Factors correlating with lymph node metastases in patients with T1 breast cancer

Identifying clinicopathological risk factors for regional lymph node metastasis in Chinese patients with T1 breast cancer: a population-based study

Objectives

To analyze clinicopathological risk factors and regular pattern of regional lymph node metastasis (LNM) in Chinese patients with T1 breast cancer and the effect on overall survival (OS) and disease-free survival (DFS).

Materials and methods

Between 1999 and 2020, breast cancer patients meeting inclusion criteria of unilateral, no distant metastatic site, and T1 invasive ductal carcinoma were reviewed. Clinical pathology characteristics were retrieved from medical records. Survival analysis was performed using Kaplan-Meier methods and an adjusted Cox proportional hazards model.

Results

We enrolled 11,407 eligible patients as a discovery cohort to explore risk factors for LNM and 3484 patients with stage T1N0 as a survival analysis cohort to identify the effect of those risk factors on OS and DFS. Compared with patients with N- status, patients with N+ status had a younger age, larger tumor size, higher Ki67 level, higher grade, higher HR+ and HER2+ percentages, and higher luminal B and HER2-positive subtype percentages. Logistic regression indicated that age was a protective factor and tumor size/higher grade/HR+ and HER2+ risk factors for LNM. Compared with limited LNM (N1) patients, extensive LNM (N2/3) patients had larger tumor sizes, higher Ki67 levels, higher grades, higher HR- and HER2+ percentages, and lower luminal A subtype percentages. Logistic regression indicated that HR+ was a protective factor and tumor size/higher grade/HER2+ risk factors for extensive LNM. Kaplan-Meier analysis indicated that grade was a predictor of both OS and DFS; HR was a predictor of OS but not DFS. Multivariate survival analysis using the Cox regression model demonstrated age and Ki67 level to be predictors of OS and grade and HER2 status of DFS in stage T1N0 patients.

Conclusion

In T1 breast cancer patients, there were several differences between N- and N+ patients, limited LNM and extensive LNM patients. Besides, HR+ plays a dual role in regional LNM. In patients without LNM, age and Ki67 level are predictors of OS, and grade and HER2 are predictors of DFS.

The Effect of Prognostic Factors on Long-Term Protection in Breast Cancer

Objectıves

Axillary lymph node involvement is considered to be one of the most important factors in the staging and survival of breast cancer. Recurrences in women with a negative axillary condition detected as a result of long patient follow-up have revealed the importance of other prognostic factors and many studies have begun. The aim of this study is to evaluate breast cancer patients and to investigate other factors affecting breast cancer.

Materials and methods

Patients with breast cancer who were operated in our clinic between January 2005 and June 2007 were included in the study. Demographic characteristics, tumor size, lymph node involvement, grade, histological type, the status of estrogen and progesterone receptors (ER and PR), type of surgery performed, and cerb-B2 receptor status were recorded retrospectively.

Results

The mortality rate of the ER (+) PR (+) group was significantly lower than that of the ER (-) PR (-) group (p<0.05). There was no statistically significant difference between the ER (+) PR (+) cases and the mortality rates of any positive cases (p>0.05). There was a statistically significant difference between survival rates according to cerb-B2 status (p<0.01); cerb-B2 was positive in all patients who died. In cerb-B2 positive cases, there was a statistically significant difference between survival rates according to the tumor stages (p <0.05).

Conclusion

As a result; preoperative and postoperative staging of all breast cancer patients who applied to surgery clinics should be performed. Prognostic factors should be determined and patients should be directed to post-surgical treatment according to this information. Axillary lymph involvement, number, tumor size, estrogen receptor, progesterone receptor, and cerb-B2 status are safe markers that can be used to determine prognosis in our series.

Analysis of factors related systemic recurrence after breast conserving surgery in stage I breast cancer

Objectives In these days, patients with stage I breast cancer have increased by regular health examination and diagnostic tool development. The aim of this retrospective study is to identify systemic recurrence related factors after breast conserving surgery (BCS) for stage I breast cancer. Methods In this study, we analyzed the correlation between systemic recurrence and pathologic factors. We reviewed 223 patients who underwent BCS for stage I breast cancer. Postoperative pathologic factors, recurrent rates and sites were studied. In addition, preoperative patients'data were also collected. Statistical analysis was done by using PASW 16.0 (SPSS Inc., Chicago, IL, USA). Results Systemic recurrence was found in 16 patients (7.17%) within 5 years after primary surgery. 5 patients had lymphatic invasion and 6 patients had vascular invasion. Lymphatic and vascular invasion had statistical correlation with systemic recurrence ( P = 0.004, P = 0.001). Conclusions In this retrospective study, we can conclude that vascular invasion and lymphatic invasion are related systemic recurrence after BCS for stage I patients. Further studies with large cohort will be required to fully understand the risk factors of systemic recurrence for stage I breast cancer patients.

Impact of Size of the Tumour, Persistence of Estrogen Receptors, Progesterone Receptors, HER2Neu Receptors and Ki67 Values on Positivity of Axillary Lymph Nodes in Patients with Early Breast Cancer with Clinically Negative Axillary Examination

AIM:

The study aimed to identify factors that influence the positivity of axillary lymph nodes in patients with early breast cancer and clinically negative axillary lymph nodes, who were subjected for modified radical mastectomy and axillary lymphadenectomy.

MATERIAL AND METHODS:

This study included 81 surgically treated, early breast cancer patients during the period from 08-2015 to 05-2017. All the cases have been analysed by standard histological analysis including macroscopic and microscopic examination by routine H&E staining. For determination of molecular receptors, immunostaining by PT LINK immunoperoxidase has been done for HER2neu, ER, PR, p53 and Ki67.

RESULTS:

Patients age ranged between 31-73 years, an average of 56.86 years. The mean size of a primary tumour in the surgically treated patient was 20.33 ± 6.0 mm. Axillary dissection revealed from 5 to 32 lymph nodes, with an average of 14. Metastases have been found in 1 to 7 lymph nodes, with an average 0.7. Only 26 (32.1%) of the patients showed metastases in the axillary lymph nodes. The univariant regression analysis showed that the size of a tumour and presence of HER2neu receptors on cancer cells influence the positivity of the axillary lymph nodes. The presence of the estrogen receptors, progesterone receptors have no influence on the positivity for metastatic deposits of lymph nodes. Multivariant model and logistic regression analysis as significant independent factors or predictors of positivity of the axillary lymph nodes are influenced by the tumour size only.

CONCLUSION:

Our study showed that the metastatic involvement of the axillary lymph nodes is mainly influenced by the size of a tumour and presence of HER2neu receptors in the univariant analysis. This point to the important influence of positivity of the axillary lymph nodes but, in multi-variant regressive analysis the lymph node status correlates with the tumour size only.

Prognostic Factors on the Positivity for Metastases of the Axillary Lymph Nodes from Primary Breast Cancer

AIM

The aim of the study was to identify the impact of T stage, the presence of estrogen, progesterone, HER2neu receptors and the values of the Ki67 on the positivity for metastases of the axillary lymph nodes, from primary breast cancer.

MATERIAL AND METHODS

290 surgically treated patients for breast cancer were included in the study. All cases have been analyzed by standard histological analysis including microscopic analysis on standard H&E staining. For determining the molecular receptors - HER2neu, ER, PR, p53 and Ki67, immunostaining by PT LINK immunoperoxidase has been done.

RESULTS

Patients age was ranged between 18-90 years, average of 57.6+11.9. The mean size of the primary tumor in the surgically treated patient was 30.27 + 18.3 mm. On dissection from the axillary pits 8 to 39 lymph nodes were taken out, an average of 13.81+5.56. Metastases have been found in 1 to 23 lymph nodes, an average 3.14+4.71. In 59% of the patients there have been found metastases in the axillary lymph nodes. The univariate regression analysis showed that the location, size of tumor, differentiation of the tumor, stage, the value of the Ki67 and presence of lymphovascular invasion influence on the positivity of the axillary lymph nodes. The presence of the estrogen receptors, progesterone receptors and HER2neu receptors showed that they do not have influence on the positivity for metastatic deposits in axillary lymph nodes. The multivariate model and the logistic regression analysis as independent significant factors or predictors of positivity of the axillary lymph nodes are influenced by the tumor size and the positive lymphovascular invasion.

CONCLUSION

Our study showed that the involving of the axillary lymph nodes is mainly influenced by the size of the tumor and the presence of lymphovascular invasion in the tumor. Ki67 determined proliferative index in the univariate analysis points the important influence of positivity in the axillary lymph nodes, but not in the multivariate regressive analysis.

Correlation of Various Biomarkers with Axillary Nodal Metastases: Can a Panel of Such Biomarkers Guide Selective Use of Axillary Surgery in T1 Breast Cancer?

To evaluate the correlation of various clinic-pathological variables with axillary nodal involvement in T1 breast cancer & to identify a sub-group of T1 cancers, on the basis of observed variables, with a low risk of axillary nodal metastases. Clinico-pathological variables observed included tumor size, lymphovascular invasion (LVI), histological grade of tumor, tumor palpability, estrogen/progesterone (ER/PR) & her2/neu receptors, age, family history, histological type of tumor, axillary nodal metastases for 100 patients without clinically palpable nodes who underwent axillary lymph node dissection in Bombay Hospital & Medical Research Center from March, 2009. Data compiled was analyzed by univariate & multivariate analysis. All the variables viz. tumor size, LVI, histological grade, tumor palpability & ER/PR/Her2 receptor profile, which were found to be significantly associated with axillary lymph node involvement (ALNI) on univariate analysis were also found to be independent predictors of ALNI on multivariate analysis. Age of the patient, family history & histological type of tumor were not significantly correlated with ALNI. None of the 12 patients with tumor biomarker profile of T1a-b tumors without LVI & with histological grade I, had ALNI. The risk of ALNI can be predicted by using various tumor biomarker variables. Based on the predicted risk of ALNI, the management strategy for axilla can be individualized. The omission of operative axillary staging may be considered in patients with low predictive risk of ALNI.

The Expression of Carbonic Anhydrase (CA) IX/XII and Lymph Node Metastasis in Early Breast Cancer

Purpose

The aim of study was to test by immunohistochemical (IHC) staining whether carbonic anhydrase (CA) 9 and 12 have an effect on sentinel lymph node (SLN) metastasis in early breast cancer and to find clinicopathologic factors associated with SLN metastasis.

Materials and Methods

Between June 2003 and June 2011, medical records of 470 patients diagnosedwith breast cancer with pT1-2, pN0-2, and M0 were reviewed. Of these 470, 314 patients who underwent SLN biopsy±axillary dissection were subjects of this study. Using tissue microarray, IHC staining for CA9 and CA12 was performed. Clinicopathologic factors such as patient age, tumour size, lymphatic invasion, hormone receptor status, and the Ki-67 labeling index were analysed together.

Results

The mean age of all patients was 51.7 years. The mean number of harvested SLN was 3.62, and 212 patients (67.5%) had negative SLN. Lymphatic invasion, the Ki-67 labelling index of primary tumours, and CA9 staining of stromal cells, were independent risk factors for SLN metastasis in the multivariate analysis. In 33 patients (10.5%) without the three risk factors, no patient had SLN metastasis. In 80 patients without lymphatic invasion of primary tumours or CA9 staining of stromal cells, only four patients (5%) had positive SLN.

Conclusion

CA9 staining of stromal cells is an independent risk factor for SLN metastasis as well as lymphatic invasion and a low Ki-67 labelling index of primary tumours in patients with early breast cancer. IHC staining of primary tumours for CA12was not associatedwith SLN metastasis.

Delays in primary surgical treatment are not associated with significant tumor size progression in breast cancer patients

OBJECTIVES

We evaluated the effect of time to surgery on tumor growth by comparing initial imaging and pathologic tumor size estimates. We also determined predictors of delay to surgery.

BACKGROUND

Preoperative work-up, coordination of reconstructive surgery, and referral to tertiary care centers can delay surgical treatment of breast cancer. Whether these delays are associated with interim tumor progression is unknown.

METHODS

We identified 818 clinically node-negative breast cancer patients at our cancer center who had undergone surgery as their first therapeutic modality for invasive breast cancer from September 2003 to December 2006. Baseline tumor size was determined by mammography and sonography; tumor size at surgery was determined from pathology reports.

RESULTS

The median time from imaging to surgery was 21 days (1-132 days). In multivariate analysis, increased time to surgery was associated with older age, total mastectomy versus breast-conserving surgery, and reconstructive surgery. The median difference from baseline mammographic tumor size to surgery was 0 cm (8.6 cm smaller to 7.3 cm larger at surgery). The median difference from baseline sonographic tumor size to surgery was 0.1 cm (7.5 cm smaller to 8.3 cm larger at surgery). Neither of these differences was significantly associated with time to surgery. Time to surgery was associated with positive lymph nodes at surgery; however, no association was found after controlling for other prognostic factors.

CONCLUSIONS

Modest time intervals from imaging to surgery are not significantly associated with change in tumor size; thus, patients may undergo preoperative work-up without experiencing significant disease progression.

Breast Cancer Close to the Nipple: Does This Increase the Risk of Nodal Metastasis at Diagnosis?

Background

Previous studies of patients with invasive breast cancer examined, with mixed results, tumour location as a predictor of axillary lymph node metastasis. This study assessed whether tumour location in relation to the nipple impacts the presence of axillary lymph node metastasis at the time of diagnosis.

Methods

A retrospective review was undertaken of the medical records and available imaging of 285 patients diagnosed with invasive breast cancer between January 2001 to June 2007 at Boston University Medical Center. The incidence of axillary lymph node metastasis was correlated with tumour location in relation to the posterior nipple line to control for variation in breast size. Bivariate analysis identified significant variables that were applied to a multiple logistic regression model.

Results

Axillary lymph node metastasis was not significantly associated with tumour proximity to the nipple. In the multivariate logistic regression analysis, known prognostic factors for axillary metastasis, such as surgical size, lymphovascular invasion, and age of diagnosis, were significant, whereas breast density, palpability, and histologic grade were no longer significant.

Conclusions

Our study found that there was no evidence that correlates intramammary tumour proximity to the nipple with the presence of axillary lymph node metastasis at diagnosis. However, known prognostic factors, such as lymphovascular invasion, surgical size, and younger age at diagnosis, are strong independent predictors for axillary lymph node involvement.

Can we identify the group of small invasive (T1a,b) breast cancers with minimal risk of axillary lymph node involvement? A pathohistological and DNA flow cytometric study

The goal of this study was to identify a group of small (≤1cm) breast cancers (T1a,b) with a particularly low probability of axillary lymph node metastases, where routine axillary staging may be unnecessary. We retrospectively analyzed 152 T1a,b breast carcinomas with axillary dissection surgically removed at Clinical Hospital Center Split (Croatia) in the period from 1997 to 2006. The analysis included 40 T1a,b cancers with, and 112 T1a,b cancers without axillary lymph node metastases. The basic morphological features of cancers were investigated histologically, while hormone receptors and HER2/neu were investigated immunohistochemically with an additional CISH analysis of HER2/neu 2+ cases. The ploidy and S-phase fraction were determined by DNA flow cytometry. The association of the investigated features with the likelihood of axillary lymph node metastases was analyzed by univariate and multivariate analysis. The univariate analysis showed that lymph node metastases were associated with tumor size (T1a/T1b; p=0.026), histological type (ductal/non-ductal; p=0.014), lymphovascular invasion (p<0.001), HER2/neu expression (p=0.04), ploidy (p=0.027), and combined values of ploidy and S-phase fraction (p=0.025). The lymphovascular invasion was the only independent factor associated with axillary nodal metastases (p=0.01). In the group of T1a,b cancers without lymphovascular invasion, HER2/neu expression (p=0.021) and combined values of ploidy and S-phase fraction (p=0.016) were independent factors associated with axillary lymph node metastases. This study showed that diploid T1a,b cancers with low S-phase fraction, which are also without lymphovascular invasion and HER2/neu amplification, represented the group of cancers with a low probability of axillary lymph node metastases.

Collagen alpha1(XI) in normal and malignant breast tissue

Little is known about collagen XI expression in normal and malignant breast tissue. Tissue microarrays, constructed from 72 patients with breast carcinoma and matched normal tissue, were immunohistochemically stained with five antisera against isoform-specific regions of collagen alpha1(XI) N-terminal domain. Staining intensity was graded on a 0-3 scale in epithelial cytoplasm, stroma, and endothelial staining of the vasculature of each tissue core. The staining was compared to known pathologic parameters: age, tumor size, overall tumor grade, nuclear grade, tubule formation, mitotic counts, angiolymphatic invasion, node status, estrogen receptor status, progesterone receptor status, and HER-2/neu status. Estrogen and progesterone receptor status were used as a control for comparison. With antisera V1a and amino propeptide (Npp), stroma surrounding cancerous cells was found to have decreased collagen alpha1(XI) staining compared to stroma adjacent to normal epithelium (P=0.0006, P<0.0001). Collagen alpha1(XI) staining with V1a antiserum in cytoplasm of cancer cells demonstrated decreased intensity in metastasized primary tumors when compared to nonmetastasized primary tumors (P=0.009). Cytoplasmic staining with Npp antiserum in cancer demonstrated an inverse relationship to positive estrogen receptor status in cancer (P=0.012) and to progesterone receptor status (P=0.044). Stromal staining for Npp in cancerous tissue demonstrated an inverse relationship with tubule formation score (P=0.015). This is the first study to localize collagen XI within normal and malignant breast tissue. Collagen alpha1(XI) appears to be downregulated in stroma surrounding breast cancer. Detection of collagen XI in breast tissue may help predict women who have lymph node metastases.

Prediction of nodal involvement in breast cancer based on multiparametric protein analyses from preoperative core needle biopsies of the primary lesion

PURPOSE

Identification of molecular characteristics that are useful to define subgroups of patients fitting into differential treatment schemes is considered a most promising approach in cancer research. In this first study of such type, we therefore investigated the potential of multiplexed sandwich immunoassays to define protein expression profiles indicative of clinically relevant properties of malignant tumors.

EXPERIMENTAL DESIGN

Lysates prepared from large core needle biopsies of 113 invasive breast carcinomas were analyzed with bead-based miniaturized sandwich immunoassays specific for 54 preselected proteins.

RESULTS

Five protein concentrations [fibroblast growth factor-2 (FGF-2), Fas, Fas ligand, tissue inhibitor of metalloproteinase-1, and RANTES] were significantly different in the groups of patients with or without axillary lymph node metastasis. All 15 protein parameters that resulted in P values <0.2 and other diagnostic information [estrogen receptor (ER) status, tumor size, and histologic grading] were analyzed together by multivariate logistic regression. This yielded sets of five (FGF-2, Fas, Fas ligand, IP10, and PDGF-AB/BB) or six (ER staining intensity, FGF-2, Fas ligand, matrix metalloproteinase-13, PDGF-AB/BB, and IP10) parameters for which receiver-operator characteristic analyses revealed high sensitivities and specificities [area under curve (AUC) = 0.75 and AUC = 0.83] to predict the nodal status. A similar analysis including all identified parameters of potential value (15 proteins, ER staining intensity, T) without selection resulted in a receiver-operator characteristic curve with an AUC of 0.87.

CONCLUSION

We clearly showed that this approach can be used to quantify numerous proteins from breast biopsies accurately in parallel and define sets of proteins whose combined analyses allow the prediction of nodal involvement with high specificity and sensitivity.

Sentinel lymph node biopsy in women with pT1a or "microinvasive" breast cancer

The role of sentinel lymph node biopsy (SLNB) in pT1a and "microinvasive" breast cancer has not been extensively studied. We report our experience with SLNB in patients with "minimal" breast cancer to determine the incidence and type of SLN metastases, and to study the potential impact on their surgical or oncological management. Among some 3387 women operated upon for primary breast cancer who underwent sentinel lymph node biopsy at nine institutions participating in the Rome Breast Cancer Study Group, 251 were staged pT1a or pT1mic (7.4%). There were 13 cases of sentinel lymph node metastases identified in this group of patients (5.2%), seven macrometastases and six micrometastases. Additionally, ITC were diagnosed by immunohistochemistry in four cases (1.6%). The incidence of SLN metastases was 7/174 (4%) and 6/77 (7.8%) in patients with pT1a and pT1mic tumors, respectively (p=0.2). Age and histological grade were predictive factors for SLN metastases. Chemotherapy was seldom directed by axillary node status (8/38 patients). As the incidence of SLN metastases in these patients is very small, particularly in the pT1a group, the indications for even a minimally invasive procedure, such as sentinel lymph node biopsy, should be probably individualized.

Preoperative selection of symptomatic breast cancer patients appropriate for lymphatic mapping and sentinel node biopsy

BACKGROUND

This study examines whether preoperative ultrasound-assessed tumour diameter and diagnostic core biopsy-determined grade can be used to select those most likely to benefit from SLNB (i.e. those that are "node negative") before their definitive operation.

METHODS

Breast ultrasound (US) and a simultaneous core biopsy was performed in all patients at their initial presentation, and their estimates of tumor size and grade compared with the final pathological specimen (FPS).

RESULTS

Of the T1 group 47% had lymphatic metastases as did 49% of those with grade I or II cancers. By combining these measures, however, subgroups of patients with lower rates of nodal metastases were identified (32% of patients with T1, non-grade III disease had lymphatic disease while only 15% of those with T < 1.5 cm, non-grade III cancers had such metastases).

CONCLUSION

Combination of the US and ultrasound guided core biopsy (UGCB) may however identify subgroups unlikely to have axillary disease that are therefore suitable for SLNB.

Predictors of axillary lymph node metastasis in breast cancer: A systematic review

AIMS

To review the established and emerging techniques in axillary lymph node prediction and explore their potential impact on clinical practice. To reliably identify patients in whom axillary lymph node surgery, including SLNB, can be safely omitted.

METHODS

Searches of PubMed were made using the search terms "axilla" (or "axillary"), "lymph", "node" and "predictor" (or "prediction"). Articles from abstracts and reports from meetings were included only when they related directly to previously published work.

FINDINGS

There are numerous studies in which the predictive utility of biomarkers as determinants of axillary lymph node status have been investigated. Few of these have specifically addressed the attributes of the primary tumour which could offer much potential for the prediction of tumour metastasis to the axillary lymph nodes.

CONCLUSIONS

Currently, no single marker is sufficiently accurate to obviate the need for formal axillary staging using SLNB or axillary clearance.

Is risk of axillary lymph node metastasis associated with proximity of breast cancer to the skin?

INTRODUCTION

Risk of axillary lymph node metastasis, the most important predictor of disease-free and overall survival in breast cancer patients, is estimated primarily from histologic features of the primary cancer including tumor size, histologic type and grade, and hormone receptor expression. Based upon a clinical impression, and research showing that palpable cancers are more likely to be node positive, we hypothesized that primary breast cancers more proximal to the skin of the breast are more likely to be positive for axillary lymph node metastasis.

METHODS

This is a retrospective medical record review of 209 women with stage T1 or T2 (</=5.0 cm) invasive breast cancer who received dedicated breast ultrasound at a single mammography clinic in Columbia, South Carolina, between 1997 and 2002.

RESULTS

None of the 26 cancers more than 14 mm from the skin had metastasized to axillary lymph nodes. In logistic regression modeling only tumor size, histologic grade and tumor proximity to the skin (as a categorical variable) were significantly associated with odds of axillary metastasis. Among cancers within 14 mm of the skin, proximity was not an independent predictor.

CONCLUSIONS

Stage T1 and T2 breast cancers located less proximally to the skin may be less likely to spread to the axillary lymph nodes. We observed what appears to be a threshold at approximately 14 mm from the skin (based upon this group of patients): none of 26 cancers below this level had spread to axillary nodes. Further research is needed to confirm these provocative findings.

Factors correlating with lymph node metastases in patients with T1 ductal invasive breast cancer

BACKGROUND: Identification of reliable predictors of axillary lymph node metastases (ALNM) may be useful in selecting appropriate management for patients with T1-size breast cancer. This study was undertaken to determine the association between ALNM and several variables, including age, tumor size, grade, estrogen receptor status, progesterone receptor status, p53 and c-erbB2 protein expression, and Ki-67 proliferative index. METHODS: In a retrospective study, 74 patients with pT1b and pT1c ductal invasive breast carcinoma and with known nodal status were analyzed. The size of the infiltrating tumor was microscopically evaluated. The histological grading was performed using the modified criteria of Bloom and Richardson, as described by Elston and Ellis. The immunophenotype of the tumor was determined as: the expression of estrogen (ER) and progesterone (PR) receptors, p53, c-erbB2 and Ki-67. The patients were grouped by age as follows: <50, 50-70, and >70 years old. RESULTS: Twenty six patients (35%) were node positive. Tumor size was related directly to nodal positivity. Nodal positivity was significantly related to negative PR status, p53 protein overexpression and high Ki-67 index (p<0.05). No significant association was found between nodal positivity and patient age, tumor grade, ER status, and c-erbB2 expression. CONCLUSION: These data suggest that PR status, Ki-67 proliferation index, and p53 protein expression might provide additional information to the lymph node status in T1 ductal breast carcinomas.

Aberrant hypermethylation of ID4 gene promoter region increases risk of lymph node metastasis in T1 breast cancer

ID4 gene is a member of the inhibitor of DNA-binding (ID) family, which inhibits DNA binding of basic helix-loop-helix transcription factors. Certain human primary breast cancers reportedly have low or no expression of ID4 protein, but its role in carcinogenesis and cancer progression is unknown. To determine its possible role, we examined epigenetic inactivation of ID4 gene by promoter hypermethylation in human breast cell lines and T1 breast cancer tissues. Methylation status of ID4 promoter CpG island was assessed by methylation-specific PCR (MSP); ID4 mRNA level was assessed by quantitative real-time RT-PCR. Of eight cell lines, two were fully methylated, four were partially methylated, and two were not methylated. ID4 mRNA level was suppressed in fully methylated cell lines. ID4 hypermethylation was observed in 16 of 24 (67%) node-positive and seven of 36 (19%) node-negative T1 primary breast cancers matched by patient age and tumor diameter. It was a significant risk factor for nodal metastasis (OR 13.1, P=0.0004). ID4 mRNA level was suppressed in hypermethylated cancer specimens (P=0.014). ID4 may play an important suppressive role in tumor progression, and its silencing by hypermethylation may increase the risk of regional lymph node metastasis.

Heparanase-1 expression is associated with the metastatic potential of breast cancer

BACKGROUND

Metastasis of malignant breast cells is in part mediated through degradation of the extra-cellular matrix by proteolysis, enabling malignant cells to migrate through the surrounding stroma. Heparanase-1 (HPR1) is an endoglycosidase that specifically degrades the heparan sulfate (HS) moiety of proteoglycans, a component of the extracellular matrix and basement membrane.

METHODS

Fifty-one primary breast tumors, 13 lymph node metastases, 4 ductal carcinoma in situ, 7 benign, and 5 normal specimens were examined for HPR1 expression using immunohistochemical staining. The functional role of HPR1 expression was determined by examining HS deposition using immunofluorescence staining.

RESULTS

Sixteen of 30 breast carcinomas (53%) with sentinel node metastasis expressed HPR1. In contrast, only 5 of 21 nonmetastatic primary breast carcinomas (23%) were HPR1 positive. Eighteen of 30 breast carcinomas between 1 and 5 cm expressed HPR1, compared with 3 of 21 HPR1-positive specimens in tumors < or =1 cm. Statistical analysis revealed that HPR1 expression was associated with breast tumor metastases (P =.04) and primary tumors between 1 and 5 cm (P =.002). Ninety percent of HPR1-positive tumors lacked HS deposition, suggesting an inverse correlation between HPR1 expression and HS deposition.

CONCLUSIONS

HPR1 expression correlates with the lack of HS deposition and with the metastatic potential of breast cancers. The frequency of HPR1 is significantly higher in breast tumors between 1 and 5 cm than in tumors < or =1 cm.