Abstract P4-10-01: High dose omega-3 fatty acid supplementation modulates breast tissue biomarkers in post-menopausal women at high risk for development of breast cancer

Background: We conducted a pilot study of high dose omega-3 fatty acid (FA) supplementation in post-menopausal women to determine if risk biomarkers for breast cancer in benign breast tissue sampled by random peri-areolar aspiration (RPFNA) could be favorably modulated and to acquire preliminary data on possible mechanism of action.

Methods: 35 post-menopausal women at increased risk for breast cancer were accrued to a trial of 6-month intervention with 4 g daily of omega-3-acid ethyl esters [1.86 g eicosapentaenoic acid (EPA), 1.5 g docosahexaenoic acid (DHA)]. Subjects had RPFNA performed pre- and post-intervention and specimens evaluated for cytomorphology and proliferation (Ki-67). FA composition was determined in plasma, red blood cells, and RPFNA specimens. Additional specimens were frozen for assessment of hormones, a panel of 11 adipokines and cytokines by Luminex, and gene expression.

Results: 34 subjects completed study with specimens evaluable for change in biomarkers. The ratio of (EPA+DHA):Arachidonic Acid (AA) levels in erythrocyte phospholipid increased significantly by a median of 2.7-fold. Although there was a significant decrease in blood EPA+DHA between discontinuation at 6 months and 2 weeks later when RPFNA was performed, all ratios were above the baseline value (median 1.6-fold). There was favorable but not statistically significant modulation for cytologic evidence of atypia (53% at baseline to 41% at off-study). However, favorable modulation was exhibited for Masood score (medians of 15 to 14; p = 0.014), number of epithelial cells recovered (p = 0.019) and Ki-67 expression (medians of 1.7% to 0.75%, p = 0.036, despite 8 subjects having no Ki-67 expression at baseline). Luminex assay of serum indicated a statistically significant increase (p = 0.003) for adiponectin and decrease (p = 0.016) for TNF-alpha between baseline and off-study. For RPFNA specimens, there was a significant decrease (P = 0.001) in MCP-1 levels adjusted for protein content. By ELISA, serum high molecular weight adiponection increased (p = 0.046) and molar ratio of IGF-1:IGFBP3 decreased (p = 0.006). Note that all analyses were exploratory and without correction for multiple analyses.

Conclusion: Favorable modulation of a variety of blood and tissue risk biomarkers, including cytomorphology and proliferation, along with good tolerability suggests that high dose omega-3 FA esters should be tested further in a placebo-controlled trial.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-10-01.

Abstract PD09-04: Weight Loss in Postmenopausal Women Is Associated with Modulation of Serum and Tissue Based Risk Biomarkers

Background

In a pilot study, a structured program of reduced energy diet, physical activity, and weekly group behavioral intervention with other high risk women was successful at producing a median 11% weight loss with at least a 5% weight loss in 88% of subjects. We evaluated the association of weight loss with changes in serum and breast tissue risk and mechanisms of action biomarkers. Methods

High risk postmenopausal women with BMI >25 kg/m2 had breast tissue harvested by random periareolar fine needle aspiration (RPFNA) before and after a 6-month energy balance intervention. Specimens were evaluated for biomarkers including cytomorphology, proliferation (immunocytochemical Ki-67), gene expression by RT-qPCR, and expression of cytokines and adpokines by Luminex assay. Fasting serum was assayed for insulin, glucose, adiponectin, leptin, high sensitivity CRP, IL-6, prolactin, SHBG, estradiol and testosterone using ELISA or Luminex.

Results

For 24 biomarker evaluable subjects, 21 had >5% weight loss (median = 11%). Cytologic atypia was present in 10/24 at baseline and 4/24 at 6 months (p=0.034). For 20 subjects with sufficient cells for assessment of Ki-67 at both times, median baseline Ki-67 was 0.7% and off study 0.3%, with a median change of -0.2% (p=0.19). Statistically significant changes (≥0.003; Wilcoxon) were observed for serum levels of adiponectin, adiponectin:leptin ratio, and SHBG (increases); and leptin, bioavailable estradiol and hsCRP (decreases). Reduction was also observed for insulin (p=0.018) and bioavailable testosterone (p=0.033). These results were duplicated (p≥0.014) by Luminex for adiponectin, leptin, adiponectin: leptin ratio, and insulin; plus hepatocyte growth factor (HGF, decrease). Also, an increase in the adiponectin:leptin ratio was observed for the RPFNA specimens (p=0.012). Gene expression (RT-qPCR) of pS2 was significantly modified (decrease, p=0.035). Further, the weight loss (expressed as relative change) was highly statistically correlated with change (relative) in serum leptin, adiponectin:leptin ratio, SHGB, and free estradiol; as well as with relative change in adiponectin:leptin ratio in RPFNA specimens. Conclusion

Weight loss in high risk postmenopausal women is accompanied by significant modulation of numerous serum and breast tissue-based biomarkers. For several risk and response biomarkers there is a significant correlation between change in the biomarker and the weight loss achieved. This suggests the possibility of identifying mechanisms of action and signaling pathways for dietary/energy balance interventions that may reduce risk for development of breast cancer.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD09-04.

Objective Spectral-Spatial Analysis of Random Periareolar Fine Needle Aspiration of Women at High Risk for Contralateral Breast Cancer

Background: Random periareolar fine needle aspiration (RPFNA) cytology coupled with the Gail risk model has been used to predict the short-term risk of breast cancer in high risk women. The cytomorphologic features of atypical epithelial cells obtained by RPFNA can be subtle and result in inter-observer diagnostic variability and decreased sensitivity. Spectral-spatial analysis (SSA) is a method for objective image analysis that uses both color and spatial information to classify features into user-defined groups. We use SSA to classify cell clusters from RPFNA specimens into objective categories and compare that result to the cytopathology interpretation, which is the current standard.Design:Cell clusters on Papanicolau stained cytology Thin Prep slides from 7 benign and 7 malignant (14 total) breast RPFNA specimen were used to generate image stacks with the CRI Nuance platform. The specimens were processed and stained in three separate cytopathology laboratories. To build the algorithmic model, image stacks were analyzed using a neural network-based artificial intelligence system now distributed commercially as the Inform system. We manually painted green and red indicating feature (malignant) versus non-feature/background (benign) cells, respectively. A diagnostic algorithmic solution was created to stratify the new images as percent pixels correctly assigned as “malignant”. The solution was tested against cell clusters from 53 high-risk RPFNA specimen stratified by an expert pathologist (CZ) into the 5 categories of benign, epithelial hyperplasia, borderline, atypical and malignant. The specimens were collected from the contra lateral breast of patients with mastectomies for invasive carcinoma. Although 14 of the 67 cases were reused, no cellular clusters used in the training set were included in the validation set. The cytopathologist diagnosis was used as the gold standard and binarized to designate malignant cases as 1 and benign 0. These were compared to the green pixel (malignant) percentage in each case processed by INform.Results: The SSA algorithm classified all 7 malignant cases concordantly with the pathologist. The remaining 60 cases were classified as benign. The ROC curve generated from the cases had an AUC of 0.974 and an accuracy of 79.1%. The sensitivity was 100% and the specificity 76.7%.Conclusions: Spectral-spatial analysis can objectively classify benign and malignant cell clusters in excellent concordance to an expert pathologist. The epithelial hyperplasia, borderline, and atypical categories were all classified as benign by this solution representing a weakness in the solution. However, since these classes are not definitive with respect to biological behavior, the algorithm was binarized as above. In the future, algorithms will be based on biologically proven classes toward the goal of more definitive classification. A mature version of this technology could allow much broader usage of RPFNA since it would no longer be solely dependent on expert cytopathology interpretation.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6001.

Short-term breast cancer prediction by random periareolar fine-needle aspiration cytology and the Gail risk model

BACKGROUND

: Biomarkers are needed to refine short-term breast cancer risk estimates from epidemiologic models and to measure response to prevention interventions. The purpose of our study was to determine whether the cytologic appearance of epithelial cells obtained from breast random periareolar fine-needle aspirates or molecular marker expression in these cells was associated with later breast cancer development.

METHODS

: Four hundred eighty women who were eligible on the basis of a family history of breast cancer, prior precancerous biopsy, and/or prior invasive cancer were enrolled in a single-institution, prospective trial. Their risk of breast cancer according to the Gail model was calculated, and random periareolar fine-needle aspiration was performed at study entry. Cells were characterized morphologically and analyzed for DNA aneuploidy by image analysis and for the expression of epidermal growth factor receptor, estrogen receptor, p53 protein, and HER2/NEU protein by immunocytochemistry. All statistical tests are two-sided.

RESULTS

: At a median follow-up time of 45 months after initial aspiration, 20 women have developed breast cancer (invasive disease in 13 and ductal carcinoma in situ in seven). With the use of multiple logistic regression and Cox proportional hazards analysis, subsequent cancer was predicted by evidence of hyperplasia with atypia in the initial fine-needle aspirate and a 10-year Gail projected probability of developing breast cancer. Although expression of epidermal growth factor receptor, estrogen receptor, p53, and HER2/NEU was statistically significantly associated with hyperplasia with atypia, it did not predict the development of breast cancer in multivariable analysis.

CONCLUSION

: Cytomorphology from breast random periareolar fine-needle aspirates can be used with the Gail risk model to identify a cohort of women at very high short-term risk for developing breast cancer. We recommend that cytomorphology be studied for use as a potential surrogate end point in prevention trials.

Breast cytology and biomarkers obtained by random fine needle aspiration: use in risk assessment and early chemoprevention trials

In a prospective pilot study, we performed breast fine needle aspirations (FNAs) on 224 high-risk and 30 low-risk women and analyzed these aspirates for cytologic changes and biomarker abnormalities of aneuploidy and overexpressed estrogen receptor (ER), epidermal growth factor receptor (EGFR), p53 and HER-2/neu. High-risk women had a first-degree relative with breast cancer (74%), prior biopsy indicating premalignant breast disease (25%), a history of breast cancer (13%), or some multiple of these risk factors (12%). Median ages of the high- and low-risk groups were 44 and 42, respectively. Seventy percent of high-risk and 17% of low-risk women had cytologic evidence of hyperplasia with or without atypia (P < .0001). Aneuploidy and overexpression of EGFR and p53 occurred in 27, 37, and 29% of high-risk subjects but only 0, 3, and 3% of low-risk subjects (P < .0023). Overexpression of ER and HER-2/neu occurred in 7 and 20% of high-risk women but in none of the low-risk subjects. Biomarker abnormalities were more frequent with increasing cytologic abnormality. Restricting the analysis to those 3 biomarkers most frequently overexpressed in the high-risk group (ploidy, EGFR, p53), 13% of high-risk women with normal cytology, 19% of high-risk women with epithelial hyperplasia, and 49% of high-risk women with hyperplasia with atypia had abnormalities of 2 or more of these 3 biomarkers (P = .00004). At a median follow-up of 32 months, four women have been diagnosed with invasive cancer and two with ductal carcinoma in situ (DCIS). Later detection of these neoplastic conditions was associated (P < or = .016) by univariate analysis with prior FNA evidence of hyperplasia with atypia; overexpression of p53 and EGFR; the modified Gail risk of breast cancer development at 10 years; and multiple biomarker abnormalities. By multivariate analysis, later detection of cancer was primarily predicted by the number of biomarker abnormalities in the 3-test battery (P = .0005) and secondarily by the Gail risk at 10 years (P = .0049). In turn, hyperplasia with atypia was associated with multiple biomarker abnormalities, particularly p53 and EGFR overexpression. Thus, hyperplasia with atypia and cytologic markers in breast FNAs have promise as risk predictors and as surrogate endpoint biomarkers for breast cancer chemoprevention trials.

Identification of a chemoprevention cohort from a population of women at high risk for breast cancer

In a prospective pilot study, we performed breast fine needle aspirations (FNAs) on 213 high-risk and 30 low-risk women and analyzed these aspirates for cytologic changes and biomarker abnormalities of aneuploidy and overexpressed estrogen receptor (ER), epidermal growth factor receptor (EGFR), p53 and HER-2/neu. High-risk women were those with a first degree relative with breast cancer (73%), prior biopsy indicating premalignant breast disease (26%), a history of breast cancer (13%), or some multiple of these risk factors (11%). Median ages of the high-risk and low-risk groups were 44 and 42, respectively. Sixty-three percent of the high-risk and 73% of the low-risk group were premenopausal. Sixty-eight percent of the high-risk and 17% of low-risk women had cytologic evidence of hyperplasia with or without atypia (P < .0001). Aneuploidy and overexpression of EGFR and p53 occurred in 25%, 36%, and 28% of high-risk subjects but in less than 4% of low-risk subjects (P < .0002). Overexpression of ER and HER-2/neu occurred in 8% and 19%, respectively of high-risk women; nc low-risk women had these abnormalities. Sixty-eight percent of high-risk women and 7% of low-risk women had abnormalities of one or more of these biomarkers exclusive of cytology. Thirty-one percent of high-risk women, but no low-risk women had abnormalities of two or more biomarkers (P = .0004). Biomarker abnormalities were more frequent with increasing cytologic abnormality. Eighteen percent of women with normal cytology, 29% of women with epithelial hyperplasia and 60% of women with hyperplasia with atypia had abnormalities of two or more biomarkers (P = .048 and < .0001, respectively). Restricting the analysis to those three biomarkers most frequently overexpressed in the high-risk group (ploidy, EGFR, p53), 13% of high-risk women with normal cytology, 20% of high-risk women with epithelial hyperplasia and 51% of high-risk women with atypical hyperplasia had abnormalities of 2 or more of these 3 biomarkers. At a median follow up of two years, 8 of 213 women have been diagnosed with in situ (n = 5) or invasive (n = 3) cancer. Later detection of neoplasia was associated with prior FNA evidence of atypical hyperplasia (P < .0001) and multiple biomarker abnormalities in the 5 test battery (P = .006) by univariate analysis. By multivariate analysis, development and/or detection of cancer was primarily predicted by atypical hyperplasia (P = .0047) and secondarily by multiple biomarker abnormalities (P = 0.021). Atypical hyperplasia, EGFR, and p53 in breast FNAs have promise as risk markers and as surrogate endpoint biomarkers for breast cancer chemoprevention trials.

Unusual CNS presentation of neuroblastoma

Neuroblastoma is a common tumor of childhood, usually occurring in children under 4 years of age [1]. We report a case of a 10-year old child who initially presented with a large calvarial mass representing a solitary site of metastasis from an occult adrenal neuroblastoma. The sunburst pattern of the calvarial metastasis noted in this case is rarely seen with neuroblastoma. The age of our patient, solitary focus of metastasis at presentation, and imaging appearance of the tumor are very uncommon findings of neuroblastoma.

Familial pulmonary lymphatic hypoplasia associated with fetal pleural effusions

Two siblings born with pleural effusions died of pulmonary insufficiency. The infant born with fetal hydrops at 30 weeks of gestational age lived 45 minutes. The lung weights were mildly hypoplastic on postmortem examination. The sibling, born at 37 weeks of gestational age lived 8 days. Postmortem lung weights were normal, but the infant had a congenital heart anomaly consisting of a complicated vascular ring. Morphometric analysis of both infants indicated relatively normal lungs except for interlobular septal lymphatic hypoplasia, apparently a specific, previously unrecognized cause of fetal pleural effusions.

Comparison between flow cytometric and cytogenetic tumor cell DNA content using a simple flow sample preparation method: ploidy comparison of 86 fresh pediatric tumors

A comparison of tumor ploidy by flow cytometry (FL) and cytogenetics (CYG) was made in 86 fresh pediatric solid (n = 47) and hematopoietic (n = 39) tumors using simple sampling and semiautomated proprietary FL preparation methods and defined histogram interpretive criteria. Tumor karyotypes with 44-48 chromosomes were regarded as CYG diploid and other chromosomal complements CYG aneuploid for comparison purposes. Five histograms were uninterpretable and nine cases failed to produce 15 or more metaphases for karyotyping. Mean G0/G1 peak coefficients of variation of all 86 cases were 2.7 and 3.0 for the diploid and aneuploid populations, respectively. Of the 72 eligible cases, 41 were concordant diploid and 16 concordant aneuploid with an overall concordance of 79%. The DNA index and karyotypic index correlation coefficient was 0.92 for the 16 concordant aneuploid cases. Analysis of the 15 discordant cases highlights the limitations of both methods and of the histogram interpretive criteria and indicates that FL is probably more sensitive for detection of tumor aneuploidy as defined and detected by these methods.

Grasp biopsy, suction biopsy, and clinical history in the evaluation of esophagitis in infants 0-6 months of age

Fifty-three infants 0-6 months of age with abnormal 24-h intraesophageal pH monitoring were evaluated by esophageal suction biopsies and endoscopic grasp biopsies. Histologic esophagitis was present in 30% of the infants. Of the infants with esophagitis, 88% were accurately identified by suction biopsy, and 75% were accurately identified by endoscopic grasp biopsy. Suction biopsy alone was not significantly different from combined grasp and suction biopsy, while differences between grasp biopsy and combined biopsy approached significance (p = 0.051). Twelve clinical symptoms and 21 intraesophageal pH monitoring parameters were evaluated for their ability to predict esophagitis, and none were found to be useful. We conclude that endoscopic esophageal biopsy, while more costly, offers no advantage over suction biopsy for the detection of esophagitis in young infants.

Prevalence of aneuploidy, overexpressed ER, and overexpressed EGFR in random breast aspirates of women at high and low risk for breast cancer

Breast tissue biomarkers which accurately predict breast cancer development within a 10 year period in high risk women are needed but currently not available. We initiated this study to determine 1) the prevalence of one or more breast tissue abnormalities in a group of women at high risk for breast cancer, and 2) if the prevalence of biomarker abnormalities is greater in high risk than in low risk women. Eligible high risk women were those with a first degree relative with breast cancer, prior breast cancer, or precancerous mastopathy. Low risk women were those without these or other major identifiable risk factors. Ductal cells were obtained via random fine needle aspirations and cytologically classified. Biomarkers included DNA ploidy, estrogen receptor (ER), and epidermal growth factor receptor (EGFR). The prevalence of DNA aneuploidy was 30%, overexpression of ER 10%, and overexpression of EGFR 35%, in the 206 high risk women whose median 10 year Gail risk (projected probability) of developing breast cancer was 4.5%. The prevalence of aneuploidy and overexpressed EGFR was significantly higher in the high risk women than in the 25 low risk controls (p < 0.002), whose median 10 year Gail risk was 0.7%. The difference in the prevalence of ER overexpression between high and low risk groups was not statistically significant (p = 0.095). This may be due to the low prevalence of overexpressed ER and the small number of controls. A significant difference was noted in the prevalence of one or more abnormal biomarkers between the high risk and low risk women (p < 0.001). A large prospective trial is needed to determine if one or more of these biomarkers, is predictive of breast cancer development.

Biomarker and cytologic abnormalities in women at high and low risk for breast cancer

Fine needle aspirates (FNA) from 106 high-risk women and 25 low-risk women were evaluated for overexpression of estrogen receptor (ER), epidermal growth factor receptor (EGFR), mutant p53, and HER-2/neu by immunocytochemistry, and for aneuploidy by image analysis. Aspirates were also classified cytologically as normal, apocrine metaplasia, epithelial hyperplasia (EH), or dysplasia. High-risk women were those with a first-degree relative with breast cancer (76%), precancerous breast disease (26%), prior cancer of the contralateral breast (9%), or multiple abnormalities (11%). Low-risk women had none of the above risk factors, nor a prior breast biopsy or clinical evidence of fibrocystic disease. The median 10-year Gail risk for the high-risk group was 4%, compared to 0.7% for the low-risk group. There were significant differences (p < 0.01) between high- and low-risk women in the prevalences of hyperplasia (55% versus 12%), dysplasia (19% versus 0%), aneuploidy (32% versus 0%), overexpressed EGFR (32% versus 4%), and overexpressed p53 (29% versus 4%). The prevalence of multiple biomarker abnormalities was also greater in high-risk than in low-risk women (28% versus 0%; p < 0.01). Four percent (4%) of FNAs from high-risk women with normal cytology, 29% of aspirates with hyperplastic cytology, and 60% of those with dysplasia were associated with two or more biomarker abnormalities. The differences in the prevalence of multiple biomarker abnormalities among various cytologic categories were statistically significant (p = 0.02, normal versus EH; p = 0.02, EH versus dysplasia; p < 0.01, normal versus dysplasia).(ABSTRACT TRUNCATED AT 250 WORDS)