Prognostic significance of occult lymph node metastases in breast cancer: a meta-analysis

A multi-center retrospective analysis of ultrasound-guided fine needle aspiration biopsy for detecting additional positive axillary node metastasis in early breast cancer

This study evaluates the effectiveness of ultrasound-guided fine needle aspiration biopsy (US-FNAB) in assessing additional positive axillary lymph node (ALN) metastasis following sentinel lymph node biopsy (SLNB) in clinically ALN-negative or N1 cases, aiming to refine patient management. A multi-center, retrospective analysis included 7617 patients with cT1-2 and cN0-1, who underwent US-FNAB for ALN and proceeding to SLNB or axillary lymph node dissection (ALND). Metastatic patterns were assessed, particularly focusing on correlations with positive FNAB results and additional ALN metastasis found during ALND, with statistical significance evaluated. Of those undergoing SLNB, 97.5% exhibited macrometastasis. In the SLNB-only group, 2.4% had 3 and more than 3 positive lymph node, compared to 19.2% in the SLNB & ALND group (P < 0.01). Among ALND patients, 63.3% had positive nodes, significantly higher in those with positive FNAB (91.9% vs. 22.8%, P < 0.001). Additionally, 40.9% were found to have additional positive ALNs in patients who underwent ALND following positive SLNB, with rates significantly higher in those with positive FNAB (60.3% vs. 35.4%, P < 0.001). LVI positivity, pT2-3, SLNR > 50% and positive FNAB were independent predictors of additional ALN metastasis in patients undergoing ALND after positive SLNB (P < 0.05). The proportion of additional positivity escalated with the number of positive SLNs. US-FNAB significantly improves the detection of additional ALN metastasis, guiding more effective strategy for ALN surgical decision-making. Our findings support the incorporation of US-FNAB into clinical practice to improve patient stratification and optimize treatment outcomes in early-stage breast cancer management.

Proteomic insights into lymph node metastasis in breast cancer subtypes: Key biomarkers and pathways

BACKGROUND

Breast cancer (BC) is a significant global cause of death in women, primarily due to its diversity and metastatic potential.

METHODS

BC, healthy lymph node (HL), and metastatic lymph node (ML) tissues were collected from 19 patients diagnosed with infiltrating ductal carcinoma. Protein isolation was performed, followed by two-dimensional gel electrophoresis (2DE) and mass spectrometry (MALDI-TOF/TOF) to identify differentially expressed proteins. Bioinformatic analyses, including protein-protein interaction networks and molecular pathways, were conducted using STRING. Kaplan-Meier analysis was performed with KM plotter to evaluate the prognostic significance of identified proteins. Receiver operating characteristic (ROC) curves were generated using TCGA and GTEx data from UCSC Xena and easyROC to assess diagnostic relevance.

RESULTS

Distinct pathways related to cytoskeletal regulation, immune modulation, and oxidative stress response were enriched in each subtype. Key proteins such as TUBA1C, CCT6A, and Vimentin (LNA), CAPZB and ENO1 (LNB), GSTO1 (HER2 OE), and CORO1A and LAP3 (TNBC) were identified as significant in driving metastatic behavior. KM survival analysis showed that CAPZB (LNB) and CORO1A (TNBC) were associated with patient outcomes, while GSTO1 was linked to improved distant metastasis-free survival in HER2 OE. ROC analysis highlighted CAPZB as a strong diagnostic marker.

CONCLUSIONS

These findings form a basis for comprehending the molecular mechanisms underlying metastasis in different subtypes of breast cancer. They may lead to the identification of new therapeutic targets for customized interventions against invasion and metastasis. Further validation is required to confirm their clinical utility in larger cohorts.

Axillary lymph node metastasis in breast cancer: from historical axillary surgery to updated advances in the preoperative diagnosis and axillary management

Axillary lymph node status, which was routinely assessed by axillary lymph node dissection (ALND) until the 1990s, is a crucial factor in determining the stage, prognosis, and therapeutic strategy used for breast cancer patients. Axillary surgery for breast cancer patients has evolved from ALND to minimally invasive approaches. Over the decades, the application of noninvasive imaging techniques, machine learning approaches and emerging clinical prediction models for the detection of axillary lymph node metastasis greatly improves clinical diagnostic efficacy and provides optimal surgical selection. In this work, we summarize the historical axillary surgery and updated perspectives of axillary management for breast cancer patients.

Prognosis of nodal micrometastasis in resectable pN0 non-small cell lung cancer

Background

Nodal micrometastasis (NMM) is the presence of a small cluster of tumor cells in a regional lymph node. However, the prognostic value of NMM in resectable NSCLC is still debated.

Methods

This retrospective cohort study at Maharaj Nakorn Chiang Mai Hospital from 2006 to 2017 assesses the prognostic impact of nodal micrometastasis in resectable pN0 NSCLC patients, using immunohistochemistry staining for cytokeratin AE1/AE3, p53, and BerEp4. Patients are categorized into three groups: pN0 without nodal micrometastasis, pN0 with nodal micrometastasis, and pN+. Overall survival is the primary endpoint, with disease-free survival as the secondary endpoint.

Results

Out of 225 patients, 98 had pathological N0 (pN0) status and 127 had pathological N positive (pN+) status. Among pN0 patients, nodal micrometastasis was found in 21 cases (21.43%), distributed as follows: 2 (2.04%) in hilar and interlobar regions (N1), 17 (17.35%) in the mediastinal region (N2), and 2 in both hilar and mediastinal regions (N1+N2) (2.04%).Univariable analysis revealed that male sex and the presence of tumor necrosis increased both the recurrence rate of lung cancer and the mortality rate, whereas larger tumor size, intra-tumoral vascular invasion, and pleural invasion were associated solely with cancer recurrence. However, multivariable analysis showed no statistically significant difference in disease-free survival and overall survival between pN0 patients with and without NMM, with hazard ratios of 0.98 (95% CI: 0.31-3.08, P=0.973) and 1.11 (95% CI: 0.23-5.42, P=0.900), respectively.

Conclusion

Nodal micrometastasis was identified in 21.43% of pN0 resectable NSCLC patients. However, the benefits of NMM detection in resectable cases remain controversial due to conflicting results from retrospective studies. Larger prospective cohort studies are needed to better understand disease prognosis and inform treatment strategies.

Development and Validation of a Nomogram for Axillary Lymph Node Metastasis Risk in Breast Cancer

Purpose: Preoperative assessment of axillary lymph node (ALN) status is essential for breast cancer treatment planning. This study prospectively analyzed risk factors for ALN metastasis by comparing high-resolution computed tomography (HRCT) imaging with pathology and developed a nomogram to aid in diagnosis. Methods: From April 2023 to May 2024, breast cancer patients confirmed by pathology participated in the study. All had chest HRCT before surgery, and ALN samples were anatomically matched to HRCT imaging and pathology. The least absolute shrinkage and selection operator (LASSO) regression helped refine metastasis features, and a nomogram was constructed using the final selected features determined by multivariate logistic regression. The nomogram's performance was evaluated with concordance index (C-index), calibration plot, and decision curve analysis, with internal validation through bootstrapping. Results: A total of 302 ALN from 98 patients were included in this study. The predictors included in the nomogram encompassed the mean CT value, short diameter, border, and shape of ALN, as well as the Ki-67 status and histological grade of the primary tumor. The model exhibited satisfactory discrimination, with a C-index of 0.869 (95% CI: 0.826-0.912) and an AUC of 0.862 (95% CI, 0.815-0.909). The calibration curve demonstrated a high degree of concordance between the predicted and actual probabilities. The decision curve analysis demonstrated that the nomogram was clinically useful when the threshold for intervention was set at the metastasis possibility range of 1% to 86%. Conclusion: The nomogram combined with preoperative pathology and HRCT imaging have the potential to improve the evaluation of ALN status.

Impact of the COVID-19 pandemic on breast cancer pathological stage at diagnosis in Tunisian patients

BACKGROUND

Breast cancer (BC) patients' diagnosis and management was affected by a global reorganization after the Coronavirus disease 2019 (COVID-19). Our study aimed to assess the impact of the pandemic on the pathological stage of newly diagnosed patients with BC compared to pre-pandemic and to identify predictive factors of tumor advanced stage.

METHODS

Pathological records of all consecutive newly operated BC patients between March 2020 and December 2021 were reviewed retrospectively. Clinical and pathological prognostic factors of BC were collected and compared between pre-pandemic and pandemic periods. Then, predictive factors of tumor advanced stage were identified.

RESULTS

Of the 225 cases included in the analysis, 98.7% were females and 1.3% were males. The median time from first histological diagnosis to first surgical treatment was enlarged by 42 days with a significant difference between the two periods (p = 0.002). Newly diagnosed BC patients during the COVID-19 pandemic were operated at a more advanced stage (54.1% vs 36.2%, p = 0.007), had a greater lymphovascular invasion (p = 0.002), lymph node metastasis (p = 0.015) and are more commonly of IBC NST histological type (p = 0.005). Moreover, multivariate analyses showed that the pandemic period (AOR = 2.28; p = 0.016) and the lympho-vascular invasion (p < 0.001) were independently associated with advanced stage of tumors.

CONCLUSION

Our findings proved an increase in alarming rates of advanced stage BC associated with the COVID-19 crisis. These findings support recommendations for a quick restoration of BC screening at full capacity, with adequate prioritization strategies to mitigate harm.

Early increase in tamoxifen dose in CYP2D6 poor metaboliser breast cancer patients and survival: A propensity score matching analysis

PURPOSE

Tamoxifen is a drug used for hormone receptor-positive breast cancers, primarily metabolised by the CYP2D6 enzyme into active metabolites such as endoxifen. CYP2D6 displays varying degrees of activity depending on its genotype. This study aims to analyse the effect of an early increase in tamoxifen dose in poor metabolisers (PM) on survival.

METHODS

We enrolled 220 patients diagnosed with breast cancer who were treated with tamoxifen. CYP2D6 polymorphisms were determined, and the phenotype was estimated according to the Clinical Pharmacogenetics Implementation Consortium. Disease-free survival (DFS) and overall survival (OS) were analysed considering the entire patient group, and a subgroup of 110 patients selected by Propensity Score Matching (PSM). All women were treated with 20 mg/day of tamoxifen for 5 years, except PM, who initially received 20 mg/day for 4 months, followed by 40 mg/day for 4 months and 60 mg/day for 4 months before returning to the standard dose of 20 mg/day until completing 5 years of treatment.

RESULTS

The analysis of the influence of CYP2D6 polymorphisms in the complete group and in the PSM subgroup revealed no significant differences for DFS or OS. Furthermore, DFS and OS were analysed in relation to various covariates such as age, histological grade, nodal status, tumour size, HER-2, Ki-67, chemotherapy, and radiotherapy. Only age, histological grade, nodal status, and chemotherapy treatment demonstrated statistical significance.

CONCLUSION

An early increase in tamoxifen dose in PM patients is not associated with survival differences among CYP2D6 phenotypes.

Best treatment options for occult breast cancer: A meta-analysis

Objectives

Occult breast cancer (OBC) is a rare malignant breast tumor. Because of the rare cases and limited clinical experience, a huge therapeutic difference has existed all over the world and standardized treatments have yet been established.

Methods

A meta-analysis was conducted using MEDLINE and Embase databases to identify the choice of OBC surgical procedures in all studies: (1) patients undergoing axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) only; (2) patients undergoing ALND with radiotherapy (RT); (3) patients undergoing ALND with breast surgery (BS); (4) patients undergoing ALND with RT and BS; and (5) patients undergoing observation or RT only. The primary endpoints were mortality rates, the second endpoints were distant metastasis and locoregional recurrence.

Results

Among the 3,476 patients, 493 (14.2%) undergo ALND or SLNB only; 632 (18.2%) undergo ALND with RT; 1483 (42.7%) undergo ALND with BS; 467 (13.4%) undergo ALND RT and BS, and 401 (11.5%) undergo observation or RT only. After comparing the multiple groups, both groups 1 and 3 have higher mortality rates than group 4 (30.7% vs. 18.6%, p < 0.0001; 25.1% vs. 18.6%, p = 0.007), and group 1 has higher mortality rates than groups 2 and 3 (30.7% vs.14.7%, p < 0.00001; 30.7 vs. 19.4%, p < 0.0001). Group (1 + 3) had a prognosis advantage over group 5 (21.4% vs. 31.0%, p < 0.00001). There was no significant difference both in the distant recurrence rates and locoregional rates between group (1 + 3) and group (2 + 4) (21.0% vs. 9.7%, p = 0.06; 12.3% vs. 6.5%, p = 0.26).

Conclusion

On the basis of this meta-analysis, our study indicates that BS including modified radical mastectomy (MRM) and breast-conserving surgery (BCS) combined RT may appear as the optimal surgical approach in patients with OBC. RT cannot prolong both the time of distant metastasis and the local recurrences.

Breast cancer: molecular mechanisms of underlying resistance and therapeutic approaches

Breast cancer (BC) affects over 250,000 women in the US each year. Drug-resistant cancer cells are responsible for most breast cancer fatalities. Scientists are developing novel chemotherapeutic drugs and targeted therapy combinations to overcome cancer cell resistance. Combining drugs can reduce the chances of a tumor developing resistance to treatment. Clinical research has shown that combination chemotherapy enhances or improves survival, depending on the patient's response to treatment. Combination therapy is a highly successful supplemental cancer treatment. This review sheds light on intrinsic resistance to BC drugs and the importance of combination therapy for BC treatment. In addition to recurrence and metastasis of BC, the article discussed biomarkers for BC.