Vitamin D Levels in Newly Diagnosed Breast Cancer Patients according to Tumor Sub-Types

Vitamin D is an important regulator of bone health. In addition, as a ligand for a nuclear receptor expressed in breast cancer cells, vitamin D exerts neoplasia modulating effects in breast cancer. However, despite extensive investigations, associations of vitamin D levels with breast cancer patient characteristics and disease sub-types are conflicting. A retrospective review of medical records of consecutive breast cancer patients treated and followed in a single cancer center was undertaken. All patients with 25-hydroxyvitamin D (25-OHD, the circulating form of vitamin D) measurements available within 3 months of their diagnosis and before the start of any systemic treatment were included. Characteristics of patients and tumors with sufficient levels of 25-OHD were compared with those of patients with 25-OHD insufficiency. Two hundred ninety-two patients were included in the study. Almost two-thirds of the patients were 25-OHD insufficient, defined as having 25-OHD levels below 75 nmol/L. Compared with the group of patients who were 25-OHD sufficient, patients with 25-OHD insufficiency were younger and more often obese. Tumors of patients with 25-OHD insufficiency were more often ductal, of higher grade, and ER negative. 25-OHD insufficiency is prevalent in breast cancer patients and even more prevalent in younger and obese patients. 25-OHD insufficiency is associated with cancers that have aggressive characteristics, including higher grade and ER negativity.

The Clonal Relationship Between the Ductal and Lobular Components of Mixed Ductal-Lobular Carcinomas Suggested a Ductal Origin in Most Tumors

The relationship between the ductal and lobular components of invasive ductolobular carcinomas (IDLC) has not been fully elucidated. In this study, the molecular alterations of both components were analyzed in a series of 20 IDLC that were selected, not only by morphologic criteria, but also by the loss of E-cadherin expression in the lobular component. We found that 80% of tumors shared alterations of driver genes in both components, being PIK3CA the most common alteration. In addition, 45% of IDLC carried CDH1 mutations in their lobular component that were absent in the ductal component. Fluorescent in situ hybridization analysis of the CDH1 gene excluded homozygous CDH1 loss as a frequent cause of E-cadherin loss in tumors without CDH1 mutations. In addition, no pathogenic mutations of catenin genes were detected in this series of tumors. In 25% of tumors, actionable mutations in PIK3CA , AKT1 , and ERBB2 were found in only 1 component. Altogether, our results confirm that most IDLC derive from invasive carcinoma of no special type, in which a population of cells lose E-cadherin and acquire a lobular phenotype. The frequency of CDH1 mutations in IDLC appears to be lower than in conventional invasive lobular carcinomas, suggesting the implication of alternative mechanisms of E-cadherin loss. Moreover, molecular heterogeneity between ductal and lobular areas suggests the need for molecular characterization of both components to guide targeted therapies.

Primary Tumour Type, Clinical Features, Treatment and Outcome of Patients with Iris Metastasis

PURPOSE

To describe the primary tumour type, clinical features, treatment and outcome of patients with Iris metastasis.

METHODS

Retrospectively analyzed articles published from 1934 to 2019 in the PubMed database.

RESULTS

In total, 133 eyes of 125 patients with iris metastatic carcinoma were retrieved. The average age at metastasis diagnosis of the patients was 56 ± 15 years; 60 left eyes and 49 right eyes were involved. The most common primary tumors were lung carcinoma (42%) and breast carcinoma (15%). Approximately one-third of the patients were first diagnosed in the ophthalmology department before the primary tumor was detected. Twenty-two percent of iris metastases were discovered before and 33% were discovered after systemic metastasis. The most common complaints were blurred vision and pain. The clinical features included iris masses, neovascularization and keratic precipitates. 57 patients (64%, N = 90) had an elevated intraocular pressure. Local administration of radiation therapy or intraocular injections of anti-VEGF drugs relieved eye discomfort and controlled the high intraocular pressures.

CONCLUSIONS

Iris nodules with increased intraocular pressure and neovascularization may indicate iris metastasis. Lung cancer is the most common primary tumor.

Solitary Dilated Ducts Revisited: Malignancy Rate and Implications for Management

RATIONALE AND OBJECTIVES

A solitary dilated duct (SDD) is a single asymmetrically dilated breast duct with diameter more than 2 mm. The Breast Imaging Reporting and Data System (BI-RADS) fifth edition recommends additional imaging and biopsy for SDDs without demonstrated benign etiology, however management of this rare entity remains controversial. This study describes practice patterns, malignancy rate, and features associated with high-risk/malignant SDDs to better stratify patients requiring biopsy versus follow-up.

MATERIALS AND METHODS

This IRB-approved retrospective study identified mammographic, sonographic and MRI exams utilizing the term "solitary dilated duct" at a multisite academic institution between 1/1/2010 and 12/31/2020. Clinical and imaging features, BI-RADS assessments, and outcomes were analyzed. Univariate and multivariate analyses identified predictors of high-risk/malignant histology.

RESULTS

SDDs identified in 49 women (mean age 56.1 years) were assessed as BI-RADS 4/5 (31/49, 63%), BI-RADS 3 (9/49, 18%), or BI-RADS 2 (9/49, 18%). Most sampled lesions were benign (16/31, 52%) and the remaining were high-risk (15/31, 48%, all papillary lesions). The only papilloma with atypia on core biopsy upgraded to grade 2 DCIS on excision (malignancy rate 1/49, 2%). All anechoic SDDs were benign (n=13), and all benign SDDs lacked internal vascularity. SDDs with associated masses were associated with malignant/high-risk outcomes on multivariate analysis (p < .001).

CONCLUSION

The BI-RADS fifth edition recommends biopsy for SDDs without demonstrated benign etiology. In our 11-year study period, practice patterns were variable with a low malignancy rate of 2%. Our findings suggest that anechoic SDDs may be followed, and SDDs with associated masses or internal vascularity require biopsy.

Axillary Staging after Neoadjuvant Chemotherapy for Initially Node-Positive Breast Carcinoma in Germany: Initial Data from the AXSANA study

Introduction To date, the optimal axillary staging procedure for initially node-positive breast carcinoma patients after neoadjuvant chemotherapy (NACT) has been unclear. The aim of the AXSANA study is to prospectively compare different surgical staging techniques with respect to the oncological outcome and quality of life for the patients. Little is known about current clinical practice in Germany. Material and Methods In this paper we analyzed data from patients enrolled in the AXSANA study at German study sites from June 2020 to March 2022. Results During the period under investigation, 1135 patients were recruited at 143 study sites. More than three suspicious lymph nodes were initially found in 22% of patients. The target lymph node (TLN) was marked in 64% of cases. This was done with clips/coils in 83% of patients, with magnetic seeds or carbon suspension in 8% each, and with a radar marker in 1% of patients. After NACT, targeted axillary dissection (TAD) or axillary lymphadenectomy (ALND) were each planned in 48% of patients, and sentinel lymph node biopsy alone (SLNB) in 2%. Clinically, the nodal status after NACT was found to be unremarkable in 65% of cases. Histological lymph node status was correctly assessed by palpation in 65% of patients and by sonography in 69% of patients. Conclusion At the German AXSANA study sites, TAD and ALND are currently used as the most common surgical staging procedures after NACT in initially node-positive breast cancer patients. The TLN is marked with various markers prior to NACT. Given the inadequate accuracy of clinical assessment of axillary lymph node status after NACT, it should be questioned whether axillary dissection after NACT should be performed based on clinical assessment of nodal status alone.

A Score to Predict the Malignancy of a Breast Lesion Based on Different Contrast Enhancement Patterns in Contrast-Enhanced Spectral Mammography

Background: To create a predictive score of malignancy of a breast lesion based on the main contrast enhancement features ascertained by contrast-enhanced spectral mammography (CESM). Methods: In this single-centre prospective study, patients with suspicious breast lesions (BIRADS > 3) were enrolled between January 2013 and February 2022. All participants underwent CESM prior to breast biopsy, and eventually surgery. A radiologist with 20 years’ experience in breast imaging evaluated the presence or absence of enhancement and the following enhancement descriptors: intensity, pattern, margin, and ground glass. A score of 0 or 1 was given for each descriptor, depending on whether the enhancement characteristic was predictive of benignity or malignancy (both in situ and invasive). Then, an overall enhancement score ranging from 0 to 4 was obtained. The histological results were considered the gold standard in the evaluation of the relationship between enhancement patterns and malignancy. Results: A total of 321 women (median age: 51 years; range: 22−83) with 377 suspicious breast lesions were evaluated. Two hundred forty-nine lesions (66%) have malignant histological results (217 invasive and 32 in situ). Considering an overall enhancement score ≥ 2 as predictive of malignancy, we obtain an overall sensitivity of 92.4%; specificity of 89.8%; positive predictive value of 94.7%; and negative predictive value of 85.8%. Conclusions: Our proposed predictive score on the enhancement descriptors of CESM to predict the malignancy of a breast lesion shows excellent results and can help in early breast cancer diagnosis and in avoiding unnecessary biopsies.

Breast Carcinoma with a Special Histological Pattern of Sebaceous Differentiation and High-Frequency Microsatellite Instability: A Case Report and Review of the Literature

The World Health Organization in its 2019 Classification of Breast Tumors termed breast sebaceous carcinoma as invasive breast carcinoma of no special type (IBC-NST), with a sebaceous pattern. Approximately 30 cases of IBC-NST with a sebaceous pattern have been reported in the literature, and in all cases the expression of mismatch repair proteins in tumors was normal. Here, we report a case of IBC-NST with a sebaceous pattern and high-frequency microsatellite instability (MSI-H). This case was a sporadic sebaceous pattern of IBC-NST with MSI-H and was unrelated to Muir-Torre syndrome. Its histopathological characteristics were similar to those of MSI-H-associated triple-negative breast carcinoma (TNBC) with a high histological grade but were without tumor-infiltrating lymphocytes (TILs). The tumor did not recur after 20 months of follow-up.

Nasopharyngeal Metastasis from Breast Carcinoma: A Case Report and a Review of the Literature

Metastasis to the nasopharynx is a rare clinical entity. Breast carcinoma is one of the primary tumors that can be responsible for a nasopharyngeal metastasis, which is an extremely rare occurrence. We report the case of a 50-year-old woman with a history of a confirmed breast carcinoma under chemotherapy who presented to our department with a unilateral hearing loss and tinnitus. Nasal endoscopy revealed a small bulging mass at the posterior wall of the nasopharynx. The biopsy of the lesion showed an infiltration of the nasopharyngeal mucosa by a mammary adenocarcinoma that was positive for estrogen and progesterone receptors and negative for human epidermal growth factor receptor 2. Computed tomography scan revealed a thickening of the nasopharyngeal mucosa, a pleural and pericardial effusion and diffused secondary bone lesions. The patient received chemotherapy. Control revealed a partial regression of the nasopharyngeal mass. The patient is still under chemotherapy.

Early onset, delayed diagnosis and laterality of breast carcinoma: Evidence from a tertiary care hospital

Objectives:

To assess age at onset, delayed diagnosis and laterality of breast carcinoma among women at Debre Markos Comprehensive Specialized Hospital, North West Ethiopia.

Methods:

Hospital-based descriptive study was conducted on 120 breast carcinoma cases at pathology department of Debre Markos Comprehensive Specialized Hospital, from October 2019 to December 2021. The women aware of symptoms until first medical consultation time was asked. The height and weight of the women were measured using the height and weight scale. The attending physician examined both breasts and regional lymph nodes. Pathological features of breast carcinomas were recorded when biopsy results arrived at the pathology department. Data were entered in Epi data version 3.1. Then, it was exported to SPSS version 25.0 statistical software for analysis.

Results:

Mean age of women was 39.9 ± 11.6 years, and median age was 38 years. Most women, 87 (72.5%) were aged less than 46 years. One hundred three (85.8%) women had complained breast lump pain for greater than 3 months before diagnosis. About 61 (50.8%) women had left breast carcinomas; 44 (36.7%) had right breast carcinomas and 15 (12.5%) had bilateral breast carcinomas. Of total, 53 (44.2%) cases were invasive ductal carcinomas; 41 (34.2%) had ductal carcinoma in situ; 14 (11.7%) were invasive lobular carcinomas; 8 (6.7%) were lobular carcinoma in situ and only 4 (3.3%) cases were mixed carcinomas.

Conclusion:

In this study, about two-third of the cases had early onset breast carcinoma. Most of the cases had delayed diagnosis of breast carcinoma. More than half of the cases had left breast carcinoma.

Two new cytotoxic tetralin derivatives from Panicum turgidum

Two new tetralin compounds were isolated from the aerial parts of Panicum turgidum Forssk. Their structures were elucidated by comprehensive 1 D and 2 D NMR experiments as well as high resolution ESI mass spectrometry. In addition, these two compounds have been tested for in vitro cytotoxicity against SKOV3 (Ovarian Carcinoma) and BT-549 (Breast Carcinoma). Compound 1 showed good cytotoxic activities against SKOV3 and BT 549 with IC₅₀ value of 5.65 ± 0.31 and 10.3 ± 0.56 µg/mL, respectively.

Radiomics Based on DCE-MRI Improved Diagnostic Performance Compared to BI-RADS Analysis in Identifying Sclerosing Adenosis of the Breast

Purpose

Sclerosing adenosis (SA) is a benign lesion that could mimic breast carcinoma and be evaluated as malignancy by Breast Imaging-Reporting and Data System (BI-RADS) analysis. We aimed to construct and validate the performance of radiomic model based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) compared to BI-RADS analysis to identify SA.

Methods

Sixty-seven patients with invasive ductal carcinoma (IDC) and 58 patients with SA were included in this retrospective study from two institutions. The 125 patients were divided into a training cohort (n= 88) from institution I and a validation cohort from institution II (n=37). Dynamic contrast-enhanced sequences including one pre-contrast and five dynamic post-contrast series were obtained for all cases with different 3T scanners. Single-phase enhancement, multi-phase enhancement, and dynamic radiomic features were extracted from DCE-MRI. The least absolute shrinkage and selection operator (LASSO) logistic regression and cross-validation was performed to build the radscore of each single-phase enhancement and the final model combined multi-phase and dynamic radiomic features. The diagnostic performance of radiomics was evaluated by receiver operating characteristic (ROC) analysis and compared to the performance of BI-RADS analysis. The classification performance was tested using external validation.

Results

In the training cohort, the AUCs of BI-RADS analysis were 0.71 (95%CI [0.60, 0.80]), 0.78 (95%CI [0.67, 0.86]), and 0.80 (95%CI [0.70, 0.88]), respectively. In single-phase analysis, the second enhanced phase radiomic signature achieved the highest AUC of 0.88 (95%CI [0.79, 0.94]) in distinguishing SA from IDC. Nine multi-phase radiomic features and two dynamic radiomic features showed the best predictive ability for final model building. The final model improved the AUC to 0.92 (95%CI [0.84, 0.97]), and showed statistically significant differences with BI-RADS analysis (p<0.05 for all). In the validation cohort, the AUC of the final model was 0.90 (95%CI [0.75, 0.97]), which was higher than all BI-RADS analyses and showed statistically significant differences with one of the BI-RADS analysis observers (p = 0.03).

Conclusions

Radiomics based on DCE-MRI could show better diagnostic performance compared to BI-RADS analysis in differentiating SA from IDC, which may contribute to clinical diagnosis and treatment.

Effect of Mastectomy Flap Fixation on Post-operative Fluid Drainage and Seroma Formation in Breast Cancer Patients A Double-blinded Randomised Control Trial

&lt;b&gt; Introduction:&lt;/b&gt; Post-operative seroma formation is one of the most common complications following modified radical mastectomy (MRM). Quilting is a technique where the mastectomy flaps are sutured to the underlying chest wall muscles with sutures, obliterating the dead space. The authors hypothesised that post-mastectomy dead space obliteration by intermittent mastectomy flap fixation leads to decreased drain output and seroma formation. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Material and methods: &lt;/b&gt; A double-blinded randomised control trial with two arms was conducted from November 2019 to March 2021 in our institute located in India. Patients with non metastatic breast carcinoma planned for MRM were randomly categorised into two groups of 35 patients each. In the test group, each flap was fixed to the underlying muscle using four intermittent 3-0 polyglactin sutures, which was followed by skin closure, and only skin closure was done in the control group. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; The test and control groups did not differ significantly with respect to demographic and tumour characteristics. The average drain output of the test group (155.43 ml) was significantly less than of the control group (206.29 ml). The overall incidence of seroma formation is lower in the test group (5.7%) when compared to the control group (28.6%). The duration of hospital stay in the test group (4.63 days) was significantly shorter when compared to the control group (6.66 days). There was no significant increase in the overall operating time or complications like surgical site infection or skin dimpling due to flap fixation. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusions:&lt;/b&gt; Fixation of MRM flaps is associated with better post-operative outcomes related to drain output and seroma formation without a significant increase in other morbidities or usage of resources.

PD-L1 (SP142 and 22C3) Immunohistochemistry in Clinical Metastatic Triple Negative or Low Hormone Receptor Breast Carcinomas: Experience from a Large Academic Institution

The discovery of new immune checkpoint molecules has led to the emergence of new treatment for metastatic breast carcinoma. We aimed to investigate PD-L1 (SP142 and 22C3) expression in 77 clinical metastatic triple negative or low hormone receptor (<10%) breast carcinomas (TNBC/LHRBC). SP142 was positive in 23.4% (18/77) of cases. SP142 positive (SP142+) cases showed lower liver metastasis and androgen receptor expression, but increased tumor infiltrating lymphocytes than SP142 negative (SP142-) cases in univariate analysis, but only increased tumor infiltrating lymphocyte in multivariate analysis. 22C3 testing was available in 21 cases including 14 with combined positive score (CPS) ≥10 (9 SP142- and 5 SP142+) and 7 with CPS <10 (7 SP142-). Ten (13%) patients received immunotherapy including 8 SP142+ (7 with atezolizumab, 1 with pembrolizumab) and 2 SP142- cases (2 with pembrolizumab). Survival data showed a trend of increased survival rate in SP142+ (72.2%) when comparing to SP142- patients (55.9%). Our study provides unique insights into the distribution of PD-L1 staining in metastatic breast carcinomas in a real-world clinical setting.

Role of MicroRNA-31 (miR-31) in Breast Carcinoma Diagnosis and Prognosis

BACKGROUND/AIM

Breast cancer (BC) is among the most widespread malignant tumors in women. In the current study, we evaluated the role of miR-31 in BC patients and its relation to the different prognostic, clinical, and pathological features.

PATIENTS AND METHODS

MiR-31 levels were determined by RT-PCR in BC and adjacent normal breast tissues from 100 BC patients. BC diagnosis was established through histopathological examinations. The expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) receptor in all tumors was determined using immunohistochemistry.

RESULTS

MiR-31 expression was reduced in BC tissues relative to adjacent healthy breast tissue (mean levels were 0.93 and 7.2, respectively). Also, the low expression of miR-31 in BC patients was significantly correlated with adverse clinical and pathological features such as: young patient's age, premenopausal status, infiltrative lobular carcinoma, ER and PR negative tumors, HER2 positive tumors, and advanced clinical stage.

CONCLUSION

MiR-31 was expressed at low levels in BC tissues and correlated with adverse clinical and pathological features, and poor survival.

The Divergent Effects of Ovarian Steroid Hormones in the MCF-7 Model for Luminal A Breast Cancer: Mechanistic Leads for Therapy

The growth modulating effects of the ovarian steroid hormones 17β-estradiol (E₂) and progesterone (PRG) on endocrine-responsive target tissues are well established. In hormone-receptor-positive breast cancer, E₂ functions as a potent growth promoter, while the function of PRG is less defined. In the hormone-receptor-positive Luminal A and Luminal B molecular subtypes of clinical breast cancer, conventional endocrine therapy predominantly targets estrogen receptor function and estrogen biosynthesis and/or growth factor receptors. These therapeutic options are associated with systemic toxicity, acquired tumor resistance, and the emergence of drug-resistant cancer stem cells, facilitating the progression of therapy-resistant disease. The limitations of targeted endocrine therapy emphasize the identification of nontoxic testable alternatives. In the human breast, carcinoma-derived hormone-receptor-positive MCF-7 model treatment with E₂ within the physiological concentration range of 1 nM to 20 nM induces progressive growth, upregulated cell cycle progression, and downregulated cellular apoptosis. In contrast, treatment with PRG at the equimolar concentration range exhibits dose-dependent growth inhibition, downregulated cell-cycle progression, and upregulated cellular apoptosis. Nontoxic nutritional herbs at their respective maximum cytostatic concentrations (IC₉₀) effectively increase the E₂ metabolite ratio in favor of the anti-proliferative metabolite. The long-term exposure to the selective estrogen-receptor modulator tamoxifen selects a drug-resistant phenotype, exhibiting increased expressions of stem cell markers. The present review discusses the published evidence relevant to hormone metabolism, growth modulation by hormone metabolites, drug-resistant stem cells, and growth-inhibitory efficacy of nutritional herbs. Collectively, this evidence provides proof of the concept for future research directions that are focused on novel therapeutic options for endocrine therapy-resistant breast cancer that may operate via E₂- and/or PRG-mediated growth regulation.

Prognostic role of SPRY4-IT1 in female breast carcinoma and malignant tumors of the reproductive system: A meta-analysis

BACKGROUND

The prognostic value of SPRY4-Intronic transcript 1 (SPRY4-IT1) in women suffering from breast carcinoma and malignant tumors of the reproductive system remains to be ascertained. Therefore, this paper attempted to assess the relationship between SPRY4-IT1 with the clinicopathological indicators and survival analysis in women suffering from breast carcinoma and malignant tumors of their reproductive organs through meta-analysis.

METHOD

Related literature retrieved from Cochrane Library, Ovid, Embase, PubMed, the CNKI, and the Web of Science databases were reviewed. The latest article search was updated to September 1, 2021. The outcome indicators included as effective measures in the study were hazard ratio (HR), odds ratio (OR), and 95% confidence interval (CI). The Stata 12.0 software was used to analyze the data.

RESULTS

The elevated SPRY4-IT1 levels were indicative of poor overall survival (OS) [HR = 2.44, 95% CI = 1.35-4.43, P < .05], and were not related to Disease-Free Survival (DFS) [HR = 1.61, 95% CI = 0.50-5.18, P = .43] in female patients suffering from malignant tumors. In terms of lymph node metastasis (LNM) for the association between long noncoding RNA SPRY4-IT1(LncRNA SPRY4-IT1) and OS, elevated LncRNA SPRY4-IT1 implied poor OS with LNM [HR = 2.79, 95% CI: 1.81-4.28, P < .001]. Based on the aspect of the LNM for the association between LncRNA SPRY4-IT1 and DFS, SPRY4-IT1 was not correlated with DFS [HR = 0.97, 95% CI: 0.73-1.28, P = .81]. SPRY4-IT1 in the TNM stage was not related to OS [HR = 1.43, 95% CI: 0.55-3.70, P = .46]. In the TNM stage, SPRY4-IT1 was not related to DFS [HR = 1.68, 95% CI: 0.92-3.06, P = .09]. SPRY4-IT1 was found to be associated with lymph node metastasis (OR = 4.15, 95% CI: 2.75-6.25, P = .000) and TNM stage (OR = 2.89, 95% CI: 1.51-7.27 P = .02). No significant correlation was noted between SPRY4-IT1 and the age of the patients (OR = 0.89, 95% CI: 0.61-1.29 P = .54).

CONCLUSIONS

Thus, this study provides evidence-based medical evidence for the target treatment of female breast carcinoma and malignant tumors of the reproductive system. The elevated level of SPRY4-IT1 was associated with poor prognosis of female breast cancer patients and of those having malignant tumors in their reproductive organs. In addition, the SPRY4-IT1 expression was also associated with the disease progression and metastasis.

Opportunities in combinational chemo-immunotherapy for breast cancer using nanotechnology: an emerging landscape

INTRODUCTION

Breast carcinoma (BC) is one of the most frequent causes of cancer-related death among women, which is due to the poor response to conventional therapy. There are several complications associated with monotherapy for cancer, such as cytotoxicity to normal cells, multidrug resistance (MDR), side effects, and limited applications. To overcome these challenges, a combination of chemotherapy and immunotherapy (monoclonal antibodies, anticancer vaccines, checkpoint inhibitors, and cytokines) has been introduced. Drug delivery systems (DDSs) based on nanotechnology have more applications in BC treatment owing to their controlled and targeted drug release with lower toxicity and reduced adverse drug effects. Several nanocarriers, such as liposomes, nanoparticles, dendrimers, and micelles, have been used for the effective delivery of drugs.

AREAS COVERED

This article presents opportunities and challenges in BC treatment, the rationale for cancer immunotherapy, and several combinational approaches with their applications for BC treatment.

EXPERT OPINION

Nanotechnology can be used for the early prognosis and cure of BC. Several novel and targeted DDSs have been developed to enhance the efficacy of anticancer drugs. This article aims to understand new strategies for the treatment of BC and the appropriate design of nanocarriers used as a combinational DDS.

Assessing the correlation between FDG PET findings of IDC breast carcinoma and histopathology of coexisting ductal carcinoma in-situ

BACKGROUND

Ductal carcinoma in-situ (DCIS) often coexists with invasive ductal carcinoma (IDC) of the breast. DCIS is considered as a non-obligate precursor of IDC when both coexist. 18F-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) imaging is commonly used in the staging and follow-up assessment of breast cancer. In this study, we aimed to assess if there is any correlation between primary tumor PET and histopathology findings and histopathological features of the coexisting DCIS.

MATERIAL AND METHODS

FDG PET/CT images and histopathology results of the patients with newly diagnosed breast cancer (IDC) with coexisting DCIS were analyzed in this retrospective study. The grade and size of the primary tumor and histopathological features of the coexisting DCIS (nuclear grade and architectural pattern) were obtained from the postoperative histopathology results. Maximum standardized uptake values (SUV: SUVmax and SULmax) of the primary tumor normalized by weight and lean body mass were measured. Statistical analysis was performed to assess the correlation between various parameters of IDC and DCIS.

RESULTS

This study included sixty-two (62) patients with IDC-DCIS. Primary tumor grade was significantly correlated and associated with the nuclear grade of the coexisting DCIS (polychoric correlation r = 0.736, and Fisher exact test, PV < 0.001, respectively). Primary tumor SUV was not correlated with the nuclear grade and architectural pattern of the coexisting DCIS (polyserial correlation r = 0.172, PV = 0.155, and Point Bi-Serial correlation r = -0.009, PV = 0.955, respectively). Median primary tumor size was marginally significantly different among DCIS nuclear grades but it was not significantly different in comedo and non-comedo cases (Kruskal-Wallis test PV = 0.053, and Mann-Whitney U test PV = 0.890, respectively).

CONCLUSIONS

Primary tumor grade is correlated with the nuclear grade of the coexisting DCIS. SUV of primary tumor does not seem to be correlated with the histopathological features of coexisting DCIS (nuclear grade and architectural pattern) but this may be further studied in a larger number of patients.

The Potential Effect of Lidocaine, Ropivacaine, Levobupivacaine and Morphine on Breast Cancer Pre-Clinical Models: A Systematic Review

Breast cancer (BC) is one of the most common types of cancer and the second leading cause of death in women. Local anaesthetics (LAs) and opioids have been shown to influence cancer progression and metastasis formation in several pre-clinical studies. However, their effects do not seem to promote consensus. A systematic review was conducted using the databases Medline (via PubMed), Scopus, and Web of Science (2010 to December 2021). Search terms included "lidocaine", "ropivacaine", "levobupivacaine", "morphine", "methadone", "breast cancer", "breast carcinoma" and "breast neoplasms" in diverse combinations. The search yielded a total of 784 abstracts for initial review, 23 of which met the inclusion criteria. Here we summarise recent studies on the effect of analgesics and LAs on BC cell lines and animal models and in combination with other treatment regimens. The results suggest that local anaesthetics have anti-tumorigenic properties, hence their clinical application holds therapeutic potential. Regarding morphine, the findings are conflicting, but this opioid appears to be a tumour-promoting agent. Methadone-related results are scarce. Additional research is clearly required to further study the mechanisms underlying the controversial effects of each analgesic or LA to establish the implications upon the outcome and prognosis of BC patients' treatment.

A seven-lncRNA signature for predicting prognosis in breast carcinoma

Background

Long non-coding RNAs (lncRNAs) play an important part in tumorigenesis and cancer metastasis and can serve as a potential biosignature for cancer prognosis. However, the use of lncRNA signatures to predict survival in breast carcinoma is yet unreported.

Methods

The lncRNA expression profiles and homologous clinical data of 913 breast carcinoma samples from the Cancer Genome Atlas (TCGA), were analyzed to obtain 2,547 differentially expressed lncRNAs. Univariate Cox proportional risk regression was applied to both the training and testing datasets to screen the common prognostic lncRNAs. Potential prognostic LncRNAs were screened by multivariate Cox proportional risk regression in the training data set of the selected LncRNAs.

Results

Seven lncRNAs (LINC02037, MAPT-AS1, RP1-37C10.3, RP11-344E13.4, RP11-454P21.1, RP11-616M22.1, SPACA6P-AS) were prominently associated with overall survival. Kaplan-Meier analysis and receiver operating characteristic (ROC) curves indicated that these indicators were sensitive and specific for survival prediction. The areas under the ROC curve of the seven-lncRNA signature in predicting 3- and 5-year survival rates were 0.771 and 0.780 respectively in the combined cohort. Furthermore, enrichment analysis revealed that these seven lncRNAs might participate multiple pathways related to tumorigenesis and prognosis.

Conclusions

The proposed seven-lncRNA signature could serve as a latent prognostic biomarker for survival prediction in patients with breast carcinoma.

Collagen and Discoidin Domain Receptor 1 Partnership: A Multifaceted Role in the Regulation of Breast Carcinoma Cell Phenotype

Type I collagen, the major components of breast interstitial stroma, is able to regulate breast carcinoma cell behavior. Discoidin domain receptor 1 (DDR1) is a type I collagen receptor playing a key role in this process. In fact, collagen/DDR1 axis is able to trigger the downregulation of cell proliferation and the activation of BIK-mediated apoptosis pathway. The aim of this review is to discuss the role of two important factors that regulate these processes. The first factor is the level of DDR1 expression. DDR1 is highly expressed in epithelial-like breast carcinoma cells, but poorly in basal-like ones. Moreover, DDR1 undergoes cleavage by MT1-MMP, which is highly expressed in basal-like breast carcinoma cells. The second factor is type I collagen remodeling since DDR1 activation depends on its fibrillar organization. Collagen remodeling is involved in the regulation of cell proliferation and apoptosis through age- and proteolysis-related modifications.

Imaging and pathological discordance amongst the plethora of breast lesions in breast biopsies

INTRODUCTION

Imaging-guided breast tissue biopsy has become an acceptable alternative to open surgical biopsy for nonpalpable breast lesions. Discussion of abnormal results of the correlation between imaging and pathological findings can be very challenging as it can assist in decision-making with regard to the further treatment options by arriving at a comprehensive diagnosis.

MATERIALS AND METHODS

This was a retrospective study. Radiological data from imaging-guided breast biopsies of 500 patients during a 6-year period was collected and classified by a specialist radiologist as per the BI-RADS format. Histopathology reports were studied and discordance analyzed.

RESULTS

A total of 500 cases were reviewed. Approximately 33% (168) cases fell into the BI-RADS 3 category, 24.4% (122) into the BI-RADS 4, and 37% (187) into BI-RADS 5 categories. Approximately 50% (n = 250) cases were benign, 2.6% (13) belonged to the high-risk category, and 47.4% (237) were malignant. The number of discordant cases was 12 (2.4%), mostly due to technical factors. Sensitivity of biopsies to detect malignancy was 85%, specificity was 96%, and accuracy of biopsy in diagnosing cancer was 90%.

DISCUSSION

The "triple assessment" is the most sensitive method for detecting early breast cancer. An effective communication pathway must be established between a clinician, radiologist, and pathologist for surgical excision in discordance as it carries a high prevalence of carcinoma in these lesions.

CONCLUSION

In discordant cases, either due to abnormal results of imaging or of abnormal pathological findings, the final decision is based on two concordant findings, out of the three parameters. This involves a multidisciplinary breast conference and an active participation by the pathologist.

Acute inflammatory response to multiple chemotherapy regimen in breast carcinoma: An unreported entity1

Increased utilization of chemotherapy in breast cancer patients has led to improved survival outcomes but it has also resulted in rising incidence of adverse effects. Occurrence of new/unreported side effect poses challenge in front of clinicians. We report the case of a 53-year lady with locally advanced, hormone receptor-positive, and human epidermal growth factor-2 (HER-2) negative right breast carcinoma. She was started on neoadjuvant chemotherapy (NACT) (doxorubicin and cyclophosphamide), to facilitate breast-conserving surgery. She developed an inflammatory reaction involving the affected breast after each of three cycles of NACT (2 cycles of doxorubicin & cyclophosphamide, and 1 cycle of docetaxel). Infectious causes and disease progression were ruled out. She was then prescribed hormone therapy but the disease progressed after three months of therapy and the patient had to be subjected to modified radical mastectomy (MRM). She then received adjuvant radiotherapy and is currently doing well on second-line hormone therapy.

Invasive Breast Carcinoma of No Special Type with Medullary Pattern: Morphological and Immunohistochemical Features

OBJECTIVE

Our study investigated the morphological and immunohistochemical characteristics of invasive breast carcinoma of no special type (IBC-NST) with medullary pattern to explore the inconsistencies between the structural and clinical traits of this category of tumor.

MATERIAL AND METHOD

The breast carcinoma samples (n = 26) with medullary pattern (defined according to established criteria) were subjected to immunohistochemical assays of the following receptors: ER, PR, HER2/neu, Ki-67, p53, Bcl-2, VEGF, MMP1, E-cadherin, EGFR, Hsp70, Hsp90, CD20, CD3, CD4, CD8, CD68, CD163, CD56, CD138, MPO, S100, IgG, IgM, and PD-L1.

RESULTS

IBC-NST with medullary pattern was found to have negative expression of ER, PR, and HER2/neu; strong positive expression of Kі-67, mutant р53, Bcl-2, E-cadherin, EGFR, and PD-L1; moderate positive expression of Hsp70 and Hsp90; and low or negative expression of VEGF and MMP1. Furthermore, there was pronounced variability in the qualitative composition of tumor immune infiltrates with regards to T-lymphocytes, B-lymphocytes, macrophages, plasmocytes, and granulocytes.

CONCLUSION

IBC-NST with medullary pattern has many unfavourable morphological and immunohistochemical prognostic characteristics, which are balanced against the pronounced protective properties of the tumor cells and the qualitative characteristics of the tumor microenvironment. These can lead to a favourable disease course despite the relatively adverse features of the carcinoma cells.

Pigmented epidermotropic breast cancer metastases: A rare variant with a particularly unusual feature

Pigmented epidermotropic breast cancer metastases are a rarity, often clinically misdiagnosed as melanocytic lesions. Histopathologically, they show a dermal proliferation of neoplastic metastatic cells that extend to the overlying epidermis in a pattern identical to that seen in primary Paget disease (PD). Differential diagnosis should be established with entities with a similar presentation, such as pigmented mammary PD and malignant melanoma. Immunohistochemistry may be useful for this purpose. We present a new case of pigmented epidermotropic breast cancer metastases with a particularly unusual feature: the absence of dermal infiltration by neoplastic cells, thus considered as pure epidermotropic metastatic involvement.