OP0037 ABATACEPT AND OTHER DMARDS HAVE COMMON TRANSCRIPTOMIC EFFECTS ON RA SYNOVIAL TISSUE

Background:

Modes of action of DMARDs (disease-modifying antirheumatic drugs) in rheumatoid arthritis (RA) are not completely understood at the level of the synovium. Studying treatment-induced modifications in RA synovial tissue can provide unique insights into the pathways modulated downstream of different DMARDs.

Objectives:

Our goal was to assess histological and transcriptomic effects of Abatacept (ABA) on RA synovium, and to compare them with previously published data obtained by our group using the same study design on other DMARDs: Tocilizumab (TCZ), Rituximab (RTX), Methotrexate (MTX) and Adalimumab (ADA).

Methods:

Synovial tissue was obtained using ultrasound-guided biopsy from affected joints before (W0) and 16 weeks (W16) after treatment with subcutaneous Abatacept 125mg per week on a MTX background. Paraffin-sections were stained for CD3, CD20 and CD68 and scored by a pathologist for T cell, B cell and macrophage infiltration. Transcriptional profiling was performed using GeneChip Human Genome U133 Plus 2.0 arrays (Affymetrix), and analyzed on Genespring GX (Agilent). Pathway analyses were performed on Genespring GX, Metascape (https://metascape.org/) and EnrichR (https://maayanlab.cloud/Enrichr/). Protein-Protein Interaction (PPI) networks were generated on STRING (https://string-db.org/).

Results:

14 RA patients were included (female: 9, ACPA/RF positive: 8, erosive disease: 12, median disease duration in years (± SD): 11.7 (± 8.1), median DAS28CRP (± SD): 4.78 (± 1.11)). Median DAS28CRP significantly decreased between W0 and W16, as did US GS score. Evaluation of histological slides (n=11 pairs of samples) showed no significant effect of Abatacept on T cell, B cell or macrophage infiltration. Gene expression analysis (n=10 pairs of samples) identified 304 transcripts differentially expressed (129 downregulated, 175 upregulated) between W0 and W16 (FC≥1.5 and p<0.05, paired Mann-Whitney). Downregulated genes were significantly enriched for immune processes and included several key T cell regulatory genes (IL2RA, CD28, IL7, IL7R), strongly overlapping with data from previous studies on TCZ (n= 12 pairs), RTX (n=12 pairs), MTX (n=8 pairs) and ADA (n=8 pairs). Thus, each treatment shares 31 to 48% of its downregulated genes with the others, with genes downregulated by at least three involved in key RA-associated pathways such as leukocyte activation, NF-kappa B signaling, TNF signaling and JAK-STAT signaling. Given their seemingly overlapping effects, data were pooled across these studies, markedly improving power thanks to their paired-design. This revealed that genes downregulated by DMARDs (n=573, Benjamini-Hochberg corrected p-value<0.05, paired Mann-Whitney) were significantly enriched for both T cell and myeloid leukocyte activation pathways. Interestingly, DMARDs seem to have a coordinate effect on the two pathways (correlation of mean Log2FC: r=0.8558, p<0.0001), with a stronger impact (Log2FCW16-W0) in good responders to therapy (n=17) as compared to moderate (n=20) and to non-responders (n=13) (p<0.0001, Mann-Whitney). Finally, Transcription Factor enrichment and PPI network analyses point to a central role for molecules including JAK/STATs as mediators of all studied therapies.

Conclusion:

We provide evidence that the effects of five DMARDs on RA synovium culminate in the same pathways (namely, T cell and myeloid leukocyte activation). This confirms previous studies suggesting the existence of common mediators downstream of DMARDs, independent of their primary targets, and suggests attractive new therapeutic targets.

Acknowledgements:

This work was funded in part by unrestricted grants from Cap48 (RTBF) and Bristol-Myers Squibb. Clément Triaille is funded by the Fonds National de la Recherche Scientifique (FNRS, Communauté française de Belgique) and Fondation Saint-Luc (Cliniques Universitaires Saint-Luc).

Disclosure of Interests:

Clément Triaille: None declared, Tilman Gaelle: None declared, Tatiana Sokolova: None declared, Laurent Meric de Bellefon: None declared, Christine Galant: None declared, Patrick Durez Grant/research support from: unrestricted research grant from Bristol-Myers Squibb, Bernard Lauwerys Employee of: currently employed at UCB Biopharma, Nisha Limaye: None declared

AB0761 HISTOPATHOLOGY OF CHECKPOINT INHIBITORS INDUCED ARTHRITIS: RETROSPECTIVE ANALYSIS OF 3 CASES

Background:

Induced arthritis (IA) is a rare immune related adverse event occurring in 0.5 to 2% of patients exposed to Immune (irAEs) Checkpoint Inhibitors (CPI). In some patients, this condition may be severe and long lasting even after CPI cessation. Cross-reactivity between tumor- and self-antigens was considered in the etiology of several cases of irAEs but disease mechanisms in IA remain elusive.

We systematically collect synovial tissue of patients with IA (Ethical Committee B403201942386).

Objectives:

Here, we report the histopathological findings from ultrasound guided (USG) synovial biopsies from the 3 first patients of our cohort. The immune cell infiltration in CPI IA patients is compared to the histopathological findings in rheumatoid arthritis.

Methods:

Patients were referred through their oncologist after the onset of an arthritis in the context of a CPI therapy. The diagnostic of arthritis was confirmed by a rheumatologist and by ultrasound assessment. USG biopsies were performed before initiation of specific therapies.

Pathological and immunohistochemical analyses include semi quantitative scoring of the following: synovial hyperplasia, fibrinoid necrosis, chorion cellular infiltrate, vascular hyperplasia, CD3-, CD20-, CD68- and CD138-positive cells.

All patients gave written informed consent.

Results:

Three patients went through the USG biopsy procedure: 2 males and 1 female. No adverse events were recorded.

All patients had metastatic neoplasms and time-to-arthritis was on average 6.7 months after CPI initiation. The USG biopsies were performed from 1 week after the onset of the IA to 16 months. The target joints displayed strong synovial thickening on ultrasound. Histological and immunohistochemistry studies showed light to moderate synovial hyperplasia and inflammatory cell infiltration of the sublining by macrophages and T cells, but no or little B cells (Table 1).

Table 1.

Clinical Characteristics and histopathological analyses on synovial biopsies.

Patient 1Patient 2Patient 3CanceruterusbladderlungsBiopsied jointfirst metatarsophalangial jointwristkneeTime-to-synovial biopsy1 week2 months16 monthsGrey scale on ultrasound3/33/33/3Hematoxylin-eosin staining:synovial hyperplasiafibrinoid necrosischorion cellular infiltratevascular hyperplasia++++0+++++++00/+++Immunochemistry staining:CD3CD20CD68CD138++++000/+++0/+++000/+

Conclusion:

USG synovial biopsies have been safely performed and the histopathological analysis have confirmed the synovitis with mainly a macrophage infiltrate (myeloid pattern). IA synovitis is characterized by synovial hyperplasia and macrophage and T cell infiltration of the sublining. Increased collaboration between oncologists and rheumatologists is needed to create opportunities for referral of patients between the two specialties and optimize treatment. Further analyses (such as global or single-cell RNA sequencing) are needed to learn more about IA physiopathology.

References:

[1]Humby F, Lewis M, Ramamoorthi N & al. Synovial cellular and molecular signatures stratify clinical response to csDMARD therapy and predict radiographic progression in early rheumatoid arthritis patients. Ann Rheum Dis. 2019 Jun;78(6):761-772. doi: 10.1136/annrheumdis-2018-214539.

[2]Postow MA, Sidlow R, Hellmann MD. Immune-Related Adverse Events Associated with Immune Checkpoint Blockade. N Engl J Med. 2018 Jan 11;378(2):158-168. doi: 10.1056/NEJMra1703481. PMID: 29320654.

Disclosure of Interests:

Meric de Bellefon Laurent: None declared, Aspeslagh Sandrone: None declared, Di Romana Silvana: None declared, Cornelis Frank: None declared, Poncin Renaud: None declared, Christine Galant: None declared, Bernard Lauwerys Employee of: Bernard Lauwerys is currently employed at UCB Biopharma, Patrick Durez: None declared

POS0067 HIGH DEGREE OF INTER-PATIENT HETEROGENEITY IN SYNOVIOCYTE HYPERPLASIA AND IMMUNE CELLS INFILTRATION IN THE SYNOVIUM OF JUVENILE IDIOPATHIC ARTHRITIS PATIENTS

Background:

Increasing evidence indicates that synovial tissue analysis can deliver pathophysiological insights but also individual clinically-relevant information in adult-onset inflammatory arthritides. Little is known about synovial pathology in juvenile idiopathic arthritis, especially regarding inter-patient variability of histopathological features.

Objectives:

To assess the heterogeneity of main synovial features (synoviocyte hyperplasia and immune cells infiltration) in juvenile idiopathic arthritis (JIA) patients and a cohort of young adults (<30 years old) with early rheumatoid arthritis (RA).

Methods:

Synovial biopsies were sampled using needle arthroscopy or ultra-sound (US) guided biopsy during intra-articular joint injection. Tissue was embedded in paraffin then sections were stained with hematoxylin and eosin. Synoviocyte hyperplasia (SH) and immune cells infiltration (ICI) was assessed by an experienced pathologist on a 0 – 3 scale where 0 represents the absence of the feature and 3 the highest level.

Results:

34 JIA patients (age (median ±SD): 15.5±6.47 years, oligo-articular JIA n=28/34, polyarticular JIA n=6/34, ANA-RF-ACPA positivity=56%-10%-3%) and 22 RA (age (median ±SD): 24.3±2.6 years, ANA-RF-ACPA positivity=10%-36%-32%) patients were included. Synovial tissue was obtained from knee (n=49/56), wrist (n=4/56) or metacarpophalangeal/intercarpophalangeal joints (n=3/56), using US guided biopsy in 27% of patients and needle arthroscopy in 73%.

Individual scores of SH and ICI were correlated in both JIA (Spearman’s r=0.503, p value=0.0024) and RA (Spearman’s r=0.636, p value=0.0015). There was no significant difference in SH and ICI scores between the 2 groups (SH score (Q25-Q50-Q75) in JIA= 0.5-1.125-2 and in RA = 0.75-2-2; ICI score (Q25-Q50-Q75) in JIA= 1-2-2 and in RA = 0.75-2-2.25). Intra-group variability of the two assessed features was comparable between the 2 groups (SH coefficient of variation: 72.2% for JIA and 68.2% for RA; ICI coefficient of variation: 52.2% for JIA and 71.2% for RA). Within JIA patients, there was no significant difference in SH/ICI scores between groups based on ANA positivity, oligo or polyarticular involvement nor ongoing treatment.

Conclusion:

Studying main histological features of synovitis, we found no difference between JIA and young RA patients. Furthermore, we report a similar degree of inter-patient heterogeneity in synovial pathological features of JIA and RA patients. These variations were not explained by common clinical characteristics. Whether they relate to different molecular signatures as suggested in adult RA will be further investigated using bulk tissue RNA sequencing.

Acknowledgements:

This work was funded in part by Cap48 (RTBF). Clément Triaille is funded by the Fonds National de la Recherche Scientifique (FNRS, Communauté française de Belgique) and Fondation Saint-Luc (Cliniques Universitaires Saint-Luc).

Disclosure of Interests:

Clément Triaille: None declared, Cécile Boulanger: None declared, Tatiana Sokolova: None declared, Laurent Meric de Bellefon: None declared, Adrien Nzeusseu Toukap: None declared, Christine Galant: None declared, Nisha Limaye: None declared, Bernard Lauwerys Employee of: currently employed at UCB Biopharma, Patrick Durez: None declared.

Conseils de bonnes pratiques pour les praticiens spécialisés en laryngologie et en phoniatrie en contexte d’épidémie COVID-19

Les gestes mettant le personnel soignant en contact étroit avec les voies aériennes sont particulièrement à risque de contamination par le virus SARS-Cov-2, en particulier en cas de crachats, toux, ou présence d’une trachéotomie. Dans la phase pandémique actuelle, tous les patients sont à considérer comme potentiellement infectés donc l’attitude du soignant est à adapter au statut COVID-19 du patient mais aussi et surtout au geste effectué. Ainsi, s’il s’agit d’un geste invasif comme une fibroscopie ou une pose de sonde naso-gastrique notamment, les précautions sont identiques pour tous les patients quel que soit leur statut COVID. Les rééducations vocales sont à considérer comme non urgentes dans ce contexte. Les recommandations présentées ici en date du 9 avril 2020 sont donc surtout destinées à la prise en charge des troubles de la déglutition (ceci pouvant parfois être dangereux pour le patient) ou d’une dysphonie récente inquiétante. Dès qu’elles sont possibles techniquement et réglementairement, les télé-consultations seront à privilégier. Seules les urgences non différables seront réalisées en présentiel et ce après décision collégiale (ou en fonction des informations venues des autorités de santé) et en prenant les précautions adéquates détaillées ici.

Guidelines of clinical practice for the management of swallowing disorders and recent dysphonia in the context of the COVID-19 pandemic

Procedures putting healthcare workers in close contact with the airway are particularly at risk of contamination by the SARS-Cov-2 virus, especially when exposed to sputum, coughing, or a tracheostomy. In the current pandemic phase, all patients should be considered as potentially infected. Thus, the level of precaution recommended for the caregivers depends more on the type of procedure than on the patient's proved or suspected COVID-19 status. Procedures that are particularly at high risk of contamination are clinical and flexible endoscopic pharyngo-laryngological evaluation, and probably also video fluoroscopic swallowing exams. Voice rehabilitation should not be considered urgent at this time. Therefore, recommendations presented here mainly concern the management of swallowing disorders, which can sometimes be dangerous for the patient, and recent dysphonia. In cases where they are considered possible and useful, teleconsultations should be preferred to face-to-face assessments or rehabilitation sessions. The latter must be maintained only in few selected situations, after team discussions or in accordance with the guidelines provided by health authorities.

Abstract P4-15-02: TILs variations, proliferative response and PEPI scores in patients with luminal breast cancer receiving neoadjuvant letrozole-palbociclib or chemotherapy: An extended analysis of the NEOPAL trial

Background

The role of chemotherapy in early luminal breast cancer remains challenged. The NEOPAL trial (NCT 02400567; Cottu et al, ESMO 2017 LBA09) compared sequential chemotherapy (CT) and letrozole-palbociclib (LP) as neoadjuvant treatment in PAM50 defined high-risk luminal breast cancer patients, showing that LP might be as efficient as CT with regard to breast conserving surgery and pathological response. We report here extended exploratory pathological results, focusing on tumor infiltrating lymphocytes (TILs), proliferative response and preoperative endocrine prognostic index (PEPI) scores.

Material and Methods

Tumor blocks from baseline biopsy and surgical specimens were available for centralized review from the 106 randomized patients (53 in each arm). TILs quantification, KI67 staining and counting, and ER quantification were performed according to standard methods. Residual proliferative cancer burden (RPCB) and PEPI scores were computed according to published algorithms. Wilcoxon rank sum test and Mann Whitney test were used to compare paired and unpaired data. The chi-square and Fisher exact tests were used for categorical variables.

Results

Overall, median TILs count did not differ between LP and CT patients, both at baseline (p=0.37) and at the end of treatment (p=0.42). Median TILs count climbed from 5% (0-60) to 10% (1-60) in the LP arm (p=0.0026) and from 2% (0-30) to 10% (0-60) in the CT arm (p=0.0023). Median Ki67 dropped sharply in both arms, from 30% (1-80) to 1% (0-30) in the LP arm (p=1.10e-8) and from 30% (2-80) to 5% (0-30) in the CT arm (p=3.10e-9). Decrease in the Ki67 geometric mean was as sharp. Of note, while baseline Ki67 was similar in both arms (p=0.315), decrease in the LP arm was significantly more profound than in the CT arm (p=0.00075). Pathological response according to RPCB were as follows, in the LP and CT arm, respectively: class 0: 9.6%/10.2%; class I: 84.6%/73.5%; class II: 5.8%/16.3%. The relapse free survival PEPI scores were as follow in the LP and CT arm, respectively: class I: 13.5%/16.3%; class II: 59.6%/46.9%; class III: 28.9%/36.8% (p=0.504). Breast cancer specific survival PEPI scores were as follow in the LP and CT arm, respectively: class I: 18.9%/8.2%; class II: 54.7%/40.8%; class III: 26.4%/51%. These results were significantly better in the LP arm (p=0.027). There was no correlation between final TILs quantification and the RPCB or PEPI scores.

Conclusions

In this prospective multicenter study with centralized pathological review, neoadjuvant letrozole-palbociclib combination generates impressive proliferative and endocrine specific response features. It compared well with chemotherapy. The LP combination also significantly increased lymphocytic infiltration. Its clinical significance and utility remain to be elucidated, but it potentially adds new prognostic and theranostic information.

Citation Format: Vincent-Salomon A, Mathieu M-C, Bataillon G, Arnould L, Verrièle V, Ghnassia J-P, Haudebourg J, Penault-Llorca F, Lefebvre C, Maran-Gonzalez A, Guinebretière J-M, Duprez R, Berghian A, Blanc-Fournier C, Calès V, Galant C, Delrée P, Lemonnier J, Delaloge S, Cottu PH. TILs variations, proliferative response and PEPI scores in patients with luminal breast cancer receiving neoadjuvant letrozole-palbociclib or chemotherapy: An extended analysis of the NEOPAL trial [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 P4-15-02.

Abstract P3-04-04: Detection of ESR1 mutations in matched primary and metastatic samples from endocrine-resistant lobular breast cancer patients

Background:

Invasive lobular breast cancer (ILBC) represents the second most common histology of breast cancer (BC) and accounts for 10-15% of all invasive cases. Since &gt;90% of ILBCs express the estrogen receptor (ER, coded by the ESR1 gene), the vast majority of these patients receive endocrine therapy. ESR1 mutations have mainly been identified in metastases from ER-positive BC at a frequency ranging from 11 to 50% and were shown to be associated with resistance to endocrine therapy. Nevertheless, ESR1 mutations have never been assessed in metastatic ILBC, hence the present study.

Patients and methods:

We aimed at interrogating the five most commonly reported ESR1 mutations (Y537S/C/N, D538G, E380Q) by droplet digital PCR (BioRad) in matched primary, axillary and metastatic ILBC samples (N=212) from 69 endocrine-resistant patients collected retrospectively from five hospitals.

Results:

We present here the results for the two most frequent ESR1 mutations (Y537S and D538G); data from the remaining mutations will be available at the time of the conference. We observed Y537S and D538G mutations in metastases from three and four patients, respectively. For one patient, the sampled metastasis harbored both the Y537S and the D538G mutations, confirming that ESR1 polyclonality can be present in the same metastasis. For another patient, two metastases were sampled and the D538G mutation was only present in one metastasis. Intriguingly, for two patients we observed D538G mutations only in the primary tumor but not in the corresponding metastasis, and for another only in an axillary lymph node. We could hypothesize that the clone carrying the mutation in the early setting has been removed either by the primary surgery or subsequent adjuvant chemotherapy. The ESR1 Y537S and D538G mutational frequencies observed in our metastatic ILC cohort (3/69, 4.35% and 4/69, 5.80%, respectively) are not statistically different from the frequencies reported in breast cancer metastases in the literature across the different studies (6.62% and 6.20%, respectively). All patients with ESR1-mutated metastases received at least 4 years of endocrine therapy and all but one were treated with an aromatase inhibitor (AI). However, half of these patients received exclusively endocrine therapy in the adjuvant setting.

Conclusion:

This is to the best of our knowledge, the first metastatic ILBC series in which the most frequently reported ESR1 mutations are being investigated, and the largest series in which ESR1 mutations are being investigated in matched metastatic, primary tumor and axillary lymph node samples. The frequencies that we found for the Y537S and D538G mutations are in line with those reported in the literature in metastatic biopsies for the general BC population. We further demonstrated using multiple samples from the primary tumor and an ultra-sensitive technology that there was no patient presenting an ESR1 mutation both in the early and metastatic disease. Data on the remaining mutations (Y537S/N, E380Q) will complete these results.

Citation Format: Desmedt C, Pingitore J, Rothé F, Rouas G, Bertucci F, Galant C, Rotmensz N, van den Eynden G, Salgado R, Larsimont D, Pruneri G, Sotiriou C. Detection of ESR1 mutations in matched primary and metastatic samples from endocrine-resistant lobular breast cancer patients [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 P3-04-04.

Abstract P3-13-19: Isolated sternal metastases: The place of surgical resection

Background: Solitary sternal metastases from breast cancer are found in approximately 1.9 to 2.5 % of all advanced breast cancer cases. According to the latest AJCC classification, they are still considered as stage IV disease, but their prognosis is better in the absence of other foci of metastatic disease. Their treatment still remains controversial.

Material and methods: This is a monocentric retrospective study performed in our breast clinic and approved by our ethics committee. Twelve patients were included in this study between 2010 and 2015; 11 had a metachronous solitary sternal metastasis and 1 had a synchronous metastatic sternal lesion. Complete restaging was negative in all patients for other metastatic lesions. The extent of resection (different parts of the sternum and frequently also adjacent rib cartilages) necessary to obtain free margins was estimated preoperatively on MRI images focused with adequate sequences. All the patients underwent a large sternal resection and a chest wall reconstruction integrated in a multimodal approach.

Characteristics of the patients and of the tumors were studied.

The major outcomes studied were disease-free (DFS) and overall survival (OS).

Results: The mean interval between the initial diagnosis of breast cancer and the discovery of sternal metastasis was 115 months. After surgical resection, free margins were obtained in 10 patients. No post-operative complications were observed except for persistent thoracic pain in one patient with a medical history of chronic pain. Excellent cosmetic and functional outcomes were obtained without significant impairment of respiratory function. Ten patients received chemotherapy pre- or postoperatively. All the tumors expressed ER and /or PgR receptors, and endocrine therapy was administered in all patients.

Mean duration of follow-up was 25 months (9-51 months). Three patients presented distant recurrences: 2 liver lesions and 1 cervical nodal recurrence with pericardic effusion. Out of these 3 patients, 1 died after 51 months. Currently the DFS of this small study is 75 % and the OS is 91.6 %.

Conclusion: Treatment of isolated sternal metastases of breast cancer must be based on a multidisciplinary strategy.

Sternectomy and multilayered chest wall reconstruction (with different types of meshes and flaps) could be a curative approach in highly selected patients with no other metastatic lesions. In this group of patients, the good prognosis observed could be due to a different mechanism of dissemination, based on lymphatic rather than hematogenic diffusion.

Longer follow-up and prospective studies are needed to confirm these encouraging results.

Citation Format: Berliere M, Taburiaux L, Lacroix V, Gerday A, Coyette M, Lecouvet F, Piette P, Galant C, Duhoux F, Lengele B. Isolated sternal metastases: The place of surgical resection [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 P3-13-19.

Aneurysmal bone cystic lesions: value of genomic studies

Aneurysmal bone cystic (ABC) lesions can be primary or secondary (to a trauma or a pre-existing benign or malignant tumour). Specific translocations of the USP6 gene are reported in about 70% of primary but never in secondary ABC lesions. We report two cases of ABC lesions in which imbalanced genomic aberrations were detected at initial presentation and showed complex clonal evolution. These demonstrative observations strengthen the guidelines regarding the diagnostic approach when an ABC is suggested by imaging. Biopsy is mandatory including genomic analysis. When a primary ABC is not clearly proven by the initial biopsy, an extensive curettage should be performed, with pathological examination of all removed tissue in order to exclude a secondary ABC. It also illustrates the added value of genomic analyses in the setting of an ABC lesion: complex clonal aberrations argues for a lesion secondary to a malignant proliferation whereas USP6 rearrangement allows the diagnosis of primary ABC.

Abstract P2-12-04: Is there any benefit to perform extensive nodal dissection in primary or recurrent aggressive form of breast cancer?

Background: Breast oncologic surgery and especially nodal surgery has become ever more minimally invasive. However, some aggressive breast cancers exhibit at their primary or recurrent presentation extensive nodal invasion at the axillary, retropectoralis and sometimes supraclavicular and cervical levels. Surgical treatment of these tumors is not standardized.

Material and methods: Between January 2012 and April 2015, 7 primary breast cancer patients (group I) and 7 recurrent breast cancer patients (group II) were included in a prospective, non randomized study approved by our local ethics committee. All the patients had cytologically proven retropectoralis and infraclavicular lymph node invasion and 7 of them had cytologically proven cervical lymph node invasion (5 in the group of primary tumors and 2 in the group of recurrences). Four of the 7 primary tumors were triple negative and 3 were HER2 positive tumors, while 4 out of the 7 recurrent tumors were triple negative and 3were HER2 positive. All the patients underwent PET/CT and breast MRI at baseline. Visceral metastases were absent in all cases. In the group of primary tumors, all the patients were treated with neoadjuvant chemotherapy (plus trastuzumab for the 3 HER2 positive tumors); in the group of recurrent tumors, neoadjuvant chemotherapy associated with trastuzumab was administered in 3 patients, while the 4 other patients underwent complementary mastectomy plus extensive nodal surgery followed by chemotherapy. Radiotherapy was administered in all primary breast cancer patients and cervical radiotherapy was administered in 3 of the 7 recurrent diseases. The following parameters were assessed: disease-free survival, overall survival and adverse events of surgical treatment.

Results: All the patients are still alive after a relatively short mean duration of follow-up [24 months in group I (6 to 40 months) and 29 months in group II (3 to 39 months)]. Six of the 7 patients in group I have no signs of recurrence, one has metastatic evolution (bilateral cervical and mediastinal node evolution) and is currently receiving chemotherapy in combination with a PARP inhibitor. In group II, 6 of the 7 patients have no signs of recurrence and one has metastatic evolution (inguinal nodes and bone metastases), treated with chemotherapy and HER2-targeted therapy. The major adverse event is arm lymphedema, affecting 4 out of 14 patients (28%). No persistent pain nor motor troubles are noted.

Discussion: Patients with nodal metastases outside the axilla seem to benefit from extensive surgery integrated in a multidisciplinary therapeutic approach. Some studies have demonstrated survival benefits for patients undergoing surgical resection of these nodes.

Conclusion: In aggressive breast tumors (HER2 positive or triple negative tumors) presenting with extensive nodal invasion, surgical excision of these nodal metastases must be integrated in the multidisciplinary treatment and patients need to be followed prospectively for a long time to confirm survival benefits.

Citation Format: Berliere M, Duhoux F, Nardai P, Schmitz S, Taburiaux L, Galant C, Leconte I, Piette P, Lengele B. Is there any benefit to perform extensive nodal dissection in primary or recurrent aggressive form of breast cancer?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-04.

Abstract S1-02: Lymphocytic infiltration in invasive lobular breast cancer

Background: The presence and prognostic value of tumor infiltrating lymphocytes (TILs) in invasive breast carcinoma has been demonstrated in several studies, especially in the triple-negative and HER2-positive subtypes. So far, TILs have not been investigated with sufficient detail in invasive lobular breast cancer (ILBC). Here we therefore aimed at: first, assessing the distribution of stromal TILs in ILBC; second, correlating the presence of TILs with standard clinical and pathological markers; third, exploring associations of TILs with recurrent genomic alterations; and, fourth, comparing the lymphocytic composition of ER-positive/HER2-negative lobular to ER-positive/HER2-negative ductal tumors.

Material and methods: The percentage of stromal TILs was independently assessed according to Salgado et al. (Ann Oncol 2015) by three pathologists on full-face hematoxylin and eosin slides in a well-annotated retrospective series of 614 primary ILBCs previously characterized at the genomic level. The median value of TILs was used for the analyses. For the association analyses, we focused on the more homogeneous group of ER-positive/HER2-negative ILBC (555/614). Breast cancer-free interval was used as survival endpoint and the analyses were censored at 12 years of follow-up. The comparison of the lymphocytic composition (relative percentage of CD45+ TILs which are CD4+, CD8+ or CD19+) was assessed by FACS in a separate prospective cohort of 51 ER-positive/HER2-negative lobular and 112 ER-positive/HER2-negative ductal tumors.

Results: The intraclass correlation coefficient between the three pathologists was 0.71 (95%CI:0.65-0.76). The median percentage of stromal TILs was 5% and the interquartile range 5-10%, with only 9% of the samples having ≥ 20%. Greater numbers of TILs were significantly associated with younger age at diagnosis, axillary lymph node involvement, high proliferative tumors as assessed by Ki67, and with the mixed non-classic ILBC subtypes. Greater numbers of TILs were associated with worse prognosis (HR=1.22; 95%CI:1.07-1.38, p=0.003) only in the unadjusted analysis, as it lost significance after adjustment for standard clinical and pathological variables. Greater numbers of TILs were observed in tumors harboring ARID1A, BRCA2, KMT2C and TP53 mutations, as well as chr3p21.31 and chr8q24.23 (PTK2) loss; whereas lower numbers were observed in tumors with ERBB3 mutations as well as chr7p and chr11q14.1 (PAK1) gains. There were no significant differences in the relative proportion of CD4+, CD8+ or CD19+ lymphocytes between ER-positive/HER2-negative lobular and ductal tumors.

Conclusion: In this work, which reports to our knowledge on the largest series of ILBC ever assessed for TILs, we showed that most ILBCs were characterized by low lymphocytic infiltration. Besides the association of TILs with clinical and pathological features of ILBC patients, we found that higher TIL levels were observed in the presence of specific mutations and copy number alterations. Higher numbers of TILs were associated with worse prognosis at the univariate analysis. Finally, based on the assessed markers, we have no evidence of differential lymphocytic composition between ER-positive/HER2-negative lobular and ductal tumors.

Citation Format: Desmedt C, Salgado R, Buisseret L, Zoppoli G, Fornili M, Van den Eynden G, Garaud S, Gundem G, Rothé F, Brown D, Kheddoumi N, Rouas G, Galant C, Bertucci F, Piccart M, Campbell P, Viale G, Larsimont D, Willard-Gallo K, Biganzoli E, Pruneri G, Sotiriou C. Lymphocytic infiltration in invasive lobular breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr S1-02.

Abstract P4-04-10: Early-stage breast carcinomas are infiltrated by oligoclonal T cell populations highly enriched relative to the blood

BACKGROUD: The immunogenicity of some human tumors towards T lymphocytes is well established. Recently, encouraging results have been obtained with immunotherapies inhibiting immune checkpoints in cancers such as melanoma, NSCLC and bladder cancer. Fewer studies explored these treatments in breast cancer (BC) as these tumors are often considered to be poorly immunogenic.

METHODS: We analysed the T cell receptor β-chains variable genes (TCRBV) repertoires of tumor-infiltrating T cells in 17 early BC. We looked for clonally amplified T cells as their presence is an expected consequence of tumor immunogenicity. RNA was extracted and reverse-transcribed from formalin-fixed, paraffin-embedded tumor tissues. A short random sequence was added to the cDNA and used as a unique molecular identifier (UMI) for each cDNA molecule. cDNA encoding TCRBV genes was then amplified and sequenced using high throughput sequencing. Usage of UMIs during this procedure strongly improved the accuracy of the analysis by avoiding amplification biases inherent to the construction of the TCRBV library and by allowing an absolute quantification of TCRBV mRNA molecules normalized with the RPP30 housekeeping gene. TCRBV sequences were aligned using IMGT/HighV-QUEST. The Simpson's index was used to evaluate TCRBV repertoires diversity (ranging from 0 = infinite diversity to 1 = no diversity). For 3 patients, the same procedure was applied on blood T cells collected a few days before tumor resection and the analysis was also carried out on 3 normal tissues obtained from breast reduction surgery.

RESULTS: T cell infiltration varied strongly from one tumor to another ranging from 5 to 2498 TCRBV/103 RPP30 mRNA molecules. TCRBV repertoires analysis indicated that infiltrated T cells corresponded to oligoclonal populations. We observed 3 clonotypes in the smaller repertoire and 74 in the largest one and the Simpson's index ranged from 0.01 to 0.65. Most tumors (16/17) contained at least one clonotype that made up ≥10% of the infiltrating T cells, with the highest observed proportions reaching 80%. Normal breast samples were infiltrated by a more diverse repertoire: 130 to 368 clonotypes were identified in those tissues and Simpson's index ranged from 0.002 to 0.008. Highest observed frequency among those clonotypes was 2%. For 3 BC patients, the frequencies of the most prevalent clonotypes in the tumor were compared to those of the same clonotypes in blood prior to surgery. These T cell clones were 250 to &gt;34000 times more frequent in the tumor than in the blood.

CONCLUSIONS: Some early BC are infiltrated by oligoclonal T cell populations that are highly enriched relative to the blood. Quantitative T cell repertoire analysis allows to distinguish 3 types of BC: (1) tumors without T cell infiltration, (2) tumors with a high T cell infiltration and a small T cell repertoire, and (3) tumors with a high T cell infiltration and a large repertoire. Our observations suggest that anti-tumor T cell responses are ongoing in some early BC and this warrants boosting such responses with immune checkpoint inhibitors in selected patients. T cell repertoire evaluation could be used as a predictive biomarker to identify patients who will benefit from this treatment.

Citation Format: Carrasco J, Schröder D, Coulie PG, Godelaine D, Berlière M, Theate I, Delrée P, Vannuffel P, Galant C, Duhoux FP, Machiels J-P, Canon J-L. Early-stage breast carcinomas are infiltrated by oligoclonal T cell populations highly enriched relative to the blood. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-04-10.

Abstract P4-04-08: Presence of tumor-specific cytolytic T cells in human primary breast carcinoma: Consequences for immunotherapy

Background: Immunotherapy through stimulatory antibodies targeting the CTLA-4 or PD-1 pathways has a clear clinical efficacy in a fraction of patients with various cancers. It is likely that the main immune effectors of these therapies are CD8+ cytolytic T lymphocytes (CTL) recognizing tumor-specific antigens. The antigenicity of human tumors has been demonstrated with studies conducted mostly on melanomas. However the genetic mechanisms leading to antigenicity, notably point mutations in the tumor cells, apply to all cancer types. Thus primary breast carcinoma cells do certainly bear tumor-specific antigens, even though the extent of this antigenicity is unknown. Most melanomas, which are highly antigenic tumors, are also immunogenic, i.e. they stimulate spontaneous anti-tumor CTL responses. This immunogenicity, of which the presence of tumor-infiltrating T cells (TILs) is probably a surrogate marker, might be a predictive marker for clinical benefit to immunostimulatory antibodies. Whether primary breast carcinomas are immunogenic is not known, mainly due the absence of autologous tumor cell lines to analyze patients' T cells. However even in the absence of T-cell aimed immunotherapy the amounts of TILs have been positively correlated with patients' survival. Here we wished to obtain evidence for the presence of tumor-specific CD8+ T cells in TILs from primary breast carcinomas.

Methods: From each tumor we isolated TILs and derived a random set of ±100 CD8+ clones maintained in culture by stimulation with anti-CD3 antibodies, thus irrespective of their antigenic specificity. We screened these clones for recognition of tumor-specific antigens present on the autologous tumor. In the absence of autologous tumor lines we restricted our analysis to mutated antigens selected on the basis of tumor exome sequencing and gene expression profiling. Indels and non-synonymous base substitutions were selected to synthesize candidate mutated peptides.

Results: Thus far we have analyzed two hormone receptor-positive HER2-negative primary carcinomas. For one patient we screened 144 T cell clones for recognition of 40 candidate mutated peptides, without any positive result. For the other patient, 6 out of 98 T cell clones recognized 4 out of 119 candidate mutated peptides. Two peptides were recognized by two different T cell clones, i.e. with different T cell receptor sequences. These 4 'antigenic' mutations appear to be passenger, i.e. the four genes have a low published mutation frequency.

Conclusions: We conclude that some human primary breast carcinomas are immunogenic, as one tumor contained at least 6% of tumor-specific T cells among the CD8+ TILs. It suggests that the corresponding patient could benefit from the currently used immunostimulatory antibodies. More work is required to understand the reasons for the negative results in the first patient. We are pursuing the work on 2 HER2-positive and 2 triple-negative tumors, in which TILs are better correlated with prognosis. Our results warrant more investigations on the activation or inhibition of tumor-specific T cells at early stages of human breast cancer development.

Citation Format: Schröder DJ, Bricard O, Hames G, Remy N, Carrasco J, Canon J-L, Berlière M, Galant C, Coulie PG. Presence of tumor-specific cytolytic T cells in human primary breast carcinoma: Consequences for immunotherapy. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-04-08.

Solitary extramedullary plasmocytoma of the thyroid: a case report and histological approach to plasma cells infiltrate in the thyroid gland

BACKGROUND

Solitary extramedullary plasmacytoma (SEP) is a rare malignant neoplasm arising from plasma cells. SEP mostly occurs in the upper respiratory tract. Thyroid gland is rarely affected (<78 cases).

METHODS/RESULTS

We describe the case of a 78-year-old woman presenting a rapidly enlarging palpable thyroid mass. Neck computed tomography scan showed enlargement of both thyroid lobes. Laboratory tests were normal, including serum protein level with no monoclonal gamma globulin peak. Cytology was suspicious for lymphoma. Biopsy showed an infiltrating neoplasm composed of atypical tumor cells with abundant cytoplasm and eccentric nuclei. These revealed diffuse immunoreactivity for CD138 and predominant staining for immunoglobulin kappa light chains. Clinical workup for multiple myeloma was negative.

CONCLUSIONS

SEP should be considered in the differential diagnosis of a rapidly enlarging thyroid nodule and be distinguished from involvement of thyroid in multiple myeloma, mucosa-associated lymphoid tissue lymphoma, plasma cell granuloma and medullary carcinoma. Clinical correlation and immunohistochemistry are crucial in avoiding pitfalls.

Quality of pathology reporting is crucial for cancer care and registration: a baseline assessment for breast cancers diagnosed in Belgium in 2008

OBJECTIVES

Given the crucial role of pathology reporting in the management of breast cancers, we aimed to investigate the quality and variability of breast cancer pathology reporting in Belgium.

MATERIALS AND METHODS

Detailed information on non-molecular and molecular parameters was retrieved from the pathology protocols available at the Belgian Cancer Registry for 10,007 breast cancers diagnosed in Belgium in 2008.

RESULTS

Substantial underreporting was shown for several clinically relevant non-molecular parameters, such as lymphovascular invasion. High-volume laboratories performed only slightly better than others, and analyses at the individual laboratory level showed clear inter-laboratory variability in reporting for all volume categories. Information on ER/PR and HER2 IHC was mentioned in respectively 91.7% and 90.8% of evaluative cases. HER2 ISH data were available for 78.5% of the cases judged to be 2+ for HER2 IHC. For cases with different specimens analysed, discordance between these specimens was highest for HER2, followed by PR. For HER2, results obtained from different laboratories were even less concordant. In addition, inter-laboratory differences were noted in the used ER/PR scoring systems, the proportion of ER-/PR+ cases, and the relation between histological grade and ER/PR positivity. Data on Ki67 were only available for 43.8% of the investigated cases, and showed inconsistent use of cut-off values.

CONCLUSION

Breast pathology reporting in Belgium in 2008 was suboptimal and showed considerable inter-laboratory variability. Synoptic reporting has been proposed as a facilitator towards increased reporting quality and harmonization, but the lack of aligned informatics remains a major hurdle in its concrete implementation.

[Dynamic palatography: Diagnostic tool for dysfunc­tional swallowing? Feasibility study]

OBJECTIVE

Dysfunctional swallowing may cause transverse occlusal disorders. The speech re-education of dysfunctional swallowing aims to correct or prevent the recurrence of occlu­sal disorders. The main objective was to test the dynamic palato­graphy as a diagnosis and quantification tool of the dysfunctional swallowing.

MATERIAL AND METHODS

The study was prospective and descriptive. Twelve average 23.5 years old women with a clinical dysfunctional swallowing have been included between January and May 2014. None was aware of presenting an atypical swallowing or dento-facial dysmorphism of class II. The dynamic palatography device measured the pressure force of the language on the palate during the lingual rest, swallowing saliva and water. Parameters measured were the duration and magnitude of support of the tongue on the palate.

RESULTS

Dynamic palatography showed a trend to predominant anterior contact during rest position (25%), and lower position of the language with little contact during swallo­wing of saliva and water.

DISCUSSION

Palatography results are consistent with the clinical diagnostic criteria of atypical swallo­wing. Our palatography tool has the advantage of being unobtrusive in the mouth compared to other pre existing systems. This device should be tested on larger patient popu­la­tions and could enable monitore atypical swallowing rehabili­ta­tion efficiency. The palatography could complete the swallo­wing assessment and be a monitoring and rehabilitation tool in real time.

Charcot spinal arthropathy in a diabetic patient

We report a case of Charcot spinal arthropathy in a diabetic patient and emphasize the clinical reasoning leading to the diagnosis, discuss the differential diagnosis, and insist on the crucial role of the radiologist and pathologist which allows the distinction between Charcot spinal arthropathy and infectious or tumoural disorders of the spine.

[Study of tongue pressure on the hard palate during exercises of swallowing rehabilitation]

INTRODUCTION

The exercises performed during the reeducation of swallowing seek to improve forces of propulsion of the bolus and airway protection during the course of swallowing. The objective of this study was to objectify the effect of pronunciation praxis of posterior phonemes /aka/ and /akra/, and swallowing maneuvers (super-supraglottic swallow with or without superimposed effort swallowing effort) on the time of the oral swallowing.

MATERIALS AND METHODS

Four healthy volunteers participated in the experiment. They are called "experts" because they have a good knowledge of physiology and rehabilitation of swallowing. The dynamic palatography setup measured continuously the different pressures from the tongue on the hard palate through three force sensors arranged in a sagittal plane during the implementation of articulatory and swallowing tasks.

RESULTS

Articulatory praxis created significant pressure on the posterior sensor for 2 of the 4 subjects. All the swallowing maneuvers increased the contact pressure and the contact duration compared to the control swallowing for the anterior and posterior pressure sensor. A large inter-individual variability was found.

CONCLUSION

The complexity of instruction, the inter-individual variability in their performance, and the non-invasive nature of the instrument make the dynamic palatography a potentially useful tool in routine practice of swallowing reeducation.

Unusual cause of severe anaemia in a patient with metastatic haemangiopericytoma

Haemangiopericytoma is a rare tumor of vascular origin. We report the case of patient with severe refractory anaemia due to peripheral destruction of red blood cells by spleen metastases. Anaemia was successfully treated by splenectomy. Afterwards, our patient developed liver and lung metastases and was treated, in a clinical trial, with gefitinib that stabilised the disease during nine years. These interesting features are discussed.

Genomic grade adds prognostic value in invasive lobular carcinoma

BACKGROUND

The prognostic value of histologic grade (HG) in invasive lobular carcinoma (ILC) remains uncertain, and most ILC tumors are graded as HG2. Genomic grade (GG) is a 97-gene signature that improves the prognostic value of HG. This study evaluates whether GG may overcome the limitations of HG in ILC.

METHODS

Gene expression data were generated from frozen tumor samples, and GG calculated according to the expression of 97 genes. The prognostic value of GG was assessed in a stratified Cox regression model for invasive disease-free survival (IDFS) and overall survival (OS).

RESULTS

A total of 166 patients were classified by GG. HG classified 33 (20%) tumors as HG1, 120 (73%) as HG2 and 12 (7%) as HG3. GG classified 106 (64%) tumors as GG low (GG1), 29 (17%) as GG high (GG3) and 31 (19%) as equivocal (cases not classified as GG1 or GG3). The median follow-up time was 6.5 years. In multivariate analyses, GG was associated with IDFS [HR(GG3 vs GG1) 5.6 (2.1-15.3); P < 0.001] and OS [HR(GG3 vs GG1) 7.2, 95% CI (1.6-32.2); P = 0.01].

CONCLUSIONS

GG outperformed HG in ILC and added prognostic value to classic clinicopathologic variables, including nodal status.

Abstract P3-05-03: Characterization of PIK3CA mutations in lobular breast cancer

Background: Invasive lobular carcinoma (ILC) is the second most common breast cancer (BC) histotype, after invasive ductal carcinoma (IDC), representing ∼10-15% of the global BC population. The vast majority of ILC are estrogen receptor (ER)-positive. PIK3CA has been reported to be the most frequently mutated gene in ER-positive BC. However, until now PIK3CA mutations have mainly been described in IDC. In this study, we sought to characterize the type, prevalence, intra-patient (pt) mutational heterogeneity, and the association with transcriptomic phenotype and clinical outcome of PIK3CA mutations in ILC.

Methods: Gene expression data (HG-U133 Plus2.0) was generated from frozen samples of 116 ILC (primary tumors). For the same series, PIK3CA mutation profiling (Sequenom) was performed on at least 2 formalin-fixed paraffin embedded (FFPE) tissue blocks of the primary tumor for 102 cases, and on the only available block for the remaining 14 cases. Matched local recurrence (LR) and multiple metastatic (M) samples were also characterized for 3 and 8 pts respectively. For the transcriptomic and survival analyses, we evaluated the association between PIK3CA mutation status and gene signatures recapitulating important biological processes, and invasive disease-free & overall survival, respectively.

Results: PIK3CA mutations were detected in the primary tumor of 40/116 (35%) ILC pts: 14 (35%) mutations in the helical domain and 25 (62.5%) in the kinase domain. PIK3CA analysis in different blocks from the same primary tumors revealed a mutational heterogeneity in 7/102 (7%) cases. There was a discordance between primary and LR samples in 1/3 patients with LR, with a mutation reported in the primary but in not the LR. In 3/8 pts for which M samples were available, we observed intra-pt heterogeneity. In the first pt, a mutation in the kinase domain was reported only in 1/2 investigated blocks from the primary tumor, and in only 1/2 liver Ms. In the second pt, a mutation in the helical domain was found in the primary tumor and in the LR but not in the pleura M. In the third pt, although no mutation was observed in the primary tumor, a mutation in the helical domain was found in the M of the epiploon, but not in the Ms from the diaphragm or the ovary. Transcriptomic analyses revealed that primary tumors with a PIK3CA mutation in the helical domain were associated with increased levels of 2 stroma signatures (Bonferroni p-val: PLAU sign -Desmedt 2008–0.042 and DCN sign- Farmer 2009 – 0.048) compared to tumors without mutation. The survival analyses did not reveal any significant difference in survival between pts with and without a PIK3CA mutation.

Conclusions: This study represents the largest series described so far which investigated PIK3CA mutations in ILC. The incidence of PIK3CA mutations reported here is similar to the one reported for IDC. The investigation of multiple tumor samples per pt revealed intra-tumor as well as primary/recurrence heterogeneity. To get a definitive answer on the prognostic role of PIK3CA mutation in ILC, we are currently performing a PIK3CA mutation profiling study (Sequenom) on a series of ∼1000 consecutive ILC with long-term follow up (Iorfida et al. 2012); results will be available by SABCS2012.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-05-03.

Influence of phonetic context on the dysphonic event: contribution of new methodologies for the analysis of pathological voice

Widely studied in terms of perception, acoustics or aerodynamics, dysphonia stays nevertheless a speech phenomenon, closely related to the phonetic composition of the message conveyed by the voice. In this paper, we present a series of three works with the aim to understand the implications of the phonetic manifestation of dysphonia. Our first study proposes a new approach to the perceptual analysis of dysphonia (the phonetic labeling), which principle is to listen and evaluate each phoneme in a sentence separately. This study confirms the hypothesis of Laver that the dysphonia is not a constant noise added to the speech signal, but a discontinuous phenomenon, occurring on certain phonemes, based on the phonetic context. However, the burden of executing the task has led us to look to the techniques of automatic speaker recognition (ASR) to automate the procedure. With the collaboration of the LIA, we have developed a system for automatic classification of dysphonia from the techniques of ASR. This is the subject of our second study. The first results obtained with this system suggest that the unvoiced consonants show predominant performance in the task of automatic classification of dysphonia. This result is surprising since it is often assumed that dysphonia occurs only on laryngeal vibration. We started looking for explanations of this phenomenon and we present our assumptions and experiences in the third work we present.

P1-02-05: Invasive Lobular Carcinoma – A Luminal Breast Cancer Histotype Enriched for Epithelial-to-Mesenchymal Transition Features

Background: Invasive lobular carcinoma (ILC) represent the second most common breast cancer (BC) histotype, but little information is available about its molecular features. We sought to perform a comprehensive molecular classification of ILC and to investigate the molecular features that can differentiate ILC from invasive ductal carcinoma (IDC).

Methods: A consecutive series of 174 ILC tumors from three different centers with mininum 5-year follow-up was selected. Gene expression data were generated using Affymetrix U133 Plus 2.0 arrays. Data were analyzed by using frozen robust multiarray analysis (Matthew et al. 2009). ILC tumors were classified into BC molecular subtypes using the PAM50 classifier. Invasive Disease Free Survival (IDFS) was defined as the interval between the date of surgery and the date of any invasive recurrence or death. Multivariate analyses for 10-y IDFS containing classical clinico-pathologic characteristics were performed for different gene signatures, which were scaled so that 2.5 and 97.5% percentiles equal −1 and 1. A cohort of 90 IDC tumor samples, normalised with the same method, was used to compare expression data between ILC and IDC.

Results: ILCs were mainly characterized as luminal A (LA: 76%, n=133) and luminal B (LB:; 20%, n=34) followed by a minority of HER2−positive (2%, n=3), basal (1%, n=2) and normal-like (1%, n=2) based on Perou's classification. LB had inferior 10-y IDFS than LA in univariate cox regression analysis (HR = 1.99, 95% CI, 1.08−3.67, p=0.026). The EMT gene module was significantly higher expressed in ILC as compared to IDC (p &lt; 0.001). Adjusted hazard ratios (HR) for different gene modules investigated are detailed in the table below.

Abstract P5-11-13: Tamoxifen and Ovarian Function

Background: to study and compare ovarian function (clinical and biological data) among premenopausal breast cancer patients receiving tamoxifen alone (group I) or tamoxifen following chemotherapy (group II), because some studies suggest that amenorrhea is an insufficient parameter to define menopausal status.

Material and methods: between 1999 and 2003, 138 premenopausal patients, treated for early breast cancer, were included: 68 patients in the group of tamoxifen alone and 70 patients in de group of tamoxifen administered after chemotherapy (6 cycles of FEC 100 on day 1 every 3 weeks -5 fluorouracil 500 mg/m2, epirubicin 100 mg/m2 and cyclophosphamide 500 mg/m2- or 4 cycles of EC on day 1 every 3 weeks -epiadriamycine 75 mg/m2, cyclophosphamide 500 mg/m2-). All patients had a confirmed premenopausal status (biological data) at the entry of the study. The median age in group I was 44.5 (36 to 48) and 42 in group II (35 to 47.5). In group I, all were stage I and in group II, 34 were stage I and 36 were stage II. They were followed prospectively every 3 months for 3 years: date about menses, physical examination and blood tests (LH, FSH, 17-bêta-estradiol). Vaginal echography was added every 6 months. After 3 years, prospective evaluation was closed. Retrospective evaluation of all data was performed in 2009.

Results: three patients were out of study in the group I and 2 were out of study in the group II. According to clinical data, patients were devided in 4 subgroups:

a: regular menses (≥10 cycles/year) b: spaniomenorrhea (5 to 9 cycles/year) c: severe spaniomenorrhea (1 to 4 cycles/year) d: complete amenorrhea.

The number of patients in each subgroup is respectively:

- For group I (65 patients): 3 (4%), 19 (29%), 38 (58%) and 5 (8%).

- For group II (68 patients): 2 (3%), 21 (30%), 38 (55%) and 7 (10%). The most interesting parameter to be studied wass the estradiol levels.

Median values of estrogen levels

For patients of subgroup a, tamoxifen mimicked an ovulatory cycle such as observed in patients receiving citrate of clomifen. For patients of subgroup b, the variations corresponded to nearly a normal ovulatory cycle. For patients of subgroups c and d, tamoxifen induced low levels of estradiol, LH and FSH, and very few variations. Estrogen levels did not to seem have an impact on disease free survival rate after 3 years of follow-up (100% in group I and 98.6% in group II and after 5 years (98.5% and 97%). In the two groups I and II, estrogen levels from patients of subgroups a and b were significantly higher than in subgroups c and d (p &lt; 0.001). Conclusion: amenorrhea is an insufficient parameter to define menopausal status of patients receiving tamoxifen. Low estradiol level must be coupled to other biological parameters to characterize endocrine status. These data are very important in the choice of endocrine therapy.

Validation of ThermoFisher's Papspin for human papillomavirus detection in cervicovaginal specimens using PCR with GP5+/GP6+ primers and the Hybrid Capture II assay

The present study aimed to validate ThermoFisher's (Thermo Fisher Scientific, Runcorn, Cheshire, UK) Papspin (PS) for human papillomavirus (HPV) testing by in-house PCR and by the Hybrid Capture II (HC2) assay and to compare the results with those obtained using Specimen Transport Medium (STM) (Digene Diagnostics, Gaithersburg, MD, USA). Forty-five patients underwent conization for known lesions ranging from atypical squamous cells of undetermined significance (ASC-US) with high-risk HPV (hr-HPV) to high-grade squamous intraepithelial lesion (H-SIL/CIN2+) or adenocarcinoma. Two negative controls were included: one patient with post-menopausal bleeding and another from whom an inflammatory cervical sample was taken without conization. Prior to conization, a gynaecologist collected two cervical samples, fixed in PS or STM, from each patient. All but four cases were tested for panHPV (GP5+/GP6+) and specific hr-HPV subtypes (HPV16, 18, 31,33) by PCR using both media and all were processed for HC2. This study demonstrates that both HPV detection techniques work with PS, showing a specificity of 78.3% for HC2 and 92.8% for PCR compared to 83.8% for HC2 and 92% for PCR using STM. The efficacy of detecting HPV in PS-preserved H-SIL/CIN2+ was very high (96% for PCR using PS and 86% for HC2 using PS), which was in the same range as for PCR using STM, and which was only slightly lower than for HC2 using STM (96% and 89%, respectively). The differences were not statistically significant. It is concluded that ThermoFisher's PS is a valid liquid-based cytology medium for cervical samples, convenient for HPV testing by PCR with GP5+/GP6+ primers and by the HC2 assay.

[Contribution of MRI for monitoring response to neoadjuvant chemotherapy in the management of breast cancer]

In the management of breast neoplasms, two breast MR examinations are performed, one before initiation of neoadjuvant chemotherapy (NAC) and one at the end. However, a third MR exam may be performed between two courses of chemotherapy in order to assess tumor response to treatment. The assessment criterion currently used is measurement of tumor diameter according to RECIST (Response Evaluation Criteria In Solid Tumors) and WHO. But according to the preliminary results of the American College of Radiology Imaging Network protocol, using measurement of tumor volume as a reference may be valuable. Larger series are therefore necessary to estimate the value of diffusion MR, spectroscopy and diffusion studies.

Mixed origin of neovascularization of human endometrial grafts in immunodeficient mouse models

BACKGROUND

In vivo mouse models have been developed to study the physiology of normal and pathologic endometrium. Although angiogenesis is known to play an important role in endometrial physiology and pathology, the origin of neovasculature in xenografts remains controversial. The aim of this study was to assess the origin of the neovasculature of endometrial grafts in different mouse models.

METHODS

Human proliferative endometrium (n = 19 women) was grafted s.c. in two immunodeficient mouse strains: nude (n = 8) and severely compromised immunodeficient (SCID; n = 20). Mice were also treated with estradiol, progesterone or levonorgestrel. Fluorescence in-situ hybridization using a centromeric human chromosome X probe, immunohistochemistry (von Willebrand factor and collagen IV) and lectin perfusion were performed to identify the origin of the vessels.

RESULTS

More than 90% of vessels within xenografts were of human origin 4 weeks after implantation. Some vessels (9.67 +/- 2.01%) were successively stained by human or mouse specific markers, suggesting the presence of chimeric vessels exhibiting a succession of human and murine portions. No difference in staining was observed between the two strains of mouse or different hormone treatments. Furthermore, erythrocytes were found inside human vessels, confirming their functionality.

CONCLUSION

This article shows that human endometrial grafts retain their own vessels, which connect to the murine vasculature coming from the host tissue and become functional.

Development of an animal experimental model to study the effects of levonorgestrel on the human endometrium

BACKGROUND

This study was designed to develop an animal model to test the response of endometrium to local progestin delivery.

METHODS

Proliferative human endometrium was subcutaneously grafted in two groups of SCID mice that received, 2 days before, a subcutaneous estradiol (E(2)) pellet and, for half of them, an additional implant of levonorgestrel (LNG). Mice were sacrificed 1, 2, 3 or 4 weeks after endometrial implantation and grafts were histologically analysed. Proliferation, steroid hormone receptors, blood vessels and stromal decidualization in both groups (E(2) and LNG) were immunohistologically evaluated and compared with proliferative endometrium and endometrium from women with an LNG intrauterine device.

RESULTS

Grafts presented normal morphological endometrial characteristics. The expression of progesterone receptors was significantly decreased in glands and stroma of the LNG group as compared with the E(2) group at all times. A significant decrease was also observed in the stromal expression of estrogen receptor-alpha in the LNG group. At 4 weeks, the mean cross-sectional area of vessels was significantly higher after LNG treatment.

CONCLUSIONS

These morphological and immunohistochemical characteristics are similar to those observed in women treated with local LNG. This mouse model might facilitate further investigations needed to understand the mechanisms responsible for the breakthrough bleeding frequently observed in progestin users.

Menstrual activity of matrix metalloproteinases is decreased in endometrium regenerating after thermal ablation

BACKGROUND

Menstruation is associated with a striking increase in matrix metalloproteinase (MMP) activity. However, it is still unknown whether the level of MMP activity correlates with the amount of menstrual bleeding.

METHODS

We used histochemistry to investigate the degradation of the extracellular matrix (ECM), and immunohistochemical labelling and zymographic analysis to determine the level of expression and activity of MMP-2 and -9, and of their tissue inhibitors (TIMPs) -1, -2 and -3, in endometria sampled during menstruation in 14 women experiencing excessive menstrual bleeding and in 10 women successfully treated for menorrhagia by thermal ablation of the endometrium.

RESULTS

After thermal ablation, regenerated menstrual endometria showed reduced areas of collagen fibre lysis and increased content of TIMP-1 and TIMP-2 compared with endometria from non-treated menorrhagic women. Surprisingly, treated endometria contained more latent gelatinase A (proMMP-2) but a lower proportion of the active form of gelatinase B (MMP-9) than non-treated endometria.

CONCLUSIONS

These results suggest that ECM degradation is decreased at menstruation in the endometrium regenerated after thermal ablation, mostly because of an increased TIMP expression. This represents the first molecular explanation for the decreased amount of menstrual bleeding.

Simultaneous occurrence of metastatic breast cancer, Hodgkin's disease and tuberculous lymphadenitis in homolateral axillary lymph nodes--a case report

We report the case of a 78-year-old woman, presenting with enlarged axillary lymph nodes. Histological analysis of the lymph nodes demonstrated the co-existence of locally advanced breast carcinoma, scleronodular Hodgkin's disease and tuberculous lymphadenitis.The association of the 3 disorders in the same lymphatic region is unreported so far.

[Contribution of sonoelastography to the characterization of breast lesions]

We evaluate the performances of sonoelastography in the characterization of breast nodules with histologic correlation. Elastosonography was performed immediately after mode B sonography in 59 patients (65 nodules) by two radiologists, independently. All sequences of elastosonography were recorded. An intra and inter -observers correlation was calculated. Each nodule was classified with BI-RADS lexicon and with Ueno elastography classification. The scores 1-3 were considered as benign and 4-5 as malignant. A cytologic/histologic diagnosis was available for all nodules. At histology, 16 nodules were malignant and 49 nodules were benign. The intra and inter-observer correlations of elastosonography were excellent. The sensitivity, specificity, PPV, NPV of sonoelastography were 87.5%, 98%, 93.3%, 96%, respectively comparing with 100%, 93.9%, 84%, 100% of Mode B sonography. Thus, 95% (36/38 nodules) of BI-RADS 3 nodules were reclassified score 2 or 1 with elastosonography, decreasing the rates of fine needle aspiration and short-term follow-up. Elastosonography is a simple, rapid and complementary method to mode B sonography that can improve the specificity in the characterization of breast nodules and the management of BI-RADS 3 nodules, leading to a decrease of false-positive and short term follow-up rates.

Identification of distinct gene expression profiles in the synovium of patients with systemic lupus erythematosus

OBJECTIVE

Synovitis is a common feature of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), but the pattern of joint involvement differs in each disease. This study was undertaken to investigate the global gene expression profiles in synovial biopsy tissue from the swollen knees of untreated SLE patients (n = 6), RA patients (n = 7), and osteoarthritis (OA) patients (n = 6).

METHODS

Synovial biopsy samples were obtained from the affected knees of patients in the 3 groups by needle arthroscopy. Half of the material was used for extraction of total RNA, amplification of complementary RNA, and high-density oligonucleotide spotted hybridization arrays. On the remaining tissue samples, real-time reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemical experiments were performed to confirm the microarray data.

RESULTS

SLE synovial biopsy tissue displayed a significant down-regulation of genes involved in extracellular matrix (ECM) homeostasis and a significant up-regulation of interferon-inducible (IFI) genes. Real-time RT-PCR experiments confirmed the up-regulation of selected IFI genes (IFI27, IFI44, and IFI44L) in the SLE synovial tissue. Immunohistochemical analyses showed that 3 molecules involved in ECM regulation, chondroitin sulfate proteoglycan 2, latent transforming growth factor beta binding protein 2, and fibroblast activation protein alpha, were significantly down-regulated in SLE synovium. In contrast, immunostaining for IFI27, Toll-like receptor 4, and STAT-1 resulted in higher quantitative scores in SLE synovial tissue, which could be attributed to the fact that the RA samples had a large population of inflammatory cell infiltrates that were negative for these markers.

CONCLUSION

Arthritis in SLE has a very distinct molecular signature as compared with that in OA and RA, characterized by up-regulation of IFI genes and down-regulation of genes involved in ECM homeostasis.

Papillomatose juvénile mammaire

The authors report a patient with juvenile papillomatosis of the breast presenting with a palpable mass and illustrate the correlation between mammographic, sonographic and pathologic features.

Triphasic pattern in the ex vivo response of human proliferative phase endometrium to oestrogens

The aim of this study was to evaluate the ex vivo oestrogen responsiveness of human proliferative phase endometrium using short-term explant cultures. The effects of oestrogen (17beta-E2) on proliferation and the expression of oestrogen-responsive genes known to be involved in regulating endometrial function were evaluated. Three distinct response patterns could be distinguished: (1) the menstrual (M) phase pattern (cycle days 2-5), which is characterised by a complete lack in the proliferative response to 17beta-E2, while an increased expression of AR (2.6-fold, P<0.01), PR (2.7-fold, P<0.01) and COX-2 (3.5-fold, P<0.01) at the mRNA level was observed and a similar upregulation was also found for AR, PR and COX-2 at the protein level; (2) the early proliferative (EP) phase pattern (cycle days 6-10) with 17beta-E2 enhanced proliferation in the stroma (1.7-fold, P<0.05), whereas the expression of AR, PR and COX-2 were not affected at the mRNA and protein levels and ER-alpha mRNA and protein levels were significantly reduced by 17beta-E2; (3) the late proliferative (LP) phase pattern (cycle days 11-14), which is characterised by a moderate stimulation of proliferation (1.4-fold, P<0.05) and PR mRNA expression (1.7-fold, P<0.01) by 17beta-E2. In conclusion, three distinct response patterns to 17beta-E2 could be identified with respect to proliferation and the expression of known oestrogen-responsive genes in human proliferative phase endometrium explant cultures.

LH-RH agonists offer very good protection against the adverse gynaecological effects induced by tamoxifen

This study was initiated to evaluate the efficacy of luteinizing hormone-releasing hormone (LH-RH) agonists in protecting premenopausal patients against the adverse gynaecological effects induced by tamoxifen. Between January 1998 and January 2000, 85 premenopausal breast cancer patients were included in this prospective study. All were to receive LH-RH agonists and tamoxifen for a minimum of two years. All patients underwent a pretreatment gynaecological evaluation and annual follow-up. Bone density was also measured at the start of treatment and then after 2, 3 and 4 years. Pretreatment evaluation revealed 2 polyps. At one and two years of follow-up, no abnormal symptoms were noted and echographic findings were normal. At three years of follow-up, a polyp associated with adnexal masses was discovered. Histology revealed ovarian and endometrial metastases of infiltrating lobular breast carcinoma. Bone density evaluation after 2, 3 and 4 years of treatment showed no significant bone loss. LH-RH agonists offer safe protection against the gynaecological side-effects of tamoxifen in premenopausal breast cancer patients.