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Alexander J, Schipper K, Nash S, Brough R, Kemp H, Iacovacci J, Isacke C, Natrajan R, Sawyer E, Lord CJ, Haider S. Pathway-based signatures predict patient outcome, chemotherapy benefit and synthetic lethal dependencies in invasive lobular breast cancer. Br J Cancer 2024; 130:1828-1840. [PMID: 38600325 PMCID: PMC11130209 DOI: 10.1038/s41416-024-02679-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Invasive Lobular Carcinoma (ILC) is a morphologically distinct breast cancer subtype that represents up to 15% of all breast cancers. Compared to Invasive Breast Carcinoma of No Special Type (IBC-NST), ILCs exhibit poorer long-term outcome and a unique pattern of metastasis. Despite these differences, the systematic discovery of robust prognostic biomarkers and therapeutically actionable molecular pathways in ILC remains limited. METHODS Pathway-centric multivariable models using statistical machine learning were developed and tested in seven retrospective clinico-genomic cohorts (n = 996). Further external validation was performed using a new RNA-Seq clinical cohort of aggressive ILCs (n = 48). RESULTS AND CONCLUSIONS mRNA dysregulation scores of 25 pathways were strongly prognostic in ILC (FDR-adjusted P < 0.05). Of these, three pathways including Cell-cell communication, Innate immune system and Smooth muscle contraction were also independent predictors of chemotherapy response. To aggregate these findings, a multivariable machine learning predictor called PSILC was developed and successfully validated for predicting overall and metastasis-free survival in ILC. Integration of PSILC with CRISPR-Cas9 screening data from breast cancer cell lines revealed 16 candidate therapeutic targets that were synthetic lethal with high-risk ILCs. This study provides interpretable prognostic and predictive biomarkers of ILC which could serve as the starting points for targeted drug discovery for this disease.
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Affiliation(s)
- John Alexander
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, SW3 6JB, UK
| | - Koen Schipper
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, SW3 6JB, UK
| | - Sarah Nash
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, SW3 6JB, UK
- Breast Cancer Genetics, King's College London, London, SE1 9RT, UK
| | - Rachel Brough
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, SW3 6JB, UK
- The CRUK Gene Function Laboratory, The Institute of Cancer Research, London, SW3 6JB, UK
| | - Harriet Kemp
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, SW3 6JB, UK
| | - Jacopo Iacovacci
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, SW3 6JB, UK
| | - Clare Isacke
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, SW3 6JB, UK
| | - Rachael Natrajan
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, SW3 6JB, UK
| | - Elinor Sawyer
- Breast Cancer Genetics, King's College London, London, SE1 9RT, UK
| | - Christopher J Lord
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, SW3 6JB, UK
- The CRUK Gene Function Laboratory, The Institute of Cancer Research, London, SW3 6JB, UK
| | - Syed Haider
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, SW3 6JB, UK.
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Göker M, Deblaere S, Denys H, Vergauwen G, Naert E, Veldeman L, Monten C, Van den Broecke R, Van Dorpe J, Braems G, Van de Vijver K. Tumor-Infiltrating Lymphocytes and PD-L1 Expression in Pleomorphic Lobular Breast Carcinoma. Cancers (Basel) 2023; 15:cancers15112894. [PMID: 37296857 DOI: 10.3390/cancers15112894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The prognostic and predictive role of stromal tumor-infiltrating lymphocytes (sTILs) is undetermined in pleomorphic invasive lobular cancer (pILC). The same applies for the expression of PD-1/PD-L1 in this rare breast cancer subtype. Here, we aimed to investigate the expression of sTILs and analyze the PD-L1 expression levels in pILC. METHODS Archival tissues from sixty-six patients with pILC were collected. The sTIL density was scored as a percentage of tumor area using the following cut-offs: 0%; <5%; 5-9%; and 10-50%. The PD-L1 expression was analyzed using IHC on formalin-fixed, paraffin-embedded tissue sections using SP142 and 22C3 antibodies. RESULTS A total of 82% of the sixty-six patients were hormone receptor positive and 8% of cases were triple negative (TN), while 10% showed human epidermal growth factor receptor 2 (HER2) amplification. sTILs (≥1%) were present in 64% of the study population. Using the SP142 antibody, 36% of tumors demonstrated a positive PD-L1 score of ≥1%, and using the 22C3 antibody, 28% had a positive PD-L1 score of ≥1. There was no correlation between sTILs or PD-L1 expression and tumor size, tumor grade, nodal status, expression of estrogen receptor (ER), or amplification of HER2. Our data did not show any difference in survival between the three molecular subtypes of pILC with respect to sTILs and PD-L1 expression. CONCLUSION This study shows that pILCs show some degree of sTILs and PD-L1 expression; however, this was not associated with a survival improvement. Additional large trials are needed to understand immune infiltration in lobular cancer, especially in the pleomorphic subtype.
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Affiliation(s)
- Menekse Göker
- Department of Gynaecology, Ghent University Hospital, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
| | - Stephanie Deblaere
- Department of Gynaecology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Hannelore Denys
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Glenn Vergauwen
- Department of Gynaecology, Ghent University Hospital, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
| | - Eline Naert
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Liv Veldeman
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Radiotherapy, Ghent University Hospital, 9000 Ghent, Belgium
| | - Chris Monten
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Radiotherapy, Ghent University Hospital, 9000 Ghent, Belgium
| | | | - Jo Van Dorpe
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Geert Braems
- Department of Gynaecology, Ghent University Hospital, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
| | - Koen Van de Vijver
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
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Göker M, Denys H, van de Vijver K, Braems G. Genomic assays for lobular breast carcinoma. J Clin Transl Res 2022; 8:523-531. [PMID: 36451999 PMCID: PMC9706320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/21/2022] [Accepted: 10/01/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND One of the current challenges in breast cancer is the appropriate treatment of invasive lobular breast cancer (ILC) and defining the high-risk group within ILC. The biological character of ILC typically translates to a good prognosis, however, several studies have indicated that the long-term prognosis is worse than for patients diagnosed with the more commonly invasive ductal carcinoma. Many genomic tests are now available to determine whether those patients are at high risk (HR) and enable tailored treatment. Unfortunately, most of the studies in which these genomic tests have been evaluated entail retrospective analysis of a prospective trial. AIM This review focuses on the validation of the available genomic assays based on trials performed in ILC patients, where in some instances, the various subtypes of ILC (classical, pleomorphic, and non-classic type) were taken into account. RESULTS Using Oncotype DX in retrospective studies, only 1.3%-8% of ILC tumors were categorized as HR tumors. For MammaPrint, 24% of patients were classified as HR, which was associated with poor outcome. In a recent sub-analysis of the MINDACT study comprising 487 ILC patients, 16.2% were high genomic risk. EndoPredict, Prosigna Breast Cancer Prognostic Gene Signature Assay, and the Breast Cancer Index have been validated in patients receiving only endocrine treatment. CONCLUSION Although ILC accounts for the second most common breast cancer subtype in women, none of these tests encompass tumor morphology in their algorithms. Prospective studies on ILC with genomic assays are warranted given the various subtypes of and treatment options for this underestimated, but frequently occurring cancer. RELEVANCE FOR PATIENTS Genomic assays can be employed in ILC patients to predict the risk of recurrence and identify those patients who might benefit from chemotherapy in addition to their standard treatment regimen.
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Affiliation(s)
- Menekse Göker
- Department of Gynecology, Ghent University, Ghent, Belgium
| | - Hannelore Denys
- Department of Medical Oncology, Ghent University, Ghent, Belgium
| | | | - Geert Braems
- Department of Gynecology, Ghent University, Ghent, Belgium
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Biomarker profile of invasive lobular carcinoma: pleomorphic versus classic subtypes, clinicopathological characteristics and prognosis analyses. Breast Cancer Res Treat 2022; 194:279-295. [PMID: 35666367 DOI: 10.1007/s10549-022-06627-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/03/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE To compare the clinicopathologic features and prognosis of pleomorphic invasive lobular carcinoma (P-ILC) and classic ILC (C-ILC) according to the biomarker profile. METHODS A total of 667 C-ILCs and 133 P-ILCs between 2011 and 2021 were included. Clinicopathologic features and stromal tumor-infiltrating lymphocytes (sTILs) status were evaluated. P-ILCs were divided into subtypes based on ER/PR and HER2 expression. The overall survival and disease-free survival (DFS) of patients were compared among matched P-ILCs, C-ILCs, and invasive ductal carcinomas (IDCs) with biomarker subtypes. RESULTS Compared to C-ILCs, P-ILCs had greater tumor sizes and stages, fewer ER-positive, more HER2-positive, triple negative (TN), and Ki-67 > 20% tumors (P < 0.05). P-ILCs were subdivided into ER+ (63.1%), HER2+ (21.1%) and TN (15.8%). ER+ P-ILCs were mainly showed trabecular and solid growth patterns. Apocrine and solid features were more strongly associated with HER2+ P-ILCs and TN-P-ILCs, respectively. The prognosis of each biomarker group (ER+, HER2+ and TN) differed by subtype. The P-ILC biomarker subtypes had worse prognosis than the same subtypes in the IDC group, while there was no difference between the P-ILC and the C-ILC counterparts. Solid variants of P-ILC had the worst prognosis. Bone was the most common metastatic site in ER+ P-ILCs and TN-P-ILCs. HER2+ P-ILCs tended to metastasize to the brain and liver. DFS of HER2+ P-ILCs and TN-P-ILCs were worse than that of ER+ P-ILCs. Lacking lobular carcinoma in situ and sTILs ≤ 10% were associated with worse survival of ER+ P-ILCs and TN-P-ILCs, respectively. For HER2+ P-ILCs, Ki-67 > 20% and sTILs ≤ 10% were significant factors for lower DFS. CONCLUSION P-ILCs is an aggressive subtype of ILCs. Analyzing the prognostic factors of P-ILCs with heterogeneous morphological and biomarker characteristics is helpful for creating an individualized treatment.
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Timbres J, Moss C, Mera A, Haire A, Gillett C, Van Hemelrijck M, Sawyer E. Survival Outcomes in Invasive Lobular Carcinoma Compared to Oestrogen Receptor-Positive Invasive Ductal Carcinoma. Cancers (Basel) 2021; 13:cancers13123036. [PMID: 34207042 PMCID: PMC8234044 DOI: 10.3390/cancers13123036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/19/2021] [Accepted: 06/07/2021] [Indexed: 01/19/2023] Open
Abstract
Invasive lobular breast cancer (ILC) accounts for 10-15% of breast cancers and has distinct characteristics compared with the more common invasive ductal carcinoma (IDC). Studies have shown that ILC may be less sensitive to chemotherapy than IDC, with lower rates of complete pathological response after neo-adjuvant chemotherapy, but it is not clear how this affects long-term survival. Patients at Guy's and St Thomas' NHS Foundation Trust between 1975 and 2016 diagnosed with ER+ IDC or ER+ ILC were eligible for inclusion. Kaplan-Meier plots and Cox proportional-hazards regression models were used for analysis. There was no difference in overall survival comparing ER+ ILC to ER+ IDC (OR: 0.94, 95% CI: 0.83, 1.04) with a median follow-up time of 8.3 years compared to 8.4 years in IDC. However, ER+HER2- ILC had worse survival compared to ER+HER2- IDC in those that received chemotherapy (OR: 1.46, 95% CI: 1.06, 2.01). Here, median follow-up time was 7.0 years in ILC compared to 8.1 years in IDC. These results indicate worse overall survival after chemotherapy (neo-adjuvant and adjuvant) in ILC compared to ER+HER2- IDC even when correcting for tumour grade, age, size, and nodal involvement, but validation is needed in a larger study population.
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Affiliation(s)
- Jasmine Timbres
- Breast Cancer Genetics, King’s College London, London SE1 9RT, UK;
- Correspondence:
| | - Charlotte Moss
- Translational Oncology and Urology Research, King’s College London, London SE1 9RT, UK; (C.M.); (A.H.); (M.V.H.)
| | - Anca Mera
- Guy’s & St. Thomas’ Hospital, London SE1 9RT, UK;
| | - Anna Haire
- Translational Oncology and Urology Research, King’s College London, London SE1 9RT, UK; (C.M.); (A.H.); (M.V.H.)
| | - Cheryl Gillett
- KHP Cancer Biobank, King’s College London, London SE1 9RT, UK;
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, King’s College London, London SE1 9RT, UK; (C.M.); (A.H.); (M.V.H.)
| | - Elinor Sawyer
- Breast Cancer Genetics, King’s College London, London SE1 9RT, UK;
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Pramod N, Nigam A, Basree M, Mawalkar R, Mehra S, Shinde N, Tozbikian G, Williams N, Majumder S, Ramaswamy B. Comprehensive Review of Molecular Mechanisms and Clinical Features of Invasive Lobular Cancer. Oncologist 2021; 26:e943-e953. [PMID: 33641217 DOI: 10.1002/onco.13734] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/12/2021] [Indexed: 12/15/2022] Open
Abstract
Invasive lobular carcinoma (ILC) accounts for 10% to 15% of breast cancers in the United States, 80% of which are estrogen receptor (ER)-positive, with an unusual metastatic pattern of spread to sites such as the serosa, meninges, and ovaries, among others. Lobular cancer presents significant challenges in detection and clinical management given its multifocality and multicentricity at presentation. Despite the unique features of ILC, it is often lumped with hormone receptor-positive invasive ductal cancers (IDC); consequently, ILC screening, treatment, and follow-up strategies are largely based on data from IDC. Despite both being treated as ER-positive breast cancer, querying the Cancer Genome Atlas database shows distinctive molecular aberrations in ILC compared with IDC, such as E-cadherin loss (66% vs. 3%), FOXA1 mutations (7% vs. 2%), and GATA3 mutations (5% vs. 20%). Moreover, compared with patients with IDC, patients with ILC are less likely to undergo breast-conserving surgery, with lower rates of complete response following therapy as these tumors are less chemosensitive. Taken together, this suggests that ILC is biologically distinct, which may influence tumorigenesis and therapeutic strategies. Long-term survival and clinical outcomes in patients with ILC are worse than in stage- and grade-matched patients with IDC; therefore, nuanced criteria are needed to better define treatment goals and protocols tailored to ILC's unique biology. This comprehensive review highlights the histologic and clinicopathologic features that distinguish ILC from IDC, with an in-depth discussion of ILC's molecular alterations and biomarkers, clinical trials and treatment strategies, and future targets for therapy. IMPLICATIONS FOR PRACTICE: The majority of invasive lobular breast cancers (ILCs) are hormone receptor (HR)-positive and low grade. Clinically, ILC is treated similar to HR-positive invasive ductal cancer (IDC). However, ILC differs distinctly from IDC in its clinicopathologic characteristics and molecular alterations. ILC also differs in response to systemic therapy, with studies showing ILC as less sensitive to chemotherapy. Patients with ILC have worse clinical outcomes with late recurrences. Despite these differences, clinical trials treat HR-positive breast cancers as a single disease, and there is an unmet need for studies addressing the unique challenges faced by patients diagnosed with ILC.
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Affiliation(s)
- Nikhil Pramod
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Akanksha Nigam
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mustafa Basree
- University of Pikeville Kentucky College of Osteopathic Medicine, Pikeville, Kentucky, USA
| | - Resham Mawalkar
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Saba Mehra
- University of Toledo - Health Science Campus, Toledo, Ohio, USA
| | - Neelam Shinde
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Gary Tozbikian
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Nicole Williams
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Sarmila Majumder
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Bhuvaneswari Ramaswamy
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
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Chen X, Lei L, Tian C, Ning P. Invasive pleomorphic lobular carcinoma of the breast with multiple metastases: A case report. Int J Surg Case Rep 2021; 80:105581. [PMID: 33609943 PMCID: PMC7903291 DOI: 10.1016/j.ijscr.2021.01.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/17/2021] [Accepted: 01/17/2021] [Indexed: 11/29/2022] Open
Abstract
Invasive Pleomorphic Lobular Carcinoma(IPLC) accounts for less than 1% of breast cancer. This paper reports a case of IPLC with multiple metastases and gives review literature. The patient’s general condition improved after our specific treatment options, which has a certain reference for the treatment of this kind of patients in the future.
Introduction and importance IPLC (Invasive Pleomorphic Lobular Carcinoma) accounts for less than 1% of breast cancer. To the best of our knowledge, this is one of the few reported cases in the IPLC with multiple metastases. The patient's general condition got improved after our treatment, which has a certain reference for the treatment of this kind of patient in the future. Case presentation A 42-year-old female with IPLC and multiple metastases. The IPLC malignant cells were positive for p120 (cytoplasmic) and human epidermal growth factor receptor 2, negative for estrogen receptor, progesterone receptor, and E-cadherin. There were nodular enhancement foci in the liver, which are considered the metastatic lesions of the breast, and the liver function was abnormal. Multiple metastatic lesions of the vertebral body, appendage of the whole spine, and sternum. And C7, T1, and T9 vertebrae showed compression fractures. Clinical discussion IPLC has systemic metastasis which molecular typing by immunohistochemistry is HER-2 overexpression can choose chemotherapy combined with targeted therapy to prolong the survival time and improve the quality of life of patients. The patient was followed up. Conclusions This paper reports a case of IPLC with multiple metastases and gives review literature. Our treatment of the patient can be a reference for other clinicians.
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Affiliation(s)
- Xiangrong Chen
- Breast Department, Chengdu Women's and Children's Central Hospital, Chengdu, 610031, China
| | - Lei Lei
- Breast Department, Chengdu Women's and Children's Central Hospital, Chengdu, 610031, China
| | - Chunxiang Tian
- Breast Department, Chengdu Women's and Children's Central Hospital, Chengdu, 610031, China
| | - Ping Ning
- Breast Department, Chengdu Women's and Children's Central Hospital, Chengdu, 610031, China.
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Naik N, Madani A, Esteva A, Keskar NS, Press MF, Ruderman D, Agus DB, Socher R. Deep learning-enabled breast cancer hormonal receptor status determination from base-level H&E stains. Nat Commun 2020; 11:5727. [PMID: 33199723 PMCID: PMC7670411 DOI: 10.1038/s41467-020-19334-3] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/25/2020] [Indexed: 12/09/2022] Open
Abstract
For newly diagnosed breast cancer, estrogen receptor status (ERS) is a key molecular marker used for prognosis and treatment decisions. During clinical management, ERS is determined by pathologists from immunohistochemistry (IHC) staining of biopsied tissue for the targeted receptor, which highlights the presence of cellular surface antigens. This is an expensive, time-consuming process which introduces discordance in results due to variability in IHC preparation and pathologist subjectivity. In contrast, hematoxylin and eosin (H&E) staining—which highlights cellular morphology—is quick, less expensive, and less variable in preparation. Here we show that machine learning can determine molecular marker status, as assessed by hormone receptors, directly from cellular morphology. We develop a multiple instance learning-based deep neural network that determines ERS from H&E-stained whole slide images (WSI). Our algorithm—trained strictly with WSI-level annotations—is accurate on a varied, multi-country dataset of 3,474 patients, achieving an area under the curve (AUC) of 0.92 for sensitivity and specificity. Our approach has the potential to augment clinicians’ capabilities in cancer prognosis and theragnosis by harnessing biological signals imperceptible to the human eye. Determination of estrogen receptor status (ERS) in breast cancer tissue requires immunohistochemistry, which is sensitive to the vagaries of sample processing and the subjectivity of pathologists. Here the authors present a deep learning model that determines ERS from H&E stained tissue, which could improve oncology decisions in under-resourced settings.
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Affiliation(s)
- Nikhil Naik
- Salesforce Research, 575 High St, Palo Alto, CA, 94301, USA.
| | - Ali Madani
- Salesforce Research, 575 High St, Palo Alto, CA, 94301, USA
| | - Andre Esteva
- Salesforce Research, 575 High St, Palo Alto, CA, 94301, USA
| | | | - Michael F Press
- Department of Pathology, Keck School of Medicine, University of Southern California, 2011 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Daniel Ruderman
- Lawrence J. Ellison Institute for Transformative Medicine, University of Southern California, 12414 Exposition Blvd, Los Angeles, CA, 90064, USA
| | - David B Agus
- Lawrence J. Ellison Institute for Transformative Medicine, University of Southern California, 12414 Exposition Blvd, Los Angeles, CA, 90064, USA
| | - Richard Socher
- Salesforce Research, 575 High St, Palo Alto, CA, 94301, USA
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9
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Ilina O, Gritsenko PG, Syga S, Lippoldt J, La Porta CAM, Chepizhko O, Grosser S, Vullings M, Bakker GJ, Starruß J, Bult P, Zapperi S, Käs JA, Deutsch A, Friedl P. Cell-cell adhesion and 3D matrix confinement determine jamming transitions in breast cancer invasion. Nat Cell Biol 2020; 22:1103-1115. [PMID: 32839548 PMCID: PMC7502685 DOI: 10.1038/s41556-020-0552-6] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 06/30/2020] [Indexed: 12/25/2022]
Abstract
Plasticity of cancer invasion and metastasis depends on the ability of cancer cells to switch between collective and single-cell dissemination, controlled by cadherin-mediated cell-cell junctions. In clinical samples, E-cadherin-expressing and -deficient tumours both invade collectively and metastasize equally, implicating additional mechanisms controlling cell-cell cooperation and individualization. Here, using spatially defined organotypic culture, intravital microscopy of mammary tumours in mice and in silico modelling, we identify cell density regulation by three-dimensional tissue boundaries to physically control collective movement irrespective of the composition and stability of cell-cell junctions. Deregulation of adherens junctions by downregulation of E-cadherin and p120-catenin resulted in a transition from coordinated to uncoordinated collective movement along extracellular boundaries, whereas single-cell escape depended on locally free tissue space. These results indicate that cadherins and extracellular matrix confinement cooperate to determine unjamming transitions and stepwise epithelial fluidization towards, ultimately, cell individualization.
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Affiliation(s)
- Olga Ilina
- Department of Cell Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Pavlo G Gritsenko
- Department of Cell Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Simon Syga
- Department of Innovative Computing, Centre for Information Services and High Performance Computing, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Lippoldt
- Peter Debye Institute for Soft Matter Physics, Leipzig University, Leipzig, Germany
| | - Caterina A M La Porta
- Center for Complexity and Biosystems, University of Milan, Milan, Italy
- Department of Environmental Science and Policy, University of Milan, Milan, Italy
- Consiglio Nazionale delle Ricerche (CNR), Istituto di Biofisica, Milan, Italy
| | - Oleksandr Chepizhko
- Institut für Theoretische Physik, Leopold-Franzens-Universität Innsbruck, Innsbruck, Austria
| | - Steffen Grosser
- Peter Debye Institute for Soft Matter Physics, Leipzig University, Leipzig, Germany
| | - Manon Vullings
- Department of Cell Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gert-Jan Bakker
- Department of Cell Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jörn Starruß
- Department of Innovative Computing, Centre for Information Services and High Performance Computing, Technische Universität Dresden, Dresden, Germany
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefano Zapperi
- Center for Complexity and Biosystems, University of Milan, Milan, Italy
- Department of Physics, University of Milan, Milan, Italy
- Consiglio Nazionale delle Ricerche (CNR), Istituto di Chimica della Materia Condensata e di Tecnologie per l'Energia, Milan, Italy
| | - Josef A Käs
- Peter Debye Institute for Soft Matter Physics, Leipzig University, Leipzig, Germany
| | - Andreas Deutsch
- Department of Innovative Computing, Centre for Information Services and High Performance Computing, Technische Universität Dresden, Dresden, Germany
| | - Peter Friedl
- Department of Cell Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
- David H. Koch Center for Applied Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Cancer Genomics Centre, Utrecht, the Netherlands.
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10
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Mukhtar RA, Krings G, Chen YY, Mamounas ME, Fahrner-Scott K, Wong J, Alvarado M, Ewing C, Esserman LJ, Rugo H. Mitotic score and pleomorphic histology in invasive lobular carcinoma of the breast: impact on disease-free survival. Breast Cancer Res Treat 2020; 181:23-29. [PMID: 32240457 DOI: 10.1007/s10549-020-05606-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/18/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Pleomorphic invasive lobular carcinoma (ILC) has long been thought to have worse outcomes than classic ILC and is therefore often treated with chemotherapy. However, recent data question the utility of the pleomorphic designation, as the poor outcomes seen may be related to other associated high-risk features. Importantly, mitotic count may better define a subset of ILC with high risk of recurrence. We sought to determine the impact of pleomorphic histology versus mitotic count on disease-free survival (DFS) in pure ILC. Additionally, we evaluated whether pleomorphic histology was associated with receipt of chemotherapy when adjusting for other factors. METHODS We analyzed a cohort of 475 patients with stage I-III pure ILC. We used Kaplan-Meier estimates, and Cox proportional hazards and logistic regression for multivariate analyses. Pleomorphic histology was confirmed by central pathology review. RESULTS In a multivariate model, pleomorphic histology was not associated with reduced DFS. Only mitotic score, receptor subtype, and pathologic stage were independently and significantly associated with DFS. Patients with pleomorphic ILC were significantly more likely to receive chemotherapy than patients with classic ILC (adjusted odds ratio 2.96, p = 0.026). CONCLUSIONS The pleomorphic designation in ILC does not have clinical utility and should not be used to determine therapy. Rather, mitotic count identified clear prognostic groups in this cohort of pure ILC.
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Affiliation(s)
- Rita A Mukhtar
- Department of Surgery, University of California, San Francisco, 1825 4th St, 3rd Floor, Box 1710, San Francisco, CA, 94143, USA.
| | - Gregor Krings
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Yunn-Yi Chen
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Matina E Mamounas
- Department of Surgery, University of California, San Francisco, 1825 4th St, 3rd Floor, Box 1710, San Francisco, CA, 94143, USA
| | - Kelly Fahrner-Scott
- Department of Surgery, University of California, San Francisco, 1825 4th St, 3rd Floor, Box 1710, San Francisco, CA, 94143, USA
| | - Jasmine Wong
- Department of Surgery, University of California, San Francisco, 1825 4th St, 3rd Floor, Box 1710, San Francisco, CA, 94143, USA
| | - Michael Alvarado
- Department of Surgery, University of California, San Francisco, 1825 4th St, 3rd Floor, Box 1710, San Francisco, CA, 94143, USA
| | - Cheryl Ewing
- Department of Surgery, University of California, San Francisco, 1825 4th St, 3rd Floor, Box 1710, San Francisco, CA, 94143, USA
| | - Laura J Esserman
- Department of Surgery, University of California, San Francisco, 1825 4th St, 3rd Floor, Box 1710, San Francisco, CA, 94143, USA
| | - Hope Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
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11
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Ilina O, Campanello L, Gritsenko PG, Vullings M, Wang C, Bult P, Losert W, Friedl P. Intravital microscopy of collective invasion plasticity in breast cancer. Dis Model Mech 2018; 11:dmm.034330. [PMID: 29997220 PMCID: PMC6176993 DOI: 10.1242/dmm.034330] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/04/2018] [Indexed: 01/15/2023] Open
Abstract
Cancer invasion programs are adaptive by switching between metastatic collective and single-cell dissemination; however, current intravital microscopy models for epithelial cancer in mice fail to reliably recreate such invasion plasticity. Using microimplantation of breast cancer spheroids into the murine mammary fat pad and live-cell monitoring, we show microenvironmental conditions and cytoskeletal adaptation during collective to single-cell transition in vivo E-cadherin-expressing 4T1 and E-cadherin-negative MMT tumors both initiated collective invasion along stromal structures, reflecting invasion patterns in 3D organotypic culture and human primary ductal and lobular carcinoma. Collectively invading cells developed weakly oscillatory actin dynamics, yet provided zones for single-cell transitions with accentuated, more chaotic actin fluctuations. This identifies collective invasion in vivo as a dynamic niche and efficient source for single-cell release.
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Affiliation(s)
- Olga Ilina
- Department of Cell Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Leonard Campanello
- Department of Physics, Institute for Physical Science and Technology, University of Maryland, College Park, MD 20742, USA
| | - Pavlo G Gritsenko
- Department of Cell Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Manon Vullings
- Department of Cell Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Chenlu Wang
- Department of Physics, Institute for Physical Science and Technology, University of Maryland, College Park, MD 20742, USA
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Wolfgang Losert
- Department of Physics, Institute for Physical Science and Technology, University of Maryland, College Park, MD 20742, USA
| | - Peter Friedl
- Department of Cell Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands .,Cancer Genomic Centre, 3584CG, Utrecht, The Netherlands.,David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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12
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Abdelkader A, Jorns JM. Pleomorphic Lobular Carcinoma: A Controversially Aggressive Variant of Invasive Lobular Carcinoma of the Breast. Int J Surg Pathol 2017; 26:434-436. [DOI: 10.1177/1066896917744878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Liu YL, Choi C, Lee SM, Zhong X, Hibshoosh H, Kalinsky K, Connolly EP. Invasive Lobular Breast Carcinoma: Pleomorphic Versus Classical Subtype, Associations and Prognosis. Clin Breast Cancer 2017; 18:114-120. [PMID: 28720418 DOI: 10.1016/j.clbc.2017.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/12/2017] [Accepted: 06/18/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Invasive pleomorphic lobular carcinoma (IPLC) has been associated with a worse prognosis compared with classic invasive lobular carcinoma (cILC); however, studies are small and conflicting. We seek to examine the prognosis of women with IPLC compared with cILC. METHODS A retrospective review of women with breast cancer at a single institution from 2003 to 2012 identified 193 women with invasive lobular carcinoma (ILC). IPLC was defined as ILC with a pathological description of primarily pleomorphic features and Nottingham histological grade score of 7, 8, or 9 or overall grade of 3 or mixed classic/pleomorphic features and overall grade of 3. All others were designated cILCs. Clinicopathologic variables, progression-free survival (PFS), per STEEP criteria, and overall survival (OS), using all-cause mortality, were examined in both groups. RESULTS Of the 193 women, 46 (24%) had IPLC and 147 (76%) had cILC. The IPLC group had significantly higher stage at diagnosis and more Hispanic women, but there were no differences in other clinicopathologic features or treatment. Median follow-up was 57 months (0.1-155 months). In univariate analysis, IPLC was associated with worse PFS (log-rank P = .09, Wilcoxon P = .01) but no significant differences in OS (log-rank P = .20, Wilcoxon P = .16). In multivariate models adjusting for stage, IPLC was not significantly associated with PFS (hazard ratio [HR] 1.43; 95% confidence interval [CI], 0.73-2.79; P = .30) or OS (HR 1.52; 95% CI, 0.58-4.01; P = .40). CONCLUSIONS IPLC was initially associated with worse PFS, but this was attenuated after adjustment for cancer stage, and there were no differences in OS.
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Affiliation(s)
- Ying L Liu
- Department of Medicine, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Christine Choi
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - Shing M Lee
- Department of Biostatistics, Columbia University School of Medicine, New York, NY
| | - Xiaobo Zhong
- Department of Biostatistics, Columbia University School of Medicine, New York, NY
| | - Hanina Hibshoosh
- Department of Pathology and Cell Biology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Kevin Kalinsky
- Department of Medical Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Eileen P Connolly
- Department of Radiation Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY.
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14
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Ohashi R, Matsubara M, Watarai Y, Yanagihara K, Yamashita K, Tsuchiya SI, Takei H, Naito Z. Pleomorphic lobular carcinoma of the breast: a comparison of cytopathological features with other lobular carcinoma variants. Cytopathology 2016; 28:122-130. [PMID: 27489086 DOI: 10.1111/cyt.12362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Pleomorphic lobular carcinoma (PLC) is a subtype of breast cancer with unique morphological features, but it remains controversial whether PLC should be considered an independent disease entity. The aim of this study was to illustrate cytopathological characteristics of PLC in comparison with other lobular carcinoma variants. METHODS We investigated clinicopathological features of PLC (n = 11) compared with those of other variants of invasive lobular carcinoma (ILC, non-PLC) (n = 32). Histological variants of the non-PLC group consisted of classic (n = 25), solid (n = 2), alveolar (n = 1) and a tubulolobular type (n = 4). A review of cytological reports and fine needle aspiration (FNA) smear samples was performed for the PLC (n = 9) and non-PLC (n = 27) groups. RESULTS Patients with PLC were older, and had a higher nuclear grade and a higher incidence of axillary lymph node metastasis and triple negative phenotype than non-PLC patients (P = 0.007, P < 0.001, P = 0.02 and P < 0.001, respectively). Cytological findings in PLC included medium- to large-sized nuclei, prominent nucleoli, a moderate-to-severe degree of pleomorphism, apocrine change and background necrosis, none of which were evident in the smears of the non-PLC group (P < 0.001, P = 0.002, P < 0.001, P < 0.001, and P = 0.03, respectively). Despite these differences, patients with PLC and non-PLC showed similar clinical outcomes in our follow-up period. CONCLUSIONS Based on our results, a cytological diagnosis of PLC should be proposed if there are moderate- to large-sized nuclei, prominent nucleoli, a moderate-to severe degree of nuclear pleomorphism, apocrine change and necrosis in the background in FNA biopsy samples.
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Affiliation(s)
- R Ohashi
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - M Matsubara
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Y Watarai
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - K Yanagihara
- Department of Breast Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - K Yamashita
- Department of Breast Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - S-I Tsuchiya
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan.,Department of Diagnostic Pathology, Iida Hospital, Tokyo, Japan
| | - H Takei
- Department of Breast Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Z Naito
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan.,Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
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15
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Park CK, Jung WH, Koo JS. Expression of cancer-associated fibroblast-related proteins differs between invasive lobular carcinoma and invasive ductal carcinoma. Breast Cancer Res Treat 2016; 159:55-69. [PMID: 27469595 DOI: 10.1007/s10549-016-3929-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 07/22/2016] [Indexed: 12/17/2022]
Abstract
Cancer-associated fibroblasts (CAFs) are classified into various functional subtypes such as fibroblast activation protein-α (FAP-α), fibroblast specific protein-1 (FSP-1), platelet-derived growth factor receptor-α (PDGFR-α), and PDGFR-β. In this study, we compared the expression of CAF-related proteins in invasive lobular carcinoma (ILC) with those in invasive carcinoma of no special type (NST) and assessed the implications of the differences observed. Using tissue microarrays of 104 ILC and 524 invasive carcinoma (NST) cases, immunohistochemistry for CAF-related proteins [podoplanin, prolyl 4-hydroxylase, FAP-α, FSP-1/S100A4, PDGFR-α, PDGFR-β, and chondroitin sulfate proteoglycan (NG2)] was conducted. In invasive carcinoma (NST), tumor cells expressed a high level of PDGFR-α, whereas ILC tumor cells expressed high levels of podoplanin, prolyl 4-hydroxylase, FAP-α, and FSP-1/S100A4. In stromal cells of invasive carcinoma (NST), high expression levels of prolyl 4-hydroxylase, PDGFR-α, and NG2 were observed, whereas ILC stromal cells expressed high levels of FAP-α, FSP-1/S100A4, and PDGFR-β. In ILC, tumoral FSP-1/S100A4 positivity was associated with higher Ki-67 labeling index (p = 0.010) and non-luminal A type cancer (p = 0.014). Stromal PDGFR-α positivity was associated with lymph node metastasis (p = 0.011). On survival analysis of entire cases, tumoral FSP-1/S100A4 positivity (p = 0.002), stromal podoplanin positivity (p = 0.041), and stromal FSP-1/S100A4 negativity (p = 0.041) were associated with shorter disease-free survival; only tumoral FSP-1/S100A4 positivity (p = 0.044) was associated with shorter overall survival. In ILC, the expression of FAP-α and FSP-1/S100A4 was higher in both tumor and stromal cells than that observed in invasive carcinoma (NST). These results indicate that CAFs are a potential target in ILC treatment.
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Affiliation(s)
- Cheol Keun Park
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Woo Hee Jung
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Ja Seung Koo
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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16
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Al-Baimani K, Bazzarelli A, Clemons M, Robertson SJ, Addison C, Arnaout A. Invasive Pleomorphic Lobular Carcinoma of the Breast: Pathologic, Clinical, and Therapeutic Considerations. Clin Breast Cancer 2015. [PMID: 26209026 DOI: 10.1016/j.clbc.2015.06.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Pleomorphic lobular carcinoma is an uncommon form of breast cancer and a subtype of invasive lobular carcinoma. It has unique histopathologic features that translate to a more aggressive phenotype with an associated poor prognosis. Unlike classical invasive lobular carcinoma, it can lose estrogen and progesterone receptor expression and demonstrate HER-2/neu amplification. It remains to be determined, however, whether the pleomorphic histology independently predicts a worse outcome or whether other known associated negative prognostic factors such as larger tumor size, increased metastatic disease, and associated worse molecular subtypes commonly present in pleomorphic carcinoma account for the poor prognosis. Here we present an updated review of the unique pathologic and clinical features of pleomorphic lobular carcinoma needed to guide management for women with this subtype of cancer.
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Affiliation(s)
- Khalid Al-Baimani
- Division of Medical Oncology, Ottawa Hospital Cancer Center, Ottawa, ON, Canada
| | - Amy Bazzarelli
- Division of General Surgery, Ottawa Hospital, Ottawa, ON, Canada
| | - Mark Clemons
- Division of Medical Oncology, Ottawa Hospital Cancer Center, Ottawa, ON, Canada; Division of Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Susan J Robertson
- Department of Anatomical Pathology, Ottawa Hospital, Ottawa, ON, Canada
| | - Christina Addison
- Division of Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Angel Arnaout
- Division of General Surgery, Ottawa Hospital, Ottawa, ON, Canada; Division of Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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