HER-2, Hormone Receptors, and clinicopathologic characteristics in Uruguayan breast cancer patients

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Background: Few Latin-American studies and none Uruguayan study have evaluated HER-2, estrogen receptor (ER) and progesterone receptor (PR) in breast cancer (BC). The purpose of the study was to investigate the frequency of these markers and the relationship between them and with clinicopathologic features in Uruguayan BC patients (pts). Methods: We retrospectively reviewed clinical records from pts who underwent curative surgery for stage I-III invasive BC at the Oncology Units of 4 institutions in Montevideo between march 2006 and march 2008. We obtained the following data: age, TNM, ER/PR status by immunohistochemistry (IHC) and HER2 status by IHC and FISH in HER2 IHC 2+. Fisher's exact test was used to analyze the data. Results: 427 pts were included. Median age was 60 years-old (range: 24–93 y), postmenopausal 75%, stages: I 33%, II 42%, III 23%, unknown 2%. ER/PR status was known in 94,6% of cases: ER+/PR+ 66,1%, ER+/PR- 11,1%, ER-/PR+ 3,5%, ER-/PR- 19,3%. HER2 status was known in 47% (199/427) of cases, being positive (IHC 3+ or FISH+) in 13.6%. Triple negative tumors were found in 32 of 199 pts (16%). HER2 was positive in 8% of pts with ER+ and/or PR+ tumors, and in 18% of pts with ER-PR- disease (p=0.08). We did not find a significant association between axillary lymph node status and HER2 status. Besides, triple negative BC did not correlate with axillary lymph node status. When analized by menopausal status, the frequency of triple negative pts was 14% in the premenopausal group and 4% in the postmenopausal group (p=0.005). In addition, the rate of triple negative BC was 0% in pts with histologic grade 1 and 10% in pts with histologic grade 2–3 (p = 0.0005). Conclusions: Our data from Uruguayan pts show a lower prevalence of HER2 positive but a similar prevalence of ER+ and PR+ operable BC than the prevalence reported in most American and European studies. In accordance with previous reports, triple negative BC correlated with younger age and higher histologic grade.

No significant financial relationships to disclose.

Is (99m)Tc-sestamibi scintimammography complementary to conventional mammography for detecting breast cancer in patients with palpable masses?

The aim of this trial was to evaluate in developing countries from different regions the diagnostic performance of (99m)Tc-sestamibi scintimammography (SM) in palpable breast lesions and to verify the clinical usefulness of a joint evaluation with mammography and SM.

METHODS

From 10 countries, a total of 238 patients with palpable breast masses (n = 245) were included in this prospective multicenter trial. Prone SM was performed 10 min and 60-90 min (157 patients) after injection using an isotime acquisition of 10 min. Mammography was assessed by the same dedicated imaging radiologist according to breast imaging reporting and data system (BI-RADS) categories for malignancy and breast density. Masked SM findings and mammography findings were checked for a correlation with histopathology findings for excisional biopsy samples. Diagnostic values for breast cancer detection were calculated per lesion.

RESULTS

Histopathology revealed 189 cancerous lesions and 56 benign lesions. The sensitivity and specificity of SM were 0.83 and 0.77, respectively. SM diagnostic values did not depend on the incidence of breast cancer in the country of origin or on the timing of imaging (early vs. delayed scans). On mammography, the technique yielded a sensitivity and specificity of 0.85 and 0.66, with 27 mammograms classified as BI-RADS category 1, 33 as category 2, 5 as category 3, 56 as category 4, and 124 as category 5. Thirty-seven lesions were considered to show increased radiologic density. No significant difference was found in SM diagnostic values among different BI-RADS categories or between the groups with low and high breast density. A sensitivity of 96% was calculated when SM and mammography results were combined, with 75% of all false-negative mammography findings classified as true-positive results by SM.

CONCLUSION

SM complements mammography in patients with palpable masses and negative mammography findings.