Status quo and development trend of breast biopsy technology

Understanding cellular proliferation activity in breast cancer using multi-compartment model of transverse relaxation time mapping on 3T MRI

Introduction

Precise understanding of proliferative activity in breast cancer holds significant value in the monitoring of neoadjuvant treatment, while current immunostaining of Ki-67 from biopsy or resected tumour suffers from partial sampling error. Multi-compartment model of transverse relaxation time has been proposed to differentiate intra- and extra-cellular space and biochemical environment but susceptible to noise, with recent development of Bayesian algorithm suggested to improve robustness. We hence hypothesise that intra- and extra-cellular transverse relaxation times using Bayesian algorithm might be sensitive to proliferative activity.

Materials and methods

Twenty whole tumour specimens freshly excised from patients with invasive ductal carcinoma were scanned on a 3 T clinical scanner. The overall transverse relaxation time was computed using a single-compartment model with the non-linear least squares algorithm, while intra- and extra-cellular transverse relaxation times were computed using a multi-compartment model with the Bayesian algorithm. Immunostaining of Ki-67 was conducted, yielding 9 and 11 cases with high and low proliferating activities respectively.

Results

For single-compartment model, there was a significant higher overall transverse relaxation time (p = 0.031) in high (83.55 ± 7.38 ms) against low (73.30 ± 11.30 ms) proliferating tumours. For multi-compartment model, there was a significant higher intra-cellular transverse relaxation time (p = 0.047) in high (73.52 ± 10.92 ms) against low (61.30 ± 14.01 ms) proliferating tumours. There was no significant difference in extra-cellular transverse relaxation time (p = 0.203) between high and low proliferating tumours.

Conclusions

Overall and Bayesian intra-cellular transverse relaxation times are associated with proliferative activities in breast tumours, potentially serving as a non-invasive imaging marker for neoadjuvant treatment monitoring.

Radiomics to Differentiate Malignant and Benign Breast Lesions: A Systematic Review and Diagnostic Test Accuracy Meta-Analysis

Breast cancer is a prevalent global health concern, necessitating accurate diagnostic tools for effective management. Diagnostic imaging plays a pivotal role in breast cancer diagnosis, staging, treatment planning, and outcome evaluation. Radiomics is an emerging field of study in medical imaging that contains a broad set of computational methods to extract quantitative features from radiographic images. This can be utilized to guide diagnosis, treatment response, and prognosis in clinical settings.  A systematic review was performed in concordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Quality was assessed using the radiomics quality score. Diagnostic sensitivity and specificity of radiomics analysis, with 95% confidence intervals (CIs), were included for meta-analysis. The area under the curve analysis was recorded. An extensive statistical analysis was performed following the Cochrane guidelines. Statistical significance was determined if p-values were less than 0.05. Statistical analyses were conducted using Review Manager (RevMan), Version 5.4.1. A total of 31 manuscripts involving 8,773 patients were included, with 17 contributing to the meta-analysis. The cohort comprised 56.2% malignant breast cancers and 43.8% benign breast lesions. MRI demonstrated a sensitivity of 0.91 (95% CI: 0.89-0.92) and a specificity of 0.84 (95% CI: 0.82-0.86) in differentiating between benign and malignant breast cancers. Mammography-based radiomic features predicted breast cancer subtype with a sensitivity of 0.79 (95% CI: 0.76-0.82) and a specificity of 0.81 (95% CI: 0.79-0.84). Ultrasound-based analysis yielded a sensitivity of 0.92 (95% CI: 0.90-0.94) and a specificity of 0.85 (95% CI: 0.83-0.88). Only one study reported the results of radiomic evaluation from CT, which had a sensitivity of 0.95 (95% CI: 0.88-0.99) and a specificity of 0.56 (95% CI: 0.45-0.67).  Across different imaging modalities, radiomics exhibited robust diagnostic accuracy in differentiating benign and malignant breast lesions. The results underscore the potential of radiomic assessment as a minimally invasive alternative or adjunctive diagnostic tool for breast cancer. This is pioneering data that reports on a novel diagnostic approach that is understudied and underreported. However, due to study limitations, the complexity of this technology, and the need for future development, biopsy still remains the current gold standard method of determining breast cancer type.

Automated carcinoma classification using efficient nuclei-based patch selection and deep learning techniques

Breast cancer can be successfully treated if diagnosed at its earliest, though it is considered as a fatal disease among women. The histopathology slide turned images are the gold standard for tumor diagnosis. However, the manual diagnosis is still tedious due to its structural complexity. With the advent of computer-aided diagnosis, time and computation intensive manual procedure can be managed with the development of an automated classification system. The feature extraction and classification are quite challenging as these images involve complex structures and overlapping nuclei. A novel nuclei-based patch extraction method is proposed for the extraction of non-overlapping nuclei patches obtained from the breast tumor dataset. An ensemble of pre-trained models is used to extract the discriminating features from the identified and augmented non-overlapping nuclei patches. The discriminative features are further fused using p-norm pooling technique and are classified using a LightGBM classifier with 10-fold cross-validation. The obtained results showed an increase in the overall performance in terms of accuracy, sensitivity, specificity, and precision. The proposed framework yielded an accuracy of 98.3% for binary class classification and 95.1% for multi-class classification on ICIAR 2018 dataset.

A Novel Detection Method of Breast Cancer through a Simple Panel of Biomarkers

Circulating tumor cells (CTCs) have been identified as responsible for the spread of tumors to other organs of the body. In this sense, the development of sensitive and specific assays for their detection is important to reduce the number of deaths due to metastases. Here, we assessed whether the detection of CTCs in peripheral blood can serve in the construction of a panel of diagnosis and monitoring treatments of breast cancer (BC), focusing on the expression of markers of epithelial-mesenchymal transition. Through analyzing the blood from women without breast alterations (control), women with benign alterations, women with breast cancer without chemotherapy, and women with breast cancer with chemotherapy, we identified the best markers by transcriptional levels and determined three profiles of CTCs (mesenchymal, intermediate, and epithelial) by flow cytometry which, combined, can be used for diagnosis and therapy monitoring with sensitivity and specificity between 80% and 100%. Therefore, we have developed a method for detecting breast cancer based on the analysis of CTC profiles by epithelial-mesenchymal transition markers which, combined, can be used for the diagnosis and monitoring of therapy.

Impact of modern personalized treatment of breast cancer on surgical attitude and outcomes

Multimodal treatment of breast cancer has made steady progress in recent years. The involvement of modern oncology, diagnostic imaging techniques and surgical treatment, have brought a definite benefit to patients, defining the multidisciplinary treatment of breast cancer. The introduction of immunohistochemical testing and genetic screening has led to the prioritization of therapy according to their results and a correct approach to initiating treatment. The main aim of the present study was to conduct a comparative analysis through a retrospective study of the therapeutic means used in breast cancer with the statistical evaluation of the obtained results. To carry out the study, a group of 125 patients hospitalized during the period January 2015 to December 2020, were included, and the parameters were selected from the observation sheets. The results of the study demonstrated the superiority of multimodal treatment of breast cancer over surgical treatment as the only therapeutic management. The introduction of ultrasound-guided biopsies and conservative surgical options has led to increased diagnostic accuracy and a significant improvement in aesthetic outcome. The multidisciplinary approach to breast cancer allows an individualized treatment by performing immunohistochemical testing and through the use of neoadjuvant and adjuvant treatment combined with conservative surgical techniques with a more favorable cosmetic and oncological result, with reduced postoperative complications.

Using an Untargeted Metabolomics Approach to Identify Salivary Metabolites in Women with Breast Cancer

Metabolic alterations are a hallmark of the malignant transformation in cancer cells, which is characterized by multiple changes in metabolic pathways that are linked to macromolecule synthesis. This study aimed to explore whether salivary metabolites could help discriminate between breast cancer patients and healthy controls. Saliva samples from 23 breast cancer patients and 35 healthy controls were subjected to untargeted metabolomics using liquid chromatography-quadrupole time-of-flight mass spectrometry and a bioinformatics tool (XCMS Online), which revealed 534 compounds, characterized by their retention time in reverse-phase liquid chromatography and by the m/z ratio detected, that were shared by the two groups. Using the METLIN database, 31 compounds that were upregulated in the breast cancer group (p < 0.05) were identified, including seven oligopeptides and six glycerophospholipids (PG14:2, PA32:1, PS28:0, PS40:6, PI31:1, and PI38:7). In addition, pre-treatment and post-treatment saliva samples were analyzed for 10 patients who experienced at least a partial response to their treatment. In these patients, three peptides and PG14:2 were upregulated before but not after treatment. The area under the curve, sensitivity, and specificity for PG14:2 was 0.7329, 65.22%, and 77.14%, respectively. These results provide new information regarding the salivary metabolite profiles of breast cancer patients, which may be useful biomarkers.

Correlation between salivary and serum CA15-3 concentrations in patients with breast cancer

The early detection of breast cancer enables the use of less aggressive treatment and increases patient survival. The transmembrane glycoprotein mucin 1, which is also known as cancer antigen 15-3 (CA15-3), is aberrantly glycosylated and overexpressed in a variety of epithelial cancers, and serves a crucial role in the progression of the disease. CA15-3 is currently used as a marker of breast cancer. In the present study, CA15-3 concentrations in saliva and blood of patients with breast cancer were evaluated to test new assays to detect salivary CA15-3 in addition to ELISA and its diagnostic value. To the best of our knowledge, there are no previous reports of the use of chemiluminescence assay (CLIA) and electrochemiluminescence assay (ECLIA) in saliva. Saliva and blood were collected on the same day from patients with breast cancer (n=26) and healthy controls (n=28). For each subject, the level of serum CA15-3 was measured using ECLIA, and the level of salivary CA15-3 was measured using ECLIA, CLIA and enzyme-linked immunosorbent assay (ELISA). ELISA and CLIA were able to detect CA15-3 in saliva; however, ECLIA could not detect salivary CA15-3. There was no significant difference between the mean serum and salivary CA15-3 levels in patients with breast cancer or healthy controls. The levels of CA15-3 were highest for luminal breast cancer subtypes and stage IV cases. A moderate correlation was observed between salivary and serum CA15-3 levels as measured by ELISA in breast cancer patients (r=0.56; P=0.0047). The results demonstrated that ECLIA was not a good method to detect salivary CA15-3, although it is the gold standard for detecting serum CA15-3. The presence of CA15-3 in saliva was confirmed, and this will be useful in future research. Further investigations are necessary to confirm the ability to detect salivary CA15-3 and its correlation with serum CA15-3.

High-resolution endomicroscopy with a spectrally encoded miniature objective

Fiber bundle endomicroscopy techniques have been used for numerous minimally invasive imaging applications. However, these techniques may provide limited spatial sampling due to the limited number of imaging cores inside the fiber bundle. Here, we present a custom-fabricated miniature objective that can be coupled to a fiber bundle and can overcome the fiber bundle's sampling threshold by utilizing the spectral encoding concept. The objective has an NA of 0.3 and an outer diameter of 2.4 mm, and can yield a maximum spatial resolution of 2 μm. The objective has been validated against a USAF resolution target and ex vivo tissue samples, and as a result yielded images with higher resolution and more details after the spectral encoding concept was employed.

Beware of hemopneumothorax following core needle breast biopsy

Minimal diagnostic procedures are conducted regularly by the radiologists for several lesions within the body. The usual methodology is biopsy with a needle, either fine needle aspiration or core biopsy. The guidance is under CT or U/S. Fine needle aspiration has usually small diameter in comparison to the core biopsy. In any case the radiologist will choose the appropriate method based on the site of the lesion and safety of the patient. Pneumothorax and hemothorax are adverse effects that can be managed either on site with the help of a small catheter, however; there are cases where video-assisted thoracic surgery is needed in order to manage a more severe case. In the current study we present such a case where video-assisted surgery was necessary.

Single-cell whole-genome sequencing identifies human papillomavirus integration in cervical tumour cells prior to and following radiotherapy

Single-cell sequencing technology is a promising systematic and comprehensive approach to delineate clonal associations between cells. The present study collected 13 and 12 cervical cells from fresh tumour tissue prior to and following radiotherapy, respectively, from a 46-year-old female patient with exogenous-type cervical carcinoma. Next, single-cell whole-genome sequencing analysis was performed on each cell. Examination revealed that normal cells could be clearly distinguished from tumour cells among the 25 cells. Tumour cells prior to and following radiotherapy almost represented two independent clones, with the main subpopulation prior to radiotherapy being killed and the minor subpopulation prior to radiotherapy becoming the main subpopulation following radiotherapy. A human papillomavirus (HPV) integration site was detected in POU class 5 homeobox 1B (POU5F1B) in tumour cells following radiotherapy, which has been reported to be a frequent HPV integration site in cervical carcinoma. These results indicate that tumour cells with HPV integration in POU5F1B survive radiotherapy, and that tumour cells prior to and following radiotherapy exhibit distinct characteristics.

AS1411 Aptamer-Anionic Linear Globular Dendrimer G2-Iohexol Selective Nano-Theranostics

Molecular theranostics is of the utmost interest for diagnosis as well as treatment of different malignancies. In the present study, anionic linear globular dendrimer G2 is employed as a suitable carrier for delivery and AS1411 aptamer is exploited as the targeting agent to carry Iohexol specifically to the human breast cancer cells (MCF-7). Dendrimer G2 was prepared and conjugation of dendrimer and aptamer was carried out thereafter. Based on the data yielded by AFM, morphology of smooth and spherical non-targeted dendrimer changed to the rough aspherical shape when it conjugated. Then, conjugation was confirmed using DLS, ELS and SLS methods. Toxicity on nucleolin positive MCF-7 cells and nucleolin negative HEK-293 cells was assessed by XTT and apoptosis/necrosis assays. In vitro uptake was determined using DAPI-FITC staining and ICP-MS methods. In vivo studies including in vivo CT imaging, pathology and blood tests were done to confirm the imaging ability, bio-safety and targeted nature of the Nano-Theranostics in vivo. In a nutshell, the prepared construction showed promising effects upon decreasing the toxicity of Iohexol on normal cells and accumulation of it in the cancer tumors as well as reducing the number of cancer cells.

Human breast cancer biopsies induce eosinophil recruitment and enhance adjacent cancer cell proliferation

Chronic inflammation is known to facilitate cancer progression and metastasis. Less is known about the effect of acute inflammation within the tumor microenvironment, resulting from standard invasive procedures. Recent studies in mouse models have shown that the acute inflammatory response triggered by a biopsy in mammary cancer increases the frequency of distal metastases. Although tumor biopsies are part of the standard clinical practice in breast cancer diagnosis, no studies have reported their effect on inflammatory response. The objective of this study is to (1) determine whether core needle biopsies in breast cancer patients trigger an inflammatory response, (2) characterize the type of inflammatory response present, and (3) evaluate the potential effect of any acute inflammatory response on residual tumor cells. The biopsy wound site was identified in the primary tumor resection tissue samples from breast cancer patients. The inflammatory response in areas adjacent (i.e., immediately around previous biopsy site) and distant to the wound biopsy was investigated by histology and immunohistochemistry analysis. Proliferation of tumor cells was also assayed. We demonstrate that diagnostic core needle biopsies trigger a selective recruitment of inflammatory cells at the site of the biopsy, and they persist for extended periods of time. While macrophages were part of the inflammatory response, an unexpected accumulation of eosinophils at the edge of the biopsy wound was also identified. Importantly, we show that biopsy causes an increase in the proliferation rate of tumor cells located in the area adjacent to the biopsy wound. Diagnostic core needle biopsies in breast cancer patients do induce a unique acute inflammatory response within the tumor microenvironment and have an effect on the surrounding tumor cells. Therefore, biopsy-induced inflammation could have an impact on residual tumor cell progression and/or metastasis in human breast cancer. These findings may carry relevance in the clinical management of breast cancer.

FNAC Versus Core Needle Biopsy: A Comparative Study in Evaluation of Palpable Breast Lump

INTRODUCTION

Breast carcinoma is the most common malignant tumour and the leading cause of carcinoma death in women in world. The main purpose of FNAC or CNB of breast lumps is to confirm cancer preoperatively and to avoid unnecessary surgery in specific benign conditions.

AIMS AND OBJECTIVE

The objective of the study was to compare between Fine Needle Aspiration Cytology (FNAC) and Core Needle Biopsy (CNB) in the diagnosis of breast carcinoma with final histological diagnosis from excision specimen as it is gold standard.

MATERIALS AND METHODS

A prospective study was done on 50 cases. Patients undergoing all three procedures (Fine Needle Aspiration Cytology and Core Needle Biopsy done at Department of Pathology; subsequent excision surgeries done at Department of General Surgery) were selected. May Grunwald Giemsa (MGG) and Papaniculou (PAP) staining were performed on cytology smears. Haematoxylin and Eosin (H&E) staining was done on both the CNB and tissue specimens obtained from subsequent excision surgeries to see the histological features.

RESULTS

FNAC showed sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 69%, 100%, 100%, 38.1%, and 74% respectively in diagnosing carcinoma. CNB had sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 88.3%, 100%, 100%, 53.3% and 86%. Both FNAC and CNB showed statistically significant correlation with confirmatory HPE of excision specimen (p-value <0.05) in the diagnosis of breast carcinoma.

CONCLUSION

Fine needle aspiration cytology (FNAC) is a rapid, less complicated, economical, reliable and relevant method for the preoperative pathological diagnosis of breast carcinoma in a developing nation like ours. If the initial FNAC is inadequate, core needle biopsy (CNB) can be a useful second line method of pathological diagnosis in order to minimize the chance of missed diagnosis of breast cancer.