrence among early-stage hormone receptor-positive human epidermal growth factor receptor-negative breast cancer (HR+/HER2- BC) is crucial for guiding adjuvant therapy. However, studies are limited for patients with low recurrence risk. HR+/HER2- early-stage (T1-2N0-1) invasive BC patients who received definitive surgery and followed by endocrine therapy from four independent medical centers were included in this retrospective study. Patients from center 1 were used as derivation cohort, while those from other centers were combined as an external test cohort. A deep learning prognostic model, HERPAI, was developed based on Transformer to predict risk of invasive disease-free survival (iDFS) utilizing clinical and pathological predictors. The model performance was evaluated using C-index for the overall population and subgroups. Threshold for selecting 5-year recurrence risk > 10% was determined. Hazard ratio (HR) was estimated between risk groups for iDFS. A total of 6340 patients were included, of whom 5424 were assigned to the derivation cohort (training and validation [N = 4882] and internal test cohort [N = 542]), while 916 patients were utilized as external cohort. HERPAI yielded a C-index of 0.73 (95% CI 0.65-0.81), 0.73 (95% CI 0.62-0.85), and 0.68 (95% CI 0.60-0.77), in the validation, internal, and external test cohort, respectively. Consistent performances were observed for pre-specified subgroups. High-risk patients were associated with an increased risk of recurrence for validation (HR, 2.56 [95% CI 1.25-5.22], P = 0.01), internal test (HR, 2.52 [95% CI 0.97-6.57], P = 0.06) and external test (HR, 1.94 [95% CI 1.00-3.74], P = 0.049) cohort, respectively. HERPAI was a promising tool for selecting vulnerable early-stage HR+/HER2- BC patients who were at high-risk of recurrence. It could facilitate the prioritization of patients who may benefit more from escalating adjuvant treatment.

Oncological outcomes of breast-conserving surgery versus mastectomy following neoadjuvant chemotherapy in a contemporary multicenter cohort

To evaluate local recurrence (LR), distant recurrence (DR) and death in non-metastatic patients undergoing breast-conserving surgery (BCS) or mastectomy following current neoadjuvant chemotherapy (NAC) regimens. Patients submitted to NAC in 2013-2023 were evaluated (n = 365; mastectomy: 165; BCS: 200). More mastectomy patients were over 70 years old (12.7% versus 7%; p = 0.02) and had T4b tumors (16.4% versus 4.5%; p = 0.0003), whereas more BCS patients had node-negative axilla (42% versus 31.5%; p = 0.02). After a mean follow-up of 65 months (range: 4-124), LR and DR were similar in the mastectomy and BCS groups (4.8% versus 5.0%; p = 0.95 and 10.9% versus 9%; p = 0.58, respectively). More deaths occurred in the mastectomy group (8.5% versus 3%; p = 0.03). Ten-year LR-free survival was higher in the BCS group (98.5% versus 95%; HR: 3.41; 1.09-10.64; p = 0.03), while 10-year DR-free survival was similar in both groups (91% BCS versus 89% mastectomy, HR: 1.25; 0.65-2.42; p = 0.4). Overall survival was better in the BCS group (97% versus 91.5%; HR: 2.62; 1.06-6.69; p = 0.03). Estimated 10-year disease-free survival, stratified according to tumor stage, showed no significant difference except for T4 disease, for which the risk was greater in the mastectomy group (94.5% versus 81.8%; HR: 2.86, 1.54-5.30, p = 0.0008). In the multivariate analysis, T3/T4 staging (OR: 4.37, 1.03-21.91; p = 0.04) and axillary dissection (OR: 5.11, 1.14-35.52; p = 0.04) were associated with LR in the BCS group. In this cohort of patients receiving contemporary NAC, BCS proved to be a safe alternative to mastectomy following treatment with NAC, even in cases of locally advanced BC.

The prognostic value of the tumor-stroma ratio compared to tumor-infiltrating lymphocytes in triple-negative breast cancer: a review

Previous literature extensively explored biomarkers to personalize treatment for breast cancer patients. The clinical need is especially high in patients with triple-negative breast cancer (TNBC) due to its aggressive nature and limited treatment modalities. This review aims to evaluate the value of tumor-infiltrating lymphocytes (TILs) and tumor-stroma ratio (TSR) as prognostic biomarkers in TNBC patients and assess their clinical potential. A literature search was conducted in PubMed, Embase, Emcare, Web of Science, and Cochrane Library. Papers comparing survival outcomes of TNBC patients with low/high or negative/positive TSR and immune cells were included. The most frequently mentioned subgroups of TILs were selected and reported in this review. Data from 43 articles on TILs and eight articles on TSR were included. Among TNBC patients, high CD8 expression was generally associated with better survival. Notable, the poor survival outcomes were related to high intra-tumoral PD-L1 expression, whereas high stromal PD-L1 expression more often was correlated with favorable outcomes. For the TSR, a high amount of stroma in the primary tumor of TNBC patients was consistently associated with worse survival. This review highlights that a high number of CD8-positive T-cells is a promising prognostic factor for TNBC patients. PD-L1 expression analyzed for intra-tumoral and stromal expression separately reports strong but contrasting information. Finally, the TSR shows potential to be an important prognostic marker, especially for TNBC patients. Utilizing both biomarkers, either on itself or combined, could enhance clinical decision-making and personalization of treatment.

Assessing Axillary Lymph Node Burden and Prognosis in cT1-T2 Stage Breast Cancer Using Machine Learning Methods: A Retrospective Dual-Institutional MRI Study

BACKGROUND

Pathological axillary lymph node (pALN) burden is an important factor for treatment decision-making in clinical T1-T2 (cT1-T2) stage breast cancer. Preoperative assessment of the pALN burden and prognosis aids in the individualized selection of therapeutic approaches.

PURPOSE

To develop and validate a machine learning (ML) model based on clinicopathological and MRI characteristics for assessing pALN burden and survival in patients with cT1-T2 stage breast cancer.

STUDY TYPE

Retrospective.

POPULATION

A total of 506 females (range: 24-83 years) with cT1-T2 stage breast cancer from two institutions, forming the training (N = 340), internal validation (N = 85), and external validation cohorts (N = 81), respectively.

FIELD STRENGTH/SEQUENCE

This study used 1.5-T, axial fat-suppressed T2-weighted turbo spin-echo sequence and axial three-dimensional dynamic contrast-enhanced fat-suppressed T1-weighted gradient echo sequence.

ASSESSMENT

Four ML methods (eXtreme Gradient Boosting [XGBoost], Support Vector Machine, k-Nearest Neighbor, Classification and Regression Tree) were employed to develop models based on clinicopathological and MRI characteristics. The performance of these models was evaluated by their discriminative ability. The best-performing model was further analyzed to establish interpretability and used to calculate the pALN score. The relationships between the pALN score and disease-free survival (DFS) were examined.

STATISTICAL TESTS

Chi-squared test, Fisher's exact test, univariable logistic regression, area under the curve (AUC), Delong test, net reclassification improvement, integrated discrimination improvement, Hosmer-Lemeshow test, log-rank, Cox regression analyses, and intraclass correlation coefficient were performed. A P-value <0.05 was considered statistically significant.

RESULTS

The XGB II model, developed based on the XGBoost algorithm, outperformed the other models with AUCs of 0.805, 0.803, and 0.818 in the three cohorts. The Shapley additive explanation plot indicated that the top variable in the XGB II model was the Node Reporting and Data System score. In multivariable Cox regression analysis, the pALN score was significantly associated with DFS (hazard ratio: 4.013, 95% confidence interval: 1.059-15.207).

DATA CONCLUSION

The XGB II model may allow to evaluate pALN burden and could provide prognostic information in cT1-T2 stage breast cancer patients.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY: Stage 2.

The Diagnostic Accuracy of 18F-FDG PET and 18F-FES PET for Staging Grade 1-2 Estrogen Receptor-Positive Breast Cancer

Background According to current guidelines, staging of patients with locally advanced breast cancer and local-regional recurrent breast cancer is preferably performed with PET using 2-fluorine 18-fluoro-2-deoxy-d-glucose (18F-FDG). However, 18F-FDG PET might underperform in low-grade estrogen receptor (ER)-positive breast cancer. Alternatively, 16α-18F-fluoro-17β-estradiol (18F-FES) has emerged as a powerful tracer for in vivo visualization of ER-positive lesions. Purpose To assess whether 18F-FES PET improves staging of grade 1 or 2 ER-positive breast cancer compared with 18F-FDG PET. Materials and Methods Patients with clinical stage II/III or local-regional recurrent, grade 1 or 2, ER-positive breast cancer were included between December 2018 and January 2021 in this prospective multicenter pilot study. All participants underwent an 18F-FES PET examination in addition to standard staging with conventional imaging and 18F-FDG PET. Both PET scans were independently assessed. The disease stage was determined independently based on conventional imaging and 18F-FDG PET or 18F-FES PET. Relevant lesions suspected of malignancy were verified histopathologically, after which a final stage was determined. Results A total of 41 female participants (median age, 56 years [IQR, 48-71 years]) with 44 breast tumors were included. Overall, 29 of 41 participants (71%) were correctly staged at 18F-FDG PET compared with 34 of 41 (83%) at 18F-FES PET (P = .18). Seven of 10 and nine of 10 cases of lobular breast cancer were correctly staged at 18F-FDG and 18F-FES PET, respectively (70% vs 90%; P = .38) and seven of 12 and 11 of 12 cases of grade 1 tumors, respectively (58% vs 92%; P = .06). Regional lymph nodes were incorrectly staged at 18F-FDG PET in six of 44 cases (14%), whereas all cases were correctly staged at 18F-FES PET (P = .02). Both imaging methods had a sensitivity of 100% (95% CI: 59, 100) and a specificity of 91% (95% CI: 76, 98) for the detection of metastatic disease. Conclusion In this prospective pilot study, there was no evidence of a difference in diagnostic accuracy of 18F-FES PET and 18F-FDG PET in staging patients with grade 1 or 2 ER-positive breast cancer. Clinical trial registration no. NCT03726931 Published under a CC BY 4.0 license Supplemental material is available for this article. See also the editorial by Fowler in this issue.

The combination of Shenhuang plaster and paclitaxel inhibits lung metastasis in breast cancer via modulation of the tumor microenvironment

Background

Paclitaxel (PTX) is a chemotherapeutic agent that is frequently used for breast cancer treatment, but it has been associated with promoting distant metastases, including to the lungs, liver, and bones. Shenhuang plaster (SHP), a traditional Chinese medicine, has shown potential for modulating the tumor microenvironment (TME). This study investigates whether a combination of SHP and PTX can enhance the anti-tumor efficacy of PTX and mitigate its pro-metastatic effects in a 4T1 breast cancer mouse model.

Methods

Female Balb/c mice were injected with 4T1 breast cancer cells and then divided into four treatment groups: control, PTX, SHP, and PTX+SHP. The combination of SHP and PTX was evaluated using bioluminescence imaging (BLI), histological analysis, and hematoxylin and eosin (HE) staining to assess lung metastasis. Flow cytometry was employed to analyze immune cell populations, including tumor-associated macrophages (TAMs), myeloid-derived suppressor cells (MDSCs), regulatory T cells (Tregs), and cytotoxic T cells (CD8+ and CD4+).

Results

SHP alone did not significantly inhibit lung metastasis but the combination of PTX and SHP led to a marked reduction in lung lesions, as confirmed by BLI and histological analysis. SHP improved the overall health of PTX-treated mice, reducing their body weight loss and mortality. Flow cytometry revealed that the combination therapy reduced the infiltration of M2 macrophages, MDSCs, and Tregs, while increasing the proportion of antitumor M1 macrophages, cytotoxic CD8+ T cells, and helper CD4+ T cells.

Conclusions

The combination of PTX and SHP has a synergistic effect, reducing lung metastasis and modulating immune cell populations within the TME. These results suggest that integrating traditional Chinese medicine with standard chemotherapy can enhance therapeutic efficacy and reduce adverse effects.

Camrelizumab vs Placebo in Combination With Chemotherapy as Neoadjuvant Treatment in Patients With Early or Locally Advanced Triple-Negative Breast Cancer: The CamRelief Randomized Clinical Trial

Importance

Preferred neoadjuvant strategies for early or locally advanced triple-negative breast cancer include a 4-drug chemotherapy regimen containing anthracyclines, cyclophosphamide, taxanes, and platinum. Blockade of the programmed death receptor 1/ligand-1 (PD-1/PD-L1) pathway may improve efficacy of classic neoadjuvant chemotherapy. Camrelizumab, an anti-PD-1 antibody, has showed antitumor activity in advanced triple-negative breast cancer.

Objective

To evaluate the efficacy and adverse events of camrelizumab plus chemotherapy vs placebo plus chemotherapy as neoadjuvant therapy for patients with early or locally advanced triple-negative breast cancer.

Design, Setting, and Participants

This randomized, double-blind, phase 3 trial enrolled patients from 40 hospitals in China between November 25, 2020, and May 12, 2023 (data cutoff: September 30, 2023). A total of 441 eligible patients were enrolled.

Interventions

Patients were randomized in a 1:1 ratio to receive either camrelizumab 200 mg (n = 222) or placebo (n = 219) combined with chemotherapy every 2 weeks. The chemotherapy included nab-paclitaxel (100 mg/m2) and carboplatin (area under the curve, 1.5) on days 1, 8, and 15 in 28-day cycles for the first 16 weeks followed by epirubicin (90 mg/m2) and cyclophosphamide (500 mg/m2) every 2 weeks for 8 weeks.

Main Outcomes and Measures

The primary end point was pathological complete response (defined as no invasive tumor in breast and lymph nodes [ypT0/Tis ypN0]).

Results

Among 441 females randomized (median age, 48 years), the median (range) follow-up duration from randomization was 14.4 (0.0-31.8) months. Pathological complete response was achieved in 126 patients (56.8% [95% CI, 50.0%-63.4%]) in the camrelizumab-chemotherapy group and 98 patients (44.7% [95% CI, 38.0%-51.6%]) in the placebo-chemotherapy group (rate difference, 12.2% [95% CI, 3.3%-21.2%]; 1-sided P = .004). In the neoadjuvant phase, adverse events of grade 3 or higher occurred in 198 patients (89.2%) in the camrelizumab-chemotherapy group and 182 (83.1%) in the placebo-chemotherapy group; serious adverse events occurred in 77 patients (34.7%) in the camrelizumab-chemotherapy group and 50 (22.8%) in the placebo-chemotherapy group, with fatal adverse events occurring in 2 patients (0.9%) in the camrelizumab-chemotherapy group.

Conclusions and Relevance

Among patients with early or locally advanced triple-negative breast cancer, the addition of camrelizumab to neoadjuvant chemotherapy significantly improved pathological complete response.

Trial Registration

ClinicalTrials.gov Identifier: NCT04613674.

Network pharmacology unveils the intricate molecular landscape of Chrysin in breast cancer therapeutics

Chrysin is one of the natural flavonoid compounds Sourced from various plant source, mainly in propolis and honey, demonstrates effective Cancer-suppressing properties, particularly in Breast cancer (BC). However, the specific molecular mechanisms underlying its efficacy in breast cancer treatment have remained elusive. This study employed network pharmacology combined with a molecular docking approach to uncover the intricate details of Chrysin's impact on breast cancer. Utilizing databases such as GeneCards, and disgenet, Pharmmapper, ctd database, Chrysin and potential breast cancer targets were meticulously curated. Through a strategic process of mapping and screening, core targets essential for Chrysin's efficacy in breast cancer treatment were identified. Further refinement through Venn diagram analysis, considering 1350 breast cancer target genes and 433 Chrysin-related targets, identified 140 intersection targets. Subsequent construction of protein-protein interaction networks of 140 intersecting using the STRING and Cytoscape software highlighted these ten targets as core candidates. Functional annotation and pathway analysis, performed using the ShinyGO database, unveiled that the key targets were significantly associated with the Prostate cancer pathways and IL17 signaling pathways. Molecular docking results underscored Chrysin's effective binding to these ten key targets, forming stable protein-ligand complexes. Molecular docking analyses were then conducted to evaluate the impact of Chrysin in the key targets, revealing TP53, JUN, HIF1A, ALB, CASP3, STAT3, BCL2, TNF, AKT1, and IL6 as pivotal players. In summary, this investigation provides valuable revelations into the essential targets and molecular processes through which Chrysin exerts its anti-breast cancer effects. These findings not only enhance our understanding of Chrysin's pharmacological actions in breast cancer but also lay a theoretical groundwork for future investigations into the therapeutic mechanisms of Chrysin in this context.

Is Axillary Lymph Node Dissection Needed? Clinicopathological Correlation in a Series of 224 Neoadjuvant Chemotherapy-Treated Node-Positive Breast Cancers

BACKGROUND

Axillary lymph node status is valuable in determining systemic and radiation therapy. Following neoadjuvant therapy for patients with clinically involved axillary nodes, the role of axillary lymph node dissection (ALND) following a positive sentinel lymph node biopsy (SLNB) is a subject of controversy.

MATERIALS AND METHODS

We retrospectively analyzed 224 neoadjuvant chemotherapy-treated node-positive breast cancer cases and evaluated the role of ALND in optimizing staging accuracy and treatment outcomes.

RESULTS

About 63 (27.8%) underwent ALND based on post neoadjuvant persistent positive lymph nodes on exam /imaging. SLNBs were performed in 161 (71.9%) patients as initial surgical planning; 67 (41.6%) patients had positive SLNB results, and 51 (76.1%) underwent further ALND. In patients with 1 positive sentinel lymph node, follow-up ALND yielded additional positive lymph nodes in 10.5% of cases, whereas in patients with 2 or more positive sentinel lymph nodes, follow-up ALND yielded additional positive lymph nodes in 87.5% of cases. The presence of 2 positive macro-metastatic sentinel lymph nodes significantly predicts additional nodal involvement, especially in patients without a pathologic complete response.

CONCLUSION

De-escalation of axillary surgery to SLNB alone in this context may be safely considered in neoadjuvant-treated clinical node positive patient with <2 positive sentinel lymph nodes. Our findings help guide surgeons to appropriately select patients who can potentially benefit from ALND for locoregional control and recommendation for adjuvant radiation.

Prediction of Microinvasion in Breast Ductal Carcinoma in Situ Using Conventional Ultrasound Combined with Contrast-Enhanced Ultrasound Features: A Two-Center Study

BACKGROUND

To develop and validate a model based on conventional ultrasound (CUS) and contrast-enhanced ultrasound (CEUS) features to preoperatively predict microinvasion in breast ductal carcinoma in situ (DCIS).

PATIENTS AND METHODS

Data from 163 patients with DCIS who underwent CUS and CEUS from the internal hospital was retrospectively collected and randomly apportioned into training and internal validation sets in a ratio of 7:3. External validation set included 56 patients with DCIS from the external hospital. Univariate and multivariate logistic regression analysis were performed to determine the independent risk factors associated with microinvasion. These factors were used to develop predictive models. The performance was evaluated through calibration, discrimination, and clinical utility.

RESULTS

Multivariate analysis indicated that centripetal enhancement direction (odds ratio [OR], 13.268; 95% confidence interval [CI], 3.687-47.746) and enhancement range enlarged on CEUS (OR, 4.876; 95% CI, 1.470-16.181), lesion size of ≥20 mm (OR, 3.265; 95% CI, 1.230-8.669) and calcification detected on CUS (OR, 5.174; 95% CI, 1.903-14.066) were independent risk factors associated with microinvasion. The nomogram incorporated the CUS and CEUS features achieved favorable discrimination (AUCs of 0.850, 0.848, and 0.879 for the training, internal and external validation datasets), with good calibration. The nomogram outperformed the CUS model and CEUS model (all P < .05). Decision curve analysis confirmed that the predictive nomogram was clinically useful.

CONCLUSION

The nomogram based on CUS and CEUS features showed promising predictive value for the preoperative identification of microinvasion in patients with DCIS.

Protein lactylation within the nucleus independently predicts the prognosis of non‑specific triple‑negative breast cancer

Protein lactylation represents a pervasive post-translational modification prevalent in histones and diverse proteins, fostering tumor initiation and progression. Nonetheless, the impact of protein lactylation on the prognosis of non-specific triple-negative breast cancer (TNBC) remains uncertain. In the present study, the pan-lysine lactylation (panKlac) levels in cytoplasmic and nuclear compartments were semi-quantitatively examined using a tissue microarray encompassing 77 non-specific TNBC tissues. The association of the prognosis of patients with the panKlac levels in the cytoplasmic and nuclear compartments or other tumor attributes was assessed using Kaplan-Meier and Cox regression analyses. Furthermore, the molecular pathways involved in the promotional effect of lactylation on cell proliferation were determined through a transcriptomic analysis. The results indicated that the panKlac levels were markedly higher in tumor tissues than in para-tumor mammary regions and showed no significant correlations with various clinicopathological parameters, such as tumor dimension, lymph node involvement or histological grading. Notably, high panKlac levels within the nucleus served as an independent predictor of recurrence-free survival, whereas high cytoplasmic panKlac levels were a protective factor for patient survival. The panKlac levels were also markedly elevated in the TNBC cell line, MDA-MB-231. Additionally, glycolysis inhibition significantly reduced the global panKlac levels and concurrently diminished cell proliferation. According to the comprehensive transcriptomic analysis results, pathways related to ribosomal subunit biosynthesis/assembly and aminoacyl-tRNA biosynthesis were involved in the tumor-promoting mechanisms of lactylation. Further results revealed the oncogenic propensity of tyrosyl-tRNA synthetase 1 (YARS1) and its association with lactate production. Overall, Klac levels within the nucleus are an independent prognostic indicator for patients with non-specific TNBC. It is imperative to delve deeper into the roles and mechanisms of nuclear protein lactylation and YARS1 in non-specific TNBC.

An overview about biomarkers in breast cancer: Insights into the diagnostic and prognostic significance

Breast cancer (BC) is one of the most significant neoplasms globally due to its high incidence and mortality, particularly among females. As a highly heterogeneous pathology, biomarkers are essential for characterizing specific tumors. Currently, several biological processes are well-described in the context of this neoplasm, such as alterations in BRCA1/2, HER, and pathways involving estrogen and progesterone hormone receptors. These studies have enabled the use of these findings as more precise methods for diagnosis, prognosis, and treatment. However, beyond patients who do not exhibit these classic markers, some individuals within the same risk group respond differently to treatment. Therefore, the search for biological markers that can improve diagnosis, aid in stratification, or serve as therapeutic targets is continuous and urgent. Genetic signatures have led to molecular tests currently used in clinical practice, though certain limitations persist. Understanding genetic and epigenetic mechanisms facilitates the identification of potential biomarkers. Biomarker targets must undergo experimental and clinical trials on samples of significant size before reaching clinical utility. In this review, we compile the classical markers and describe the potential use of other markers associated with the biological processes of this neoplasm.

Luminol/PtCo@rGO and Au@CNTs-based electrochemiluminescence cytosensor for ultrasensitive detection of breast cancer CTCs

BACKGROUND

Breast cancer CTCs have recently been recognized as an emerging biomarker for liquid biopsy of breast cancer. In this work, based on two-dimensional (2D) noble metal PtCo@rGO nanozymes and Au@CNTs bioconjugates, a novel electrochemiluminescence (ECL) cytosensor was developed in order to detect breast cancer CTCs (MCF-7) ultrasensitively.

RESULTS

The PtCo@rGO nanozymes possessed large specific surface area and high efficiency peroxidase-like activity, which can be used as nanocarriers to anchor and catalyze luminol ECL emission efficiently. Moreover, the PtCo@rGO nanozymes have fractal nanostructures similar to that of CTCs and can capable of enhancing the adhesion of MCF-7 when assembled together with aptamers containing HS-modified epithelial specific cell adhesion molecules (EpCAM, S1). Importantly, the S1/Au@CNTs bioconjugates loaded on the glassy carbon electrode (GCE) can effectively capture MCF-7 cells. Benefiting from the above-mentioned advantages, the ECL cytosensor constructed for MCF-7 cells detection performed well with a wide linear range (2-1 × 104 cells mL-1) and a low limit of detection (1 cells mL-1).

SIGNIFICANCE

The designed ECL cytosensor could provide a promising platform for CTC-based liquid biopsy and have broad application prospects in breast cancer early diagnosis and prognostic monitoring.

Evaluating the correlation between pretreatment 18F-FDG PET/CT metabolic parameters and tumor-infiltrating lymphocyte levels in nonluminal breast cancer and impact on survival

Background and Objectives

This study aims to evaluate the correlation between Tumor-Infiltrating Lymphocyte (TIL) levels and Fluorine-18 fluorodeoxyglucose (18F-FDG) metabolic parameters, including spleen and bone marrow FDG uptake and tumor heterogeneity in non-luminal breast cancers (NLBC), and to elucidate their association with survival outcomes.

Methods

We retrospectively analyzed data from 100 females with stage 2-4 NLBC who underwent pretreatment 18F-FDG Positron emission tomography-computed tomography (PET/CT). TIL was scored based on Hematoxylin-Eosin-stained specimens and 18F-FDG PET metabolic parameters, including maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), liver, spleen, and bone marrow FDG uptake were calculated. Heterogeneity Index (HI)1, HI2, and HI3 indices were analyzed with FDG metabolic parameters. The association between these factors and overall survival was analyzed using multivariate Cox regression models.

Results

TIL showed weak negative correlations with tumor size, tumor (T), and metastasis (M) stages. No significant correlation was found between TIL levels and overall SUV values. However, in stage 4, TIL correlated positively with liver, spleen, and bone marrow SUV values and negatively with heterogeneity indices (HI2, HI3). Higher tumor size, HI values, and Bone marrow-to-liver ratio (BLR) SUVmean were associated with increased mortality. A TIL cut-off value of <5 was linked to significantly worse survival.

Conclusion

Our study demonstrates a strong connection between TIL, FDG metabolic parameters, and tumor heterogeneity, particularly in advanced NLBC. Although TIL is not generally associated with SUV values, its association with certain metabolic and heterogeneity indices suggests that it is important in influencing survival. Further research involving larger cohorts and diverse breast cancer subtypes is needed to validate these results.

The efficacy of screening with FDG-PET/CT for distant metastases in breast cancer patients scheduled for neoadjuvant systemic therapy

PURPOSE

This study aims to identify which breast cancer patients benefit from the routine use of FDG-PET/CT in a large cohort of patients scheduled for neoadjuvant systemic therapy (NST).

METHODS

A total of 1337 breast cancer patients eligible for NST were identified from a retrospective database between 2011 and 2020 at a single tertiary care hospital. All patients underwent staging with FDG-PET/CT prior to NST. The incidence and extent of asymptomatic distant metastases in different patient subgroups were determined, as well as the impact on treatment. Logistic regression analysis was used to identify prognostic patient and tumor characteristics.

RESULTS

FDG-PET/CT detected distant metastases in 109 patients (8%). Initial clinical stage was a prognostic factor for the presence of distant metastases, with a significantly higher risk for stage 2b and 3 as opposed to lower stages (p < 0.001). The incidence of distant metastases was 3% (4/125) for stage 1, 2% (8/534) for stage 2a, 7% (24/354) for stage 2b and 23% (73/324) for stage 3. Other characteristics such as age, tumor subtype, histological type and grade were not correlated with the risk of distant metastases. Among the subset of patients with distant metastases, 46% received palliative treatment, while the remaining 54% were diagnosed with oligometastatic breast cancer and were treated with curative intent.

CONCLUSION

The results of the current study support the routine use of FDG-PET/CT for the detection of distant metastases in breast cancer patients with initial clinical stage 2b and 3, regardless of tumor subtype.

Nucleolar casein kinase 2 alpha as a prognostic factor in patients with surgically resected early‑stage lung adenocarcinoma

Lung cancer remains a leading cause of global cancer‑related deaths, therefore the identification of prognostic factors for lung cancer is critical. Casein kinase 2 alpha (CK2α) is one of the driver kinases in various cancers, and it was previously demonstrated that CK2α localization was associated with a poor prognosis in invasive breast cancer. In the present study, the importance of CK2α in the nucleolus was explored as a potential prognostic marker for surgically resected early‑stage lung adenocarcinoma. The present study included 118 patients who underwent pulmonary lobectomy between 2014 and 2018 in Fukushima Medical University Hospital (Fukushima, Japan), and in whom CK2α localization in tumor samples was assessed by immunohistochemistry. Patient and tumor characteristics, including pathological stage, histological type and histological grade, were analyzed. Recurrence‑free survival (RFS) and overall survival were evaluated in relation to nucleolar CK2α staining. CK2α staining in the nucleoli was observed in 50.8% of lung adenocarcinoma tumors. Positive nucleolar CK2α staining was independent of pathological stage, histological type and histological grade. Patients with positive nucleolar CK2α staining exhibited significantly worse RFS compared with patients with negative staining. Multivariate analysis identified nucleolar CK2α staining and lymph node metastasis as independent poor prognostic factors. The results of the present study suggested that nucleolar CK2α staining is a novel and independent prognostic factor in surgically resected early‑stage lung adenocarcinoma. These findings indicated the potential of nucleolar CK2α as a predictive biomarker for future recurrence, and a guide to treatment decisions. Further research is required, particularly in understanding the molecular mechanisms linking nucleolar CK2α to recurrence.

Tumor infiltrating lymphocytes and change in tumor load on MRI to assess response and prognosis after neoadjuvant chemotherapy in breast cancer

PURPOSE

In this study, we aimed to explore if the combination of tumor infiltrating lymphocytes (TILs) and change in tumor load on dynamic contrast-enhanced magnetic resonance imaging leads to better assessment of response to neoadjuvant chemotherapy (NAC) in patients with breast cancer, compared to either alone.

METHODS

In 190 NAC treated patients, MRI scans were performed before and at the end of treatment. The percentage of stromal TILs (%TILs) was assessed in pre-NAC biopsies according to established criteria. Prediction models were developed with linear regression by least absolute shrinkage and selection operator and cross validation (CV), with residual cancer burden as the dependent variable. Discrimination for pathological complete response (pCR) was evaluated using area under the receiver operating characteristic curves (AUC). We used Cox regression analysis for exploring the association between %TILs and recurrence-free survival (RFS).

RESULTS

Fifty-one patients reached pCR. In all patients, the %TILs model and change in MRI tumor load model had an estimated CV AUC of 0.69 (95% confidence interval (CI) 0.53-0.78) and 0.69 (95% CI 0.61-0.79), respectively, whereas a model combining the variables resulted in an estimated CV AUC of 0.75 (95% CI 0.66-0.83). In the group with tumors that were ER positive and HER2 negative (ER+/HER2-) and in the group with tumors that were either triple negative or HER2 positive (TN&HER2+) separately, the combined model reached an estimated CV AUC of 0.72 (95% CI 0.60-0.88) and 0.70(95% CI 0.59-0.82), respectively. A significant association was observed between pre-treatment %TILS and RFS (hazard ratio (HR) 0.72 (95% CI 0.53-0.98), for every standard deviation increase in %TILS, p = 0.038).

CONCLUSION

The combination of TILs and MRI is informative of response to NAC in patients with both ER+/HER2- and TN&HER2+ tumors.

Diagnostic performance of TILs-US score and LPBC in biopsy specimens for predicting pathological complete response in patients with breast cancer

BACKGROUND

Tumor-infiltrating lymphocytes-ultrasonography (TILs-US) score is used to predict lymphocyte-predominant breast cancer (LPBC) in surgical specimens. We aimed to compare diagnostic performance of TILs-US score for predicting pathological complete response (pCR) with that of LPBC in biopsy specimens.

METHODS

TILs ≥ 50% in biopsy specimens was defined as biopsy-LPBC, and TILs-US score ≥ 4 was categorized as TILs-US score-high. Basic nomogram for pCR was developed using stepwise logistic regression based on the smallest Akaike Information Criterion, and biopsy-LPBC and TILs-US score nomograms were developed by integrating biopsy-LPBC or TILs-US scores into a basic nomogram. The diagnostic performance of the nomograms for pCR was compared using area under the curve (AUC), categorical net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

RESULTS

This retrospective study evaluated 118 patients with breast cancer, including 33 (28.0%) with biopsy-LPBC, 52 (44.1%) with TILs-US score-high, with 34 (28.8%) achieving pCR. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and AUC for predicting pCR were 0.53, 0.82, 2.96, 0.57, and 0.68, respectively, for biopsy-LPBC, and 0.76, 0.69, 2.47, 0.34, and 0.73, respectively, for TILs-US score. The biopsy-LPBC nomogram showed significant improvements in categorical NRI (p = 0.023) and IDI (p = 0.007) but not in AUC (p = 0.25), compared with the basic nomogram. The TILs-US nomogram exhibited significant improvements in AUC (p = 0.039), categorical NRI (p = 0.010), and IDI (p < 0.001).

CONCLUSIONS

The TILs-US score may serve as a novel marker for prediction of pCR in patients with breast cancer. An external validation study is warranted to confirm our findings.

Prevalence of Programmed Death-Ligand 1 Positivity Using SP142 in Patients With Advanced Stage Triple-Negative Breast Cancer in Malaysia: A Cross-Sectional Study

PURPOSE

Triple-negative breast cancer (TNBC) is a subtype of breast cancer known for its poor prognosis and the absence of viable targets for standard receptor-based therapies. Several studies have suggested that targeting programmed death-ligand 1 (PD-L1) in tumors that express this biomarker, either on tumor cells and/or in the tumor inflammatory infiltrate, may be beneficial in some patients. This study aimed to assess the overall prevalence of PD-L1 positivity using the SP142 antibody clone in patients with advanced TNBC in Malaysia.

METHODS

This was a multicenter, cross-sectional prevalence study on PD-L1 positivity among patients with advanced-stage TNBC in Malaysia. Patients were identified using medical records and were enrolled in the study if they met the inclusion criteria. PD-L1 evaluation was performed using archived formalin-fixed paraffin-embedded tissue specimens. Demographic and clinical data were also obtained and summarized using descriptive statistics. The association of these parameters with PD-L1 positivity was assessed using chi-square and logistic regression analysis.

RESULTS

Three medical centers provided 138 complete cases for analysis. Of these 138 cases, 52 (37.7%; 95% confidence interval, 29.6%-46.3%) showed positive PD-L1 expression, defined as immune cell PD-L1 expression ≥ 1%. In a univariate analysis, stage III of the disease and tumor samples from resected specimens were significantly associated with a positive PD-L1 status. However, further assessment using a multivariate model revealed that only resected tumor samples remained significantly associated with PD-L1 positivity after controlling for disease staging.

CONCLUSION

The prevalence of PD-L1 positivity among patients with stage III or IV TNBC was 37.7%. A significant association was noted between PD-L1 positivity and the tumor tissue obtained from resected specimens. Although the mechanism and clinical significance of this association remain unclear, this finding indicates a possible disparity in the PD-L1 status of samples obtained using surgical resection or biopsy.

Prelude to malignancy: A gene expression signature in normal mammary gland from breast cancer patients suggests pre-tumorous alterations and is associated with adverse outcomes

Despite advances in early detection and treatment strategies, breast cancer recurrence and mortality remain a significant health issue. Recent insights suggest the prognostic potential of microscopically healthy mammary gland, in the vicinity of the breast lesion. Nonetheless, a comprehensive understanding of the gene expression profiles in these tissues and their relationship to patient outcomes remain missing. Furthermore, the increasing trend towards breast-conserving surgery may inadvertently lead to the retention of existing cancer-predisposing mutations within the normal mammary gland. This study assessed the transcriptomic profiles of 242 samples from 83 breast cancer patients with unfavorable outcomes, including paired uninvolved mammary gland samples collected at varying distances from primary lesions. As a reference, control samples from 53 mammoplasty individuals without cancer history were studied. A custom panel of 634 genes linked to breast cancer progression and metastasis was employed for expression profiling, followed by whole-transcriptome verification experiments and statistical analyses to discern molecular signatures and their clinical relevance. A distinct gene expression signature was identified in uninvolved mammary gland samples, featuring key cellular components encoding keratins, CDH1, CDH3, EPCAM cell adhesion proteins, matrix metallopeptidases, oncogenes, tumor suppressors, along with crucial genes (FOXA1, RAB25, NRG1, SPDEF, TRIM29, and GABRP) having dual roles in cancer. Enrichment analyses revealed disruptions in epithelial integrity, cell adhesion, and estrogen signaling. This signature, named KAOS for Keratin-Adhesion-Oncogenes-Suppressors, was significantly associated with reduced tumor size but increased mortality rates. Integrating molecular assessment of non-malignant mammary tissue into disease management could enhance survival prediction and facilitate personalized patient care.

Deep learning Radiomics Based on Two-Dimensional Ultrasound for Predicting the Efficacy of Neoadjuvant Chemotherapy in Breast Cancer

We investigate the predictive value of a comprehensive model based on preoperative ultrasound radiomics, deep learning, and clinical features for pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) for the breast cancer. We enrolled 155 patients with pathologically confirmed breast cancer who underwent NAC. The patients were randomly divided into the training set and the validation set in the ratio of 7:3. The deep learning and radiomics features of pre-treatment ultrasound images were extracted, and the random forest recursive elimination algorithm and the least absolute shrinkage and selection operator were used for feature screening and DL-Score and Rad-Score construction. According to multifactorial logistic regression, independent clinical predictors, DL-Score, and Rad-Score were selected to construct the comprehensive prediction model DLRC. The performance of the model was evaluated in terms of its predictive effect, and clinical practicability. Compared to the clinical, radiomics (Rad-Score), and deep learning (DL-Score) models, the DLRC accurately predicted the pCR status, with an area under the curve (AUC) of 0.937 (95%CI: 0.895-0.970) in the training set and 0.914 (95%CI: 0.838-0.973) in the validation set. Moreover, decision curve analysis confirmed that the DLRC had the highest clinical value among all models. The comprehensive model DLRC based on ultrasound radiomics, deep learning, and clinical features can effectively and accurately predict the pCR status of breast cancer after NAC, which is conducive to assisting clinical personalized diagnosis and treatment plan.

The contrast-free diffusion MRI multiple index for the early prediction of pathological response to neoadjuvant chemotherapy in breast cancer

Early tumor response prediction can help avoid overtreatment with unnecessary chemotherapy sessions. It is important to determine whether multiple apparent diffusion coefficient indices (S index, ADC-diff) are effective in the early prediction of pathological response to neoadjuvant chemotherapy (NAC) in breast cancer (BC). Patients with stage II and III BCs who underwent T1WI, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced MRI using a 3 T system were included. They were divided into two groups: major histological responders (MHRs, Miller-Payne G4/5) and nonmajor histological responders (nMHRs, Miller-Payne G1-3). Three b values were used for DWI to derive the S index; ADC-diff values were obtained using b = 0 and 1000 s/mm2. The different interquartile ranges of percentile S-index and ADC-diff values after treatment were calculated and compared. The assessment was performed at baseline and after two and four NAC cycles. A total of 59 patients were evaluated. There are some correlations of interquartile ranges of S-index parameters and ADC-diff values with histopathological prognostic factors (such as estrogen receptor and human epidermal growth factor receptor 2 expression, all p < 0.05), but no significant differences were found in some other interquartile ranges of S-index parameters or ADC-diff values between progesterone receptor positive and negative or for Ki-67 tumors (all P > 0.05). No differences were found in the dynamic contrast-enhanced MRI characteristics between the two groups. HER-2 expression and kurtosis of the S-index distribution were screened out as independent risk factors for predicting MHR group (p < 0.05, area under the curve (AUC) = 0.811) before NAC. After early NAC (two cycles), only the 10th percentile S index was statistically significant between the two groups (p < 0.05, AUC = 0.714). No significant differences were found in ADC-diff value at any time point of NAC between the two groups (P > 0.1). These findings demonstrate that the S-index value may be used as an early predictor of pathological response to NAC in BC; the value of ADC-diff as an imaging biomarker of NAC needs to be further confirmed by ongoing multicenter prospective trials.

Prognostic values of tumor size and location in early stage endometrial cancer patients who received radiotherapy

OBJECTIVE

To investigate the correlation between tumor size, tumor location, and prognosis in patients with early-stage endometrial cancer (EC) receiving adjuvant radiotherapy.

METHODS

Data of patients who had been treated for stage I-II EC from March 1999 to September 2017 in 13 tertiary hospitals in China was screened. Cox regression analysis was performed to investigate associations between tumor size, tumor location, and other clinical or pathological factors with cancer-specific survival (CSS) and distant metastasis failure-free survival (DMFS). The relationship between tumor size as a continuous variable and prognosis was demonstrated by restricted cubic splines. Prognostic models were constructed as nomograms and evaluated by Harrell's C-index, calibration curves and receiver operating characteristic (ROC) curves.

RESULTS

The study cohort comprised 805 patients with a median follow-up of 61 months and a median tumor size of 3.0 cm (range 0.2-15.0 cm). Lower uterine segment involvement (LUSI) was found in 243 patients (30.2%). Tumor size and LUSI were identified to be independent prognostic factors for CSS. Further, tumor size was an independent predictor of DMFS. A broadly positive relationship between poor survival and tumor size as a continuous variable was visualized in terms of hazard ratios. Nomograms constructed and evaluated for CSS and DMFS had satisfactory calibration curves and C-indexes of 0.847 and 0.716, respectively. The area under the ROC curves for 3- and 5-year ROC ranged from 0.718 to 0.890.

CONCLUSION

Tumor size and LUSI are independent prognostic factors in early-stage EC patients who have received radiotherapy. Integrating these variables into prognostic models would improve predictive ability.

Epidermal growth factor receptor (EGFR) and vascular endothelial growth factor A (VEGF-A) expressions in Ethiopian female breast cancer and their association with histopathologic features

BACKGROUND

Epidermal growth factor receptor (EGFR) and vascular endothelial growth factor receptor (VEGF) play important role in breast tumor growth, invasion, metastasis, patient survival and drug resistance. The aim of this study was to evaluate the protein expression status of EGFR and VEGF-A, as well as their association with hormone receptor status and histopathological characteristics in the invasive type of female breast cancer among Ethiopians.

METHOD

The primary breast tumor tissues were obtained from 85 Ethiopian invasive breast cancer cases that underwent modified radical mastectomy (MRM) from June 2014 to June 2015. Their FFPE blocks were analyzed for EGFR and VEGF protein expressions using immunohistochemical techniques. The expressions were also correlated with histopathologic features.

RESULT

Epidermal growth factor receptor over-expression was observed in 22% of the tumor samples. VEGF-A expression was negative in 13.41%, low in 63.41%, moderate in 20.73%, and high in 2.44%. EGFR expression, but not VEGF-A, showed a significant inverse correlation with both estrogen receptor (ER) (P = 0.01) and progesterone receptor (PR) statuses (P = 0.04). EGFR and VEGF expressions did not show significant association with tumor size, grade, lymph node status or age at diagnosis.

CONCLUSION

Epidermal growth factor receptor expression was most likely associated with ER and PR negative tumors. Assessments of multiple molecular markers aid to understand the biological behavior of the disease in Ethiopian population. It might also help to predict which group of patients might get more benefit from the selected treatment strategies and which are not.

Subdivision of M1 category and prognostic stage for de novo metastatic breast cancer to enhance prognostic prediction and guide the selection of locoregional therapy

BACKGROUND

Although de novo metastatic breast cancer (dnMBC) is acknowledged as a heterogeneous disease, the current staging systems do not distinguish between patients within the M1 or stage IV category. This study aimed to refine the M1 category and prognostic staging for dnMBC to enhance prognosis prediction and guide the choice of locoregional treatment.

METHODS

We selected patients with dnMBC from the SEER database (2010-2019), grouping them into training (N = 8048) and internal validation (N = 3450) cohorts randomly at a 7:3 ratio. An independent external validation cohort (N = 660) was enrolled from dnMBC patients (2010-2023) treated in three hospitals. Nomogram-based risk stratification was employed to refine the M1 category and prognostic stage, incorporating T/N stage, histologic grade, subtypes, and the location and number of metastatic sites. Both internal and external validation sets were used for validation analyses.

RESULTS

Brain, liver, or lung involvement and multiple metastases were independent prognostic factors for overall survival (OS). The nomogram-based stratification effectively divided M1 stage into three groups: M1a (bone-only involvement), M1b (liver or lung involvement only, with or without bone metastases), and M1c (brain metastasis or involvement of both liver and lung, regardless of other metastatic sites). Only subtype and M1 stage were included to define the final prognostic stage. Significant differences in OS were observed across M1 and prognostic subgroups. Patients with the M1c stage benefited less from primary tumor surgery in comparison with M1a stage.

CONCLUSION

Subdivision of the M1 and prognostic stage could serve as a supplement to the current staging guidelines for dnMBC and guide locoregional treatment.

Vitamin D receptor is associated with prognostic characteristics of breast cancer after neoadjuvant chemotherapy-an observational study

Background

Breast cancer (BC) is the most commonly diagnosed malignant tumor in women. The disease and its subsequent treatment pose a serious burden on the quality of life of patients. Neoadjuvant chemotherapy (NAC) has become one of the crucial strategies for the management of BC. Since the identification of the vitamin D receptor (VDR) in mammary tissues, extensive mechanistic research has been conducted on its function. The expression of VDR in BC cells and the tumor microenvironment could be a new prognostic factor for BC after NAC.

Patients and Methods

This observational, single-center study compared data from clinical and histopathological records of 111 female subjects with the expression of VDR in different cellular and tissue components of breast specimens obtained from surgery after NAC. VDR expression was evaluated using an immunoreactive score assigned after immunohistochemistry. Intergroup comparisons and logistic regression were used to identify associations between VDR expression and clinicopathological features of BC.

Results

We found that the expression of VDR is associated with various clinical features (i.e., age, menopausal status, and NAC cycle number) and characteristics of prognostic significance, such as residual cancer burden class. Logistic regression analysis revealed that the expression of VDR in the nuclei and cytoplasm of surrounding normal mammary cells predicted vascular invasion and lymph node involvement.

Conclusions

The expression of VDR in tumor cells and their microenvironment is related to the clinicopathological characteristics of BC after NAC.

Breast conserving surgery with intraoperative electron beam radiation therapy for low-risk breast cancer: Five-year follow-up of 306 patients

Recent studies have reported a higher than expected risk of ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) and a single dose of electron beam intra-operative radiotherapy (IORT). This finding was the rationale to perform a retrospective single center cohort study evaluating the oncologic results of consecutive patients treated with BCS and IORT. Women were eligible if they had clinical low-risk (N0, ≤2 cm unifocal, Bloom and Richardson grade 1-2), estrogen receptor-positive and human-epidermal-growth-factor-receptor-2-negative breast cancer. Prior to BCS, pN0 status was determined by sentinel lymph node biopsy. Data on oncologic follow-up were analyzed. Between 2012 and 2019, 306 consecutive patients were treated and analyzed, with a median age of 67 (50-86) years at diagnosis. Median follow-up was 60 (8-120) months. Five-year cumulative risk of IBTR was 13.4% (95% confidence interval [CI] 9.4-17.4). True in field recurrence was present in 3.9% of the patients. In 4.6% of the patients, the IBRT was classified as a local recurrence due to seeding of tumor cells in the cutis or subcutis most likely related to percutaneous biopsy. In 2.9% of the patients, the IBRT was a new outfield primary tumor. Three patients had a regional lymph node recurrence and two had distant metastases as first event. One breast cancer-related death was observed. Estimated 5-year overall survival was 89.8% (95% CI 86.0-93.6). In conclusion, although some of IBTR cases could have been prevented by adaptations in biopsy techniques and patient selection, BCS followed by IORT was associated with a substantial risk of IBTR.

Newer combination treatments for breast cancer coexisting with acute myeloid leukemia in the novel regimens era: A case report and literature review

The occurrence of acute myeloid leukemia (AML) with a simultaneous diagnosis of breast cancer (BC) is rarely reported in the literature. The present study reports the case of a 50-year-old female patient diagnosed with AML coexisting with metastatic BC. Following one cycle of treatment with azacytidine in combination with oral venetoclax for AML, the patient achieved complete remission with incomplete hematological recovery. In addition, the mass in the left breast was smaller following adjuvant chemotherapy. However, due to a refusal from the patient to accept an allogeneic hematopoietic stem cell transplantation (allo-HSCT), the patient succumbed 3 months after diagnosis due to septic shock from neutropenia following the third cycle of chemotherapy. Altogether, the present case report highlighted the application of venetoclax, an oral selective B-cell lymphoma-2 inhibitor, both in hematologic malignancies and solid neoplasms, as an effective therapeutic regimen. Considering the fatality rate associated with AML, allo-HSCT is the only available strategy that can be used to achieve the long-term survival of patients with AML and BC.

The effect of total size, area, and volume of lesions in multifocal/multicentric breast cancers and unifocal breast cancers on survival: An observational study

In this study, we aimed to investigate the prognostic effect of the classifications made according to the stage of the largest lesion diameter (T-max stage) and of the sum of the longest diameters of the lesions (T-sum stage), the largest area stage (A-max stage), the sum of the largest areas (A-sum stage), the highest volume stage (V-max stage), the sum of the highest volume (V-sum stage) on disease-free survival, and overall survival (OS) in multifocal/multicentric breast cancers (MMBCs) and unifocal breast cancers (UBCs). The study included a total of 769 patients either with MMBC (n = 128) or UBC (n = 641) who underwent surgery between 2006 and 2015. In the analysis, the median age of 769 patients was 53.0 (20.0-94.0) years, and 16.6% of these 769 patients were MMBC and 83.4% were UBC. In multivariate analysis, lymphovascular invasion (LVİ), estrogen receptor, and nodal status were common independent prognostic factors, whereas T-max stage [(HR: 1.17) (CI 95%: 1.03-1.33) (P = .018)] was a prognostic factor for OS. In multivariate analysis, the T-max stage is an independent risk factor for OS. Therefore, T-max should be continued to be used for measurement and T-stage should be used for classification in MMBCs/UBCs.

Role of [18F]FDG PET/CT in patients with invasive breast carcinoma of no special type: Literature review and comparison between guidelines

PURPOSE

The recently released EANM/SNMMI guideline, endorsed by several important clinical and imaging societies in the field of breast cancer (BC) care (ACR, ESSO, ESTRO, EUSOBI/ESR, EUSOMA), emphasized the role of [18F]FDG PET/CT in management of patients with no special type (NST) BC. This review identifies and summarizes similarities, discrepancies and novelties of the EANM/SNMMI guideline compared to NCCN, ESMO and ABC recommendations.

METHODS

The EANM/SNMMI guideline was based on a systematic literature search and the AGREE tool. The level of evidence was determined according to NICE criteria, and 85 % agreement or higher was reached regarding each statement. Comparisons with NCCN, ESMO and ABC guidelines were examined for specific clinical scenarios in patients with early stage through advanced and metastatic BC.

RESULTS

Regarding initial staging of patients with NST BC, [18F]FDG PET/CT is the preferred modality in the EANM-SNMMI guideline, showing superiority as a single modality to a combination of contrast-enhanced CT of thorax-abdomen-pelvis plus bone scan in head-to-head comparisons and a randomized study. Its use is recommended in patients with clinical stage IIB or higher and may be useful in certain stage IIA cases of NST BC. In NCCN, ESMO, and ABC guidelines, [18F]FDG PET/CT is instead recommended as complementary to conventional imaging to solve inconclusive findings, although ESMO and ABC also suggest [18F]FDG PET/CT can replace conventional imaging for staging patients with high-risk and metastatic NST BC. During follow up, NCCN and ESMO only recommend diagnostic imaging if there is suspicion of recurrence. Similarly, EANM-SNMMI states that [18F]FDG PET/CT is useful to detect the site and extent of recurrence only when there is clinical or laboratory suspicion of recurrence, or when conventional imaging methods are equivocal. The EANM-SNMMI guideline is the first to emphasize a role of [18F]FDG PET/CT for assessing early metabolic response to primary systemic therapy, particularly for HER2+ BC and TNBC. In the metastatic setting, EANM-SNMMI state that [18F]FDG PET/CT may help evaluate bone metastases and determine early response to treatment, in agreement with guidelines from ESMO.

CONCLUSIONS

The recently released EANM/SNMMI guideline reinforces the role of [18F]FDG PET/CT in the management of patients with NST BC supported by extensive evidence of its utility in several clinical scenarios.

Exploring the behavioral intentions of PICC-related thrombosis prevention in breast cancer patients undergoing chemotherapy: a qualitative study based on theory of planned behavior

PURPOSE

To explore the behavioral intention of breast cancer patients undergoing chemotherapy to prevent PICC-related thrombosis based on the theory of planned behavior (TPB).

METHODS

This qualitative study employed purposive sampling and conducted semi-structured interviews with 14 breast cancer patients undergoing chemotherapy in the outpatient chemotherapy ward of a tertiary A-level comprehensive hospital in Beijing from July to August 2023. Data were analyzed using Colaizzi's descriptive analysis framework.

RESULTS

Data analysis identified 10 themes that were derived from 4 aspects. Regarding behavioral attitude, three themes were condensed: (1) Considering the benefits of preventive measures, (2) Simple and easy preventive measures, and (3) Underestimating the importance of PICC-related thrombosis prophylaxis. Subjective norms yielded two main themes and five sub-themes: (1) Support from those close to the patient motivates adherence to prophylaxis (support from the patient's family, healthcare professionals, and other patients) and (2) Patients are influenced by personal factors to form an internal driving force (physical symptoms, fear of PICC-related thrombosis). Regarding perceived behavioral control, three main themes and four sub-themes were extracted: (1) Obstacles before actual prevention exercise (prevention information, hard-to-remember information), (2) Forgetfulness is the main obstacle factor, and (3) Wanting to overcome barriers to adhere to regular prevention (confidence to overcome obstacles, hope to get support).

CONCLUSIONS

The impediments and facilitators identified in this study may provide a scientific foundation for subsequent targeted non-pharmacological preventive interventions for PICC-related thrombosis based on TPB in breast cancer patients undergoing chemotherapy. Special interventions should be designed for the patients in three areas: the patients themselves, the supporters around the patient, and the healthcare professionals.

Cross-modal deep learning model for predicting pathologic complete response to neoadjuvant chemotherapy in breast cancer

Pathological complete response (pCR) serves as a critical measure of the success of neoadjuvant chemotherapy (NAC) in breast cancer, directly influencing subsequent therapeutic decisions. With the continuous advancement of artificial intelligence, methods for early and accurate prediction of pCR are being extensively explored. In this study, we propose a cross-modal multi-pathway automated prediction model that integrates temporal and spatial information. This model fuses digital pathology images from biopsy specimens and multi-temporal ultrasound (US) images to predict pCR status early in NAC. The model demonstrates exceptional predictive efficacy. Our findings lay the foundation for developing personalized treatment paradigms based on individual responses. This approach has the potential to become a critical auxiliary tool for the early prediction of NAC response in breast cancer patients.

Multi-modality radiomics model predicts axillary lymph node metastasis of breast cancer using MRI and mammography

OBJECTIVES

We aimed to develop a multi-modality model to predict axillary lymph node (ALN) metastasis by combining clinical predictors with radiomic features from magnetic resonance imaging (MRI) and mammography (MMG) in breast cancer. This model might potentially eliminate unnecessary axillary surgery in cases without ALN metastasis, thereby minimizing surgery-related complications.

METHODS

We retrospectively enrolled 485 breast cancer patients from two hospitals and extracted radiomics features from tumor and lymph node regions on MRI and MMG images. After feature selection, three random forest models were built using the retained features, respectively. Significant clinical factors were integrated with these radiomics models to construct a multi-modality model. The multi-modality model was compared to radiologists' diagnoses on axillary ultrasound and MRI. It was also used to assist radiologists in making a secondary diagnosis on MRI.

RESULTS

The multi-modality model showed superior performance with AUCs of 0.964 in the training cohort, 0.916 in the internal validation cohort, and 0.892 in the external validation cohort. It surpassed single-modality models and radiologists' ALN diagnosis on MRI and axillary ultrasound in all validation cohorts. Additionally, the multi-modality model improved radiologists' MRI-based ALN diagnostic ability, increasing the average accuracy from 70.70 to 78.16% for radiologist A and from 75.42 to 81.38% for radiologist B.

CONCLUSION

The multi-modality model can predict ALN metastasis of breast cancer accurately. Moreover, the artificial intelligence (AI) model also assisted the radiologists to improve their diagnostic ability on MRI.

CLINICAL RELEVANCE STATEMENT

The multi-modality model based on both MRI and mammography images allows preoperative prediction of axillary lymph node metastasis in breast cancer patients. With the assistance of the model, the diagnostic efficacy of radiologists can be further improved.

KEY POINTS

• We developed a novel multi-modality model that combines MRI and mammography radiomics with clinical factors to accurately predict axillary lymph node (ALN) metastasis, which has not been previously reported. • Our multi-modality model outperformed both the radiologists' ALN diagnosis based on MRI and axillary ultrasound, as well as single-modality radiomics models based on MRI or mammography. • The multi-modality model can serve as a potential decision support tool to improve the radiologists' ALN diagnosis on MRI.

Characteristics of Invasive Cribriform Carcinoma

Invasive cribriform carcinoma (ICC) is a type of malignant tumor with slow growth and good prognosis. The study was a single center retrospective study. The percentage of ICC among patients diagnosed with breast cancer was 0.3% (8/2454 patients). All patients tested positive for estrogen or progesterone receptors and 12.5% (1/8) patients tested positive for human epidermal growth factor receptor type2 (HER2). The present study suggests that the clinicopathological features of ICC are low-grade hormone receptor-positive luminal type with a good prognosis. However, some patients were HER2-positive and require careful follow-up.

Guidelines of the Brazilian Society of Surgical Oncology for anatomopathological, immunohistochemical, and molecular testing in female tumors

INTRODUCTION

Precision medicine has revolutionized oncology, providing more personalized diagnosis, treatment, and monitoring for patients with cancer. In the context of female-specific tumors, such as breast, ovarian, endometrial, and cervical cancer, proper tissue collection and handling are essential for obtaining tissue, immunohistochemical (IHC), and molecular data to guide therapeutic decisions.

OBJECTIVES

To establish guidelines for the collection and handling of tumor tissue, to enhance the quality of samples for histopathological, IHC, genomic, and molecular analyses. These guidelines are fundamental in informing therapeutic decisions in cancer treatment.

METHOD

The guidelines were developed by a multidisciplinary panel of renowned specialists between June 12, 2013 and February 12, 2024. Initially, the panel deliberated on critical and controversial topics related to conducting precision medicine studies focusing on female tumors. Subsequently, 22 pivotal topics were identified within the framework and assigned to groups. These groups reviewed relevant literature and drafted preliminary recommendations. Following this, the recommendations were reviewed by the coordinators and received unanimous approval. Finally, the groups made the final adjustments, classified the level of evidence, and ranked the recommendations.

CONCLUSION

The collection of surgical samples requires minimum quality standards to enable histopathological, IHC, genomic, and molecular analyses. These analyses provide crucial data for informing therapeutic decisions, significantly impacting potential survival gains for patients with female tumors.

MRI features of breast cancer immunophenotypes with a focus on luminal estrogen receptor low positive invasive carcinomas

To compare the magnetic resonance imaging (MRI) features of different immunophenotypes of breast carcinoma of no special type (NST), with special attention to estrogen receptor (ER)-low-positive breast cancer. This retrospective, single-centre, Institutional Review Board (IRB)-approved study included 398 patients with invasive breast carcinoma. Breast carcinomas were classified as ER-low-positive when there was ER staining in 1-10% of tumour cells. Pretreatment MRI was reviewed to assess the tumour imaging features according to the 5th edition of the Breast Imaging Reporting and Data System (BI-RADS) lexicon. Of the 398 cases, 50 (12.6%) were luminal A, 191 (48.0%) were luminal B, 26 (6.5%) were luminal ER-low positive, 64 (16.1%) were HER2-overexpressing, and 67 (16.8%) were triple negative. Correlation analysis between MRI features and tumour immunophenotype showed statistically significant differences in mass shape, margins, internal enhancement and the delayed phase of the kinetic curve. An oval or round shape and rim enhancement were most frequently observed in triple-negative and luminal ER-low-positive tumours. Spiculated margins were most common in luminal A and luminal B tumours. A persistent kinetic curve was more frequent in luminal A tumours, while a washout curve was more common in the triple-negative, HER2-overexpressing and luminal ER-low-positive immunophenotypes. Multinomial regression analysis showed that luminal ER-low-positive tumours had similar results to triple-negative tumours for almost all variables. Luminal ER-low-positive tumours present with similar MRI findings to triple-negative tumours, which suggests that MRI can play a fundamental role in adequate radiopathological correlation and therapeutic planning in these patients.

Insights into the performance of PREDICT tool in a large Mainland Chinese breast cancer cohort: a comparative analysis of versions 3.0 and 2.2

BACKGROUND

PREDICT is a web-based tool for forecasting breast cancer outcomes. PREDICT version 3.0 was recently released. This study aimed to validate this tool for a large population in mainland China and compare v3.0 with v2.2.

METHODS

Women who underwent surgery for nonmetastatic primary invasive breast cancer between 2010 and 2020 from the First Affiliated Hospital of Wenzhou Medical University were selected. Predicted and observed 5-year overall survival (OS) for both v3.0 and v2.2 were compared. Discrimination was compared using receiver-operator curves and DeLong test. Calibration was evaluated using calibration plots and chi-squared test. A difference greater than 5% was deemed clinically relevant.

RESULTS

A total of 5424 patients were included, with median follow-up time of 58 months (IQR 38-89 months). Compared to v2.2, v3.0 did not show improved discriminatory accuracy for 5-year OS (AUC: 0.756 vs 0.771), same as ER-positive and ER-negative patients. However, calibration was significantly improved in v3.0, with predicted 5-year OS deviated from observed by -2.0% for the entire cohort, -2.9% for ER-positive and -0.0% for ER-negative patients, compared to -7.3%, -4.7% and -13.7% in v2.2. In v3.0, 5-year OS was underestimated by 9.0% for patients older than 75 years, and 5.8% for patients with micrometastases. Patients with distant metastases postdiagnosis was overestimated by 10.6%.

CONCLUSIONS

PREDICT v3.0 reliably predicts 5-year OS for the majority of Chinese patients with breast cancer. PREDICT v3.0 significantly improved the predictive accuracy for ER-negative groups. Furthermore, caution is advised when interpreting 5-year OS for patients aged over 70, those with micrometastases or metastases postdiagnosis.

SHG Fiberscopy Assessment of Collagen Morphology and Its Potential for Breast Cancer Optical Histology

OBJECTIVE

This study is to investigate the feasibility of our recently developed nonlinear fiberscope for label-free in situ breast tumor detection and lymph node status assessment based on second harmonic generation (SHG) imaging of fibrillar collagen matrix with histological details. The long-term goal is to improve the current biopsy-based cancer paradigm with reduced sampling errors.

METHODS

In this pilot study we undertook retrospective SHG imaging study of ex vivo invasive ductal carcinoma human biopsy tissue samples, and carried out quantitative image analysis to search for collagen structural signatures that are associated with the malignance of breast cancer.

RESULTS

SHG fiberscopy image-based quantitative assessment of collagen fiber morphology reveals that: 1) cancerous tissues contain generally less extracellular collagen fibers compared with tumor-adjacent normal tissues, and 2) collagen fibers in lymph node positive biopsies are more aligned than lymph node negative counterparts.

CONCLUSION/SIGNIFICANCE

The results demonstrate the promising potential of our SHG fiberscope for in situ breast tumor detection and lymph node involvement assessment and for offering real-time guidance during ongoing tissue biopsy.

Setting-up a training programme for intraoperative molecular imaging and sentinel node mapping: how to teach? How to learn?

BACKGROUND

The current expansion of image-guided surgery is closely related to the role played by radio-guided surgery in supporting the sentinel node (SN) procedure during more than three decades. The so-called triple approach (lymphoscintigraphy, gamma probe detection and blue dye) was not only essential in the seminal validation of the SN procedure but also a first collective learning effort based on skill transfer and outcome-related evaluation which laid the fundaments to delineate the field of intraoperative molecular imaging (IMI) based on a similar multimodality approach and multidisciplinary practice.

METHODS

These elements are also becoming valid in the current incorporation of SPECT/CT and PET/CT to existing and new protocols of IMI procedures and SN mapping concerning other clinical applications. On the other hand, there is a growing tendency to combine novel modern technologies in an allied role with gamma guidance in the operating room following the development of hybrid tracers and multimodal detection approaches. Against this background, learning initiatives are required for professionals working in this area.

RESULTS

This objective has led to a group of European practitioners with large experience in SN mapping and IMI applications to give shape to a programme made up out of specific learning modules aimed to be used as a conductive thread in peripherical or centralised training instances concerning the topic.

CONCLUSION

The presented work, written as a tutorial review, is placed in an available prior-art context and is primarily aimed at medical and paramedical practitioners as well as at hardware and software developers.

The Prognostic Value of Serum Albumin to Globulin Ratio in Patients with Breast Cancer: A Retrospective Study

Objective

This study examined the potential risk value of the serum albumin to globulin ratio (AGR) in patients with breast cancer (BC).

Methods

This study employed a retrospective design, enrolling 332 patients with BC and 38 patients without BC treated at Taizhou People's Hospital between September 2015 and May 2021. Multivariate Cox proportional hazard regression models were used to identify potential risk factors. A prognostic nomogram was developed based on the multivariate analyses. The receiver operating characteristic curve determined the optimal cutoff value for AGR.

Results

The results indicated a statistically significant decrease in AGR among patients with BC. Significant disparities were observed in globulin and AGR levels between the two cohorts. AGR was significantly associated with tumor size and stage, with a marked decline in advanced stages of BC. Additionally, AGR and aspartate transaminase/Alanine aminotransferase (AST/ALT) emerged as significant diagnostic indicators for invasive carcinoma and advanced stages (II-IV) of BC. Specifically, AGR exhibited an area under the curve of 0.645 (P < 0.003), highlighting the discriminatory capacity of serum globulin levels in distinguishing between BC and non-BC cohorts.

Conclusions

The AGR, routinely assessed due to its simplicity, objectivity, and cost-effectiveness, holds promise as a potential risk factor for BC and may have practical implications in clinical settings.

Factors associated with prognosis and staging of intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma (ICC) is a relatively rare but aggressive primary liver cancer with a poor prognosis. A number of established clinical and pathologic factors correlate with prognosis, and this is reflected in the American Joint Committee on Cancer (AJCC) 8th Edition staging manual. Researchers have identified areas for improvement in staging and prognostication of ICC using more nuanced tools, including serum biomarkers, molecular profiling, immunophenotyping, and multimodal prognostic scoring systems. These data have led to proposals of novel staging systems that attempt to improve the correlation between stage and prognosis. More accurate staging tools may aid in treatment decisions that are tailored to each individual patient, to maximize therapy for individuals most likely to benefit and to avoid unnecessary toxicity and decision regret in those for whom aggressive treatment is unlikely to alter outcomes. Artificial intelligence and machine learning may help researchers develop new models that predict outcomes with more accuracy and precision.

Joint EANM-SNMMI guideline on the role of 2-[18F]FDG PET/CT in no special type breast cancer : (endorsed by the ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA)

INTRODUCTION

There is much literature about the role of 2-[18F]FDG PET/CT in patients with breast cancer (BC). However, there exists no international guideline with involvement of the nuclear medicine societies about this subject.

PURPOSE

To provide an organized, international, state-of-the-art, and multidisciplinary guideline, led by experts of two nuclear medicine societies (EANM and SNMMI) and representation of important societies in the field of BC (ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA).

METHODS

Literature review and expert discussion were performed with the aim of collecting updated information regarding the role of 2-[18F]FDG PET/CT in patients with no special type (NST) BC and summarizing its indications according to scientific evidence. Recommendations were scored according to the National Institute for Health and Care Excellence (NICE) criteria.

RESULTS

Quantitative PET features (SUV, MTV, TLG) are valuable prognostic parameters. In baseline staging, 2-[18F]FDG PET/CT plays a role from stage IIB through stage IV. When assessing response to therapy, 2-[18F]FDG PET/CT should be performed on certified scanners, and reported either according to PERCIST, EORTC PET, or EANM immunotherapy response criteria, as appropriate. 2-[18F]FDG PET/CT may be useful to assess early metabolic response, particularly in non-metastatic triple-negative and HER2+ tumours. 2-[18F]FDG PET/CT is useful to detect the site and extent of recurrence when conventional imaging methods are equivocal and when there is clinical and/or laboratorial suspicion of relapse. Recent developments are promising.

CONCLUSION

2-[18F]FDG PET/CT is extremely useful in BC management, as supported by extensive evidence of its utility compared to other imaging modalities in several clinical scenarios.

Direct Comparison of Ultrasound and Tactile Imaging in Measuring Lesion Diameter in Breast Phantoms

Previous clinical study has shown tactile imaging (TI) is better than ultrasound at measuring breast lesion diameter. Given continuing research in this area, and significant respective advancements over the last 20 years, this needs revisited. This paper compares TI and ultrasound in accurately measuring breast lesions (4-18 mm) in chicken breast and silicone phantoms; revealing comparative strengths/weaknesses to combine strengths in a future integrated prototype. The results show that ultrasound has greater accuracy than TI on chicken breasts (Mean Absolute Error=9.28% vs 16.02%) and silicone (28.50% vs. 33%) phantoms. This contrasts previous studies where TI was more accurate than ultrasound, due to technological advancements over time. However, TI offers user-friendly rapid imaging, with simpler visualization of lesions, due to large field-of-view, vs. ultrasound, with lower training burden. This work directly compared modern TI and ultrasound, indicating ultrasound is better for lesion characterization and TI better for initial detection. This provides a baseline for future integration of these techniques for simple screening, following the recent drive for hybrid imaging systems.

Implementation of the Targeted Axillary Dissection Procedure in Clinically Node-Positive Breast Cancer: A Retrospective Analysis

BACKGROUND

The targeted axillary dissection (TAD) procedure is used in clinically positive lymph node (cN+) breast cancer to assess whether pathological complete response (pCR) is achieved after neoadjuvant systemic therapy (NST) to decide on de-escalation of axillary lymph node dissection (ALND). In this study, we review the implementation of the TAD procedure in a large regional breast cancer center.

METHODS

All TAD procedures between 2016 and 2022 were reviewed. The TAD procedure consists of marking pre-NST the largest suspected metastatic lymph node(s) using a radioactive I-125 seed. During surgery, the marked node was excised together with a sentinel node procedure. Axillary therapy (ALND, axillary radiotherapy, or nothing) recommendations were based on the amount of suspected positive axillary lymph nodes (ALNs < 4 or ≥ 4) pre-NST and if pCR was achieved after NST.

RESULTS

A total of 312 TAD procedures were successfully performed in 309 patients. In 134 (43%) cases, pCR of the TAD lymph nodes were achieved. Per treatment protocol, 43 cases (14%) did not receive any axillary treatment, 218 cases (70%) received adjuvant axillary radiotherapy, and 51 cases (16%) underwent an ALND. During a median follow-up of 2.8 years, 46 patients (14%) developed recurrence, of which 11 patients (3.5%) had axillary recurrence.

CONCLUSIONS

Introduction of the TAD procedure has resulted in a reduction of 84% of previously indicated ALNDs. Moreover, 18% of cases did not receive adjuvant axillary radiotherapy. These data show that implementation of de-escalation axillary treatment with the TAD procedure appeared to be successful.

Circulating C-reactive protein levels as a prognostic biomarker in breast cancer across body mass index groups

Obesity and systemic inflammation are associated with breast cancer (BC) outcomes. Systemic inflammation is increased in obesity. We examined the association between C-reactive protein (CRP) and disease-free survival (DFS) and overall survival (OS) overall, and according to body mass index (BMI). We assembled a cohort of women with BC (stage I-III) seen at Aarhus University Hospital between 2010 and 2020 who donated blood at BC diagnosis (N = 2673). CRP levels were measured and divided into quartiles. We followed patients from surgery to recurrence, contralateral BC, other malignancy, death, emigration, or end-of-follow-up. We used Cox regression to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs) to compare outcomes across CRP quartiles, overall and stratified by BMI (normal-weight (18.5 ≤ BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), and obesity (BMI ≥ 30 kg/m2)). During follow-up, 368 events (212 recurrences, 38 contralateral BCs, and 118 deaths) occurred (median follow-up 5.55 years). For DFS, high CRP (CRP ≥ 3.19 mg/L) was associated with an increased risk of events (HRadj:1.62 [95% CI = 1.14-2.28]). In BMI-stratified analyses, high CRP was associated with elevated risk of events in normal-weight and overweight (HRadj:1.70 [95% CI = 1.09-2.66]; HRadj:1.75 [95% CI = 1.08-2.86]), but in obesity, the estimate was less precise (HRadj:1.73 [95% CI = 0.78-3.83]). For OS, high CRP was associated with increased risk of death (HRadj:2.47 [95% CI = 1.62-3.76]). The association was strong in normal-weight and overweight (HRadj:3.66 [95% CI = 1.95-6.87]; HRadj:1.92 [95% CI = 1.06-3.46]), but less clear in obesity (HRadj:1.40 [95% CI = 0.64-3.09]). To sum up, high CRP levels at BC diagnosis were associated with inferior prognosis in early BC irrespective of BMI, although less clear in patients with obesity.