First Comprehensive Report of Clinicopathological Profile of Breast Cancer from Bihar, India

A study to compare the efficacy of neoadjuvant chemotherapy in locally advanced human epidermal growth factor receptor 2 overexpressing breast cancer

Background

This prospective single institutional study was conducted to compare the efficacy of the two different neoadjuvant chemotherapy (NACT) regimens in human epidermal growth factor receptor 2 (Her2neu) overexpressing non metastatic breast cancer.

Materials and methods

Patients randomly assigned into two arms in a 1:1 ratio. Arm A received NACT containing docetaxel, doxorubicin, and cyclophosphamide (TAC) regimen. Arm B received NACT containing docetaxel, carboplatin, and trastuzumab (TCH) regimen. Patients underwent surgical intervention following completion of 6 cycles of NACT. Postoperative histopathological reports were compared in terms of pathological response.

Results

122 patients (Arm A = 61; Arm B = 61) analysed. The mean breast tumor size was 7.724 cm and 7.896 cm in Arm A and Arm B, respectively, at diagnosis and clinical staging. After 6 cycles of NACT, the mean breast tumor size in Arm A and Arm B was 3.495 cm and 3.711 cm, respectively. The Arm A and Arm B exhibited 22.9% and 40.9% of pathological complete response (pCR), respectively, with statistically significant difference (p = 0.033). All patients experienced varying degrees of bone marrow suppression. Grade 2 or 3 chemotherapy induced nausea and vomiting was 37.7% and 23% in Arm A and Arm B, respectively, without statistically significant difference (p = 0.076). 14.8% and 4.9% of patients exhibited febrile neutropenia in Arm A and Arm B, respectively, without statistically significant differences (p = 0.067).

Conclusion

TCH exhibited greater pCR with tolerable adverse reactions in Her2neu overexpressing breast cancer compared to TAC regimen as NACT. Therefore, TCH regimen should be considered for node positive Her2neu overexpressing breast cancer.

Is it time to say goodbye to drainage after axillary lymph node dissection in breast cancer? A randomized clinical trial of systemic tranexamic acid combined with topical epinephrine + xylocaine versus conventional drainage

Drainage after axillary lymph node dissection is a major cause of morbidity. We evaluated the outcomes of topical epinephrine with xylocaine + systemic tranexamic acid (EXT) after axillary lymph node dissection. The primary endpoint was the rate of seroma development. This resulted in reduced hospital stay with similar rates of seroma as drainage after axillary lymph node dissection; thereby making it possible to avoid drainage.

Exploring Molecular Alterations in Breast Cancer Among Indian Women Using Label-Free Quantitative Serum Proteomics

The clinical data indicate that diverse parameters characterize breast cancer patients in India, including age at presentation, risk factors, outcomes, and behavior. Alarming incidence and mortality rates emphasize the crucial need for early screening measures to combat breast cancer-related deaths effectively. Quantitative proteomic approaches prove pivotal in predicting cancer prognosis, analyzing protein expression patterns tied to disease aggressiveness and metastatic potential, and facilitating conversant therapy selection. Thus, this study was envisioned with the goal of identifying protein markers associated with breast cancer in Indian women, which could potentially be developed as diagnostic tools and therapeutic targets in the future. Applying label-free proteomic quantitation method and statistical analysis, several differentially expressed proteins (DEPs) were identified in the serum of breast cancer patients compared to controls, including SBSN, ANG, PCOLCE, and WFDC3 (upregulated), and PFN1, FLNA, and DSG2 (downregulated). The expression of SBSN was also validated by western blotting. Statistical methods were employed to proteomic expression data, which highlighted the ability of DEPs to distinguish between breast cancer and control samples. Conclusively, this study recognizes prospective biomarkers for breast cancer among Indian women and highlights the requisite of in-depth functional studies to elucidate their precise roles in breast cancer development. We particularly emphasize on SBSN and PFN1, as these proteins were observed to be progressively overexpressed and under expressed, respectively, in breast cancer samples compared to control samples, ranging from early-stage to metastatic cases.

Mastalgia and Why It Should Be Evaluated With Imaging in Areas Where Use of Breast Cancer Screening Services are Unsatisfactory

Objective

Mastalgia or breast pain is a very common symptom in women attending breast clinic. The aim of this study was to evaluate whether imaging for mastalgia leads to cancer detection in an area where routine breast cancer screening services are underutilized.

Materials and Methods

This prospective study was performed between 1st March 2021 to 31st January 2023 at a tertiary care academic institution of central India. All patients underwent through clinical examination by a surgeon. Then patients were referred for ultrasound and/or X-ray mammography (MMG) depending on age. Cancer detection rate was calculated.

Results

The final cohort consisted of 176 patients with mastalgia and without any abnormality on clinical breast examination. Sixteen patients had mass lesion on radiology and core needle biopsy resulted as infiltrating duct carcinoma in 7 patients and benign phylloides tumor in one patient. Overall case detection rate for cancer was 4%.

Conclusion

The breast cancer detection rate in patients presenting with mastalgia was low. However, in the absence of routine mammographic screening in the Indian general population, these would have been missed. Hence, diagnostic assessment for mastalgia is an appropriate strategy in countries where routine screening MMG is lacking.

A Retrospective Analysis of Breast Cancer Presentation Among Young and Older Women in an Indian Cohort of 70 Patients

Introduction In females, carcinoma of the breast is a common malignancy. Disease management can be challenging for the treating clinician if the condition is presented in a locally advanced stage. Clinical presentation of a disease in a defined area provides a comprehensive map to target the at-risk population efficiently and select the appropriate intervention accordingly. In this retrospective study, we analyzed different factors that can affect breast carcinoma outcomes by assessing patients for a specific period of one year. Methods This is a retrospective study of carcinoma of breast patients and was conducted between 2017 and 2018. Results We reported a 25.83% incidence of breast cancer during the study period. A painful breast lump was present in 54.2% of patients, axillary nodes were present in 50% of patients, ulcers were present in 10% of patients, and nipple discharge was present in 8.5% of patients. According to the side and quadrant of involvement, the right side was the most common site of involvement in 55.7% of patients, and the upper outer quadrant was the most common quadrant involved in 61.4% of patients. The most familiar stage of the presentation was stage II, presented in 45.7% of patients. The most common histology was infiltrating ductal carcinoma, presented in 85.7% of patients. Conclusions This retrospective cohort study shows that carcinoma of the breast is a predominant malignancy among middle-aged females in developing countries such as India. This predominance is due to unawareness regarding disease symptoms and the fear of diagnosed malignancy during the investigation of symptoms. Early detection by screening and intervention at an early stage is the core of treatment success in this malignant disease. However, it is still challenging to apply screening as a tool to pick up early malignant disease in developing countries like India.

Low-Cost Radio-Opaque Tumor Marking Techniques for Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy: a Systematic Review

Current standard of care localization techniques used in breast conserving surgery (BCS) after neoadjuvant chemotherapy (NACT) are expensive and may not be available in LMICs (lower-middle income countries). This review evaluated the efficacy of radio-opaque low-cost tumor markers. A systematic search was conducted as per PRISMA guidelines through November 30, 2022, for all studies using non-commercial radio-opaque tumor markers for patients undergoing BCS post NACT. Rate of unsatisfactory margin on final histology was the primary outcome. Oxford Centre for Evidence Based Medicine (OCEBM) levels were used to assess internal validity. After screening, 07 studies were included for data synthesis. For marking, four studies used LIGA clips, two used 5-mm cut pieces of K-wire, and one used cut pieces of 25-G needle. Incidence of unsatisfactory margins (positive/close) ranged from 0 to 11%. All studies found these low-cost markers to be feasible, with 100% pre-surgery visibility and 100% retrieval rate. Low-cost radio-opaque tumor markers (LIGA clips, 5-mm cut pieces of K-wire and 25-G needle) are effective methods of tumor localization especially for LMICs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13193-023-01845-2.

Significance of Serum Lactate Dehydrogenase as a Prognostic Marker and Outcome Predictor in Patients With Breast Cancer

Background Breast carcinoma has been the most prevalent cancer in women, with research-based evidence showing a significant rise in the incidence of cancer and related morbidity and mortality in the Indian subcontinent. The predictive value of plasmatic lactate dehydrogenase (LDH) levels has been studied in breast cancer. Numerous studies have connected high LDH values to a poor prognosis, increased risk of incidence, recurrence, and associated mortality in patients with breast carcinoma. This study aimed to assess the clinical profile of breast carcinoma and determine the correlation of serum lactate dehydrogenase levels with the stage of the disease and assessment of high-risk features using histopathology and immunohistochemistry. Methods A total of 75 patients with carcinoma breast were enrolled for this study and classified into two groups: upfront surgery and post-adjuvant therapy. Serum LDH levels were estimated a day before the surgery (baseline) and on postoperative days 1, 7, 14, and 30. The clinical tumor, node, metastasis (cTNM) staging was correlated with pathological tumor, node, metastasis TNM (pTNM) staging and immunohistochemistry findings. Results The clinical characteristics of breast cancer, serum LDH levels, and stage of the disease were collected and analyzed. A significant decreasing trend was noted in LDH values post-op days, and statistically significant higher LDH values were noted in the triple-negative group, positive lymph nodes, and positive lymphovascular invasion patients. Conclusion Regularly elevated levels or an unanticipated rise in serum LDH might indicate poor outcomes. Hence, this non-specific enzyme marker can be suggested to be used routinely to assess disease outcomes.

A Systematic Review and Meta-analysis of Touch Imprint Cytology and Frozen Section Biopsy and Their Comparison for Evaluation of Sentinel Lymph Node in Breast Cancer

INTRODUCTION

Evaluation of axillary lymph nodes after sentinel lymph node biopsy (SLNB) in breast cancer is mostly done by intra-operative frozen section biopsy (FSB) and/ or touch imprint cytology (TIC). In this systematic review and meta-analysis, we have compared the accuracy of the two modalities.

METHODS

PubMed, EMBASE, and Cochrane electronic databases were searched for articles comparing TIC with FSB. Articles were assessed for methodological and reporting quality. The main summary measures were pooled sensitivity, pooled specificity, and diagnostic accuracy using bivariate generalized linear mixed models using random effects.

RESULTS

Fourteen studies were included. The pooled sensitivity, specificity, and diagnostic accuracy for FSB were 78%, 100%, and 98.57%. For TIC, the pooled sensitivity, specificity, and diagnostic accuracy were 74%, 98%, and 98.37%. For both methods, visual inspection of summary ROC curves and of forest plots did not show significant heterogeneity.

CONCLUSION

TIC showed comparable sensitivity, specificity, and accuracy to FSB and hence can be used as its substitute as a rapid and economical test for the detection of axillary lymph node metastasis during SLNB especially in low-resource settings.

Low-cost solutions incorporated in a standard surgical pathway for early breast cancer: A pilot study

We present the results of incorporation of low-cost solutions to provide a standard surgical care for early breast cancer (EBC) patients. This surgical pathway consists of a low-cost vacuum-assisted core needle biopsy, sentinel lymph node biopsy (SLNB) using low-cost methylene blue and fluorescin dyes under local anesthesia and oncoplastic breast surgery. Patients assessed as clinically node-negative axilla underwent such treatment. SLNB using low-cost dyes was performed without any complication. Oncoplastic surgical techniques were opted for in 32 patients, and the lumps were all excised with a ∼1-cm all-around margin on the final histopathological examination. Standard breast cancer surgery can be provided in low-resource settings to eligible EBC patients with low-cost solutions.