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Rabindran B, Corben AD. Wide-field optical coherence tomography for microstructural analysis of key tissue types: a proof-of-concept evaluation. Pathol Oncol Res 2023; 29:1611167. [PMID: 37521364 PMCID: PMC10374948 DOI: 10.3389/pore.2023.1611167] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023]
Abstract
Introduction: The presence of positive margins following tumor resection is a frequent cause of re-excision surgery. Nondestructive, real-time intraoperative histopathological imaging methods may improve margin status assessment at the time of surgery; optical coherence tomography (OCT) has been identified as a potential solution but has not been tested with the most common tissue types in surgical oncology using a single, standardized platform. Methods: This was a proof-of-concept evaluation of a novel device that employs wide-field OCT (WF-OCT; OTIS 2.0 System) to image tissue specimens. Various cadaveric tissues were obtained from a single autopsy and were imaged with WF-OCT then processed for permanent histology. The quality and resolution of the WF-OCT images were evaluated and compared to histology and with images in previous literature. Results: A total of 30 specimens were collected and tissue-specific microarchitecture consistent with previous literature were identified on both WF-OCT images and histology slides for all specimens, and corresponding sections were correlated. Application of vacuum pressure during scanning did not affect specimen integrity. On average, specimens were scanned at a speed of 10.3 s/cm2 with approximately three features observed per tissue type. Conclusion: The WF-OCT images captured in this study displayed the key features of the most common human tissue types encountered in surgical oncology with utility comparable to histology, confirming the utility of an FDA-cleared imaging platform. With further study, WF-OCT may have the potential to bridge the gap between the immediate information needs of the operating room and the longer timeline inherent to histology workflow.
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Affiliation(s)
| | - Adriana D. Corben
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, United States
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2
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Gucalp A, Corben AD, Patil S, Feigin KN, Boyle LA, Hudis CA, Traina TA. Abstract P2-08-05: Phase I/II trial of palbociclib in combination with bicalutamide for the treatment of androgen receptor (AR)+ metastatic breast cancer (MBC). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-08-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- A Gucalp
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - AD Corben
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Patil
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - KN Feigin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - LA Boyle
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - CA Hudis
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - TA Traina
- Memorial Sloan Kettering Cancer Center, New York, NY
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Pareja F, Corben AD, Brennan SB, Murray MP, Bowser ZL, Jakate K, Sebastiano C, Morrow M, Morris EA, Brogi E. Breast intraductal papillomas without atypia in radiologic-pathologic concordant core-needle biopsies: Rate of upgrade to carcinoma at excision. Cancer 2016; 122:2819-27. [PMID: 27315013 DOI: 10.1002/cncr.30118] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [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: 01/15/2016] [Revised: 04/21/2016] [Accepted: 05/02/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND The surgical management of mammary intraductal papilloma without atypia (IDP) identified at core-needle biopsy (CNB) is controversial. This study assessed the rate of upgrade to carcinoma at surgical excision (EXC). METHODS This study identified women with a CNB diagnosis of intraductal papilloma without atypia or carcinoma at a cancer center between 2003 and 2013. Radiologic-pathologic concordance was assessed for all cases, and discordant cases were excluded. The radiologic and clinicopathologic features of patients with a CNB diagnosis of IDP were correlated with an upgrade to carcinoma at EXC. RESULTS The study population consists of 189 women with 196 IDPs; 166 women (171 IDPs) underwent EXC. The upgrade rate was 2.3% (4 of 171). The upgraded lesions were 2 invasive lobular carcinomas and 2 cases of ductal carcinoma in situ (DCIS). One case of DCIS involved the residual IDP, whereas the other 3 carcinomas were ≥ 8 mm away. Twenty-four women (25 IDPs) did not undergo EXC and had stable imaging on follow-up (median, 23.5 months). CONCLUSIONS The upgrade rate at EXC for IDPs diagnosed at CNB with radiologic-pathologic concordance was 2.3%. These findings suggest that observation is appropriate for patients with radiologic-pathologic concordant CNB yielding IDP, regardless of its size. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2819-2827. © 2016 American Cancer Society.
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Affiliation(s)
- Fresia Pareja
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adriana D Corben
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sandra B Brennan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa P Murray
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zenica L Bowser
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kiran Jakate
- Department of Pathology, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Monica Morrow
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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4
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Theodoraki MA, Rezende CO, Chantarasriwong O, Corben AD, Theodorakis EA, Alpaugh ML. Spontaneously-forming spheroids as an in vitro cancer cell model for anticancer drug screening. Oncotarget 2016; 6:21255-67. [PMID: 26101913 PMCID: PMC4673263 DOI: 10.18632/oncotarget.4013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 02/16/2015] [Accepted: 06/08/2015] [Indexed: 12/12/2022] Open
Abstract
The limited translational value in clinic of analyses performed on 2-D cell cultures has prompted a shift toward the generation of 3-dimensional (3-D) multicellular systems. Here we present a spontaneously-forming in vitro cancer spheroid model, referred to as spheroidsMARY-X, that precisely reflects the pathophysiological features commonly found in tumor tissues and the lymphovascular embolus. In addition, we have developed a rapid, inexpensive means to evaluate response following drug treatment where spheroid dissolution indices from brightfield image analyses are used to construct dose-response curves resulting in relevant IC50 values. Using the spheroidsMARY-X model, we demonstrate the unique ability of a new class of molecules, containing the caged Garcinia xanthone (CGX) motif, to induce spheroidal dissolution and apoptosis at IC50 values of 0.42 +/−0.02 μM for gambogic acid and 0.66 +/−0.02 μM for MAD28. On the other hand, treatment of spheroidsMARY-X with various currently approved chemotherapeutics of solid and blood-borne cancer types failed to induce any response as indicated by high dissolution indices and subsequent poor IC50 values, such as 7.8 +/−3.1 μM for paclitaxel. Our studies highlight the significance of the spheroidsMARY-X model in drug screening and underscore the potential of the CGX motif as a promising anticancer pharmacophore.
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Affiliation(s)
| | - Celso O Rezende
- Department of Chemistry and Biochemistry, University of California - San Diego, La Jolla, CA, USA
| | - Oraphin Chantarasriwong
- Department of Chemistry and Biochemistry, University of California - San Diego, La Jolla, CA, USA.,Department of Chemistry, Faculty of Science, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Adriana D Corben
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emmanuel A Theodorakis
- Department of Chemistry and Biochemistry, University of California - San Diego, La Jolla, CA, USA
| | - Mary L Alpaugh
- Department of Chemistry and Biochemistry, University of California - San Diego, La Jolla, CA, USA.,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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5
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Conlon N, Howard J, Catalano J, Gallagher M, Tan LK, Corben AD. Breast Carcinoma in Young Women: No Evidence of Increasing Rates of Metastatic Breast Carcinoma in a Single Tertiary Center Review. Breast J 2016; 22:287-92. [PMID: 26923423 DOI: 10.1111/tbj.12575] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Breast carcinoma in young women aged less than 40 years attracts a high level of mainstream media coverage, and there is a gap between societal perceptions of the disease as a growing problem and epidemiological trends. Several population studies have reported that the overall incidence of breast carcinoma in young women is stable, while one recent article suggested that the relative proportion of breast carcinoma in young women that is metastatic at diagnosis is growing. We sought to establish whether these trends were apparent at our institution. In this study, the clinical database at a breast carcinoma tertiary center was reviewed in terms of clinicopathologic data on patient age, diagnosis, clinical and pathologic stage, hormone receptor status, and HER-2 overexpression status for the period 2000-2011. Over the study period, young patients represented a decreasing proportion of all breast carcinoma cases (10.8% [2000-2003] to 8.7% [2008-2011]; p < 0.0001) treated at our institution. Young patients were more likely than patients aged 40 years or older to present with metastatic (M1) disease (5.4% versus 4.4%; p = 0.009), to be triple negative (21.6% versus 13%; p < 0.001), or to be HER-2 positive (24.3% versus 14.8%; p < 0.01). Young patients with HER-2-positive cancers were significantly more likely to present with metastatic disease (8.3% versus 4.8%; p = 0.004). This study showed no demonstrable increase in the relative proportion of breast cancer occurring in patients aged <40 years over the 12-year period 2000-2011 and no increase in the proportion of young patients presenting with metastatic disease.
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Affiliation(s)
- Niamh Conlon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jane Howard
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jeffrey Catalano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meighan Gallagher
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lee K Tan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adriana D Corben
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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Conlon N, Sadri N, Corben AD, Tan LK. Acinic cell carcinoma of breast: morphologic and immunohistochemical review of a rare breast cancer subtype. Hum Pathol 2016; 51:16-24. [PMID: 27067778 DOI: 10.1016/j.humpath.2015.12.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 12/09/2015] [Accepted: 12/16/2015] [Indexed: 12/24/2022]
Abstract
Acinic cell carcinoma of breast is a rare subtype of triple-negative breast carcinoma and demonstrates extensive morphologic overlap with acinic cell carcinoma of the salivary gland. In this study, we perform a detailed morphologic and immunohistochemical description of 2 cases of this rare entity and undertake a comprehensive review of all reported cases of breast acinic cell carcinoma in the English language literature to date. One-third of reported cases of breast acinic cell carcinoma have been associated with the presence of a ductal carcinoma not otherwise specified component, which is frequently poorly differentiated. Breast acinic cell carcinoma can demonstrate focal morphologic features similar to microglandular adenosis; these areas are frequently negative for collagen IV and laminin on immunohistochemistry. The true relationship between these 2 entities remains unclear, but we advocate that microglandular adenosis-like areas at the periphery of a breast acinic cell carcinoma should be considered part of the carcinomatous process and re-excised if this process extends to the initial surgical margins.
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Affiliation(s)
- Niamh Conlon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065.
| | - Navid Sadri
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Adriana D Corben
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Lee K Tan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
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Jhaveri K, Chandarlapaty S, Iyengar N, Morris PG, Corben AD, Patil S, Akram M, Towers R, Sakr RA, King TA, Norton L, Rosen N, Hudis C, Modi S. Biomarkers That Predict Sensitivity to Heat Shock Protein 90 Inhibitors. Clin Breast Cancer 2015; 16:276-83. [PMID: 26726007 DOI: 10.1016/j.clbc.2015.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 06/16/2015] [Revised: 11/04/2015] [Accepted: 11/10/2015] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Heat shock protein (HSP) 90, a viable target for cancer treatment, mediates the maturation and stabilization of client oncoproteins. HSP90 inhibitors (HSP90i) are potentially active in a variety of tumors, but therapeutic benefit is confirmed in only a small subset. We explored potential biomarkers across multiple studies of HSP90i in advanced solid tumors. PATIENTS AND METHODS Archived tumor specimens from patients treated with HSP90i in 7 different phase I/II trials at Memorial Sloan Kettering Cancer Center were identified. Tumor tissue was tested using immunohistochemistry; estrogen, progesterone, and androgen receptors ≥ 1% positive and < 1% negative; HSP90 and HSP70: 0, 1 + negative, and 2+, 3 + positive; phosphatase and tensin homolog: 0 negative, 1 reduced, and 2 positive; HER2: 0, 1 + negative, 2 + equivocal, 3 + positive; and epidermal growth factor receptor: 0 negative, and 1+, 2+, 3 + positive. The expression of the biomarker panel was correlated with clinical benefit (CB) (defined by overall response [ORR] or CB by the "8-week" scan) using Fisher exact test. RESULTS Adequate tissue was available for 51 of 158 patients (32%), including 10 different solid tumors. Of these, 71% (36 of 51) and 51% (26 of 51) patients met the criteria to assess CB by best ORR or by the "8-week scan" assessment, respectively. Breast was the most frequent tumor. The mean duration of HSP90i therapy was 55 days (range, 16-411 days). There were 16 responses (4 partial response; 12 stable disease); 13 of 16 responses strongly correlated with HER2-positive status (P = .001). CONCLUSION Our findings suggest HER2 as a sensitive client and perhaps the only effective biomarker for sensitivity to these HSP90i.
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Affiliation(s)
- Komal Jhaveri
- Memorial Sloan Kettering Cancer Center, New York, NY.
| | | | - Neil Iyengar
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Patrick G Morris
- Memorial Sloan Kettering Cancer Center, New York, NY; Beaumont Hospital, Dublin, Ireland
| | | | - Sujata Patil
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Rita A Sakr
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tari A King
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Larry Norton
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neal Rosen
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Shanu Modi
- Memorial Sloan Kettering Cancer Center, New York, NY
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8
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Abstract
Optimal management of a lesion yielding radial scar (RS) without epithelial atypia on breast biopsy is controversial. In this single-institution study spanning 17 years, 53 patients with this biopsy diagnosis were evaluated in terms of clinical, radiologic, and pathologic features and outcomes. RSs were categorized as either "incidental" or as the "targeted" lesion according to defined criteria. Of 48 patients who underwent surgical excision after a diagnosis of RS on biopsy, only 1 had an "upgrade" diagnosis of malignancy (2%). No "incidental" RS was associated with the presence of malignancy on surgical excision. Meta-analysis of 20 RS excision studies demonstrated an overall upgrade rate of 10.4%, with a higher rate in patients with a diagnosis of RS with atypia (26%). The upgrade rate for RS without atypia was 7.5% overall. The lower rate of upgrade to malignancy in this study (2%) is likely related to the thorough radiologic-pathologic review undertaken. In the setting of multidisciplinary agreement and careful radiologic-pathologic correlation, it may be appropriate for patients with a biopsy diagnosis of RS without atypia to forego surgical excision in favor of imaging follow-up.
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Affiliation(s)
- Niamh Conlon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Clare D’Arcy
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jennifer B. Kaplan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zenica L. Bowser
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anibal Cordero
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Adriana D. Corben
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
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9
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Dashevsky BZ, Goldman DA, Parsons M, Gönen M, Corben AD, Jochelson MS, Hudis CA, Morrow M, Ulaner GA. Appearance of untreated bone metastases from breast cancer on FDG PET/CT: importance of histologic subtype. Eur J Nucl Med Mol Imaging 2015; 42:1666-1673. [PMID: 25971426 DOI: 10.1007/s00259-015-3080-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/28/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine if the histology of a breast malignancy influences the appearance of untreated osseous metastases on FDG PET/CT. METHODS This retrospective study was performed under IRB waiver. Our Hospital Information System was screened for breast cancer patients who presented with osseous metastases, who underwent FDG PET/CT prior to systemic therapy or radiotherapy from 2009 to 2012. Patients with invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), or mixed ductal/lobular (MDL) histology were included. Patients with a history of other malignancies were excluded. PET/CT was evaluated, blinded to histology, to classify osseous metastases on a per-patient basis as sclerotic, lytic, mixed lytic/sclerotic, or occult on CT, and to record SUVmax for osseous metastases on PET. RESULTS Following screening, 95 patients who met the inclusion criteria (74 IDC, 13 ILC, and 8 MDL) were included. ILC osseous metastases were more commonly sclerotic and demonstrated lower SUVmax than IDC metastases. In all IDC and MDL patients with osseous metastases, at least one was FDG-avid. For ILC, all patients with lytic or mixed osseous metastases demonstrated at least one FDG-avid metastasis; however, in only three of seven patients were sclerotic osseous metastases apparent on FDG PET. CONCLUSION The histologic subtype of breast cancer affects the appearance of untreated osseous metastases on FDG PET/CT. In particular, non-FDG-avid sclerotic osseous metastases were more common in patients with ILC than in patients with IDC. Breast cancer histology should be considered when interpreting non-FDG-avid sclerotic osseous lesions on PET/CT, which may be more suspicious for metastases (rather than benign lesions) in patients with ILC.
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Affiliation(s)
| | - Debra A Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Molly Parsons
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Adriana D Corben
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Maxine S Jochelson
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Clifford A Hudis
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Gary A Ulaner
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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10
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Corben AD, Uddin MM, Crawford B, Farooq M, Modi S, Gerecitano J, Chiosis G, Alpaugh ML. Ex vivo treatment response of primary tumors and/or associated metastases for preclinical and clinical development of therapeutics. J Vis Exp 2014:e52157. [PMID: 25350385 DOI: 10.3791/52157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The molecular analysis of established cancer cell lines has been the mainstay of cancer research for the past several decades. Cell culture provides both direct and rapid analysis of therapeutic sensitivity and resistance. However, recent evidence suggests that therapeutic response is not exclusive to the inherent molecular composition of cancer cells but rather is greatly influenced by the tumor cell microenvironment, a feature that cannot be recapitulated by traditional culturing methods. Even implementation of tumor xenografts, though providing a wealth of information on drug delivery/efficacy, cannot capture the tumor cell/microenvironment crosstalk (i.e., soluble factors) that occurs within human tumors and greatly impacts tumor response. To this extent, we have developed an ex vivo (fresh tissue sectioning) technique which allows for the direct assessment of treatment response for preclinical and clinical therapeutics development. This technique maintains tissue integrity and cellular architecture within the tumor cell/microenvironment context throughout treatment response providing a more precise means to assess drug efficacy.
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Affiliation(s)
| | - Mohammad M Uddin
- Molecular Pharmacology and Chemistry Program, Memorial Sloan Kettering Cancer Center
| | | | - Mohammad Farooq
- Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Shanu Modi
- Department of Oncology, Memorial Sloan Kettering Cancer Center
| | - John Gerecitano
- Department of Oncology, Memorial Sloan Kettering Cancer Center
| | - Gabriela Chiosis
- Molecular Pharmacology and Chemistry Program, Memorial Sloan Kettering Cancer Center
| | - Mary L Alpaugh
- Department of Surgery, Memorial Sloan Kettering Cancer Center;
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11
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Gooch J, King TA, Eaton A, Dengel L, Stempel M, Corben AD, Morrow M. The extent of extracapsular extension may influence the need for axillary lymph node dissection in patients with T1-T2 breast cancer. Ann Surg Oncol 2014; 21:2897-903. [PMID: 24777858 PMCID: PMC4346337 DOI: 10.1245/s10434-014-3752-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Whether extracapsular extension (ECE) of tumor in the sentinel lymph node (SLN) is an indication for axillary lymph node dissection (ALND) in patients managed by American College of Surgeons Oncology Group Z0011 criteria is controversial. Here we examine the correlation between ECE in the SLN and disease burden in the axilla. METHODS Patients meeting Z0011 clinicopathologic criteria (pT1-2, cN0 with <3 positive SLNs) were selected from a prospectively maintained database (2006-2013). Chart review documented the presence and extent of ECE. Neoadjuvant chemotherapy patients were excluded. Comparisons were made by presence and extent (≤2 vs. >2 mm) of ECE. RESULTS Of 11,730 patients, 778 were pT1-2, cN0 with <3 positive SLNs without ECE, and 331 (2.8 %) had ECE. Of these, 180 had ≤2 mm and 151 had >2 mm of ECE. Patients with ECE were older (57 vs. 54 years; p = 0.001) and had larger (2.0 vs. 1.7 cm; p < 0.0001), multifocal (p = 0.006), hormone receptor-positive tumors (p = 0.0164) with lymphovascular invasion (p < 0.0001). Presence and extent of ECE were associated with greater axillary disease burden; 20 and 3 % of patients with and without ECE, respectively, had ≥4 additional positive nodes at completion ALND (p < 0.0001), and 33 % of patients with >2 mm ECE had ≥4 additional positive nodes at completion ALND, compared with 9 % in the <2 mm group (p < 0.0001). On multivariate analysis, >2 mm of ECE was the strongest predictor of ≥4 positive nodes at completion ALND (odds ratio 14.2). CONCLUSIONS Presence and extent of ECE were significantly correlated with nodal tumor burden at completion ALND, thus suggesting that >2 mm of ECE may be an indication for ALND or radiotherapy when applying Z0011 criteria to patients with metastases in <3 SLNs. ECE reporting should be standardized to facilitate future studies.
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Affiliation(s)
- Jessica Gooch
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tari A. King
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anne Eaton
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lynn Dengel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Adriana D. Corben
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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12
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Jhaveri K, Ochiana SO, Dunphy MPS, Gerecitano JF, Corben AD, Peter RI, Janjigian YY, Gomes-DaGama EM, Koren J, Modi S, Chiosis G. Heat shock protein 90 inhibitors in the treatment of cancer: current status and future directions. Expert Opin Investig Drugs 2014; 23:611-28. [PMID: 24669860 PMCID: PMC4161020 DOI: 10.1517/13543784.2014.902442] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Heat shock protein 90 (HSP90) serves as a critical facilitator for oncogene addiction. There has been augmenting enthusiasm in pursuing HSP90 as an anticancer strategy. In fact, since the initial serendipitous discovery that geldanamycin (GM) inhibits HSP90, the field has rapidly moved from proof-of-concept clinical studies with GM derivatives to novel second-generation inhibitors. AREAS COVERED The authors highlight the current status of the second-generation HSP90 inhibitors in clinical development. Herein, the authors note the lessons learned from the completed clinical trials of first- and second-generation inhibitors and describe various assays attempting to serve for a more rational implementation of these agents to cancer treatment. Finally, the authors discuss the future perspectives for this promising class of agents. EXPERT OPINION The knowledge gained thus far provides perhaps only a glimpse at the potential of HSP90 for which there is still much work to be done. Lessons from the clinical trials suggest that HSP90 therapy would advance at a faster pace if patient selection and tumor pharmacokinetics of these drugs were better understood and applied to their clinical development. It is also evident that combining HSP90 inhibitors with other potent anticancer therapies holds great promise not only due to synergistic antitumor activity but also due to the potential of prolonging or preventing the development of drug resistance.
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Affiliation(s)
- Komal Jhaveri
- New York University Cancer Institute, NYU Clinical Cancer Center, Division of Hematology/Medical Oncology, NY, USA
| | - Stefan O Ochiana
- Sloan-Kettering Institute, Molecular Pharmacology and Chemistry Program, NY, USA
| | - Mark PS Dunphy
- Memorial Sloan-Kettering Cancer Center, Department of Radiology, NY, USA
| | - John F Gerecitano
- Memorial Sloan-Kettering Cancer Center, Lymphoma Medicine Service, NY, USA
| | - Adriana D Corben
- Memorial Sloan-Kettering Cancer Center, Breast Cancer Medicine Service, NY, USA
| | - Radu I Peter
- Technical University of Cluj-Napoca, Department of Mathematics, Cluj-Napoca, Romania
| | - Yelena Y Janjigian
- Memorial Sloan-Kettering Cancer Center, Gastrointestinal Oncology Service, NY, USA
| | - Erica M Gomes-DaGama
- Sloan-Kettering Institute, Molecular Pharmacology and Chemistry Program, NY, USA
| | - John Koren
- Sloan-Kettering Institute, Molecular Pharmacology and Chemistry Program, NY, USA
| | - Shanu Modi
- Memorial Sloan-Kettering Cancer Center, Breast Cancer Medicine Service, NY, USA
| | - Gabriela Chiosis
- Sloan-Kettering Institute, Molecular Pharmacology and Chemistry Program, NY, USA
- Memorial Sloan-Kettering Cancer Center, Breast Cancer Medicine Service, NY, USA
- Molecular Pharmacology & Chemistry, Sloan-Kettering Institute, Department of Medicine, Breast Cancer Service, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, and Weill Graduate School of Medical Sciences, NY, USA
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13
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Barbashina V, Corben AD, Akram M, Vallejo C, Tan LK. Time to change the way we diagnose mucinous carcinomas of breast--reply. Hum Pathol 2014; 45:435. [PMID: 24439235 DOI: 10.1016/j.humpath.2013.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 09/30/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Violetta Barbashina
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Adriana D Corben
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
| | - Muzaffar Akram
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
| | - Christina Vallejo
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
| | - Lee K Tan
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
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Barbashina V, Corben AD, Akram M, Vallejo C, Tan LK. Reversed MUC1/EMA polarity in both mucinous and micropapillary breast carcinoma--reply. Hum Pathol 2014; 45:434. [PMID: 24439234 DOI: 10.1016/j.humpath.2013.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Violetta Barbashina
- Department of Pathology Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
| | - Adriana D Corben
- Department of Pathology Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Muzaffar Akram
- Department of Pathology Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Christina Vallejo
- Department of Pathology Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Lee K Tan
- Department of Pathology Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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15
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Corben AD, Abi-Raad R, Popa I, Teo CHY, Macklin EA, Koerner FC, Taghian AG, Brachtel EF. Pathologic response and long-term follow-up in breast cancer patients treated with neoadjuvant chemotherapy: a comparison between classifications and their practical application. Arch Pathol Lab Med 2013; 137:1074-82. [PMID: 23899063 DOI: 10.5858/arpa.2012-0290-oa] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Breast cancer is increasingly treated with neoadjuvant chemotherapy to improve surgical resectability and evaluate tumor response, which is assessed histopathologically. Several histopathologic classification systems have been previously described for assessment of treatment response. OBJECTIVES To test performance in a side-by-side comparison of several histopathologic classification systems after neoadjuvant chemotherapy with clinical outcome. DESIGN Sixty-two patients were enrolled in a randomized trial receiving sequential neoadjuvant chemotherapy with doxorubicin and paclitaxel. Histologic sections from the patients' tumors sampled before (core biopsy) and after treatment (excision or mastectomy) were reviewed. Histologic response was assessed following National Surgical Adjuvant Breast and Bowel Project protocol B18, Miller-Payne grading, Sataloff tumor and nodes, Residual Cancer Burden (RCB), and Residual Disease in Breast and Nodes (RDBN). Pathologic classification results were correlated with survival using Kaplan-Meier and Cox hazards regression with a median follow-up of 93 months. RESULTS RDBN was associated with distant disease-free survival by univariate and multivariate analysis (P = .01 and .004, respectively), as were lymph node metastases (P = .02 and .01, respectively). Five patients (8%) had complete pathologic response after neoadjuvant chemotherapy, and none of them relapsed during the study period. Survival was shorter among patients with higher Residual Cancer Burden scores, but the associations were not significant. Miller-Payne grading and Sataloff tumor scores were not correlated with survival. CONCLUSIONS Evaluation of breast specimens after neoadjuvant chemotherapy by the composite index RDBN correlates with long-term outcome. The residual disease in breast and nodes system is suitable for routinely processed pathology cases. This study confirms the importance of lymph node status after neoadjuvant chemotherapy and favorable outcome in patients with pathologic complete response.
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Affiliation(s)
- Adriana D Corben
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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16
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Edelweiss M, Corben AD, Liberman L, Kaplan J, Nehhozina T, Catalano JP, Brogi E. Focal extravasated mucin in breast core needle biopsies: is surgical excision always necessary? Breast J 2013; 19:302-9. [PMID: 23534893 DOI: 10.1111/tbj.12104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Focal extravasated mucin (EM) with benign or atypical epithelium is a rare finding at breast core needle biopsy (CNB) and usually prompts surgical excision to rule out mucin-producing carcinoma. In the largest detailed series to date, we assessed surgical outcomes in lesions yielding EM with atypical or nonatypical epithelium at CNB. With IRB approval, we retrospectively reviewed 28 consecutive atypical and nonatypical CNBs with EM that underwent surgical excision at our center over a 22-year period. CNB imaging and pathologic findings were concordant if pathology sufficiently explained the radiologic features of the lesions. Pathologic findings in CNB and excision specimens were correlated. Statistical analysis was performed. CNBs sampled mammographic calcifications in 25/28 (89%) women and a mass in 3/28 (11%). All cases had concordant pathologic and imaging findings. At CNB, the epithelium associated with EM was atypical in 18/28 (64%) lesions and nonatypical in 10 (36%). Cancer (one mucinous carcinoma; three ductal carcinoma in situ) was present in 4/28 excision specimens (14%; 95% confidence intervals [CI], 4%-33%). All carcinomas were in lesions with epithelial atypia at CNB (4/18; 22%; 95% CI, 6%-48%) versus none (0/10; 0%; 95% CI, 0%-31%) in nonatypical lesions at CNB; this difference was not statistically significant (p = 0.3). Surgery is warranted for lesions yielding EM with atypia at CNB due to the high (22%) prevalence of cancer. Our data suggest that surgical excision of lesions yielding EM without epithelial atypia at CNB may not be necessary provided that imaging and pathologic findings are concordant.
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Affiliation(s)
- Marcia Edelweiss
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York City, NY, USA.
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Abstract
Non-mammary metastases to the breast and axilla are rare occurrences. However, they are important diagnostic considerations as their treatment and prognosis differ significantly from primary breast cancer. Between 1990 and 2010, we identified a total of 85 patients, 72 women and 13 men, with non-mammary malignancies involving the breast, axilla, or both. The tumor types consisted of carcinoma (58%), melanoma (22%) and sarcoma (20%). Ovary was the most common site of origin for carcinoma, and metastatic high-grade ovarian serous carcinoma was most frequently misdiagnosed as a primary breast carcinoma. Melanoma was the single most common non-carcinomatous tumor type to involve the breast and/or axilla, and uterine leiomyosarcoma was the most common type of sarcoma. Most patients (77%) had other metastases at the time of diagnosis of the tumor, but in 11% the breast or axillary lesion was the first presentation. Without a clinical history, non-mammary metastases were difficult to diagnose because the majority of cases presented with a solitary nodule and lacked pathognomonic pathologic features. There were, however, certain recurrent histological findings identified, such as the often relatively well-circumscribed growth pattern of the metastatic lesion surrounded by a fibrous pseudocapsule, and the absence of an in situ carcinoma. Overall, these patients had poor survival; 96% of patients with follow-up available are dead of disease, with a median survival of 15 months after the diagnosis of the breast or axillary lesion. This finding emphasizes the need to accurately identify these tumors as metastases in order to avoid unnecessary procedures and treatments in these patients.
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Affiliation(s)
- Deborah F DeLair
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Abstract
Invasive breast cancers constitute a heterogeneous group of lesions. Although the most common types are ductal and lobular, this distinction is not meant to indicate the site of origin within the mammary ductal system. The main purpose of the identification of specific types of invasive breast carcinoma is to refine the prediction of likely behavior and response to treatment also offered by the other major prognostic factors, including lymph node stage, histologic grade, tumor size, and lymphovascular invasion.
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Affiliation(s)
- Adriana D Corben
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Abstract
The aim of core needle biopsy (CNB) is to diagnose a breast abnormality prior to open surgical excision. The radiology-pathology correlation helps in interpretation of pathologic findings and is greatly assisted by specimen radiology of all cores performed for calcifications, separation of cores containing calcification from those without, and the availability of the specimen radiograph to the pathologist at the time of reporting. The nature of the imaging abnormality should also be clearly conveyed. CNB is processed in a routine manner for paraffin embedding with preservation of sufficient material in the block for further studies as needed. Possible pitfalls include the loss of calcifications at the time of section cutting, calcium remained in the formalin of the specimen container, and failure to recognize calcium oxalate deposition in the CNB. The challenges of CNB interpretation are complicated by the availability of only limited material, but are generally similar to those encountered in open surgical excision specimens. This discussion focuses on high-risk lesions and lesions that raise management issues. The most prudent approach for the pathologist is to provide sufficient information to prompt a surgical excision without overdiagnosing the lesion, thus placing the patient into the appropriate therapeutic algorithm.
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Affiliation(s)
- Adriana D Corben
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
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Kaewlai R, Digumarthy SR, Smith BL, Corben AD, Austen WG, Shepard JAO, Sharma A. Significance of internal mammary lymph nodes in patients after mastectomy with tissue-expander reconstruction: a case-control study. Clin Radiol 2010; 65:453-9. [PMID: 20451012 DOI: 10.1016/j.crad.2010.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 01/10/2010] [Accepted: 01/14/2010] [Indexed: 11/30/2022]
Abstract
AIM To retrospectively assess the frequency of internal mammary lymph nodes (IMNs) in patients after mastectomy and tissue-expander reconstruction. MATERIALS AND METHODS Statistical analysis was performed for all available data in patients with mastectomy and tissue-expander reconstruction from 2004-2007 (study group). The data were compared with that of a control population with mastectomy who did not have reconstruction (control group). Patients with recurrent breast cancers, previous breast reconstruction, surgeries performed at outside hospitals, no available pre- or postoperative computed tomography (CT) or magnetic resonance imaging (MRI) data, or inadequate imaging follow-up were excluded. RESULTS There were eight patients in the study group (median age 50.5 years, seven breast cancers), and eight patients in the control group (median age 52 years, seven breast cancers). No patients had IMNs on their preoperative imaging examinations. New IMNs were present in postoperative imaging in seven of eight patients (7/8, 87.5%) in the study group. All of them were stable or decreased in size on subsequent imaging examinations. None of the patients in the control group had IMNs (0/8). CONCLUSION IMNs are common on imaging after mastectomy and tissue-expander placement. The IMNs decreased or remained stable on follow-up imaging and may represent reactive nodes.
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Affiliation(s)
- R Kaewlai
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Corben AD, Lerwill MF. Use of Myoepithelial Cell Markers in the Differential Diagnosis of Benign, In situ, and Invasive Lesions of the Breast. Surg Pathol Clin 2009; 2:351-373. [PMID: 26838326 DOI: 10.1016/j.path.2009.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Immunohistochemical markers for myoepithelial cells are commonly used to distinguish invasive from noninvasive lesions in the breast. The approach takes advantage of the fact that conventional invasive carcinomas lack surrounding myoepithelial cells, whereas nearly all benign lesions and in situ carcinomas retain their myoepithelial cell layer. Although conceptually straightforward, the interpretation of myoepithelial cell markers can be complicated by misleading patterns of reactivity (such as stromal or tumor cell staining) or lack of reactivity (due to reduced numbers of myoepithelial cells or variable antigenicity). In this article, we discuss the advantages and disadvantages of commonly used myoepithelial cell markers, their general utility in distinguishing invasive from noninvasive processes, and pitfalls in their interpretation. We also examine whether the detection of myoepithelial cells is helpful in the evaluation of papillary lesions, another common application. Myoepithelial cell markers can be diagnostically useful in the distinction of many benign, in situ, and invasive lesions, but they must be interpreted in conjunction with careful morphologic analysis.
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Affiliation(s)
- Adriana D Corben
- James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Melinda F Lerwill
- James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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