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Sars C, Sackey H, Frisell J, Dickman PW, Karlsson F, Kindts I, Marta GN, Freitas-Junior R, Tvedskov TF, Kassem L, Ali AS, Ihalainen H, Neron M, Kontos M, Kaidar-Person O, Meattini I, Francken AB, van Duijnhoven F, Moberg IO, Marinko T, Kollar A, Ahmed M, Remoundos D, Banks J, Jagsi R, Dossett LA, Lindqvist EK. Current clinical practice in the management of phyllodes tumors of the breast: an international cross-sectional study among surgeons and oncologists. Breast Cancer Res Treat 2023; 199:293-304. [PMID: 36879102 PMCID: PMC9988205 DOI: 10.1007/s10549-023-06896-1] [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: 11/29/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Phyllodes tumors of the breast are rare fibroepithelial lesions that are classified as benign, borderline or malignant. There is little consensus on best practice for the work-up, management, and follow-up of patients with phyllodes tumors of the breast, and evidence-based guidelines are lacking. METHODS We conducted a cross-sectional survey of surgeons and oncologists with the aim to describe current clinical practice in the management of phyllodes tumors. The survey was constructed in REDCap and distributed between July 2021 and February 2022 through international collaborators in sixteen countries across four continents. RESULTS A total of 419 responses were collected and analyzed. The majority of respondents were experienced and worked in a university hospital. Most agreed to recommend a tumor-free excision margin for benign tumors, increasing margins for borderline and malignant tumors. The multidisciplinary team meeting plays a major role in the treatment plan and follow-up. The vast majority did not consider axillary surgery. There were mixed opinions on adjuvant treatment, with a trend towards more liberal regiments in patients with locally advanced tumors. Most respondents preferred a five-year follow-up period for all phyllodes tumor types. CONCLUSIONS This study shows considerable variation in clinical practice managing phyllodes tumors. This suggests the potential for overtreatment of many patients and the need for education and further research targeting appropriate surgical margins, follow-up time and a multidisciplinary approach. There is a need to develop guidelines that recognize the heterogeneity of phyllodes tumors.
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Affiliation(s)
- Carl Sars
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Helena Sackey
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden.,Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Jan Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden.,Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Karlsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden.,Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | | | | | - Ruffo Freitas-Junior
- CORA Advanced Center for Diagnosis of Breast Diseases, Hospital das Clínicas, Federal University of Goias, Goiânia, Brazil
| | | | - Loay Kassem
- Department of Clinical Oncology, Cairo University Hospitals, Cairo, Egypt
| | - Ahmed S Ali
- Department of Clinical Oncology, Cairo University Hospitals, Cairo, Egypt
| | - Hanna Ihalainen
- Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mathias Neron
- Institut du Cancer de Montpellier, Surgical Oncology Department, Université Montpellier, Montpellier, France
| | - Michalis Kontos
- 1st Department of Surgery, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Orit Kaidar-Person
- Breast Radiation Unit, Sheba Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | | | - Ingvild Ona Moberg
- Department of Breast and Endocrine Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Tanja Marinko
- Institute of Oncology, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Attila Kollar
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Mahbubl Ahmed
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, USA
| | - Ebba K Lindqvist
- Department of Clinical Science and Education, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Stockholm South General Hospital, Stockholm, Sweden
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Santti K, Beule A, Rönty M, Ihalainen H, Tarkkanen M, Blomqvist C. The CDK 4/6 inhibitor ribociclib has activity in the treatment of inoperable desmoid tumor. A case report. Acta Oncol 2019; 58:897-900. [PMID: 30905251 DOI: 10.1080/0284186x.2019.1588992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Kirsi Santti
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Annette Beule
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mikko Rönty
- Department of Pathology, HUSLAB and University of Helsinki, Helsinki, Finland
| | - Hanna Ihalainen
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Maija Tarkkanen
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Carl Blomqvist
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Oncology, Örebro University Hospital, Örebro, Sweden
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Santti K, Ihalainen H, Rönty M, Karlsson C, Haglund C, Sampo M, Tarkkanen M, Blomqvist C. Estrogen receptor beta expression correlates with proliferation in desmoid tumors. J Surg Oncol 2019; 119:873-879. [PMID: 30742303 DOI: 10.1002/jso.25407] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Estrogen receptor signaling and cyclin D1 have a major role in tumor cell proliferation in breast cancer. Desmoid tumors are rare neoplasms that may respond to endocrine treatment. The present study aimed to investigate the expression levels and the clinical relevance of estrogen receptor beta (ERβ) and cyclin D1 in desmoid tumors. METHODS This study consists of 83 patients with a surgically treated desmoid tumor. ERβ and cyclin D1 expression was examined by immunohistochemistry in tissue microarrays. Cyclin A and Ki67 were studied in our previous work. RESULTS Median ERβ expression was 10.8%. ERβ expression correlated with expression of the proliferation antigens Ki67 (rp = 0.35, P = 0.003), cyclin D1 (rp = 0.34, P = 0.004), and cyclin A (rp = 0.34, P = 0.004). ERβ immunoexpression showed a trend towards predictive impact for recurrence as a continuous variable. Further explorative analysis indicated that very high ERβ expression was related to high risk of relapse (hazard ratio [HR] 2.6; P = 0.02). Median cyclin D1 expression was 15.6%. High cyclin D1 expression was associated with high Ki67 and cyclin A expression. Cyclin D1 was not associated with time to recurrence. CONCLUSIONS ERβ and cyclin D1 immunopositivity correlated with high proliferation in desmoid tumors. High ERβ expression might be predictive for postoperative recurrence.
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Affiliation(s)
- Kirsi Santti
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanna Ihalainen
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mikko Rönty
- Department of Pathology, HUSLAB and University of Helsinki, Helsinki, Finland
| | - Christina Karlsson
- Department of Medical Diagnostics, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Caj Haglund
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Translational Cancer Biology, Reseach Programs Unit, University of Helsinki, Helsinki, Finland
| | - Mika Sampo
- Department of Pathology, HUSLAB and University of Helsinki, Helsinki, Finland
| | - Maija Tarkkanen
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Carl Blomqvist
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Oncology, Örebro University Hospital, Örebro, Sweden
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4
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Santti K, Ihalainen H, Rönty M, Böhling T, Karlsson C, Haglund C, Tarkkanen M, Blomqvist C. High cyclin A expression, but not Ki67, is associated with early recurrence in desmoid tumors. J Surg Oncol 2018; 118:192-198. [PMID: 29878366 DOI: 10.1002/jso.25121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/09/2018] [Accepted: 05/07/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Desmoid tumors are soft-tissue tumors originating from myofibroblasts with a tendency to recur after surgery. High expression of proliferation markers is associated with shortened progression-free and/or overall survival in many neoplasms, including soft-tissue sarcomas. We investigated the prognostic role of cyclin A and Ki67 in desmoid tumors by immunohistochemistry. METHODS The study included 76 patients with desmoid tumor operated at Helsinki University Hospital between 1987 and 2011. A tissue micro array (TMA) was constructed and the TMA sections were immunostained with cyclin A and Ki67 antibodies. A computer-assisted image analysis was performed. RESULTS Cyclin A expression was evaluable in 74 and Ki67 in 70 patients. Cyclin A immunopositivity varied from 0% to 9.9%, with a mean of 1.9%. Cyclin A expression correlated significantly with Ki67. Cyclin A expression was associated with recurrence-free survival (HR 1.9, 95% CI = 1.1-3.2, P = .02), as were positive margin (HR 6.0, 95% CI = 1.6-22.5, P = .008) and extremity location (HR 5.3, 95% CI = 1.7-16.8, P = 0.005). Ki67 immunopositivity varied from 0.33% to 13.8%, with a mean of 4.6%, but had no significant prognostic impact (HR 1.1, P = .2). CONCLUSIONS Our study indicates that cyclin A may be a new prognostic biomarker in surgically treated desmoid tumors.
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Affiliation(s)
- Kirsi Santti
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanna Ihalainen
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mikko Rönty
- Department of Pathology, HUSLAB and University of Helsinki, Helsinki, Finland
| | - Tom Böhling
- Department of Pathology, HUSLAB and University of Helsinki, Helsinki, Finland
| | - Christina Karlsson
- Department of Medical Diagnostics, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Caj Haglund
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Reseach Program Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
| | - Maija Tarkkanen
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Carl Blomqvist
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Oncology, Örebro University Hospital, Örebro, Sweden
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Meretoja T, Ihalainen H, Leidenius M. [Inflammations of the mammary gland]. Duodecim 2017; 133:855-861. [PMID: 29240317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Breast inflammation, i.e. mastitis is an entity with a variable etiology and severity, typically affecting women of fertile age. In most cases, anamnesis reveals the etiology of the disease, bacterial puerperal mastitis associated with breastfeeding being the most common. Periductal mastitis is a breast inflammation typically associated with smoking in women of 40 to 50 years of age, localized to the region of the areola. Granulomatous mastitis and other rare breast inflammations usually require specialized care. Regardless of etiology, treatment of acute inflammation depends on the clinical picture and, with the exception of puerperal mastitis, emergency ultrasound imaging is often necessary in order to detect an abscess and drain it. In all cases of mastitis, the possibility of underlying malignancy as well as inflammatory breast cancer should be kept in mind. If specialized care is required, breast inflammation is treated in a breast, general or plastic surgery unit.
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Kalli S, Grönlund J, Ihalainen H, Siimes A, Välimäki I, Antila K. Multivariate autoregressive modeling of autonomic cardiovascular control in neonatal lamb. Comput Biomed Res 1988; 21:512-30. [PMID: 3233934 DOI: 10.1016/0010-4809(88)90009-2] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The neonatal cardiovascular control system is a complicated interactive system which is under vigorous development at birth. From the measurement point of view the cardiovascular control is a closed-loop system. However, it can be examined on a beat-by-beat basis by analyzing circulatory-controlled variables with advanced signal analysis techniques. This paper proposes to use a multivariate autoregressive modeling technique in the analysis of several simultaneous physiological signals in order to examine interactions and inherent properties in the system. With the proposed multivariate autoregressive modeling technique, a signal is modeled as a linear combination of its own past and the past values of the other simultaneous signals plus a predictive error term of the model. The interactions in the system after the model identification are analyzed in frequency domain utilizing power spectrum estimates of the signals and signal contributions. The applicability of the proposed method was examined by a three-variable model between heart rate, blood pressure and respiration in the study of autonomic cardiovascular control in a chronic neonatal lamb model, in which the cardiovascular status was changed by using a beta-adrenergic autonomic nervous blockade. The study showed that the multivariate autoregressive modeling technique is a feasible technique in studying complicated interactions within the cardiovascular control system.
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Affiliation(s)
- S Kalli
- Medical Engineering Laboratory, Technical Research Centre of Finland, Tampere
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