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Kolberg HC, Kühn T, Krajewska M, Bauerfeind I, Fehm TN, Fleige B, Helms G, Lebeau A, Stäbler A, Loibl S, Untch M, Kolberg-Liedtke C. Factors associated with axillary conversion after neoadjuvant chemotherapy (NAT) in initially node positive breast cancer patients – a transSENTINA analysis. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Affiliation(s)
| | | | | | | | - TN Fehm
- Universitätsklinikum Düsseldorf
| | | | - G Helms
- Universitätsklinikum Tübingen
| | - A Lebeau
- Universitätsklinikum Hamburg - Eppendorf
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Kolberg HC, Liedtke C, Bauerfeind I, Fehm T, Fleige B, Hauschild M, Helms G, Lebeau A, Schmatloch S, Schrenk P, Schwentner L, Stäbler A, Loibl S, Untch M, Kühn T. Abstract PD8-02: Residual axillary involvement in early breast cancer in patients with positive sentinel nodes after neoadjuvant chemotherapy (NACT). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd8-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:The association between pathological complete remission (pCR) in the breast and clinical/pathological parameters is well established, whereas the role of these parameters in the prediction of residual axillary involvement after NACT is unclear. The goal is to identify a subset of patients who do not need axillary treatment. We used data from Arm B of the SENTINA trial to analyze this association.
Methods:Patients from arm B of the SENTINA trial with clinically and sonographically unsuspicious axillary nodes but with histologically proven involvement of SLNs prior to NACT were analyzed. All patients had SLNB and axillary dissection after NACT. Univariate analyses were performed to evaluate the association between clinical/pathological parameters and axillary involvement after NACT.
Results:Arm B of the SENTINA study contained 360 patients, 318 of which were evaluable with respect to the above parameters. After NACT 71/318 (22.3%) patients had involved SLNs or non-SLNs; 71/318 (22.3%) had a pCR in the breast. We observed a significant association between pCR in the breast and negative ER status, negative PR status, positive HER2 status, triple negative (TN) status, tumor size before and after NACT, multifocality, lobular morphology and axillary involvement after NACT. Regarding residual axillary burden only the associations with lobular morphology, extracapsular invasion, multifocality, positive HER2 status and pCR in the breast were statistically significant.
Conclusion:Our analysis demonstrates that patients enrolled in the SENTINA trial with clinically and sonographically unsuspicious axillary nodes but proven histological involvement of SLNs prior to NACT have positive axillary nodes in 22.3 % after NACT. This rate is confirming similar results from other groups. Although we found statistically significant associations between pCR in the breast and clinical/pathological parameters, only the association between lobular type, extracapsular invasion, positive HER2 status and pCR in the breast and residual axillary involvement after NACT were statistically significant. We cannot clearly identify a subset of patients for whom axillary treatment after NACT could be safely omitted if SLNs were positive. Our data are well in line with recently presented data demonstrating that the association between pCR in the breast and free axillary nodes after NACT is particularly strong in patients with TN and HER2 positive tumors. This question will be addressed in future trials currently under development.
Citation Format: Kolberg H-C, Liedtke C, Bauerfeind I, Fehm T, Fleige B, Hauschild M, Helms G, Lebeau A, Schmatloch S, Schrenk P, Schwentner L, Stäbler A, Loibl S, Untch M, Kühn T. Residual axillary involvement in early breast cancer in patients with positive sentinel nodes after neoadjuvant chemotherapy (NACT) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-02.
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Affiliation(s)
- H-C Kolberg
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - C Liedtke
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - I Bauerfeind
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - T Fehm
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - B Fleige
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - M Hauschild
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - G Helms
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - A Lebeau
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - S Schmatloch
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - P Schrenk
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - L Schwentner
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - A Stäbler
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - S Loibl
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - M Untch
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - T Kühn
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
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Liedtke C, Kolberg HC, Krajewska M, Bauerfeind I, Fehm T, Fleige B, Helms G, Lebeau A, Staebler A, Loibl S, Untch M, Kühn T. Abstract PD8-03: Conversion rates from positive to negative axillary involvement in breast cancer patients presenting with biopsy-proven axillary metastases prior to primary systemic therapy (PST) – A transSENTINA subproject. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd8-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Modern chemotherapy carries a high potential of converting patients with clinically suspicious axillary nodes (cN+) prior to PST to clinically (ycN0) or pathologically (ypN0) negative nodes after PST. Clinical and sonographical axillary assessment, however, may be inadequate and therefore pathological assessment of suspicious axillary nodes is recommended. We analyzed the association between clinical / pathological parameters and positive to negative conversion in patients with biopsy-proven axillary metastases in Arm C of the SENTINA trial (i.e. patients with “true conversion”).
Methods:
Arm C of the SENTINA trial included patients converting from cN+ to ycN0 through PST from a prospective study. We limited our analysis to patients who had biopsy-proven axillary involvement. Univariate regression analysis was carried out to assess the association between patients with vs. without axillary disease after PST in i) patients with biopsy-proven involvement and ii) patients without biopsy proof of metastases.
Results:
Among 596 patients in arm C of the SENTINA trial with clinically and or sonographically suspicious ipsilateral axillary nodes, 439 (73,7%) 157 (26,3%) patients had a biopsy. In 152 patients (96,8%), lymph node metastases were confirmed and in 5 patients (3,2%), no malignant cells were identified. In both groups, we found a significant association (p<0,05) between increased rate of axillary conversion and small tumor diameter after PST, absence of multifocality, absence of lymphovascular invasion (LVI), ER and/or PR negativity, HER2 negativity, triple negative disease, and complete pathological response (pCR). No multiple testing corrections were performed due to an exploratory setting. However, only among patients with biopsy-proven involvement prior to PST, we found grade-3-tumors to be significantly associated with reduced probability of residual axillary involvement (76.1 vs. 33.8%, compared to G1 and G2, p=0.0323).
Conclusion:
Our analysis demonstrates that in patients with biopsy-proven axillary involvement before NST, parameters associated with axillary conversion are similar to those among patients classified as having nodal disease based on clinical and or sonographical assessment (cN+). Our analyses demonstrate that in biopsy-proven axillary metastases before NST, modern chemotherapy regimens result in significant rates of axillary conversion. This underscores the need to deescalate axillary staging / treatment with the goal to further avoid unnecessary axillary surgery.
Citation Format: Liedtke C, Kolberg H-C, Krajewska M, Bauerfeind I, Fehm T, Fleige B, Helms G, Lebeau A, Staebler A, Loibl S, Untch M, Kühn T. Conversion rates from positive to negative axillary involvement in breast cancer patients presenting with biopsy-proven axillary metastases prior to primary systemic therapy (PST) – A transSENTINA subproject [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-03.
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Affiliation(s)
- C Liedtke
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - H-C Kolberg
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - M Krajewska
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - I Bauerfeind
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - T Fehm
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - B Fleige
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - G Helms
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - A Lebeau
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - A Staebler
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - S Loibl
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - M Untch
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - T Kühn
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
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Liedtke C, Kolberg HC, Kerschke L, Görlich D, Bauerfeind I, Fehm T, Fleige B, Helms G, Lebeau A, Stäbler A, Schmatloch S, Hausschild M, Schwentner L, von Minckwitz G, Loibl S, Untch M, Kühn T. Systematic analysis of parameters predicting pathological axillary status (ypN0 vs. ypN+) in patients with breast cancer converting from cN+ to ycN0 through primary systemic therapy (PST). Clin Exp Metastasis 2018; 35:777-783. [PMID: 30324492 DOI: 10.1007/s10585-018-9938-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/20/2018] [Indexed: 12/14/2022]
Abstract
Optimization of axillary staging among patients converting from clinically node-positive disease to clinically node-negative disease through primary systemic therapy is needed. We aimed at developing a nomogram predicting the probability of positive axillary status after chemotherapy based on clinical/pathological parameters. Patients from study arm C of the SENTINA trial were included. Univariable/multivariable analyses were performed for 13 clinical/pathological parameters to predict a positive pathological axillary status after chemotherapy using logistic regression models. Odds ratios and 95%-confidence-intervals were reported. Model performance was assessed by leave-one-out cross-validation. Calculations were performed using the SAS Software (Version 9.4, SAS Institute Inc., Cary, NC, USA). 369 of 553 patients in Arm C were included in multivariable analysis. Stepwise backward variable selection based on a multivariable analysis resulted in a model including estrogen receptor (ER) status (odds ratio (OR) 3.916, 95% confidence interval (CI) 2.318-6.615, p < 0.001), multifocality (OR 2.106, 95% CI 1.203-3.689, p = 0.0092), lymphovascular invasion (OR 9.196, 95% CI 4.734-17.864, p < 0.001), and sonographic tumor diameter after PST (OR 1.034, 95% CI 1.010-1.059, p = 0.0051). When validated, our model demonstrated an accuracy of 70.2% using 0.5 as cut-point. An area under the curve of 0.81 was calculated. The use of individual parameters as predictors of lymph node status after chemotherapy resulted in an inferior accuracy. Our model was able to predict the probability of a positive axillary nodal status with a high accuracy. The use of individual parameters showed reduced predictive performance. Overall, tumor biology was the strongest parameter in our models.
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Affiliation(s)
- C Liedtke
- Department of Gynecology, Charité University Hospital Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | | | - L Kerschke
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität, Münster, Germany
| | - D Görlich
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität, Münster, Germany
| | - I Bauerfeind
- Department of Gynecology and Obstetrics, Klinikum Landshut, Landshut, Germany
| | - T Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Dusseldorf, Germany
| | - B Fleige
- Department of Pathology, Multidisciplinary Breast Centre, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - G Helms
- Department of Gynecology and Obstetrics, University Medical Centre Tübingen, Tübingen, Germany
| | - A Lebeau
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Stäbler
- Department of Pathology, University of Tübingen, Tübingen, Germany
| | | | - M Hausschild
- Klinikum Rheinfelden, Schweiz, Rheinfelden, Switzerland
| | - L Schwentner
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | | | - S Loibl
- German Breast Group, Neu Isenburg, Germany
| | - M Untch
- Department of Gynecology and Obstetrics, Multidisciplinary Breast Centre, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - T Kühn
- Department of Gynecology and Obstetrics, Interdisciplinary Breast Centre, Klinikum Esslingen, Esslingen, Germany
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Liedtke C, Kolberg HC, Kerschke L, Goerlich D, Bauerfeind I, Fehm T, Fleige B, Hauschild M, Helms G, Lebeau A, Schmatloch S, Schrenk P, Schwentner L, Staebler A, von Minckwitz G, Loibl S, Untch M, Kuehn T. Abstract P3-13-06: Development and validation of a nomogram predicting pathological axillary status (ypN0 vs. ypN+) in a subgroup of patients converting from cN+ to ycN0 through neoadjuvant therapy (NAT) – A transSENTINA substudy. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-13-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Particularly among patients converting from cN+ to ycN0 status through neoadjuvant therapy (NAT) the optimal method and extent of axillary staging is unclear. The aim of this analysis was to develop a nomogram predicting the probability of positive axillary status (ypN+) after PST among these patients based on clinical and pathological parameters.
Methods:Patients converting from cN+ to ycN0 due to PST included in a prospective study (SENTINA, Arm C) were included. Univariate and multivariate analyses were carried out to evaluate the association between 14 clinical/pathological parameters and pathological axillary status (ypN0 vs ypN+) using logistic regression models. Model accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were assessed applying leave-one-out cross-validation (LOOCV) and ROC analyses. Different cut-points were evaluated. Calculations were performed using the SAS Software (Version 9.4, SAS Institute Inc., Cary, NC, USA.).
Results: Arm C contained 553 patients, 369 patients were evaluable with respect to the above parameters. Univariate analyses revealed a significant association between pathological axillary status and ER status (odds ratio (OR) 4.05, 95% confidence interval (95%CI) 2.81-5.83), PR status (OR 3.07, 95%CI 2.16-4.36), multifocality (OR 2.37, 95%CI 1.57-3.58), lymphovascular invasion (OR 8.61, 95%CI 5.12-14.46), detection of a SLN after NAT (OR .56, 95%CI .36-.87), detection method (IHC vs routine: OR .46, 95%CI .27-.78; IHC vs serial HE: OR .72, 95%CI .49-1.07; serial hematoxylin eosin (HE) vs routine: OR .639, 95%CI .39-1.04), clinical tumor size (OR 1.051, 95%CI 1.03-1.07) and pCR-status in the breast (ypT0 and ypTis vs others, OR .11, 95%CI .08-.17). A multivariate model was fitted including significant clinical parameters. Stepwise backward variable selection was carried out resulting in a model including ER status (OR 3.81, 95%CI 2.25-6.44), multifocality (OR 2.22, 95%CI 1.26-3.92), LVI (OR 9.16, 95%CI 4.68-17.90), detection of a SLN after NAT (OR .50, 95%CI .26-.95) and clinical tumor size (OR 1.03, 95%CI 1.01-1.06). In LOOCV, this model demonstrated an accuracy of 73% (sensitivity 73%, specificity 72%, PPV 75%, NPV 70%) using .5 as cut-off. Based on the performed ROC analysis an area under the curve (AUC) of 0.81 was calculated.
Conclusion: A model using ER status, multifocality, LVI, detection of a SLN after NAT and clinical tumor size was built to predict pathological axillary status (ypN+) with a high accuracy. If successfully validated based upon an independent dataset, this nomogram could allow advising patients for / against axillary surgery in case of clinical axillary conversion after NAT.
Citation Format: Liedtke C, Kolberg H-C, Kerschke L, Goerlich D, Bauerfeind I, Fehm T, Fleige B, Hauschild M, Helms G, Lebeau A, Schmatloch S, Schrenk P, Schwentner L, Staebler A, von Minckwitz G, Loibl S, Untch M, Kuehn T. Development and validation of a nomogram predicting pathological axillary status (ypN0 vs. ypN+) in a subgroup of patients converting from cN+ to ycN0 through neoadjuvant therapy (NAT) – A transSENTINA substudy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-06.
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Affiliation(s)
- C Liedtke
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - H-C Kolberg
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - L Kerschke
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - D Goerlich
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - I Bauerfeind
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - T Fehm
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - B Fleige
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - M Hauschild
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - G Helms
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - A Lebeau
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - S Schmatloch
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - P Schrenk
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - L Schwentner
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - A Staebler
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - G von Minckwitz
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - S Loibl
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - M Untch
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - T Kuehn
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
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Liedtke C, Goerlich D, Bauerfeind I, Fehm T, Fleige B, Helms G, Lebeau A, Staebler A, Minckwitz GV, Untch M, Kühn T. Validierung eines Nomogramms zur Prädiktion von Non-Sentinellymphknoten-Metastasen bei Patientinnen mit primär-systemischer Therapie (PST) – eine transSENTINA Substudie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Fleige B. B3-Läsionen aus der Sicht der Pathologie. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Thorsten K, Bauerfeind I, Fehm T, Fleige B, Gisela H, Lebeau A, Liedtke C, Mai M, Von Minckwitz G, Schrenk P, Staebler A, Untch M. Abstract P1-01-04: Axillary Intervention in Patients Undergoing Neoadjuvant Therapy (NST) — First Results from the SENTINA Study. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p1-01-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The optimal scheduling for sentinel lymph node biopsy (SLNB) among patients with breast cancer undergoing neoadjuvant systemic therapy (NST) is unclear. SENTINA-study is the first prospective multicenter trial that systematically examines the feasibilty and reliability of SLNB prior to and after (NST). Here we present results of a first exploratory analysis by examining distribution of N-stages in the different treatment arms and correlating the axillary status with the type of breast surgery (breast conserving therapy [BCT] vs mastectomy [ME]).
Methods: The SENTINA study is a four-arm multicenter (n= XXX) observation study. Patients will be stratified based on their clinical lymph node status prior to treatment. If the lymph node status is clinically negative SLNB is performed before NST. Patients with a negative SLN will undergo no further axillary surgery (Arm A), whereas patients with a positive SLN will be treated with sentinel-node-guided axillary dissection (SLNB-AD) after NST (Arm B). If the lymph node is clinically positive upon initial presentation, patients will undergo NST prior to any axillary intervention. If patients convert to a clinically negative lymph node status through NST they will undergo SLNB-AD (ARM C). Patients with persistent positive nodes or whose tumors progress under NST undergo primary axillary dissection (Arm D). Clinically node positive patients will be endcouraged to undergo FNA to confirm their lymph node status. A total of 1508 patients in the entire study will be needed to calculate the false-negative rate in this group with a one-sided 95% confidence interval not exceeding 10%.
Results: 873 patients have been accrued into SENTINA until may 31th 2010, 523 (59,9%) have completed their treatment. 180 (34,4%) women have been treated in Arm A and 117 (22,4%) in Arm B. In 170 (32,5%) patients the clinical axillary status converted from a clinical positive to a clinical negative status (Arm C). In 65 pts (12,4%) the axillary status remained positive or the tumor progressed under NCHT (Arm D). BCT rates in Arm A-D were 88.3%, 75.2%, 61.8% and 22.2% respectively.
Conclusion: First results of the SENTINA study show a strong correlation between the axillary status and the type of breast surgery in patients, who are treated with NST. Importantly, we demonstrate that the clinical assessment of the axillary status is unprecise. There is an urgent need to optimize the tailoring of axillary intervention in the setting of NST
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-04.
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Affiliation(s)
- K Thorsten
- Klinikum Esslingen, Baden Württemberg, Germany; Klinikum Landshut, Bavarian, Germany; Universitaetsklinikum, Tuebingen, Germany; Fleige; Universitätsklinikum Eppendorf; Universitätsklinikum Münster, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany; University Hospital Tübingen, Germany
| | - I Bauerfeind
- Klinikum Esslingen, Baden Württemberg, Germany; Klinikum Landshut, Bavarian, Germany; Universitaetsklinikum, Tuebingen, Germany; Fleige; Universitätsklinikum Eppendorf; Universitätsklinikum Münster, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany; University Hospital Tübingen, Germany
| | - T Fehm
- Klinikum Esslingen, Baden Württemberg, Germany; Klinikum Landshut, Bavarian, Germany; Universitaetsklinikum, Tuebingen, Germany; Fleige; Universitätsklinikum Eppendorf; Universitätsklinikum Münster, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany; University Hospital Tübingen, Germany
| | - B Fleige
- Klinikum Esslingen, Baden Württemberg, Germany; Klinikum Landshut, Bavarian, Germany; Universitaetsklinikum, Tuebingen, Germany; Fleige; Universitätsklinikum Eppendorf; Universitätsklinikum Münster, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany; University Hospital Tübingen, Germany
| | - H Gisela
- Klinikum Esslingen, Baden Württemberg, Germany; Klinikum Landshut, Bavarian, Germany; Universitaetsklinikum, Tuebingen, Germany; Fleige; Universitätsklinikum Eppendorf; Universitätsklinikum Münster, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany; University Hospital Tübingen, Germany
| | - A Lebeau
- Klinikum Esslingen, Baden Württemberg, Germany; Klinikum Landshut, Bavarian, Germany; Universitaetsklinikum, Tuebingen, Germany; Fleige; Universitätsklinikum Eppendorf; Universitätsklinikum Münster, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany; University Hospital Tübingen, Germany
| | - C Liedtke
- Klinikum Esslingen, Baden Württemberg, Germany; Klinikum Landshut, Bavarian, Germany; Universitaetsklinikum, Tuebingen, Germany; Fleige; Universitätsklinikum Eppendorf; Universitätsklinikum Münster, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany; University Hospital Tübingen, Germany
| | - M Mai
- Klinikum Esslingen, Baden Württemberg, Germany; Klinikum Landshut, Bavarian, Germany; Universitaetsklinikum, Tuebingen, Germany; Fleige; Universitätsklinikum Eppendorf; Universitätsklinikum Münster, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany; University Hospital Tübingen, Germany
| | - G Von Minckwitz
- Klinikum Esslingen, Baden Württemberg, Germany; Klinikum Landshut, Bavarian, Germany; Universitaetsklinikum, Tuebingen, Germany; Fleige; Universitätsklinikum Eppendorf; Universitätsklinikum Münster, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany; University Hospital Tübingen, Germany
| | - P Schrenk
- Klinikum Esslingen, Baden Württemberg, Germany; Klinikum Landshut, Bavarian, Germany; Universitaetsklinikum, Tuebingen, Germany; Fleige; Universitätsklinikum Eppendorf; Universitätsklinikum Münster, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany; University Hospital Tübingen, Germany
| | - A Staebler
- Klinikum Esslingen, Baden Württemberg, Germany; Klinikum Landshut, Bavarian, Germany; Universitaetsklinikum, Tuebingen, Germany; Fleige; Universitätsklinikum Eppendorf; Universitätsklinikum Münster, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany; University Hospital Tübingen, Germany
| | - M. Untch
- Klinikum Esslingen, Baden Württemberg, Germany; Klinikum Landshut, Bavarian, Germany; Universitaetsklinikum, Tuebingen, Germany; Fleige; Universitätsklinikum Eppendorf; Universitätsklinikum Münster, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany; University Hospital Tübingen, Germany
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Kühn T, Bauerfeind I, Fehm TN, Fleige B, Helms G, Liedtke C, Mai M, Von Minckwitz G, Staebler A, Untch M. Sentinel-node biopsy before or after neoadjuvant systemic treatment: The German SENTINA trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fleige B. B3-Läsionen aus Sicht der Pathologie. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fleige B, Kettritz U. Umgang mit B3-Läsionen in der minimal-invasiven Diagnostik – eine interdisziplinäre Aufgabe. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kettritz U, Fleige B. Gutartige Läsionen mit nicht eindeutig benigner Bildgebung und Läsionen mit unklarem biologischen Potenzial – Radiologisch-pathologische Korrelation. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
There is a wide variety of conjunctival tumors. A good diagnosis can be reached by discussing the case history with the patient in conjunction with a slit-lamp examination. Presented here is the case of a 39-year-old patient with a rapidly growing conjunctival tumor on his left eye. After tumor resection and histological analysis, a plasmacytoma was found. The completed hemato-oncological analysis gave no further suspicious pathological results, leading to the diagnosis of a solitary extramedullary plasmacytoma. Percutaneous radiotherapy was carried out.
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Affiliation(s)
- B Schulze
- Augenklinik, Helios Klinikum Berlin Buch, Schwanebecker Chaussee 50, 13125 Berlin, Deutschland.
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Tunn PU, Andreou D, Illing H, Fleige B, Dresel S, Schlag PM. Sentinel node biopsy in synovial sarcoma. Eur J Surg Oncol 2008; 34:704-7. [PMID: 17870276 DOI: 10.1016/j.ejso.2007.07.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2007] [Accepted: 07/19/2007] [Indexed: 10/22/2022] Open
Abstract
AIMS To examine the relevance of sentinel node biopsy in patients with synovial sarcoma. METHODS Between July 2004 and February 2007 11 consecutive patients with synovial sarcoma treated in our clinic underwent sentinel node biopsy after a preoperative lymphoscintigraphy. A handheld gamma-probe was used during the procedure to identify the sentinel nodes, which were then resected and submitted for histopathologic evaluation. RESULTS At least one sentinel node was identified in every patient. Of a total of 15 sentinels, one was positive and 14 negative. The patient with the positive sentinel underwent a regional lymph node dissection and remains disease-free 17 months later. One patient developed regional nodal metastases despite negative sentinel node biopsy and died 12 months after the procedure. No biopsy-associated complications were observed. CONCLUSIONS Sentinel node biopsy can be successfully and safely applied to patients with synovial sarcoma. Further prospective studies are required to determine the optimal treatment approach, the false negative rate and the prognostic significance of a positive sentinel node biopsy.
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Affiliation(s)
- P-U Tunn
- Department of Surgery and Surgical Oncology, Robert-Rössle-Klinik, Charité Campus Buch, Universitätsmedizin Berlin, Schwanebecker Chaussee 50, 13125 Berlin, Germany.
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Gross A, Fleige B, Dieckmann KP. Penismetastase als erstes Zeichen eines Nierenzellkarzinoms. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1060525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schulze B, Fleige B, Kuchenbecker J. Wie gut ist die Spaltlampenmikroskopie zur Diagnosestellung bei Bindehauttumoren geeignet? Klin Monbl Augenheilkd 2007. [DOI: 10.1055/s-2007-1004477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Untch M, Keil E, Kettritz U, Mairinger T, Fleige B, Dresel S, Krempien R, Kretzschmar A, Preussker P, Loll H, Lüders H, Wildberger J, Schuler E. Das Interdisziplinäre Brustzentrum im HELIOS Klinikum Berlin-Buch. Breast Care (Basel) 2007. [DOI: 10.1159/000109748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Ortner MAEJ, Ebert B, Hein E, Zumbusch K, Nolte D, Sukowski U, Weber-Eibel J, Fleige B, Dietel M, Stolte M, Oberhuber G, Porschen R, Klump B, Hörtnagl H, Lochs H, Rinneberg H. Time gated fluorescence spectroscopy in Barrett's oesophagus. Gut 2003; 52:28-33. [PMID: 12477755 PMCID: PMC1773497 DOI: 10.1136/gut.52.1.28] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Specialised intestinal metaplasia and its dysplastic transformation, which precedes cancer in Barrett's oesophagus cannot be differentiated in standard gastroscopy. The aim of this study was to investigate whether laser induced protoporphyrin IX fluorescence permits the detection of specialised intestinal metaplasia and dysplasia during endoscopy and to take biopsy specimens in a guided rather than random manner. METHODS In 53 patients with Barrett's oesophagus 5-aminolaevulinic acid was sprayed on the mucosa. Approximately 60 to 120 minutes later, biopsy specimens were taken based on point-like measurements of delayed fluorescence intensity ratios of protoporphyrin IX in vivo. Two independent pathologists examined the 596 biopsy specimens taken, 168 of which were selected to be investigated by a third pathologist. Among these specimens only those (n=141) with a consensus diagnosis by at least two pathologists and p53 expression as additional marker were included in the analysis. RESULTS The median of normalised fluorescence intensity (ratio of delayed PpIX fluorescence intensity to immediate autofluorescence intensity) in non-dysplastic specialised intestinal metaplasia (0.51, 68% CI 0.09 to 1.92) and low grade dysplasia (1.89, 68% CI 0.55 to 3.92) differed significantly (p<0.005). Dysplasia was detected at a rate 2.8-fold higher compared with screening endoscopy despite taking fewer specimens. In addition, three early cancers were detected for the first time. Moreover, this method permitted differentiation of specialised intestinal metaplasia from junctional or gastric-fundic type epithelium (p<0.013). CONCLUSIONS For the first time it was possible to differentiate low grade dysplasia from non-dysplastic Barrett's mucosa during endoscopy based on delayed laser induced fluorescence endoscopy of PpIX. Furthermore, the method helps to detect specialised intestinal metaplasia in short Barrett's oesophagus.
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Affiliation(s)
- M-A E J Ortner
- 4th Medical Department, Charité University Hospital, Humboldt University, Berlin, Germany.
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Ortner MA, Zumbusch K, Liebetruth J, Ebert B, Fleige B, Dietel M, Lochs H. Is topical delta-aminolevulinic acid adequate for photodynamic therapy in Barrett's esophagus? A pilot study. Endoscopy 2002; 34:611-6. [PMID: 12173080 DOI: 10.1055/s-2002-33247] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS The methods of endoscopic ablation of metaplastic and dysplastic areas in Barrett's esophagus so far described, are not satisfactory with respect to efficacy and safety. Therefore we investigated whether photodynamic therapy (PDT) with topical delta-aminolevulinic acid (delta-ALA) leads to ablation of specialized columnar epithelium and eradication of low-grade dysplasia while not producing phototoxicity and systemic side effects. PATIENTS AND METHODS 14 patients with histologically proven Barrett's esophagus, seven of whom had evidence of low-grade dysplasia, underwent endoscopic treatment with topical delta-ALA. Photoactivation (wavelength, 632 nm) was performed at 1.5 - 2 hours after drug administration using an argon dye laser. Patients received omeprazole 80 mg daily for 2 months; thereafter; maintenance therapy depended on reflux symptoms. Patients were endoscopically re-evaluated after 7 days, and subsequently at 3, 6, 12 and up to 48 months (mean follow up 33 months). Re-treatment with high-dose topical delta-ALA was offered to the 11 patients with remaining metaplasia and was carried out in five of them. RESULTS Low-grade dysplasia was eradicated in all patients. One patient with no dysplasia before PDT developed a high-grade dysplasia after PDT. Complete ablation of Barrett's metaplasia was observed in 21 % of the patients after the first treatment session and in 20 % after the second treatment session. The mean reduction in the length of Barrett's metaplasia was 1.54 +/- 1.29 cm after the first PDT session and 1.02 +/- 0.80 cm after the second PDT session. Post-endoscopic pain and photosensitivity reactions were less frequent with low-dose delta-ALA PDT than with high-dose PDT (pain 15 %, 100 %, respectively; P = 0.001 by Fisher's exact test; phototoxicity, 0 %, 50 %, respectively; P = 0.021 by Fisher's exact test). CONCLUSION Low-dose topical administration of delta-ALA provides ablation of low-grade dysplasia in the range obtained with oral delta-ALA. In addition, it is safe and well tolerated. Since, however, topical administration of delta-ALA is not able to consistently eradicate Barrett's esophagus, alternative methods will have to be developed.
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Affiliation(s)
- M -A Ortner
- Department of Gastroenterology, Hepatology, Endocrinology, Metabolism and Nutrition, Medical Faculty Charité, Humboldt University, Berlin, Germany.
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Rückert RI, Fleige B, Rogalla P, Woodruff JM. Schwannoma with angiosarcoma. Report of a case and comparison with other types of nerve tumors with angiosarcoma. Cancer 2000; 89:1577-85. [PMID: 11013374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Schwannoma with angiosarcomatous change is a rare tumor, the clinical characteristics of which have not been analyzed. METHODS A patient with schwannoma with angiosarcoma arising in the midneck and clinically mimicking a carotid body paraganglioma is described with a literature review of all previously reported cases and a comparison of their clinical features with those of schwannoma with conventional malignant transformation and cases of neurofibroma and malignant peripheral nerve sheath tumor (MPNST) with angiosarcoma. RESULTS There are four reported cases, including the present case. Schwannoma with angiosarcoma affects older adults, mainly men. Three tumors arose from the vagus nerve in the neck. Three of the four angiosarcomas were epithelioid in type. Treatment in all cases was surgical resection followed by radiation and chemotherapy in one case and by radiation alone in another. One patient died with residual local angiosarcoma 5 months after the diagnosis. The remaining three patients were alive and disease free at 27 months, 43 months, and 90 months, with distant metastasis (after 15 months) reported only in the patient described in this case report. CONCLUSIONS Schwannoma with angiosarcoma should be included in the differential diagnosis of presumed carotid body paragangliomas. Like angiosarcoma alone and schwannoma with conventional malignant transformation, but unlike cases of neurofibroma and MPNST with angiosarcoma, the patients are older adults, and there is a male prevalence. Schwannoma with angiosarcoma is capable of local spread with a fatal outcome and of distant metastasis, but follow-up strongly suggests that these patients have a better prognosis than patients with neurofibroma or MPNST with angiosarcoma. Recommended treatment is attempted complete surgical resection followed by radiation therapy and chemotherapy, if it can be tolerated by the patient.
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Affiliation(s)
- R I Rückert
- Department of Surgery, Humboldt University Medical School, Campus Charité Mitte, Berlin, Germany.
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21
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Sachs MD, Schlechte H, Lenk VS, Brenner S, Schnorr D, Fleige B, Ditscherlein G, Loening SA. Genetic analysis of Tp53 from urine sediment as a tool for diagnosing recurrence and residual of bladder carcinoma. Eur Urol 2000; 38:426-33. [PMID: 11025381 DOI: 10.1159/000020319] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Longitudinal study of Tp53 mutation in urine sediments of 26 patients with mutated primary transitional cell carcinoma (TCC) of the urinary bladder at different time periods after transurethral resection of the bladder (TURB), i.e. before and after the first TURB, prior to the control resection and before treatment of a recurrence. METHODS DNA of the critical Tp53 exons 5-8 was anaylzed by temperature gradients (TGGE) and sequence. RESULTS (1) In 11 of 12 patients (91.7%) mutation reoccurred with the detection of recurrence of the disease. The mutation frequency in patients without any recurrence was 1 in 8 (12.5%) after a follow-up period of 4-16 months. (2) In 7 of 10 patients, the mutation was no longer detectable in the urine sediment after TURB. (3) The mutation frequency at the control resection 6 weeks after the first TURB was 5 in 7 (71.4%) in patients found to have residual and 1 in 7 (14.2%) in the tumor-free patients. (4) In 9 of 10 samples identical mutations were found by sequence in the recurrent tumor. These results show a significant correlation between the detection of a Tp53 mutation in the urine sediments and tumor recurrence or residual. CONCLUSIONS (1) Tp53 mutations in the urine sediment could be a useful indicator of tumor recurrence or tumor residual in patients ( approximately 40%) with primary mutated bladder cancer tissue. (2) These results support the monoclonal seeding theory. (3) The finding of identical mutations at different times indicate that the tumor was never totally removed.
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Affiliation(s)
- M D Sachs
- Department of Urology, Charité-Hospital of the Humboldt University, Berlin, Germany
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22
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Richard F, Pacyna-Gengelbach M, Schlüns K, Fleige B, Winzer KJ, Szymas J, Dietel M, Petersen I, Schwendel A. Patterns of chromosomal imbalances in invasive breast cancer. Int J Cancer 2000; 89:305-10. [PMID: 10861509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Invasive breast carcinomas are characterized by a complex pattern of chromosomal alterations. We applied comparative genomic hybridization (CGH) to analyze 105 primary breast carcinomas using histograms to indicate the incidence of DNA imbalances of tumor subgroups and difference histograms to compare invasive ductal carcinomas (IDC) with lobular carcinomas (ILC), well and poorly differentiated carcinomas (G1/G3) and estrogen receptor-positive and -negative tumors (ER(+)/ER(-)). Only single imbalances showed a higher incidence in ILC compared with IDC, i.e., gains on chromosomes 4 and 5q13-q23 as well as deletions on chromosomes 6q, 11q14-qter, 12p12-pter, 16q, 17p, 18q, 19, and 22q. Of these, particularly gains of 4 and losses at 16q21-q23, and 18q12-q21 were statistically significant. For most loci, IDC showed more alterations providing a genetic correlate to the fact that ductal carcinoma overall is associated with a worse prognosis than ILC. Of these, many imbalances showing statistical significance were also observed in G3 and ER(-) tumors, i.e., deletions at 2q35-q37, 3p12-p14, 4p15-p16, 5q, 7p15, 8p22-p23, 10q, 11p, 14q21-q31, 15q, and gains at 2p, 3q21-qter, 6p, 8q21-qter, 10p, 18p11-q11, and 20q, suggesting that they contribute to a more aggressive tumor phenotype. By contrast, gains on chromosome 5q13-q23 as well as deletions at 6q, 16q and 22q were more prevalent in G1 and ER(+) tumors. The ratio profiles of all cases as well as histograms are accessible at our CGH online tumor database at http://amba.charite.de/cgh. Our results highlight distinct chromosomal subregions for cancer-associated genes. In addition, these imbalances may serve as markers for a genetic classification of invasive breast cancer.
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Affiliation(s)
- F Richard
- Institute of Pathology, University Hospital Charite, Berlin, Germany
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23
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Blohmer JU, Paepke S, Kissner L, Elling D, Fleige B, Grineisen Y, Lichtenegger W. Dose- intensified, preoperative and adjuvant chemotherapy in patients with T3- and T4- breast cancer: toxicity, clinical and pathological remission. Zentralbl Gynakol 1999; 121:522-5. [PMID: 10612219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE The aim of the study was to investigate a dose-intensified, preoperative chemotherapy with 3 cycles (cy) of epirubicin 60 mg/m2, ifosfamide 5 g/m2 with mesna 5 g/m2, biweekly with G-CSF 5 micrograms/kg (filgrastim), in terms of toxicity, clinical and pathological remission rates and changes of immunohistochemical characteristics (ER, PR, c-erbB2, p53) during chemotherapy of inoperable patients (pt) with poor prognosis (locally advanced (LABC, 9 pt), inflammatory breast cancer (IBC, 12 pt) and M0. PATIENTS AND METHODS Following preoperative chemotherapy (63 cy) and mastectomy patients received adjuvant 3 cy of epirubicin 60 mg/m2 and paclitaxel 175 mg/m2 (biweekly) with G-CSF (54 cy), and subsequently radiation of the thoracic wall and tamoxifen 20 mg/day. RESULTS Primary toxicity (T): grade 3 alopecia (21 pt), grade 3-4 leucopenia (7 cy), grade 1-2 leucopenia (26 cy), grade 1-2 anemia (61 cy), grade 1-2 neurocortical T (13 cy), grade 1-2 neurosensory T (7 cy), grade 1 cardiac toxicity (1 pt). ORR: 65% (CR: 0 pt, PR: 13 pt, NC: 8 pt). The grades of histological regression were: 0: 14 pt, 1: 6 pt, 2: 0 pt, 3: 1 pt. No significant correlation was observed between the clinical response and the histological regression (Fischer's exact test). The immunohistochemical expression of tumor characteristics did not change significantly during preoperative chemotherapy (Wilcoxon test). 81% of the pt were disease-free after a median follow-up of 20 months (7-26). CONCLUSION This therapy is safe, feasible and effective, both as primary and adjuvant chemotherapy in women with LABC and IBC.
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Affiliation(s)
- J U Blohmer
- Klinik für Frauenheilkunde und Geburtshilfe, Charité Berlin.
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Abstract
For imaging of the female pelvis, transvaginal ultrasound is the method of choice. Magnetic resonance imaging and CT provide important additional information in various disorders. Magnetic resonance imaging is superior to CT in diagnosing benign and malignant disorders of the uterus. The same holds for the characterization of adnexal masses, where MR imaging reliably differentiates dermoids, ovarian fibromas, and most endometriomas. Differentiation of other benign and malignant ovarian tumors by CT and MR imaging is based on identical morphological criteria; no superiority of MR imaging over CT has been established. Computed tomography is still the preferred imaging modality for staging ovarian cancer. A thorough knowledge of the pathomorphological changes associated with the different disorders of the female pelvis not only helps to choose the proper imaging modality and examination protocol, but also improves image interpretation.
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Affiliation(s)
- B Hamm
- Department of Radiology, Charité University Hospital, Humboldt-Universität zu Berlin, Schumannstrasse 20/21, D-10098 Berlin, Germany
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Rogalla P, Fleige B, Hamm B. Quiz case of the month. Multifocal bronchioloalveolar carcinoma (alveolar cell carcinoma). Eur Radiol 1998; 7:1349-50. [PMID: 9377528 DOI: 10.1007/s003300050302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- P Rogalla
- Department of Radiology, Charite, Humboldt-Universitat zu Berlin, D-10098, Berlin, Germany
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Wolff KD, Hölzle F, Fleige B. [Vascular quality of various microsurgical transplants. A histological study]. HANDCHIR MIKROCHIR P 1997; 29:178-82. [PMID: 9340301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- K D Wolff
- Abteilung für Kiefer- und Plastische Gesichtschirurgie, Universitäts-klinikum Benjamin Franklin, Freie Universität Berlin
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Abstract
This is the first report of a desmoid tumor 19 years after radiation therapy for seminoma of the testis at the age of 40. It stresses the need to include the desmoid tumor in the differential diagnosis of an intra-abdominal tumor after treatment of testicular cancer as well as the possible radiation induction of desmoid tumor.
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Affiliation(s)
- H E Wegner
- Department of Urology, Universitätsklinikum Steglitz, Freie Universität Berlin, FRG
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Prüfer-Krämer L, Krämer A, Weigel R, Rögler G, Fleige B, Krause PH, Hahn EG, Riecken EO, Pohle HD. Hepatic involvement in patients with human immunodeficiency virus infection: discrepancies between AIDS patients and those with earlier stages of infection. J Infect Dis 1991; 163:866-9. [PMID: 2010640 DOI: 10.1093/infdis/163.4.866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The effect of human immunodeficiency virus (HIV) infection on type and severity of liver disease was studied in 61 HIV-positive patients who did not have AIDS and in 45 AIDS patients. Liver biopsies revealed viral hepatitis in 12 of 18 non-AIDS patients but in only 4 of 34 AIDS patients (P less than .0005, Fisher's exact test). Acute, non-A non-B, and chronic active hepatitis B were seen exclusively in the non-AIDS group; however, chronic persistent hepatitis B was seen in both groups. In 9 of 18 AIDS patients intra vitam liver histopathology established diagnoses of opportunistic infections or tumors. Tissue reaction to certain pathogens, such as hepatitis B virus, mycobacteria, and cryptococci, seems to be milder in AIDS patients than in others who are HIV positive or the expected reaction of the normal host. This is likely because of impaired cell-mediated immunity in patients with advanced HIV disease.
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Affiliation(s)
- L Prüfer-Krämer
- Department of Medicine II (Klinikum Rudolf-Virchow), Freie Universität Berlin, Germany
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Pickartz H, Beckmann R, Fleige B, Düe W, Gerdes J, Stein H. Steroid receptors and proliferative activity in non-neoplastic and neoplastic endometria. Virchows Arch A Pathol Anat Histopathol 1990; 417:163-71. [PMID: 2114696 DOI: 10.1007/bf02190535] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the glands of cyclic endometria, proliferative activity (PA), as revealed by expression of the Ki-67 antigen, is highest in the proliferative phase (P) and early secretory phase (S1). The PA decreases in the middle secretory phase (S2). In the stroma the PA is low during the whole cycle. In P and S1, the oestrogen receptor (ER) and the progesterone receptor (PR) are strongly expressed in glands and stroma. The number of positive cells and the staining intensity decreases in S2, particularly in the glands. In atrophic endometria, fibro-glandular polyps and in endometria with arrested secretion the PA is low in both glands and stroma. ER and PR can be detected in glands and stroma. The PA in atypical hyperplasias is only slightly higher than in cyclic endometria and endometria with simple hyperplasia. The ER and PR levels are comparable to those in proliferative endometria. The PA of endometrial adenocarcinomas is positively and the ER and PR negatively correlated with the degree of de-differentiation. No ER-negative carcinoma displays the PR. Immunohistologically, non-neoplastic receptor positive tissue can be seen in many ER- and PR-negative carcinomas. These structures may falsify the biochemical receptor analysis.
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Affiliation(s)
- H Pickartz
- Institute of Pathology, Universitätsklinikum Steglitz, Free University, Berlin
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Fleige B, Pickartz H, Stein H. [Comparison of the receptor content and growth fraction of breast cancers and their axillary lymph node metastases]. Pathologe 1989; 10:12-5. [PMID: 2646629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- B Fleige
- Institut für Pathologie, Klinikum Steglitz
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