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Schüler K, Bethmann D, Kaufhold S, Hartung C, Stückrath K, Lantzsch T, Uleer C, Hanf V, Peschel S, John J, Pöhler M, Buchmann J, Bürrig KF, Weigert E, Thomssen C, Kantelhardt EJ, Vetter M. Prognostic Value of Tumour-Infiltrating Lymphocytes in an Unselected Cohort of Breast Cancer Patients. Diagnostics (Basel) 2022; 12:2527. [PMID: 36292215 PMCID: PMC9601161 DOI: 10.3390/diagnostics12102527] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 02/13/2024] Open
Abstract
Tumour-infiltrating lymphocytes (TILs) are considered to have prognostic and predictive value for patients with early breast cancer. We examined 1166 breast cancer patients from a prospective, multicentre cohort (Prognostic Assessment in Routine Application (PiA), n = 1270, NCT01592825) following recommendations from the International TILs Working Group. TIL quantification was performed using predefined groups and as a continuous variable in 10% increments. The primary objective was the distribution of TILs in different breast cancer types. The second objective was the association with the recurrence-free interval (RFI) and overall survival (OS). Stromal infiltration with more than 60% TILs appeared in 2% of hormone receptor (HR)-positive and HER2-negative tumours, in 9.8% of HER2-positive tumours (any HR) and 19.4% of triple-negative breast cancers (TNBCs). Each 10% increment was associated with an improvement in the prognosis in HER2-positive samples (RFI, hazard ratio 0.773, 95% CI 0.587-1.017; OS, hazard ratio 0.700, 95% CI 0.523-0.937). When defining exploratory cut-offs for TILs, the use of a 30% threshold for the HR-positive and HER2-negative group, a 20% threshold for the HER2 group and a 60% threshold for the TNBC group appeared to be the most suitable. TILs bore prognostic value, especially in HER2-positive breast cancer. For clinical use, additional research on the components of immune infiltration might be reasonable.
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Affiliation(s)
- Kathleen Schüler
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Daniel Bethmann
- Institute of Pathology, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Sandy Kaufhold
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Carolin Hartung
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Kathrin Stückrath
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Tilmann Lantzsch
- Department of Gynaecology, Hospital St. Elisabeth and St. Barbara, 06110 Halle (Saale), Germany
| | - Christoph Uleer
- Gynäkologisch-Onkologische Praxis, 31134 Hildesheim, Germany
| | - Volker Hanf
- Department of Gynaecology, Nathanstift, Hospital Fürth, 90766 Fürth, Germany
| | - Susanne Peschel
- Department of Gynaecology, St. Bernward Hospital, 31134 Hildesheim, Germany
| | - Jutta John
- Department of Gynaecology, Helios Hospital Hildesheim, 31135 Hildesheim, Germany
| | - Marleen Pöhler
- Department of Gynaecology, Asklepios Hospital Goslar, 38642 Goslar, Germany
| | - Jörg Buchmann
- Institute of Pathology, Hospital Martha-Maria, 81479 Halle (Saale), Germany
| | | | - Edith Weigert
- Institute of Pathology, Hospital Fürth, 90766 Fürth, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Eva Johanna Kantelhardt
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
- Institute of Epidemiology, Biometry and Informatics, Martin Luther University Halle-Wittenberg, 06108 Halle (Saale), Germany
| | - Martina Vetter
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
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Garlaschi A, Fregatti P, Oddone C, Friedman D, Houssami N, Calabrese M, Tagliafico AS. Intraoperative digital breast tomosynthesis using a dedicated device is more accurate than standard intraoperative mammography for identifying positive margins. Clin Radiol 2019; 74:974.e1-974.e6. [PMID: 31521327 DOI: 10.1016/j.crad.2019.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022]
Abstract
AIM To compare a standard intra-operative mammography (IM) device with digital breast tomosynthesis using a dedicated device (Mozart system) in the evaluation of surgical margins at first excision. MATERIALS AND METHODS The study received institutional review board approval and written informed consent was obtained from participants. From January 2018 to December 2018, a prospective analysis of the images of IM device and intra-operative digital breast tomosynthesis with a dedicated device (Mozart system) in n=89 breast cancer patients (average patients age: 58 years, age range: 35-76 years) was undertaken. Images were evaluated by two expert breast radiologists independently of each other and blinded to each other's interpretation, who indicated the positive cases requiring surgical re-excision intra-operatively. RESULTS Mean cancer size was 12.5±4.5 mm. Radiological signs of the lesions were microcalcifications (n=71), nodules (n=10), and architectural distortions (n=8). A total of 20/89 (17%) patients underwent intra-operative re-excision for positive margins. Intra-operative digital breast tomosynthesis with a dedicated device and IM showed discrepancies in 15/89 cases (17%). Mozart system results informed the necessity to perform a re-excision (n=15). Overall, receiver operating characteristic (ROC) curve analysis showed and area under the ROC curve (AUC) of 0.82 for the Mozart system versus 0.65 for IM. ROC analysis of radiological findings with microcalcifications showed an AUC of 0.92 for the Mozart system versus 0.74 for IM, whereas AUC in cases with no microcalcifications were 0.87 and 0.75, respectively. CONCLUSION Intra-operative digital breast tomosynthesis with a dedicated device provides more information (better accuracy) than IM and facilitated a reduction in re-excision rates.
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Affiliation(s)
- A Garlaschi
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy
| | - P Fregatti
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - C Oddone
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy
| | - D Friedman
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - N Houssami
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - M Calabrese
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy
| | - A S Tagliafico
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy; Department of Health Sciences (DISSAL) - Radiology Unit, University of Genoa, Genoa, Italy.
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Kyriazoglou A, Zagouri F, Fotiou D, Dimitrakakis C, Marinopoulos S, Zakopoulou R, Kaparelou M, Zygogianni A, Dimopoulos MA. Discrepancies of current recommendations in breast cancer follow-up: a systematic review. Breast Cancer 2019; 26:681-686. [PMID: 30887287 DOI: 10.1007/s12282-019-00963-6] [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: 01/08/2019] [Accepted: 02/24/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Management and optimal follow-up of early breast cancer survivors remain up to this day a challenge due to the lack of well-established guidelines. Multiple medical societies, organizations and working groups have provided recommendations for follow-up but there is no uniform, globally approved algorithm to guide clinical practice. METHODS A systematic review was performed to identify and evaluate discrepancies between available guidelines for the follow-up of breast cancer survivors. RESULTS Differences in the follow-up schedule, laboratory and imaging investigations were noted. In the clinical practice setting, the situation is complicated further by clinicians who often request unnecessary tests not currently incorporated in any of the existing guidelines. CONCLUSIONS Follow-up of patients with early breast cancer needs to become standardized and prospective clinical trials focusing on optimal follow-up are more than mandatory.
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Affiliation(s)
- Anastasios Kyriazoglou
- Department of Clinical Therapeutics, General Hospital Alexandra, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - Flora Zagouri
- Department of Clinical Therapeutics, General Hospital Alexandra, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Despina Fotiou
- Department of Clinical Therapeutics, General Hospital Alexandra, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Spyros Marinopoulos
- Department of Obstetrics and Gynecology, General Hospital Alexandra, Athens, Greece
| | - Roubini Zakopoulou
- Department of Clinical Therapeutics, General Hospital Alexandra, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Kaparelou
- Department of Clinical Therapeutics, General Hospital Alexandra, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Anna Zygogianni
- Department of Radiology, General Hospital Aretaieion, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Meletios Athanasios Dimopoulos
- Department of Clinical Therapeutics, General Hospital Alexandra, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Estrogen receptor (ESR1) mutation in bone metastases from breast cancer. Mod Pathol 2018; 31:56-61. [PMID: 28799536 DOI: 10.1038/modpathol.2017.95] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/07/2017] [Accepted: 06/18/2017] [Indexed: 12/14/2022]
Abstract
Activating mutations of estrogen receptor α gene (ESR1) in breast cancer can cause endocrine resistance of metastatic tumor cells. The skeleton belongs to the metastatic sides frequently affected by breast cancer. The prevalence of ESR1 mutation in bone metastasis and the corresponding phenotype are not known. In this study bone metastases from breast cancer (n=231) were analyzed for ESR1 mutation. In 27 patients (12%) (median age 73 years, range: 55-82 years) activating mutations of ESR1 were detected. The most frequent mutation was p.D538G (53%), no mutations in exon 4 (K303) or 7 (S463) were found. Lobular breast cancer was present in 52% of mutated cases (n=14) and in 49% of all samples (n=231), respectively. Mutated cancers constantly displayed strong estrogen receptor expression. Progesterone receptor was positive in 78% of the mutated cases (n=21). From 194 estrogen receptor-positive samples, 14% had ESR1 mutated. Except for one mutated case, no concurrent HER2 overexpression was noted. Metastatic breast cancer with activating mutations of ESR1 had a higher Ki67 labeling index than primary luminal cancers (median 30%, ranging from 5 to 60% with 85% of cases revealing ≥20% Ki67-positive cells). From those patients from whom information on endocrine therapy was available (n=7), two had received tamoxifen only, 4 tamoxifen followed by aromatase inhibitors and one patient had been treated with aromatase inhibitors only. We conclude that ESR1 mutation is associated with estrogen receptor expression and high proliferative activity and affects about 14% of estrogen receptor-positive bone metastases from breast cancer.
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Response and prognosis after neoadjuvant chemotherapy in 1,051 patients with infiltrating lobular breast carcinoma. Breast Cancer Res Treat 2014; 144:153-62. [DOI: 10.1007/s10549-014-2861-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
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Thomssen C, Scharl A, Harbeck N. AGO Recommendations for Diagnosis and Treatment of Patients with Primary and Metastatic Breast Cancer. Update 2011. Breast Care (Basel) 2011; 6:299-313. [PMID: 22164127 PMCID: PMC3225216 DOI: 10.1159/000331459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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