Breast cancer cutaneous metastasis at core needle biopsy site

The diagnostic utility of cell block in fine needle aspiration cytology of palpable breast lesions in a Nigerian tertiary health institution

BACKGROUND

Although fine needle aspiration cytology (FNAC) is highly accurate for detecting breast malignancies, concerns remain among cytopathologists about false-positive and false-negative diagnoses. Cell block (CB) preparations have been advocated by some cytopathologists as one of the methods to improve and consolidate the diagnostic accuracy of FNAC. The aim of this study was to determine the diagnostic utility of CB in FNAC of palpable breast lesions among female patients.

METHODS

Following FNA, CBs were prepared using 10% neutral-buffered formalin from the residual breast aspirates of 100 consecutive female patients attending the FNAC clinic. The slides of the conventional smears, CB and excisional biopsies were examined, and results were analysed using the SPSS.

RESULTS

Of the 100 patients that had FNAC, 44 (44%) had excisional biopsy performed. An additional 13% diagnostic yield for malignancy was obtained with the use of CB preparations. CB reduced equivocal diagnoses by 25%, corresponding with 90.9% improvement on definitive diagnoses.

CONCLUSION

In our setting, the addition of CB to smear remarkably improved the diagnostic utility of breast FNAC by minimising atypical and suspicious for malignancy diagnostic categories.

Defining the Hallmarks of Metastasis

Metastasis is the primary cause of cancer morbidity and mortality. The process involves a complex interplay between intrinsic tumor cell properties as well as interactions between cancer cells and multiple microenvironments. The outcome is the development of a nearby or distant discontiguous secondary mass. To successfully disseminate, metastatic cells acquire properties in addition to those necessary to become neoplastic. Heterogeneity in mechanisms involved, routes of dissemination, redundancy of molecular pathways that can be utilized, and the ability to piggyback on the actions of surrounding stromal cells makes defining the hallmarks of metastasis extraordinarily challenging. Nonetheless, this review identifies four distinguishing features that are required: motility and invasion, ability to modulate the secondary site or local microenvironments, plasticity, and ability to colonize secondary tissues. By defining these first principles of metastasis, we provide the means for focusing efforts on the aspects of metastasis that will improve patient outcomes.

Core needle biopsy promotes lung metastasis of breast cancer: An experimental study

Core needle biopsy (CNB) may be used to diagnose early-stage breast cancer, but it may increase the risk of distant metastasis of tumor cells. The aim of the present study was to explore the effect of CNB on the distant metastasis of breast cancer. A total of 30 BALB/c mice were divided into two groups, namely biopsy and non-biopsy groups. The biopsy-related lung metastasis model (biopsy group) was established by the inoculation in the mammary fat pad of the mouse breast cancer cell line 4T1 combined with CNB. Flow cytometry, quantitative polymerase chain reaction analysis, morphological analysis, as well as other techniques, were used to evaluate the biological behavior of the tumors in the mouse model. A stable and reliable lung metastasis model of breast cancer was successfully established. The number of metastatic lung nodules in the biopsy group was significantly higher compared with that in the non-biopsy group (P<0.05). Compared with the non-biopsy group, the mRNA expression of transforming growth factor (TGF)-β1, SOX4 and Ezh2 in the biopsy group was significantly upregulated (P<0.05) and the number of natural killer (NK) cells detected by flow cytometry was increased, but the difference was not statistically significant (P>0.05). Therefore, CNB was found to promote the lung metastasis of breast cancer, and the underlying mechanism may be associated with epithelial-to-mesenchymal transition (EMT) mediated by the TGF-β1 signaling pathway.

Characterization of a murine xenograft model for contrast agent development in breast lesion malignancy assessment

Background

The aim of the study was to develop a nude mouse xenograft model implanted with both benign and malignant xenografts as the preliminary candidate screening tool for contrast agent development in lesion malignancy indication.

Results

A malignant xenograft (either MCF-7 cell/matrigel™ or MDA-MB 231 cell/matrigel) and a benign xenograft (culture medium/matrigel) with cleft and slit-like features of intracanaliculer fibroadenoma were implanted subcutaneously into flanks of individual nu/nu nude mouse with >90 % successful inoculation rate. Both malignant and benign xenografts with volume up to 4 cm³ and (size up to 2 cm) after 5^th week were characterized in vivo by sonogram (exhibiting endogenous morphological contrast features between benign and malignant xenografts), dynamic contrast enhanced multi-detector computed tomography (presenting non-targeting exogenous morphological and dynamic contrast features between benign and malignant xenografts), and then were harvested for histological and immunohistochemistry (revealing example of targeting/molecular contrast features, such as expression of cancer vascular markers of malignant xenografts). Malignant xenografts appeared morphologically taller than wide (axis parallel to skin) with angular/ill-defined margin under sonogram observations, revealed more evident rim enhancement, angular margin and washout pattern in the time-density curve from dynamic contrast enhance multi-detector computed tomography images, and had more visible cancer vascular markers (CD31 and VEGF) expression. With limited number of subjects (5–27 for each group of a specific imaging contrast feature), those imaging contrast features of the xenograft model had larger than 85 % sensitivity, specificity, accuracy, positive and negative prediction values in indicating xenograft malignancy except for results from color Doppler detections.

Conclusions

The murine xenograft model might provide an earlier efficacy evaluation of new contrast agent candidate for lesion malignancy interrogation with qualitative and quantitative indication before a human study to reduce the risk and conserve the resources (time, finance and manpower).

On the origin of cancer metastasis

Metastasis involves the spread of cancer cells from the primary tumor to surrounding tissues and to distant organs and is the primary cause of cancer morbidity and mortality. In order to complete the metastatic cascade, cancer cells must detach from the primary tumor, intravasate into the circulatory and lymphatic systems, evade immune attack, extravasate at distant capillary beds, and invade and proliferate in distant organs. Currently, several hypotheses have been advanced to explain the origin of cancer metastasis. These involve an epithelial mesenchymal transition, an accumulation of mutations in stem cells, a macrophage facilitation process, and a macrophage origin involving either transformation or fusion hybridization with neoplastic cells. Many of the properties of metastatic cancer cells are also seen in normal macrophages. A macrophage origin of metastasis can also explain the long-standing "seed and soil" hypothesis and the absence of metastasis in plant cancers. The view of metastasis as a macrophage metabolic disease can provide novel insight for therapeutic management.