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Olawoyin OM, Mehta S, Chouairi F, Gabrick KS, Avraham T, Pusztai L, Alperovich M. Comparison of Autologous Breast Reconstruction Complications by Type of Neoadjuvant Chemotherapy Regimen. Plast Reconstr Surg 2021; 148:1186-96. [PMID: 34644277 DOI: 10.1097/PRS.0000000000008505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy before mastectomy helps reduce tumor burden and pathologic response in breast cancer. Limited evidence exists regarding how neoadjuvant chemotherapy impacts outcomes following microvascular breast reconstruction. This study examines the effects of neoadjuvant chemotherapy regimens and schedules on microvascular breast reconstruction complication rates and also assesses the effects of neoadjuvant chemotherapy on circulating immune cells related to wound healing. METHODS Patients who underwent neoadjuvant chemotherapy and microvascular breast reconstruction at Yale New Haven Hospital between 2013 and 2018 were identified. Demographic variables, oncologic history, chemotherapy regimens, and complication profiles were collected. Chemotherapy regimens were stratified by inclusion of anthracycline and order of taxane administration. Chi-square, Fisher's exact, and t tests were used for univariate analysis. Multivariate binary logistic regression was used to control for covariates. RESULTS One hundred patients met inclusion criteria. On multivariate analysis, the administration of taxane first in an anthracycline-containing chemotherapy sequence was associated with increased complications (OR, 3.521; p = 0.012), particularly fat necrosis (OR, 2.481; p = 0.040). In the logistic regression model evaluating the effect of the taxane-first regimen on complication rates, the area under the curve was estimated to be 0.760 (p < 0.0001), particularly fat necrosis 0.635 (p < 0.05). The dosage of chemotherapy, number of days between neoadjuvant chemotherapy completion and surgery, and number of circulating immune cells did not significantly differ among patients who experienced complications. CONCLUSIONS Taxane-first, anthracycline-containing neoadjuvant chemotherapy regimens were associated with increased complications, particularly fat necrosis. The increased postreconstruction complication risk must be weighed against the benefits of taxane-first regimens in improving tumor outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Vincent L, Jankowski C, Arnould L, Coudert B, Rouzier R, Reyal F, Humbert O, Coutant C. [Comparing prediction performances of 18F-FDG PET and CGFL/Curie nomogram to predict pathologic complete response after neoadjuvant chemotherapy for HER2-positive breast cancers]. ACTA ACUST UNITED AC 2020; 48:679-686. [PMID: 32205278 DOI: 10.1016/j.gofs.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to compare the value of 18F-fluorodesoxyglucose positron emission tomography (18F-FDG PET/CT) with CGFL/Curie nomogram to predict a pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in women with human epidermal growth factor 2 (HER2)-positive breast cancer treated by trastuzumab. METHODS Fifty-one women with HER2-positive breast cancer treated with trastuzumab plus taxane-based NAC were retrospectively included from January 2005 to December 2015. For 18F-FDG PET/CT, the analyzed predictor was the maximum standardized uptake value of the primary tumor and axillary nodes after the first course of NAC (PET2.SUVmax). pCR was defined by no residual infiltrative tumor but in situ tumor was accepted. Accuracy of CGFL/Curie nomogram and PET2.SUVmax was evaluated measuring sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Combined prediction was evaluated testing predictor's associations. RESULTS For CGFL/Curie nomogram's performances, Se, Sp, PPV and NPV were respectively: 76% (95%CI: 58-90%), 57% (95%CI: 43-66%), 55% (95%CI: 42-65), 77% (95%CI: 59-90%). For PET2.SUVmax's performances, Se, Sp, PPV and NPV were respectively: 67% (95%CI: 48-81%), 77% (95%CI: 64-97%), 67% (95%CI: 48-82%), 77% (95%CI: 64-87%). ROC curves for these predictors were similar; the areas under the curve were 0.6 (95%CI: 0.56-0.64) for PET2.SUVmax and 0.55 (95%CI: 0.50-0.59) for CGFL/Curie nomogram. Combined prediction was efficient with Se at 80%, VPN at 76%, Sp at 78% and VPP at 81%. CONCLUSIONS CGFL/Curie nomogram and PET2.SUVmax were two efficient predictors of pCR in patients with HER2-positive breast cancer. Combined prediction has an improved accuracy.
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Affiliation(s)
- L Vincent
- Département de chirurgie oncologique, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France.
| | - C Jankowski
- Département de chirurgie oncologique, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - L Arnould
- Département de biologie et pathologie des tumeurs, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - B Coudert
- Département d'oncologie médicale, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - R Rouzier
- Département de chirurgie oncologique, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - F Reyal
- Département de chirurgie oncologique, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - O Humbert
- Département de médecine nucléaire, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - C Coutant
- Département de chirurgie oncologique, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France; ImVia, UFR des sciences de santé, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
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Mrkonjic M, Berman HK, Done SJ, Youngson B, Mulligan AM. Breast specimen handling and reporting in the post-neoadjuvant setting: challenges and advances. J Clin Pathol 2019; 72:120-132. [PMID: 30670564 DOI: 10.1136/jclinpath-2018-205598] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/23/2022]
Abstract
Neoadjuvant systemic therapy is becoming more commonly used in patients with earlier stages of breast cancer. To assess tumour response to neoadjuvant chemotherapy, pathological evaluation is the gold standard. Depending on the treatment response, the pathological examination of these specimens can be quite challenging. However, a uniform approach to evaluate post-neoadjuvant-treated breast specimens has been lacking. Furthermore, there is no single universally accepted or endorsed classification system for assessing treatment response in this setting. Recent initiatives have attempted to create a standardised protocol for evaluation of post-neoadjuvant breast specimens. This review outlines the necessary information that should be collected prior to macroscopic examination of these specimens, the recommended and most pragmatic approach to tissue sampling for microscopic examination, describes the macroscopic and microscopic features of post-therapy breast specimens, summarises two commonly used systems for classifying treatment response and outlines the critical variables that should be included in the final pathology report.
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Affiliation(s)
- Miralem Mrkonjic
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Hal K Berman
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Susan J Done
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Bruce Youngson
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Anna Marie Mulligan
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada .,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Heil J, Sinn P, Richter H, Pfob A, Schaefgen B, Hennigs A, Riedel F, Thomas B, Thill M, Hahn M, Blohmer JU, Kuemmel S, Karsten MM, Reinisch M, Hackmann J, Reimer T, Rauch G, Golatta M. RESPONDER - diagnosis of pathological complete response by vacuum-assisted biopsy after neoadjuvant chemotherapy in breast Cancer - a multicenter, confirmative, one-armed, intra-individually-controlled, open, diagnostic trial. BMC Cancer 2018; 18:851. [PMID: 30144818 PMCID: PMC6109284 DOI: 10.1186/s12885-018-4760-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/17/2018] [Indexed: 11/30/2022] Open
Abstract
Background Neoadjuvant chemotherapy (NACT) is a standard approach of the multidisciplinary treatment of breast cancer. Depending on the biological subtype a pathological complete response in the breast (bpCR) can be achieved in up to 60% of the patients. However, only limited accuracy can be reached when using imaging for prediction of bpCR prior to surgery. Due to this diagnostic uncertainty, surgery after NACT is considered to be obligatory for all patients in order to either completely remove residual disease or to diagnose a bpCR histologically. The purpose of this trial is to evaluate the accuracy of a vacuum-assisted biopsy (VAB) to diagnose a bpCR after NACT prior to surgery. Methods This study is a multicenter, confirmative, one-armed, intra-individually-controlled, open, diagnostic trial. The study will take place at 21 trial sites in Germany. Six hundred female patients with breast cancer after completed NACT showing at least a partial response to NACT treatment will be enrolled. A vacuum-assisted biopsy (VAB) guided either by ultrasound or mammography will be performed followed by histopathological evaluation of the VAB specimen before standard, guideline-adherent breast surgery. The study is designed to prove that the false negative rate of the VAB is below 10%. Discussion As a bpCR is becoming a more frequent result after NACT, the question arises whether breast surgery is therapeutically necessary in such cases. To study this subject further, it will be crucial to develop a reliable test to diagnose a bpCR without surgery. During the study we anticipate possible problems in patient recruitment as the VAB intervention does not provide participating patients with any personal benefit. Hence, a proficient informed consent discussion with the patient and a detailed explanation of the study aim will be crucial for patient recruitment. Another critical issue is the histopathological VAB evaluation of a non-tumorous specimen as this may have been taken either from the former tumor region (bpCR) or outside of the (former) tumor region (non-representative VAB, sampling error). Trial registration The trial has been registered at clinicaltrials.gov with the identifier NCT02948764 on October 28, 2016 and at the German Clinical Trials Register (DRKS00011761) on February 20, 2017. The date of enrolment of the first participant to the trial was on March 8, 2017.
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Affiliation(s)
- Joerg Heil
- Department of Gynecology, Breast Center, Heidelberg University, Heidelberg, Germany.
| | - Peter Sinn
- Department of Pathology, Heidelberg University, Heidelberg, Germany
| | - Hannah Richter
- Department of Gynecology, Breast Center, Heidelberg University, Heidelberg, Germany
| | - André Pfob
- Department of Gynecology, Breast Center, Heidelberg University, Heidelberg, Germany
| | - Benedikt Schaefgen
- Department of Gynecology, Breast Center, Heidelberg University, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology, Breast Center, Heidelberg University, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology, Breast Center, Heidelberg University, Heidelberg, Germany
| | - Bettina Thomas
- Koordinierungszentrum für Klinische Studien (KKS), Heidelberg University, Heidelberg, Germany
| | - Marc Thill
- Department of Gynecology, Agaplesion Markus Hospital, Frankfurt am Main, Germany
| | - Markus Hahn
- Department of Gynecology, Tuebingen University, Tuebingen, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Sherko Kuemmel
- Department of Gynecology, Hospital Kliniken Essen-Mitte, Essen, Germany
| | | | - Mattea Reinisch
- Department of Gynecology, Hospital Kliniken Essen-Mitte, Essen, Germany
| | - John Hackmann
- Department of Gynecology, Marien Hospital Witten, Witten, Germany
| | - Toralf Reimer
- Department of Gynecology, Rostock University, Rostock, Germany
| | - Geraldine Rauch
- Charité Universitaetsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Institute of Medical biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology, Breast Center, Heidelberg University, Heidelberg, Germany
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Schmitz AMT, Veldhuis WB, Menke-Pluijmers MBE, van der Kemp WJM, van der Velden TA, Viergever MA, Mali WPTM, Kock MCJM, Westenend PJ, Klomp DWJ, Gilhuijs KGA. Preoperative indication for systemic therapy extended to patients with early-stage breast cancer using multiparametric 7-tesla breast MRI. PLoS One 2017; 12:e0183855. [PMID: 28949967 PMCID: PMC5614529 DOI: 10.1371/journal.pone.0183855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 08/11/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose To establish a preoperative decision model for accurate indication of systemic therapy in early-stage breast cancer using multiparametric MRI at 7-tesla field strength. Materials and methods Patients eligible for breast-conserving therapy were consecutively included. Patients underwent conventional diagnostic workup and one preoperative multiparametric 7-tesla breast MRI. The postoperative (gold standard) indication for systemic therapy was established from resected tumor and lymph-node tissue, based on 10-year risk-estimates of breast cancer mortality and relapse using Adjuvant! Online. Preoperative indication was estimated using similar guidelines, but from conventional diagnostic workup. Agreement was established between preoperative and postoperative indication, and MRI-characteristics used to improve agreement. MRI-characteristics included phospomonoester/phosphodiester (PME/PDE) ratio on 31-phosphorus spectroscopy (31P-MRS), apparent diffusion coefficients on diffusion-weighted imaging, and tumor size on dynamic contrast-enhanced (DCE)-MRI. A decision model was built to estimate the postoperative indication from preoperatively available data. Results We included 46 women (age: 43-74yrs) with 48 invasive carcinomas. Postoperatively, 20 patients (43%) had positive, and 26 patients (57%) negative indication for systemic therapy. Using conventional workup, positive preoperative indication agreed excellently with positive postoperative indication (N = 8/8; 100%). Negative preoperative indication was correct in only 26/38 (68%) patients. However, 31P-MRS score (p = 0.030) and tumor size (p = 0.002) were associated with the postoperative indication. The decision model shows that negative indication is correct in 21/22 (96%) patients when exempting tumors larger than 2.0cm on DCE-MRI or with PME>PDE ratios at 31P-MRS. Conclusions Preoperatively, positive indication for systemic therapy is highly accurate. Negative indication is highly accurate (96%) for tumors sized ≤2,0cm on DCE-MRI and with PME≤PDE ratios on 31P-MRS.
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Affiliation(s)
- A. M. T. Schmitz
- Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
| | - W. B. Veldhuis
- Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - W. J. M. van der Kemp
- Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - T. A. van der Velden
- Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M. A. Viergever
- Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - W. P. T. M. Mali
- Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M. C. J. M. Kock
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - P. J. Westenend
- Department of Pathology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - D. W. J. Klomp
- Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K. G. A. Gilhuijs
- Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
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Schmitz AMT, Teixeira SC, Pengel KE, Loo CE, Vogel WV, Wesseling J, Rutgers EJT, Valdés Olmos RA, Sonke GS, Rodenhuis S, Vrancken Peeters MJTFD, Gilhuijs KGA. Monitoring tumor response to neoadjuvant chemotherapy using MRI and 18F-FDG PET/CT in breast cancer subtypes. PLoS One 2017; 12:e0176782. [PMID: 28531188 PMCID: PMC5439668 DOI: 10.1371/journal.pone.0176782] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 04/17/2017] [Indexed: 12/31/2022] Open
Abstract
Purpose To explore guidelines on the use of MRI and PET/CT monitoring primary tumor response to neoadjuvant chemotherapy (NAC), taking breast cancer subtype into account. Materials and methods In this prospective cohort study, 188 women were included with stages II and III breast cancer. MRI and 18F-FDG-PET/CT were acquired before and during NAC. Baseline pathology was assessed from tumor biopsy. Tumors were stratified into HER2-positive, ER-positive/HER2-negative (ER-positive), and ER-negative/PR-negative/HER2-negative (triple-negative) subtypes, and treated according to subtype. Primary endpoint was pathological complete response (pCRmic) defined as no or only small numbers of scattered invasive tumor cells. We evaluated imaging scenarios using MRI only, PET/CT only, and combinations. Results pCRmic was found in 35/46 (76.1%) of HER2-positive, 11/87 (12.6%) of ER-positive, and 31/55 (56.4%) of triple-negative tumors. For HER2-positive tumors, MRI yielded the strongest predictor (AUC: 0.735; sensitivity 36.2%), outperforming PET/CT (AUC: 0.543; p = 0.04), and with comparable results to combined imaging (AUC: 0.708; p = 0.213). In ER-positive tumors, the combination of MRI and PET/CT was slightly superior (AUC: 0.818; sensitivity 55.8%) over MRI alone (AUC: 0.742; p = 0.117) and PET/CT alone (AUC: 0.791). However, even though relatively large numbers of ER-positive tumor patients were included, no significant differences were yet found. For triple-negative tumors, MRI (AUC: 0.855; sensitivity 45.4%), PET/CT (AUC: 0.844; p = 0.220) and combined imaging (AUC: 0.868; p = 0.213) yielded comparable results. Conclusions For HER2-positive tumors, MRI shows significant advantage over PET/CT. For triple-negative tumors, comparable results were seen for MRI, PET/CT and combined imaging. For ER-positive tumors, combining MRI with PET/CT may result in optimal response monitoring, although not yet significantly.
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Affiliation(s)
- Alexander M. Th. Schmitz
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Radiology / Image Sciences Institute; University Medical Center Utrecht, Utrecht, Netherlands
- * E-mail:
| | - Suzana C. Teixeira
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Kenneth E. Pengel
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Claudette E. Loo
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Wouter V. Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Jelle Wesseling
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Renato A. Valdés Olmos
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Gabe S. Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Sjoerd Rodenhuis
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Kenneth G. A. Gilhuijs
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Radiology / Image Sciences Institute; University Medical Center Utrecht, Utrecht, Netherlands
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Yadav P, Mirza M, Nandi K, Jain SK, Kaza RCM, Khurana N, Ray PC, Saxena A. Serum microRNA-21 expression as a prognostic and therapeutic biomarker for breast cancer patients. Tumour Biol 2016; 37:15275-15282. [PMID: 27696295 DOI: 10.1007/s13277-016-5361-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/07/2016] [Indexed: 11/27/2022] Open
Abstract
MiRNA-21 is recognized as the main active candidate and high expression in many solid tumors consequential cell proliferation, differentiation, apoptosis, and closely related to metastasis of disease. The study aimed to evaluate the serum miRNA-21 expression and therapy outcome in breast cancer patients and cell lines. Seventy-five histopathologically confirmed newly diagnosed breast cancer patients were included in the study; before and after therapy, patient's blood sample were collected and analyzed for serum microRNA-21 expression by quantitative real-time PCR. In patients, 8.9 mean fold increased microRNA-21 expression was observed compared to controls. Increased expression was found to be associated with advanced stage (11.72-fold), lymph node involvement (11.12-fold), and distant metastases (20.17-fold). After treatment significant decrease in miRNA-21 expression was observed and found to be significant (p < 0.0001). Patients treated with neoadjuvant therapy had significant impact on miRNA-21 suppression and found to be significantly associated with different clinicopathological features of patients. Increased miRNA-21 expression was also found to be significantly associated with poor survival of breast cancer patients (p = 0.002). MicroRNA-21 expression could be used as promising predictive indicators for breast cancer prognosis. MicroRNA-21 over-expression was associated with response to neoadjuvant therapy and may perhaps be considered as primary treatment choice.
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Affiliation(s)
- Prasant Yadav
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, 110002, India
| | - Masroor Mirza
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, 110002, India
| | - Kajal Nandi
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, 110002, India
| | - S K Jain
- Department of Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - R C M Kaza
- Department of Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - P C Ray
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, 110002, India
| | - Alpana Saxena
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, 110002, India.
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Vieira RADC, Carrara GFA, Scapulatempo Neto C, Morini MA, Brentani MM, Folgueira MAAK. The role of oncoplastic breast conserving treatment for locally advanced breast tumors. A matching case-control study. Ann Med Surg (Lond) 2016; 10:61-8. [PMID: 27547399 PMCID: PMC4983144 DOI: 10.1016/j.amsu.2016.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/01/2016] [Indexed: 01/13/2023] Open
Abstract
Background Breast conserving surgery (BCS) after neoadjuvant chemotherapy (NC) in patients with locally advanced breast cancer (LABC) is an infrequent procedure. In these patients the association with BCS and oncoplastic surgery (OS) is reported as a possible procedure in case-series, but there are limited case-control studies. Methods A matched case-control study evaluated LABC submitted to NC and BCS. We evaluated 78 patients submitted to doxorubicin-cyclophosphamide regimen followed by paclitaxel regimen. The match case-control proportion was 2:1 and the patients were selected by tumor size, clinical T stage and year of diagnosis. Results 52 underwent classic BCS and 26 OS. The average size tumor was 5.25 cm and 88.5% of the tumors were larger than 3 cm. The clinical and pathological group characteristics were similar, except the weight of surgical specimens (p = 0.004), and surgical margins (p = 0.06), which were higher in OS group. The rate of complete pathologic response was 26.9%. 97.4% received postoperative radiotherapy. At 67.1 months of follow up, 10.2% had local recurrence (LR) and 12.8% locoregional recurrence (LRR) and 19.2% died because disease progression. The overall survival at 60 months was 81.7%. After surgery the disease free-survival at 60 months was 76.5%. The was no difference between groups related to pathologic response (p = 0.42), LR (p = 0.71), LRR (p = 1.00), overall survival (p = 0.99) and disease specific survival (p = 0.87). Conclusion This study corroborates the fact that OS is a safety procedure for LABC, offering the similar oncologic results observed in patients submitted to classic BCS. A matched case-control study evaluates oncoplastic techniques for locally advanced breast cancer. The size of tumors were bigger than other series. The matched case-control study was selected base on tumor size and year of diagnosis to decrease possible bias selection. The security of this procedure was evaluated based a long follow up. Oncoplastic surgery has the same results than conventional breast conserving surgery for locally advanced breast tumors.
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Affiliation(s)
- René Aloisio da Costa Vieira
- Oncology Postgraduate Course, Barretos Cancer Hospital, Brazil; Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Brazil
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Ramos M, Díez J, Ramos T, Ruano R, Sancho M, González-Orús J. Intraoperative ultrasound in conservative surgery for non-palpable breast cancer after neoadjuvant chemotherapy. Int J Surg 2014; 12:572-7. [DOI: 10.1016/j.ijsu.2014.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/10/2014] [Indexed: 11/27/2022]
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10
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Abstract
One of the most important lessons learned from trials of neoadjuvant chemotherapy (NACT) is that achievement of pathological complete response (pCR) is a powerful prognostic predictor of long-term outcome, with significantly better disease-free and overall survival for patients achieving pCR, as compared with patients having residual tumour after NACT. The pathologists' role in the neoadjuvant setting is: (i) to ensure an accurate assessment of pCR, and (ii) to evaluate burden and biological characteristics of residual tumour if pCR has not been achieved. A conversion of receptor status from the core biopsy to the post-NACT surgical specimen may cause uncertainty in the choice of the post-surgical systemic treatment for the patients. It is therefore imperative to ensure accuracy in the assessment of ER, PgR and HER2, and to double check any apparent conversion by re-staining the previous core biopsy and the residual tumour in the same run, thus minimizing the technical artifacts, and to use both immunohistochemical and in situ hybridization assays to evaluate HER2 status. It is essential that protocols for evaluation of tumour response and for assessment of prognostic/predictive parameters of residual disease after NACT be eventually harmonized.
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11
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Ibarra JA. The Value of Combined Large Format Histopathology Technique to Assess the Surgically Removed Breast Tissue following Neoadjuvant Chemotherapy: A Single Institution Study of 40 Cases. Int J Breast Cancer 2012; 2012:361707. [PMID: 23119168 DOI: 10.1155/2012/361707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/03/2012] [Indexed: 11/23/2022] Open
Abstract
Historically, neoadjuvant chemotherapy has been used to treat patients with advanced breast disease in an attempt to convert them into candidates for breast conservation surgery. The ultimate goal of histopathologic examination of the specimens removed after neoadjuvant chemotherapy is the identification of either residual disease or positive identification of the tumor bed. We report a series of 40 patients treated with neoadjuvant chemotherapy and evaluation of the surgical specimens by a combination of standard histopathology and the use of large format histopathology techniques.
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Bansal C, Singh US, Misra S, Sharma KL, Tiwari V, Srivastava AN. Comparative evaluation of the modified Scarff-Bloom-Richardson grading system on breast carcinoma aspirates and histopathology. Cytojournal 2012; 9:4. [PMID: 22363393 PMCID: PMC3280007 DOI: 10.4103/1742-6413.92550] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 01/23/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Fine needle aspiration (FNA) is a quick, minimally invasive procedure for evaluation of breast tumors. The Scarff-Bloom-Richardson (SBR) grade on histological sections is a well-established tool to guide selection of adjuvant systemic therapy. Grade evaluation is possible on cytology smears to avoid and minimize the morbidity associated with overtreatment of lower grade tumors. AIM The aim was to test the hypothesis whether breast FNA from the peripheral portion of the lesion is representative of Scarff-Bloom-Richardson grade on histopathology as compared to FNA from the central portion. MATERIALS AND METHODS Fine-needle aspirates and subsequent tissue specimens from 45 women with ductal carcinoma (not otherwise specified) were studied. FNAs were performed under ultrasound guidance from the central as well as the peripheral third of the lesion for each case avoiding areas of necrosis/calcification. The SBR grading was compared on alcohol fixed aspirates and tissue sections for each case. RESULTS Comparative analysis of SBR grade on aspirates from the peripheral portion and histopathology by the Pearson chi-square test (χ(2) =78.00) showed that it was statistically significant (P<0.001) with 93% concordance. Lower mitotic score on aspirates from the peripheral portion was observed in only 4 out of 45 (9%) cases. The results of the Pearson chi-square test (χ(2) = 75.824) with statistically significant (P=0.000). CONCLUSION This prospective study shows that FNA smears from the peripheral portion of the lesion are representative of the grading performed on the corresponding histopathological sections. It is possible to score and grade by SBR system on FNA smears.
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Affiliation(s)
- Cherry Bansal
- Department of Pathology, Era's Medical College and Hospital, Lucknow, Uttar Pradesh, India
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Espinosa-bravo M, Sao Avilés A, Esgueva A, Córdoba O, Rodriguez J, Cortadellas T, Mendoza C, Salvador R, Xercavins J, Rubio I. Breast conservative surgery after neoadjuvant chemotherapy in breast cancer patients: Comparison of two tumor localization methods. Eur J Surg Oncol 2011; 37:1038-43. [DOI: 10.1016/j.ejso.2011.08.136] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 08/16/2011] [Accepted: 08/22/2011] [Indexed: 10/17/2022] Open
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Valachis A, Mauri D, Polyzos NP, Chlouverakis G, Mavroudis D, Georgoulias V. Trastuzumab combined to neoadjuvant chemotherapy in patients with HER2-positive breast cancer: a systematic review and meta-analysis. Breast 2011; 20:485-90. [PMID: 21784637 DOI: 10.1016/j.breast.2011.06.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 04/19/2011] [Accepted: 06/29/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To perform a meta-analysis in order to quantify the actual cumulative randomized evidence for the benefit and toxicity of trastuzumab combined with neoadjuvant chemotherapy in HER2-positive breast cancer. METHODS Potentially eligible trials were located through PubMed and Cochrane Library searches and abstracts of major international conferences. The endpoints that we assessed were pathologic complete response (pCR) rate, breast-conserving surgery (BCS) rate and toxicity. RESULTS Five trials were identified with 515 eligible patients. The probability to achieve pCR was higher for the trastuzumab plus chemotherapy arm (RR 1.85, 95% CI: 1.39-2.46; p-value < 0.001). No significant difference in terms of breast-conserving surgery between the two treatment arms was observed (OR: 0.98, 95% CI: 0.80-1.19, p-value = 0.82). Regarding toxicity, the addition of trastuzumab did not increase the incidence of neutropenia, neutropenic fever, and cardiac adverse events. CONCLUSION The addition of trastuzumab in HER2-positive breast cancer in the neoadjuvant setting improves the probability of achieving higher pCR with no additional toxicity. Based on the available evidence, the use of trastuzumab combined with neoadjuvant chemothetherapy in patients with HER2-positive breast cancer seems to offer substantial benefit in terms of pCR.
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Affiliation(s)
- Antonis Valachis
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece.
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Peintinger F, Kuerer HM, McGuire SE, Bassett R, Pusztai L, Symmans WF. Residual specimen cellularity after neoadjuvant chemotherapy for breast cancer. Br J Surg 2008; 95:433-7. [PMID: 18161887 DOI: 10.1002/bjs.6044] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy for breast cancer reduces tumour cellularity, the percentage of the primary tumour area that is composed of invasive tumour cells. Minimal residual tumour cellularity (5 per cent or less of tumour area composed of invasive tumour cells) may be associated with an increased risk of false-negative intraoperative margins. The aim of this study was to evaluate the incidence of minimal residual tumour cellularity after neoadjuvant chemotherapy and its impact on the frequency of false-negative margins and conversion from breast-conserving surgery to mastectomy. METHODS The final pathology slides of 510 patients who had surgery after neoadjuvant chemotherapy were reviewed. RESULTS Of 396 patients with residual invasive breast cancer after neoadjuvant chemotherapy, 100 specimens (25.3 per cent) had minimal residual cellularity; this was more frequent in patients with invasive lobular carcinoma (17.0 versus 5.1 per cent; P < 0.001) or well and moderately differentiated carcinoma (68.0 versus 52.4 per cent; P = 0.007). Among 149 patients who had initial breast-conserving surgery, false-negative intraoperative margin rates were 23 per cent in specimens with minimal and 13.8 per cent in those with higher residual cellularity (P = 0.210). There was no significant difference in the rate of conversion to mastectomy between the groups. CONCLUSION Minimal residual cellularity after neoadjuvant chemotherapy occurred in about 25 per cent of specimens, but did not alter the rate of false-negative intraoperative margins.
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Affiliation(s)
- F Peintinger
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Mathieu MC, Bonhomme-Faivre L, Rouzier R, Seiller M, Barreau-Pouhaer L, Travagli JP. Tattooing breast cancers treated with neoadjuvant chemotherapy. Ann Surg Oncol 2007; 14:2233-8. [PMID: 17505861 DOI: 10.1245/s10434-006-9276-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Revised: 08/11/2006] [Accepted: 08/16/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND In breast carcinomas treated with neoadjuvant chemotherapy, intraoperative identification of residual tumors may be difficult. A well-tolerated, low-diffusion charcoal suspension has been designed to tattoo breast tumors. In this study, we investigated whether this tattooing technique is efficient for localizing the tumor after treatment with chemotherapy. METHODS In a series of 109 patients with large breast tumors, a 4% or 10% charcoal suspension was injected at the time of the initial biopsy before preoperative chemotherapy. RESULTS Tolerance was good. After three or four cycles of chemotherapy, 91 patients underwent conservative treatment, and the surgical specimen was examined intraoperatively. The charcoal was detected in 94% of the cases. The charcoal was seen in the nodule or at the periphery in the surgical specimen without any acute inflammatory reaction or diffusion. CONCLUSIONS On the basis of these results, this micronized charcoal suspension at a defined granulometry and a concentration of 10% seems to be ideal for tattooing breast carcinomas over a period of 3 months in patients in whom neoadjuvant chemotherapy is planned.
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Affiliation(s)
- Marie-Christine Mathieu
- Department of Pathology, Institut Gustave-Roussy, rue Camille Desmoulins, 94800 Villejuif, France.
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Fan F, Namiq AL, Tawfik OW, Thomas PA. Proposed prognostic score for breast carcinoma on fine needle aspiration based on nuclear grade, cellular dyscohesion and bare atypical nuclei. Diagn Cytopathol 2006; 34:542-6. [PMID: 16850493 DOI: 10.1002/dc.20529] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fine needle aspiration is an established diagnostic tool in breast carcinoma. Although the potential of using the same diagnostic aspirate material to provide additional cytomorphologic prognostic or predictive information has been investigated, no well-recognized, practical grading system has been established. Such system is necessary in guiding treatment, monitoring neoadjuvant chemotherapy effect and predicting outcome. We herein propose a new grading system, combining nuclear grade, cellular dyscohesion, and bare atypical nuclei to arrive at one cytoprognostic score. Cytoprognostic scores were compared with other known prognostic factors. Fine needle aspirations of breast diagnosed as adenocarcinoma from 55 patients were reviewed. The cytoprognostic score combined three features including nuclear grade (score 1-3), cellular dyscohesion (score 1-3), and bare atypical nuclei (score 0, 1). A cytoprognostic score of 3 and below was considered a low score, and a score of 4-7 was considered a high score. The cytoprognostic score was then compared to histologic grade, lymph node status, and expressions of estrogen receptor, progesterone receptor, Her2-Neu, Ki-67, and p53 in the subsequently excised tumor. A low cytoprognostic score predicted a low to intermediate grade carcinoma and a high score predicted an intermediate to high-grade carcinoma. A high cytoprognostic score also correlated with more positive lymph node metastasis, and poor expression of prognostic markers. In conclusion, cytoprognostic score is performed with ease and shows a great promise as a cost-effective way to predict biological behavior of breast carcinoma and guide clinical management.
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Affiliation(s)
- Fang Fan
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas 66160-7417, USA.
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Ueno NT, Konoplev S, Buchholz TA, Smith T, Rondón G, Anderlini P, Giralt SA, Gajewski JL, Donato ML, Cristofanilli M, Champlin RE. High-dose chemotherapy and autologous peripheral blood stem cell transplantation for primary breast cancer refractory to neoadjuvant chemotherapy. Bone Marrow Transplant 2006; 37:929-35. [PMID: 16565737 DOI: 10.1038/sj.bmt.1705355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The role of high-dose chemotherapy (HDCT) in patients with refractory breast cancer is not well established. Forty-two female patients (median age of 46 years) with breast cancer refractory to neoadjuvant chemotherapy received HDCT (cyclophosphamide, carmustine and thiotepa) supported by an autologous peripheral blood stem cells transplant. Their disease had been refractory (defined as less than partial response) to one (18 patients) or two (24 patients) regimens of neoadjuvant chemotherapy. Twenty-nine patients had surgery before HDCT. The best response after surgery, HDCT, and radiation therapy was assessed 60 days after transplantation. Thirty patients had complete remission, eight had a PR, one had a minor response, and three had progressive disease. In seven of 13 patients whose disease was inoperable before HDCT, it became operable. After a median follow-up of 42 months, 21 patients were alive, and 15 remained disease free. Five-year overall survival (OS) was 57% (CI, 50-64%), and the estimated 5-year progression-free survival was 40% (CI, 32-48%). Both OS and PFS were better in patients whose disease became operable after chemotherapy than in those whose disease remained inoperable. A randomized study is warranted in this patient population.
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Affiliation(s)
- N T Ueno
- Department of Blood and Marrow Transplantation, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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