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Asgeirsson KS, Dixon JM, Darrigues L, Sarfati B, Macmillan RD. Multicenter Evaluation of Hydrodissection-Assisted Mastectomy (HAM). Ann Surg Oncol 2021; 28:4780-4781. [PMID: 33861405 DOI: 10.1245/s10434-021-09932-w] [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] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 11/18/2022]
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Miligy IM, Toss MS, Shiino S, Oni G, Syed BM, Khout H, Tan QT, Green AR, Macmillan RD, Robertson JFR, Rakha EA. Correction: The clinical significance of oestrogen receptor expression in breast ductal carcinoma in situ. Br J Cancer 2020; 124:856. [PMID: 33116277 DOI: 10.1038/s41416-020-01139-2] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Islam M Miligy
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, The University of Nottingham, Nottingham, UK
| | - Michael S Toss
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, The University of Nottingham, Nottingham, UK.
| | - Sho Shiino
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, The University of Nottingham, Nottingham, UK
| | - Georgette Oni
- The Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Binafsha M Syed
- Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Hazem Khout
- The Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Qing Ting Tan
- The Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew R Green
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, The University of Nottingham, Nottingham, UK
| | - R Douglas Macmillan
- The Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - John F R Robertson
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham Royal Derby Hospital, Derby, UK
| | - Emad A Rakha
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, The University of Nottingham, Nottingham, UK
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Miligy IM, Toss MS, Shiino S, Oni G, Syed BM, Khout H, Tan QT, Green AR, Macmillan RD, Robertson JFR, Rakha EA. The clinical significance of oestrogen receptor expression in breast ductal carcinoma in situ. Br J Cancer 2020; 123:1513-1520. [PMID: 32773767 PMCID: PMC7653904 DOI: 10.1038/s41416-020-1023-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/07/2020] [Accepted: 07/22/2020] [Indexed: 01/04/2023] Open
Abstract
Background Oestrogen receptor (ER) in invasive breast cancer (BC) predicts response to endocrine therapy (ET) and provides prognostic value. In this study, we investigated the value of ER expression in ductal carcinoma in situ (DCIS) in terms of outcome and the impact on ET decision. Methods In total, 643 pure DCIS, diagnosed at Nottingham University Hospitals, were assessed for ER. Clinicopathological data were correlated against ER status, together with assessment of recurrence rate. Results ER positivity was observed in 74% (475/643) of cases. ER positivity was associated with clinicopathological variables of good prognosis; however, outcome analysis revealed that ER status was not associated with local recurrence. In the intermediate- and high-grade ER-positive DCIS, 58% (11/19) and 63% (15/24) of the recurrences were invasive, respectively, comprising 7% and 6% of all ER-positive DCIS, respectively. Invasive recurrence in low-grade DCIS was infrequent (2%), and none of these patients died of BC. The ER status of the recurrent invasive tumours matched the primary DCIS ER status (94% in ipsilateral and 90% of contralateral recurrence). Conclusion The strong correlation between DCIS and invasive recurrence ER status and the clinical impact of ET justify discussion of the use of ET in ER-positive DCIS treated by breast-conserving surgery. The excellent outcome of low-grade DCIS, which was almost always ER-positive, does not, in the opinion of authors, justify the use of risk-reducing ET. Therefore, the decision on ET for DCIS should be personalised and consider grade, ER status and other characteristics.
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Affiliation(s)
- Islam M Miligy
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, The University of Nottingham, Nottingham, UK.,Histopathology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Michael S Toss
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, The University of Nottingham, Nottingham, UK.
| | - Sho Shiino
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, The University of Nottingham, Nottingham, UK
| | - Georgette Oni
- The Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Binafsha M Syed
- Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Hazem Khout
- The Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Qing Ting Tan
- The Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew R Green
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, The University of Nottingham, Nottingham, UK
| | - R Douglas Macmillan
- The Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - John F R Robertson
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham Royal Derby Hospital, Derby, UK
| | - Emad A Rakha
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, The University of Nottingham, Nottingham, UK
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Potter S, Trickey A, Rattay T, O'Connell RL, Dave R, Baker E, Whisker L, Skillman J, Gardiner MD, Macmillan RD, Holcombe C. Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction. Br J Surg 2020; 107:832-844. [PMID: 32073654 DOI: 10.1002/bjs.11468] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/14/2019] [Accepted: 11/17/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Therapeutic mammaplasty (TM) may be an alternative to mastectomy, but few well designed studies have evaluated the success of this approach or compared the short-term outcomes of TM with mastectomy with or without immediate breast reconstruction (IBR). Data from the national iBRA-2 and TeaM studies were combined to compare the safety and short-term outcomes of TM and mastectomy with or without IBR. METHODS The subgroup of patients in the TeaM study who underwent TM to avoid mastectomy were identified, and data on demographics, complications, oncology and adjuvant treatment were compared with those of patients undergoing mastectomy with or without IBR in the iBRA-2 study. The primary outcome was the percentage of successful breast-conserving procedures in the TM group. Secondary outcomes included postoperative complications and time to adjuvant therapy. RESULTS A total of 2916 patients (TM 376; mastectomy 1532; mastectomy and IBR 1008) were included in the analysis. Patients undergoing TM were more likely to be obese and to have undergone bilateral surgery than those having IBR. However, patients undergoing mastectomy with or without IBR were more likely to experience complications than the TM group (TM: 79, 21·0 per cent; mastectomy: 570, 37·2 per cent; mastectomy and IBR: 359, 35·6 per cent; P < 0·001). Breast conservation was possible in 87·0 per cent of patients who had TM, and TM did not delay adjuvant treatment. CONCLUSION TM may allow high-risk patients who would not be candidates for IBR to avoid mastectomy safely. Further work is needed to explore the comparative patient-reported and cosmetic outcomes of the different approaches, and to establish long-term oncological safety.
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Affiliation(s)
- S Potter
- Population Health Sciences, Bristol Medical School, Bristol, UK.,Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
| | - A Trickey
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - T Rattay
- Cancer Research Centre, University of Leicester, Leicester Royal Infirmary, Leicester, UK
| | | | - R Dave
- Nightingale Breast Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - E Baker
- Department of Breast Surgery, Airedale General Hospital, Keighley, UK
| | - L Whisker
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - M D Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK.,Department of Plastic Surgery, Frimley Health NHS Foundation Trust, Slough, UK
| | - R D Macmillan
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
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O'Connell RL, Baker E, Trickey A, Rattay T, Whisker L, Macmillan RD, Potter S. Current practice and short-term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study. Br J Surg 2018; 105:1778-1792. [PMID: 30132807 DOI: 10.1002/bjs.10959] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/12/2018] [Accepted: 06/21/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Therapeutic mammaplasty, which combines breast reduction and mastopexy techniques with tumour excision, may extend the boundaries of breast-conserving surgery and improve outcomes for patients, but current practice is unknown and high-quality outcome data are lacking. This prospective multicentre cohort study aimed to explore the practice and short-term outcomes of the technique. METHODS Consecutive patients undergoing therapeutic mammaplasty at participating centres between 1 September 2016 and 30 June 2017 were recruited to the study. Demographic, preoperative, operative, oncological and complication data were collected. The primary outcome was unplanned reoperation for complications within 30 days of surgery. Secondary outcomes included re-excision rates and time to adjuvant therapy. RESULTS Overall, 880 patients underwent 899 therapeutic mammaplasty procedures at 50 centres. The most common indications were avoidance of poor cosmetic outcomes associated with standard breast-conserving surgery (702 procedures, 78·1 per cent) or avoidance of mastectomy (379, 42·2 per cent). Wise-pattern skin incisions were the most common (429 of 899, 47·7 per cent), but a range of incisions and nipple-areola pedicles were used. Immediate contralateral symmetrization was performed in one-third of cases (284 of 880, 32·3 per cent). In total, 205 patients (23·3 per cent) developed a complication, but only 25 (2·8 per cent) required reoperation. Median postoperative lesion size was 24·5 (i.q.r. 16-38) mm. Incomplete excision was seen in 132 procedures (14·7 per cent), but completion mastectomy was required for only 51 lesions (5·7 per cent). Median time to adjuvant therapy was 54 (i.q.r. 42-66) days. CONCLUSION Therapeutic mammaplasty is a safe and effective alternative to mastectomy or standard breast-conserving surgery. Further work is required to explore the impact of the technique on quality of life, and to establish cost-effectiveness.
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Affiliation(s)
- R L O'Connell
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - E Baker
- Department of Breast Surgery, Airedale General Hospital, Keighley, UK
| | - A Trickey
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - T Rattay
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - L Whisker
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R D Macmillan
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Potter
- Population Health Sciences, Bristol Medical School, Bristol, UK.,Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
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Shipp DW, Rakha EA, Koloydenko AA, Macmillan RD, Ellis IO, Notingher I. Intra-operative spectroscopic assessment of surgical margins during breast conserving surgery. Breast Cancer Res 2018; 20:69. [PMID: 29986750 PMCID: PMC6038277 DOI: 10.1186/s13058-018-1002-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [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: 03/16/2018] [Accepted: 06/04/2018] [Indexed: 11/17/2022] Open
Abstract
Background In over 20% of breast conserving operations, postoperative pathological assessment of the excised tissue reveals positive margins, requiring additional surgery. Current techniques for intra-operative assessment of tumor margins are insufficient in accuracy or resolution to reliably detect small tumors. There is a distinct need for a fast technique to accurately identify tumors smaller than 1 mm2 in large tissue surfaces within 30 min. Methods Multi-modal spectral histopathology (MSH), a multimodal imaging technique combining tissue auto-fluorescence and Raman spectroscopy was used to detect microscopic residual tumor at the surface of the excised breast tissue. New algorithms were developed to optimally utilize auto-fluorescence images to guide Raman measurements and achieve the required detection accuracy over large tissue surfaces (up to 4 × 6.5 cm2). Algorithms were trained on 91 breast tissue samples from 65 patients. Results Independent tests on 121 samples from 107 patients - including 51 fresh, whole excision specimens - detected breast carcinoma on the tissue surface with 95% sensitivity and 82% specificity. One surface of each uncut excision specimen was measured in 12–24 min. The combination of high spatial-resolution auto-fluorescence with specific diagnosis by Raman spectroscopy allows reliable detection even for invasive carcinoma or ductal carcinoma in situ smaller than 1 mm2. Conclusions This study provides evidence that this multimodal approach could provide an objective tool for intra-operative assessment of breast conserving surgery margins, reducing the risk for unnecessary second operations. Electronic supplementary material The online version of this article (10.1186/s13058-018-1002-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dustin W Shipp
- School of Physics and Astronomy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Emad A Rakha
- Division of Oncology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Alexey A Koloydenko
- Mathematics Department, Royal Holloway, University of London, Egham, TW20 0EX, UK
| | - R Douglas Macmillan
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Ian O Ellis
- Division of Oncology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Ioan Notingher
- School of Physics and Astronomy, University of Nottingham, Nottingham, NG7 2RD, UK.
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Mazari FAK, Asgeirsson KS, Whisker L, Gutteridge E, Rasheed T, Douglas Macmillan R. Complete resorption of Veritas® in acellular dermal matrix (ADM)-assisted implant-based breast reconstructions—is there a need for tighter regulation of new products developed for use in breast reconstruction? Eur J Plast Surg 2018. [DOI: 10.1007/s00238-017-1389-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kelsall JE, McCulley SJ, Brock L, Akerlund MT, Macmillan RD. Comparing oncoplastic breast conserving surgery with mastectomy and immediate breast reconstruction: Case-matched patient reported outcomes. J Plast Reconstr Aesthet Surg 2017; 70:1377-1385. [DOI: 10.1016/j.bjps.2017.05.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/25/2017] [Accepted: 05/09/2017] [Indexed: 11/30/2022]
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Baker E, Kim B, Rattay T, Williams K, Ives C, Remoundos D, Holcombe C, Gardiner MD, Jain A, Sutton R, Achuthan R, Turton P, Fairbrother P, Brock L, Aggarwal S, Basu N, Murphy J, Trickey A, Macmillan RD, Potter S. The TeaM ( Th er apeutic Mammaplasty) study: Protocol for a prospective multi-centre cohort study to evaluate the practice and outcomes of therapeutic mammaplasty. Int J Surg Protoc 2016; 1:3-10. [PMID: 31851757 PMCID: PMC6913574 DOI: 10.1016/j.isjp.2016.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 07/10/2016] [Revised: 08/20/2016] [Accepted: 08/20/2016] [Indexed: 11/15/2022] Open
Abstract
Multicentre prospective study involving breast and plastic surgical units across the UK. Will produce valuable data regarding the practice and outcomes of therapeutic mammaplasty. Will inform decision-making and lead to future definitive study. Will strengthen the collaborative network to facilitate the delivery of future projects. Will increase awareness of the techniques among trainees such that participation is educational.
Introduction Wide local excision and adjuvant radiotherapy is the standard of care for early breast cancer. For large tumours, however, mastectomy is frequently recommended as conventional breast-conserving techniques often result in poor cosmetic outcomes. Therapeutic mammaplasty (TM) may extend the boundaries of breast-conserving surgery by combining breast reduction and mastopexy techniques with tumour excision, preserving a natural breast shape and avoiding the need for mastectomy. The prevalence of this operative option among surgeons in the UK and its success rate are unknown. The TeaM study is a multicentre prospective study that aims to investigate the practice and outcomes of TM. Methods and analysis Breast centres performing TM will be invited to participate through the research collaborative network and the professional associations. All patients undergoing TM between September 2016 and March 2017 will be included. Demographic, operative, oncological and complication data within 30-days of surgery will be collected. The primary outcome will be unplanned re-operation for complications. Secondary outcomes will include unplanned readmission, re-excision rates and time to adjuvant therapy. Prospective data on 500 patients from 50 centres are anticipated. Exploratory analyses will identify predictors for complications and inform the design of a definitive study. Ethics and dissemination Research ethics approval is not required for this study. This has been confirmed by the on-line Health Research Authority decision tool. This study will provide novel information regarding the practice and outcomes of TM in the UK. This will inform decision-making for patients and surgeons and inform future research. Dissemination of the study protocol will be via the Mammary Fold Academic and Research Collaborative, the Reconstructive Surgery Trials Network and the professional associations, the Association of Breast Surgery and British Association of Plastic, Reconstructive and Aesthetic Surgeons. Results will be presented at relevant surgical conferences and published in peer-reviewed journals.
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Affiliation(s)
- Elizabeth Baker
- Breast Unit, Bradford Teaching Hospitals, Duckworth Lane, Bradford BD9 6RJ, UK
| | - Baek Kim
- Department of Breast Surgery, St. James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Tim Rattay
- Department of Cancer Studies, Clinical Sciences Building, University of Leicester, Leicester LE2 2LX, UK
| | - Kathryn Williams
- Nightingale Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
| | - Charlotte Ives
- Torbay and South Devon NHS Foundation Trust, Newton Road, Torquay, Devon TQ2 7AA, UK
| | - Dennis Remoundos
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - Matthew D Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE, UK.,Department of Surgery and Cancer, Imperial College London, SW7 2AZ, UK
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE, UK.,Imperial College London NHS Trust, London SW7 2AZ, UK
| | - Richard Sutton
- Royal United Hospital NHS Foundation Trust, Combe Park, Bath, Avon BA1 3NG, UK
| | - Rajgopal Achuthan
- Breast Unit, Bradford Teaching Hospitals, Duckworth Lane, Bradford BD9 6RJ, UK
| | - Philip Turton
- Breast Unit, Bradford Teaching Hospitals, Duckworth Lane, Bradford BD9 6RJ, UK
| | | | - Lisa Brock
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK
| | - Shweta Aggarwal
- Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London E11 1NR, UK
| | - Naren Basu
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
| | - John Murphy
- Nightingale Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
| | - Adam Trickey
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol BS8 2PS, UK
| | - R Douglas Macmillan
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK
| | - Shelley Potter
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol BS8 2PS, UK
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Green AR, Aleskandarany MA, Agarwal D, Elsheikh S, Nolan CC, Diez-Rodriguez M, Macmillan RD, Ball GR, Caldas C, Madhusudan S, Ellis IO, Rakha EA. MYC functions are specific in biological subtypes of breast cancer and confers resistance to endocrine therapy in luminal tumours. Br J Cancer 2016; 114:917-28. [PMID: 26954716 PMCID: PMC4984797 DOI: 10.1038/bjc.2016.46] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/11/2016] [Accepted: 02/09/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND MYC is amplified in approximately 15% of breast cancers (BCs) and is associated with poor outcome. c-MYC protein is multi-faceted and participates in many aspects of cellular function and is linked with therapeutic response in BCs. We hypothesised that the functional role of c-MYC differs between molecular subtypes of BCs. METHODS We therefore investigated the correlation between c-MYC protein expression and other proteins involved in different cellular functions together with clinicopathological parameters, patients' outcome and treatments in a large early-stage molecularly characterised series of primary invasive BCs (n=1106) using immunohistochemistry. The METABRIC BC cohort (n=1980) was evaluated for MYC mRNA expression and a systems biology approach utilised to identify genes associated with MYC in the different BC molecular subtypes. RESULTS High MYC and c-MYC expression was significantly associated with poor prognostic factors, including grade and basal-like BCs. In luminal A tumours, c-MYC was associated with ATM (P=0.005), Cyclin B1 (P=0.002), PIK3CA (P=0.009) and Ki67 (P<0.001). In contrast, in basal-like tumours, c-MYC showed positive association with Cyclin E (P=0.003) and p16 (P=0.042) expression only. c-MYC was an independent predictor of a shorter distant metastases-free survival in luminal A LN+ tumours treated with endocrine therapy (ET; P=0.013). In luminal tumours treated with ET, MYC mRNA expression was associated with BC-specific survival (P=0.001). In ER-positive tumours, MYC was associated with expression of translational genes while in ER-negative tumours it was associated with upregulation of glucose metabolism genes. CONCLUSIONS c-MYC function is associated with specific molecular subtypes of BCs and its overexpression confers resistance to ET. The diverse mechanisms of c-MYC function in the different molecular classes of BCs warrants further investigation particularly as potential therapeutic targets.
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Affiliation(s)
- Andrew R Green
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
| | - Mohammed A Aleskandarany
- Cellular Pathology, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK
| | - Devika Agarwal
- School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK
| | - Somaia Elsheikh
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
- Cellular Pathology, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK
| | - Christopher C Nolan
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
| | - Maria Diez-Rodriguez
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
| | - R Douglas Macmillan
- Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK
| | - Graham R Ball
- School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK
| | - Carlos Caldas
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE
| | - Srinivasan Madhusudan
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
| | - Ian O Ellis
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
- Cellular Pathology, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK
| | - Emad A Rakha
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
- Cellular Pathology, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK
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11
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McCulley SJ, Schaverien MV, Tan VK, Macmillan RD. Lateral thoracic artery perforator (LTAP) flap in partial breast reconstruction. J Plast Reconstr Aesthet Surg 2015; 68:686-91. [DOI: 10.1016/j.bjps.2015.01.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/28/2014] [Accepted: 01/09/2015] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Currently, there is no clinical evidence of oncologic risk associated with fat grafting, although its safety has been questioned. The authors investigated the risk of relapse associated with fat grafting in women with a history of breast cancer. METHODS Of 328 women with previously treated malignant breast disease who underwent fat grafting at the Nottingham Breast Institute, complete data were available for 211 (invasive carcinoma, n = 184; ductal carcinoma in situ, n = 27). Mean follow-up was 88 months after primary cancer surgery and 32 months after fat grafting. Control subjects were matched 2:1 for date of primary cancer operation (within 2 years), age (within 5 years), type of surgery, tumor histology, estrogen receptor status, and disease-free status by time equivalent to that of fat grafting. Final endpoints were tumor recurrence and death. Outcome results were compared with a systematic review of all patients undergoing fat grafting with adequate follow-up reported in the literature. RESULTS No significant excess oncologic events were observed in patients who had fat grafting compared to controls with regard to local (0.95 percent versus 1.90 percent; p = 0.33), regional (0.95 percent versus 0 percent; p = 0.16), and distant recurrences (3.32 percent versus 2.61 percent; p = 0.65). A systematic review identified case series with a total of 1573 women who had fat grafting after primary oncologic breast surgery. The locoregional relapse rate for these patients was 2.92 percent (0.95 percent per year). CONCLUSION This study has found no evidence of increased oncologic risk associated with fat grafting in women previously treated for breast cancer. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
- Katherine L Gale
- Nottingham, United Kingdom From the Nottingham Breast Institute and the Departments of Pathology and Plastic Surgery, City Hospital; and the Van Geest Cancer Center, School of Science and Technology, Nottingham Trent University
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Aleskandarany M, Caracappa D, Nolan CC, Macmillan RD, Ellis IO, Rakha EA, Green AR. DNA damage response markers are differentially expressed in BRCA-mutated breast cancers. Breast Cancer Res Treat 2015; 150:81-90. [PMID: 25690937 PMCID: PMC4344553 DOI: 10.1007/s10549-015-3306-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/09/2015] [Indexed: 01/07/2023]
Abstract
Cells have stringent DNA repair pathways that are specific for each different set of DNA lesions which is accomplished through the integration of complex array of proteins. However, BRCA-mutated breast cancer (BC) has defective DNA repair mechanisms. This study aims to investigate differential expression of a large panel of DNA repair markers to characterise DNA repair mechanisms in BRCA-associated tumours compared to sporadic tumours in an attempt to characterise these tumours in routine practice. Immunohistochemistry and tissue microarray technology were applied to a cohort of clinically annotated series of sporadic (n = 1849), BRCA1-mutated (n = 48), and BRCA2-mutated (n = 27) BC. The following DNA damage response (DDR) markers are used; BRCA1, BRCA2, RAD51, Ku70/Ku80, BARD, PARP1 (cleaved), PARP1 (non-cleaved), and P53 in addition to basal cytokeratins, ER, PR, and HER2. A significant proportion of BRCA1 tumours were positive for PARP1 (non-cleaved), and negative for BARD1 and RAD51 compared with sporadic BC. BRCA2 tumours were significantly positive for PARP1 (non-cleaved) compared with sporadic tumours. RAD51 was significantly higher in BRCA1 compared with BRCA2 tumours (p = 0.005). When BRCA1/2 BCs were compared to triple-negative (TN) sporadic tumours of the studied DDR proteins, BARD1 (p < 0.001), PARP1 (non-cleaved) (p < 0.001), and P53 (p = 0.002) remained significantly different in BRCA1/2 tumours compared with TN BC. DNA repair markers showed differential expression in BRCA-mutated tumours, with a substantial degree of disruption of DNA repair pathways in sporadic BC especially TN BC. DNA double-strand break (DSB) repair is assisted by PARP1 expression in BRCA-mutated tumours, whereas the loss of DSB repair via RAD51 is predominant in BRCA1 rather than BRCA2 BC.
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Affiliation(s)
- Mohammed Aleskandarany
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK,
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14
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James R, McCulley SJ, Macmillan RD. Oncoplastic and reconstructive breast surgery in the elderly. Br J Surg 2015; 102:480-8. [DOI: 10.1002/bjs.9733] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/11/2014] [Accepted: 11/03/2014] [Indexed: 11/08/2022]
Abstract
Abstract
Background
The recommendations of the UK All Party Parliamentary Group on Breast Cancer (2013) have been endorsed recently by the UK Association of Breast Surgeons and are in line with the 2007 Cancer Reform Strategy, which states that treatment in older British women should be equivalent to that in younger patients unless precluded by co-morbidity or patient choice. Oncoplastic and reconstructive techniques are increasingly available to women with breast cancer. A review of the literature was carried out to investigate use of these techniques in older patients.
Methods
A MEDLINE search was conducted to identify studies relating to oncoplastic and reconstructive surgery in the elderly.
Results and conclusion
Nine studies were identified and included in the review. Older patients undergoing reconstruction, particularly autologous reconstruction, have outcomes that are at least as good as those achieved in younger patients, yet are far less likely to be offered these techniques. Issues influencing oncoplastic and reconstructive surgery in the elderly include: lack of standard pathways of care, concerns regarding higher operative risk, lack of evidence regarding outcomes, preconceptions regarding body image and lack of engagement with the decision-making process. A minority of older women are likely to accept reconstruction, but those who do are pleased with the results and experience good quality of life. There is now a range of safe oncoplastic and reconstructive options that could be considered as an alternative to standard mastectomy or wide local excision in older patients.
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Affiliation(s)
- R James
- Nottingham Breast Institute, Nottingham, UK
| | - S J McCulley
- Department of Plastic Surgery, Nottingham City Hospital, Nottingham, UK
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15
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Green AR, Caracappa D, Benhasouna AA, Alshareeda A, Nolan CC, Macmillan RD, Madhusudan S, Ellis IO, Rakha EA. Biological and clinical significance of PARP1 protein expression in breast cancer. Breast Cancer Res Treat 2014; 149:353-62. [PMID: 25528020 PMCID: PMC4308637 DOI: 10.1007/s10549-014-3230-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/02/2014] [Indexed: 01/05/2023]
Abstract
Poly(ADP-ribose) polymerase-1 (PARP1) is a key facilitator of DNA repair. PARP inhibitors have gained recent attention as promising therapeutic agents for the treatment of solid tumours including breast cancer (BC). However, the biological and clinical significance of PARP1 expression in BC and its role in DNA-damage response (DDR) remain to be defined. We investigated the expression of PARP1 expression, cleaved (PARP1c) and non-cleaved (PAR1nc) forms, in a large and well-characterised cohort of clinically annotated stage I-III operable BCs (n = 1,269) and 43 BRCA1-mutated BCs using immunohistochemistry. PARP1 expression was correlated to clinicopathological variables, outcome and expression of other key DNA repair proteins (BRCA1, RAD51, Ku70/80, PIASγ and CHK1). Expression of PARP1 was exclusively nuclear. 49 and 85 % of sporadic BC showed expression PARP1nc and PARP1c, respectively. In BRCA1-mutated tumours, PARP1nc/PARP1c was highly expressed (95 and 79 %, respectively). PARP1nc expression was positively associated with premenopausal younger age patients, larger size and higher tumour grade. PARP1 was positively associated with DDR-proteins; RAD51, BRCA1, CHK1 and PIASγ (p < 0.001). Negative association was found between PARP1nc and Ki67. PARP1c was associated with ER (p < 0.001). Different associations between PARP1 and DDR-proteins were observed when stratified based on ER/BRCA1 status. PARP1 was not an independent predictor of outcome in sporadic or BRCA1-mutated BC. Our results demonstrate a potential biological role for PARP1c and PARP1nc in DNA repair in BC based on the significant association with other key DNA damage repair proteins. These associations were not restricted to ER-negative or triple-negative subgroup.
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Affiliation(s)
- Andrew R Green
- Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK,
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16
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Jerjees DA, Alabdullah M, Green AR, Alshareeda A, Macmillan RD, Ellis IO, Rakha EA. Prognostic and biological significance of proliferation and HER2 expression in the luminal class of breast cancer. Breast Cancer Res Treat 2014; 145:317-30. [PMID: 24744091 DOI: 10.1007/s10549-014-2941-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/26/2014] [Indexed: 01/05/2023]
Abstract
The definition of Luminal-B subclass of breast cancer (BC) varies in literature. In this study, we have compared the proliferation status; assessed using KI67 labeling index (KI67-LI), and HER2-expression in estrogen receptor positive (ER+) BC to assess their impact on the biological and clinical characteristics of luminal-BC. 1547 (73.8 %) well-characterized clinically annotated stage I-III ER + BC were assessed for expression of KI67, HER2 (ASCO guidelines), and a large panel of relevant biomarkers (no = 37). 46.3 % of the cases show high KI67-LI (>13 %) and 8.4 % show HER2+ and both markers are positively associated with younger age, higher tumor grade and poorer outcome. High KI67-LI and HER2+ are associated with upregulation of ER-coactivators and proliferation-related markers and with downregulation of good prognostic markers. High KI67-LI is associated with larger size, advanced stage, and lymphovascular invasion (LVI) and with downregulation of luminal-enriched and DNA-damage repair markers. In contrast, HER2+ is associated with upregulation of ER-regulated proteins and E-cadherin. When analysis is restricted to high KI67-LI subgroup, HER2+ shows an association with upregulation of differentiation-associated proteins and E-cadherin. Conversely, within HER2+ class, high KI67-LI maintains its association with downregulation of differentiation-associated/luminal-enriched proteins. Outcome analyses indicate that both markers are independently associated with shorter survival but HER2+ is associated with a worse outcome. Although both are associated with high proliferation and poor prognosis within ER + BC, HER2+ is less frequent than high KI67-LI. Unlike KI67, HER2 seems to independently drive the aggressive behavior of ER+ tumors without downregulation of luminal proteins.
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Affiliation(s)
- Dena A Jerjees
- Department of Histopathology, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK,
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17
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Green AR, Powe DG, Rakha EA, Soria D, Lemetre C, Nolan CC, Barros FFT, Macmillan RD, Garibaldi JM, Ball GR, Ellis IO. Identification of key clinical phenotypes of breast cancer using a reduced panel of protein biomarkers. Br J Cancer 2013; 109:1886-94. [PMID: 24008658 PMCID: PMC3790179 DOI: 10.1038/bjc.2013.528] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 07/02/2013] [Accepted: 08/13/2013] [Indexed: 11/29/2022] Open
Abstract
Background: Breast cancer is a heterogeneous disease characterised by complex molecular alterations underlying the varied behaviour and response to therapy. However, translation of cancer genetic profiling for use in routine clinical practice remains elusive or prohibitively expensive. As an alternative, immunohistochemical analysis applied to routinely processed tissue samples could be used to identify distinct biological classes of breast cancer. Methods: In this study, 1073 archival breast tumours previously assessed for 25 key breast cancer biomarkers using immunohistochemistry and classified using clustering algorithms were further refined using naïve Bayes classification performance. Criteria for class membership were defined using the expression of a reduced panel of 10 proteins able to identify key molecular classes. We examined the association between these breast cancer classes with clinicopathological factors and patient outcome. Results: We confirm patient classification similar to established genotypic biological classes of breast cancer in addition to novel sub-divisions of luminal and basal tumours. Correlations between classes and clinicopathological parameters were in line with expectations and showed highly significant association with patient outcome. Furthermore, our novel biological class stratification provides additional prognostic information to the Nottingham Prognostic Index. Conclusion: This study confirms that distinct molecular phenotypes of breast cancer can be identified using robust and routinely available techniques and both the luminal and basal breast cancer phenotypes are heterogeneous and contain distinct subgroups.
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Affiliation(s)
- A R Green
- Breast Cancer Pathology Research Group, Division of Oncology, School of Medicine, Academic Unit of Clinical Oncology, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
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18
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Schaverien MV, Macmillan RD, McCulley SJ. Is immediate autologous breast reconstruction with postoperative radiotherapy good practice?: a systematic review of the literature. J Plast Reconstr Aesthet Surg 2013; 66:1637-51. [PMID: 23886555 DOI: 10.1016/j.bjps.2013.06.059] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [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: 01/02/2013] [Revised: 05/11/2013] [Accepted: 06/18/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND There remains controversy as to whether immediate autologous breast reconstruction with postoperative radiotherapy is associated with acceptable complications and aesthetic outcomes. This systematic review analyses the literature regarding outcomes of immediate autologous breast reconstruction with postoperative radiotherapy compared with no radiotherapy, as well as with delayed autologous breast reconstruction following post-mastectomy irradiation. METHODS Pubmed (1966 to October 2012), Ovid MEDLINE (1966 to October 2012), EMBASE (1980 to October 2012), and the Cochrane Database of Systematic Reviews (Issue 10, 2012) were searched. Overall complications (including fat necrosis), fat necrosis, revisional surgery, loss of volume, and aesthetic outcome, were analysed individually. Comparable data from observational studies were combined for meta-analysis where possible and quality assessment of the studies was performed. RESULTS The majority of studies of immediate autologous breast reconstruction and postoperative radiotherapy reported satisfactory outcomes (19 of 25 studies; n=1,247 patients). Meta-analysis of observational studies demonstrated no significant differences in total prevalence of complications (p=0.59) or revisional surgery (p=0.38) and a summary measure for fat necrosis favouring the group without radiotherapy (OR 2.82, 95% CI 1.35-5.92, p=0.006). The majority of studies comparing immediate reconstruction and postoperative radiotherapy with delayed reconstruction following post-mastectomy radiotherapy (10 of 12 observational studies; n=1,633 patients) reported satisfactory outcomes following immediate reconstruction. Meta-analysis of observational studies demonstrated no significant difference in overall incidence of complications (p=0.53) and fat necrosis (OR 0.63, 95% CI 0.29-1.38, p=0.25), and a summary measure for revisional surgery (OR 0.15, 95% CI 0.05-0.48, p=0.001) favouring the delayed surgery group. No randomised-controlled trials met the inclusion criteria, and all of the observational studies included were missing more than one important component for reporting of observational studies. DISCUSSION The majority of studies reported satisfactory outcomes and a similar incidence of complications for immediate autologous breast reconstruction and adjuvant radiotherapy when compared with no radiotherapy or delayed reconstruction following radiotherapy; the proportion that required revisional surgery was higher though for immediate than delayed breast reconstruction. The findings are limited by the paucity of high quality data in the published literature, and until better data is available the findings of this review suggest that immediate autologous breast reconstruction should at least be considered when adjuvant chest wall radiotherapy is anticipated.
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Affiliation(s)
- Mark V Schaverien
- Department of Plastic Surgery, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK; Department of Breast Surgery, Nottingham Breast Institute, City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
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19
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Blamey RW, Bates T, Chetty U, Duffy SW, Ellis IO, George D, Mallon E, Mitchell MJ, Monypenny I, Morgan DAL, Macmillan RD, Patnick J, Pinder SE. Radiotherapy or tamoxifen after conserving surgery for breast cancers of excellent prognosis: British Association of Surgical Oncology (BASO) II trial. Eur J Cancer 2013; 49:2294-302. [PMID: 23523089 DOI: 10.1016/j.ejca.2013.02.031] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 01/31/2013] [Accepted: 02/25/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of local recurrence (LR) after conservative surgery for early breast cancer without adjuvant therapy is unacceptably high even with favourable tumours. The aim of this study was to examine the effect of adjuvant therapies in tumours with excellent prognostic features. METHODS Patients with primary invasive breast cancer <2 cm diameter, grade 1 or good prognosis special type, and node negative, treated by wide local excision (WLE) with clear margins were randomised into a 2 × 2 clinical trial of factorial design with or without radiotherapy and with or without tamoxifen. Trial entry was allowed to either comparison or both. FINDINGS The actuarial breast cancer specific survival in 1135 randomised patients at 10 years was 96%. Analysis by intention to treat showed that LR after WLE was reduced in patients randomised to radiotherapy (RT) (HR 0.37, CI 0.22-0.61 p<0.001) and to tamoxifen (HR 0.33, CI 0.15 - 0.70 p<0.004). Actuarial analysis of patients entered into the four-way randomisation showed that LR after WLE alone was 1.9% per annum (PA) versus 0.7% with RT alone and 0.8% with tamoxifen alone. No patient randomised to both adjuvant treatments developed LR. Analysis by treatment received showed LR at 2.2%PA for surgery alone versus 0.8% for either adjuvant radiotherapy or tamoxifen and 0.2% for both treatments. CONCLUSIONS Even in these patients with tumours of excellent prognosis, LR after conservative surgery without adjuvant therapy was still very high. This was reduced to a similar extent by either radiotherapy or tamoxifen but to a greater extent by the receipt of both treatments.
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Affiliation(s)
- R W Blamey
- Nottingham City Hospital, Hucknall Rd., Nottingham NG5 1PB, United Kingdom
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20
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Storr SJ, Lee KW, Woolston CM, Safuan S, Green AR, Macmillan RD, Benhasouna A, Parr T, Ellis IO, Martin SG. Calpain system protein expression in basal-like and triple-negative invasive breast cancer. Ann Oncol 2012; 23:2289-2296. [PMID: 22745213 PMCID: PMC3425372 DOI: 10.1093/annonc/mds176] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 03/28/2012] [Accepted: 04/30/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Basal-like and triple-negative breast tumours encompass an important clinical subgroup and biomarkers that can prognostically stratify these patients are required. MATERIALS AND METHODS We investigated two breast cancer tissue microarrays for the expression of calpain-1, calpain-2 and calpastatin using immunohistochemistry. The first microarray was comprised of invasive tumours from 1371 unselected patients, and the verification microarray was comprised of invasive tumours from 387 oestrogen receptor (ER)-negative patients. RESULTS The calpain system contains a number of proteases and an endogenous inhibitor, calpastatin. Calpain activity is implicated in important cellular processes including cytoskeletal remodelling, apoptosis and survival. Our results show that the expression of calpastatin and calpain-1 are significantly associated with various clinicopathological criteria including tumour grade and ER expression. High expression of calpain-2 in basal-like or triple-negative disease was associated with adverse breast cancer-specific survival (P = 0.003 and <0.001, respectively) and was verified in an independent cohort of patients. Interestingly, those patients with basal-like or triple-negative disease with a low level of calpain-2 expression had similar breast cancer-specific survival to non-basal- or receptor- (oestrogen, progesterone or human epidermal growth factor receptor 2 (HER2)) positive disease. CONCLUSIONS Expression of the large catalytic subunit of m-calpain (calpain-2) is significantly associated with clinical outcome of patients with triple-negative and basal-like disease.
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MESH Headings
- Adolescent
- Adult
- Aged
- Breast Neoplasms/metabolism
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Calcium-Binding Proteins/metabolism
- Calpain/metabolism
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Disease-Free Survival
- Female
- Humans
- Kaplan-Meier Estimate
- Middle Aged
- Multivariate Analysis
- Neoplasm Invasiveness
- Neoplasms, Basal Cell/metabolism
- Proportional Hazards Models
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Young Adult
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Affiliation(s)
| | | | | | | | - A R Green
- Histopathology, School of Molecular Medical Sciences, University of Nottingham
| | - R D Macmillan
- The Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham
| | - A Benhasouna
- Histopathology, School of Molecular Medical Sciences, University of Nottingham
| | - T Parr
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Loughborough, Leicestershire, UK
| | - I O Ellis
- Histopathology, School of Molecular Medical Sciences, University of Nottingham
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Andree C, Farhadi J, Goossens D, Masia J, Sarfati I, Germann G, Macmillan RD, Scheflan M, Van Not HP, Catanuto G, Nava MB. A position statement on optimizing the role of oncoplastic breast surgery. Eplasty 2012; 12:e40. [PMID: 22977675 PMCID: PMC3426932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To propose initiatives and actions that could improve access to and outcomes from oncoplastic breast surgery. METHODS The author group met in May 2010 to draft position statements on key unmet needs in oncoplastic breast surgery and how these may be addressed. At a second meeting in December 2010, the statements were voted upon and adjusted as necessary to achieve unanimous agreement. RESULTS It was agreed that every patient undergoing breast cancer surgery should be assessed by an oncoplastic team capable of offering the full range of surgical options. However, currently, not all women are adequately informed about the surgical options available. Furthermore, levels of multidisciplinary working, standards of care, and levels of surgical training in the full range of breast oncoplastic techniques are suboptimal. Institution-specific guidelines relating to the optimal patient pathway, the definition of clinical standards, and improved education in reconstructive surgery are required. Oncoplastic breast surgery should be offered to all patients, within the context of multidisciplinary teams that include accredited surgeons who consult with each other early in the treatment pathway. These teams should be focused on achieving not just positive oncologic outcomes, but also esthetic outcomes in line with patient wishes, to achieve optimal quality of life. CONCLUSIONS There is a desire within the surgical community to improve patient outcomes by better incorporating oncoplastic procedures into the treatment pathways for breast cancer. These position statements represent the perspectives of a group of European plastic surgeons on the key elements required to achieve this goal.
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Affiliation(s)
- Christoph Andree
- aDepartment of Plastic and Aesthetic Surgery, Sana Hospital Düsseldorf, Germany,Correspondence:
| | - Jian Farhadi
- bDepartment of Plastic Surgery, Guy's and St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Dennis Goossens
- cZiekenhuis Walcheren, Middelburgsestraat, Zeeland, The Netherlands
| | - Jaume Masia
- dPlastic Surgery Department, Sant Pau University Hospital, Barcelona, Spain
| | | | - Günter Germann
- fClinic for Plastic and Reconstructive Surgery, Preventive and Aesthetic Medicine at Heidelberg University Hospital, Heidelberg, Germany
| | | | | | | | - Giuseppe Catanuto
- jUnit of Plastic and Reconstructive Surgery, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
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Abstract
BACKGROUND Macrophages constitute a major component of the leucocytic infiltrate of tumours. Human studies show an association between tumour-associated macrophages and tumours with poor prognostic features. In breast cancer, the presence of macrophages has been correlated with increased angiogenesis and poor prognosis but little information is available about the independent prognostic role of macrophages infiltrating breast carcinomas. AIMS AND METHODS This study used immunohistochemistry and tissue microarrays to assess the density and localisation of CD68 macrophages infiltrating 1322 breast tumours and to identify any relationship with clinicopathological factors and patient outcome. RESULTS Tumour-infiltrating macrophages were present in the majority of tumours with a predominantly diffuse pattern. The density of distant stromal macrophages (infiltrating stroma away from the carcinoma, median count 14 cells) was higher than intratumoural (median zero cells) and adjacent stromal macrophages (median three cells). Higher total macrophage number was associated with higher tumour grade (r(s)=0.39, p<0.001), ER and PgR negativity, HER-2 positivity and basal phenotype (p<0.001). In univariate survival analysis, higher numbers of CD68 macrophages were significantly associated with worse breast cancer-specific survival (p<0.001) and shorter disease-free interval (p=0.004). However in multivariate model analysis, the CD68 macrophage count was not an independent prognostic marker. CONCLUSIONS Macrophages are heterogeneous with different subsets having different functions. The present study suggests that overall macrophage numbers are not related to prognosis in breast cancer. However, further studies are needed to investigate the potential role of different subsets of macrophages.
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Affiliation(s)
- S M A Mahmoud
- Division of Pathology, School of Molecular Medical Sciences, University of Nottingham, Nottingham, UK
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23
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Agboola AJ, Paish EC, Rakha EA, Powe DG, Macmillan RD, Ellis IO, Green AR. EpCAM expression is an indicator of recurrence in basal-like breast cancer. Breast Cancer Res Treat 2011; 133:575-82. [DOI: 10.1007/s10549-011-1813-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 09/29/2011] [Indexed: 02/06/2023]
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Cornford EJ, James JJ, McMahon M, Macmillan RD, Lee AHS. The importance of low-lying axillary sentinel nodes in breast cancer patients. Clin Radiol 2011; 66:974-6. [PMID: 21546009 DOI: 10.1016/j.crad.2011.03.019] [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] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 03/21/2011] [Accepted: 03/25/2011] [Indexed: 11/16/2022]
Affiliation(s)
- E J Cornford
- Nottingham Breast Institute, Nottingham University Hospitals, UK.
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25
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Mahmoud SMA, Paish EC, Powe DG, Macmillan RD, Grainge MJ, Lee AHS, Ellis IO, Green AR. Tumor-infiltrating CD8+ lymphocytes predict clinical outcome in breast cancer. J Clin Oncol 2011; 29:1949-55. [PMID: 21483002 DOI: 10.1200/jco.2010.30.5037] [Citation(s) in RCA: 1027] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Breast carcinomas are often infiltrated by inflammatory cells, particularly macrophages and T lymphocytes, but the significance of these cells remains unclear. One possible role of these inflammatory cells is that they represent a cell-mediated immune response against the carcinoma. CD8(+) lymphocytes are a known crucial component of cell-mediated immunity. The purpose of this study was to explore the prognostic value of tumor-infiltrating CD8(+) cytotoxic lymphocytes in breast cancer. Tumor-infiltrating CD8(+) lymphocytes were assessed by immunohistochemical staining of tissue microarray cores from 1,334 unselected breast tumors from patients with long-term follow-up. The number of CD8(+) T cells was counted in tumor nests (intratumoral), in stroma adjacent to tumor cells, and in stroma distant to tumor cells, and their relationship with clinical outcome was determined. The total number of CD8(+) cells was positively correlated with tumor grade (r(s) = 0.20; P < .001) and inversely correlated with patient's age at diagnosis, estrogen receptor-alpha (ER-α), and progesterone receptor (PgR) expression (Mann-Whitney U test, P < .001). The total patient cohort was randomly divided into two separate training and validation sets before performing univariate survival analysis. Total number and distant stromal CD8(+) lymphocytes were associated with better patient survival (P = .041 and P < .001, respectively) in the training set. In multivariate analysis, total CD8(+) T-cell count was an independent prognostic factor in both training and validation sets. These results suggest that tumor-infiltrating CD8(+) T lymphocytes have antitumor activity as judged by their favorable effect on patients' survival and could potentially be exploited in the treatment of breast cancer.
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Affiliation(s)
- Sahar M A Mahmoud
- School of Molecular Medical Sciences and School of Community Health Sciences, University of Nottingham, Nottingham, United Kingdom
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26
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Mohammed RAA, Martin SG, Mahmmod AM, Macmillan RD, Green AR, Paish EC, Ellis IO. Objective assessment of lymphatic and blood vascular invasion in lymph node-negative breast carcinoma: findings from a large case series with long-term follow-up. J Pathol 2010; 223:358-65. [PMID: 21171081 DOI: 10.1002/path.2810] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 09/19/2010] [Accepted: 10/11/2010] [Indexed: 11/05/2022]
Abstract
In a previous study on a small series of breast cancers, we developed objective methods for the assessment of vascular invasion (VI), using immunohistochemical staining. We found that VI was predominantly lymphovascular invasion (LVI), with minimal contribution of blood vascular invasion (BVI). The aims of the current study were: (a) to assess the frequency, extent and prognostic role of LVI and BVI in a large, well-characterized series of LN-negative breast cancers; and (b) to assess the ability of VI to stratify early breast cancer into different prognostic groups. Paraffin-embedded sections from 1005 lymph-node (LN)-negative primary invasive breast cancers were stained for CD34, CD31 and podoplanin/D240 to detect BVI and LVI. VI lesions were assessed and the results were correlated with clinicopathological criteria and survival. VI was detected in 218 (22%); 211/218 (97%) were LVI, while BVI was detected in 7/218 (3%). The frequency of LVIs/section ranged from 1 to 79, with no significant difference between the frequency of LVI and outcome. The presence of LVI was significantly associated with adverse disease-free interval (DFI) and poor overall survival (OS) in both univariate and multivariate analyses. The results from the study indicated that VI in early stage breast cancer is predominantly LVI and that its objective assessment is a powerful independent prognostic factor. Efforts to detect early metastatic activity, such as diligent pathological examination of sentinel LN biopsies would be complimented by the objective evaluation of VI status of the primary tumour. VI status should be included routinely in breast cancer staging systems.
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Aleskandarany MA, Rakha EA, Macmillan RD, Powe DG, Ellis IO, Green AR. MIB1/Ki-67 labelling index can classify grade 2 breast cancer into two clinically distinct subgroups. Breast Cancer Res Treat 2010; 127:591-9. [DOI: 10.1007/s10549-010-1028-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 06/30/2010] [Indexed: 11/30/2022]
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Mahmoud SMA, Paish EC, Powe DG, Macmillan RD, Lee AHS, Ellis IO, Green AR. An evaluation of the clinical significance of FOXP3+ infiltrating cells in human breast cancer. Breast Cancer Res Treat 2010; 127:99-108. [DOI: 10.1007/s10549-010-0987-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 06/05/2010] [Indexed: 12/21/2022]
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Hodi Z, Ellis IO, Elston CW, Pinder SE, Donovan G, Macmillan RD, Lee AHS. Comparison of margin assessment by radial and shave sections in wide local excision specimens for invasive carcinoma of the breast. Histopathology 2010; 56:573-80. [DOI: 10.1111/j.1365-2559.2010.03518.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aleskandarany MA, Green AR, Rakha EA, Mohammed RA, Elsheikh SE, Powe DG, Paish EC, Macmillan RD, Chan S, Ahmed SI, Ellis IO. Growth fraction as a predictor of response to chemotherapy in node-negative breast cancer. Int J Cancer 2010; 126:1761-9. [DOI: 10.1002/ijc.24860] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Habashy HO, Powe DG, Rakha EA, Ball G, Macmillan RD, Green AR, Ellis IO. The prognostic significance of PELP1 expression in invasive breast cancer with emphasis on the ER-positive luminal-like subtype. Breast Cancer Res Treat 2009; 120:603-12. [PMID: 19495959 DOI: 10.1007/s10549-009-0419-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [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: 04/30/2009] [Accepted: 05/02/2009] [Indexed: 11/25/2022]
Abstract
The transcription functions of oestrogen receptors (ER) are influenced by several coregulators such as PELP1 (proline, glutamate and leucine rich protein 1). The aim of the present study, which uses tissue microarrays and immunohistochemistry, is to explore the clinical and biological relevance of PELP1 protein expression in a large series of consecutive patients (1,162 patients) with invasive breast cancers with particular emphasis on its role in the ER-positive/luminal-like class of tumours. Our results showed that increased PELP1 expression is associated with tumours of larger size, higher histological grade, higher mitotic count, and with positive expression of basal cytokeratins (CK) (CK14; P = 0.018 and CK5/6; P = 0.029), P-cadherin (P = 0.002), p53 and MIB1 (P = 0.018). There was an inverse association between PELP1 expression and ER (P = 0.002), progesterone (PgR) (P = 0.004), androgen (AR) receptor (P < 0.001), and luminal CK (CK18; P = 0.027) expression. A significant association between PELP1 expression and shorter breast cancer specific survival (BCSS) (P = 0.002) and disease-free survival (DFI) (P = 0.006) was found. Multivariate Cox hazard analysis showed that PELP1 expression was an independent predictor of shorter BCSS (Hazard ratio (HR) = 1.349, P = 0.006) and shorter DFI (HR = 1.255, P = 0.011). In the ER-positive/luminal-like group (n = 768), PELP1 expression showed similar association with other clinicopathological variables and was an independent predictor of shorter DFI (HR = 1.256, P = 0.036). In conclusion, PELP1 protein expression is an independent prognostic predictor of shorter BCSS and DFI in breast cancer and its elevated expression is positively associated with markers of poor outcome. PELP1 appears to have a potential application in assessing the clinical outcome of patients with ER-positive breast cancer.
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Affiliation(s)
- Hany Onsy Habashy
- Department of Histopathology, School of Molecular Medical Sciences, Nottingham University Hospitals NHS Trust, University of Nottingham, Hucknall Road, Nottingham, UK
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Paish EC, Green AR, Rakha EA, Macmillan RD, Maddison JR, Ellis IO. Three-dimensional reconstruction of sentinel lymph nodes with metastatic breast cancer indicates three distinct patterns of tumour growth. J Clin Pathol 2009; 62:617-23. [PMID: 19304588 DOI: 10.1136/jcp.2009.065219] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM A better understanding of the biology of nodal metastatic disease is of indisputable value. Three-dimensional (3D) serial section alignment and reconstruction techniques can be used for visualisation of nodal metastasis and could provide better understanding of disease growth patterns. METHODS 19 tumour-involved sentinel nodes (SLNs) from breast cancer patients were serially sectioned, immunohistochemically stained, and digitally scanned. Digital image alignment and voxel-based rendering was used to construct informative 3D visual representations of metastatic tumour distribution within involved nodes. RESULTS The 3D reconstruction technique was successful and informative. The reconstructions of all 19 SLNs enabled the metastatic tumour cells to be viewed infiltrating normal SLN tissue from all angles. Metastases were present at the afferent lymphatic pole in 17/19 cases, confined to the afferent pole only in 7 cases, located at the efferent pole in 12/19 cases, and efferent pole only in just 2 cases. Finally, this study made the novel observation that metastatic growth occurs in three distinct patterns: sinusoidal, nodular and diffuse. CONCLUSIONS This methodology provides improved understanding of metastatic disease development and potentially could be used to develop strategies to improve techniques for its routine detection. Further studies are required in order to evaluate the prognostic and biological significance of the growth patterns identified.
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Affiliation(s)
- E C Paish
- Breast Cancer Pathology Research Group, Department of Histopathology, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
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Habashy HO, Powe DG, Staka CM, Rakha EA, Ball G, Green AR, Aleskandarany M, Paish EC, Douglas Macmillan R, Nicholson RI, Ellis IO, Gee JMW. Transferrin receptor (CD71) is a marker of poor prognosis in breast cancer and can predict response to tamoxifen. Breast Cancer Res Treat 2009; 119:283-93. [PMID: 19238537 DOI: 10.1007/s10549-009-0345-x] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 02/09/2009] [Indexed: 11/24/2022]
Abstract
Transferrin receptor (CD71) is involved in the cellular uptake of iron and is expressed on cells with high proliferation. It may be implicated in promoting the growth of endocrine resistant phenotypes within ER+/luminal-like breast cancer. We used a panel of in vitro cell models of acquired resistance to tamoxifen (TAMR), Faslodex (FASR) or severe oestrogen deprivation (MCF-7X) and the ER+ luminal MCF-7 parental line to determine CD71 mRNA expression and to study transferrin (Tf) effects on in vitro tumour growth and its inhibition. Furthermore, CD71 protein expression was assessed in a well-characterized series of patients with invasive breast carcinoma using tissue microarrays. Our results demonstrated a striking elevation of CD71 in all cell models of acquired resistance. Exogenous Tf significantly promoted growth in MCF-7-X and MCF-7 cells but more so in MCF-7-X; this growth was significantly reduced by Faslodex (FAS) or a phosphoinositide-3 kinase inhibitor (LY294002). Increased CD71 expression was associated with poor NPI score, tumour proliferation, basal CKs, p53, EGFR, HER2, steroid receptor negativity and shortened breast cancer specific survival (P < 0.001). On multivariate analysis, CD71 was found to be an independent prognostic factor in the ER+ cohort of patients. In conclusion, therapies of current interest in breast cancer (e.g. FAS, PI3K-inhibitors) appear able to partially impact on transferrin/CD71-promoted growth, but further investigation of this important mitogenic mechanism may assist in designing new therapeutic strategies to target highly proliferative, endocrine resistant breast cancers. CD71 appears to be a candidate marker of a subgroup of ER+/luminal-like breast cancer characterised by poor outcome and resistance to tamoxifen.
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Affiliation(s)
- Hany Onsy Habashy
- Department of Histopathology, School of Molecular Medical Sciences, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK
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Green AR, Garibaldi JM, Soria D, Ambrogi F, Ball G, Lisboa PJG, Etchells TA, Boracchi P, Biganzoli E, Macmillan RD, Blamey RW, Powe DG, Rakha EA, Ellis IO. Identification and definition of novel clinical phenotypes of breast cancer through consensus derived from automated clustering methods. Breast Cancer Res 2008. [PMCID: PMC3300772 DOI: 10.1186/bcr1953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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35
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Green AR, Burney C, Granger CJ, Paish EC, El-Sheikh S, Rakha EA, Powe DG, Macmillan RD, Ellis IO, Stylianou E. The prognostic significance of steroid receptor co-regulators in breast cancer: co-repressor NCOR2/SMRT is an independent indicator of poor outcome. Breast Cancer Res Treat 2007; 110:427-37. [PMID: 17902051 DOI: 10.1007/s10549-007-9737-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [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: 08/14/2007] [Accepted: 08/14/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Advances in understanding the molecular basis of breast cancer has necessitated a definition of improved indicators of prognosis that are central to the underlying cancer biology and that reflect the heterogeneous nature of the disease. This study investigates the pattern of expression of the steroid receptor co-regulators NCOA1/SRC1, NCOA3/RAC3, NCOR2/SMRT, and CBP/p300 in breast cancer. The aims were to identify whether their expression was related to patient outcome, their relationships to known prognostic factors and to provide a basis for further research into the mechanistic significance of such associations. METHODS The protein levels of steroid receptor co-regulators were assessed by immunohistochemistry in a large well-characterised series of breast carcinomas prepared as tissue microarrays. Relationships between these targets, other clinicopathological variables and patients' outcome were examined. RESULTS NCOR2/SMRT was an independent prognostic indicator of overall patient survival (OS) and disease free interval (DFI) and was significantly correlated with distant metastases and local recurrence whereas tumours expressing NCOA1/SRC1 had a significantly longer OS and DFI. There were also significant correlations between co-regulator expression of NCOA1/SRC1, CBP/p300 and NCOA3/RAC3, which were associated with lower tumour grade. NCOA1/SRC1 was also correlated with smaller tumour size. Furthermore, the co-activators had a significant association with steroid receptors, particularly ERalpha. CONCLUSIONS NCOR2/SMRT is associated with poor patient outcome, independent of other prognostic factors. In contrast, steroid receptor co-activator expression is generally associated with a good prognosis. Further investigations are needed to establish the mechanisms of these links between the steroid receptor co-regulator system and patient outcome.
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Affiliation(s)
- Andrew R Green
- Division of Pathology, School of Molecular Medical Sciences, Nottingham University Hospitals NHS and University of Nottingham, Nottingham, UK.
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36
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Blamey RW, Ellis IO, Pinder SE, Lee AHS, Macmillan RD, Morgan DAL, Robertson JFR, Mitchell MJ, Ball GR, Haybittle JL, Elston CW. Survival of invasive breast cancer according to the Nottingham Prognostic Index in cases diagnosed in 1990-1999. Eur J Cancer 2007; 43:1548-55. [PMID: 17321736 DOI: 10.1016/j.ejca.2007.01.016] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.2] [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: 08/24/2006] [Revised: 01/12/2007] [Accepted: 01/15/2007] [Indexed: 11/26/2022]
Abstract
UNLABELLED The Nottingham Prognostic Index (NPI) is a well established and widely used method of predicting survival of operable primary breast cancer. AIMS Primary: To present the updated survival figures for each NPI Group. Secondary: From the observations to suggest reasons for the reported fall in mortality from breast cancer. METHODS The NPI is compiled from grade, size and lymph node status of the primary tumour. Consecutive cases diagnosed and treated at Nottingham City Hospital in 1980-1986 (n=892) and 1990-1999 (n=2,238) are compared. Changes in protocols towards earlier diagnosis and better case management were made in the late 1980s between the two data sets. RESULTS Case survival (Breast Cancer Specific) at 10 years has improved overall from 55% to 77%. Within all Prognostic groups there are high relative and absolute risk reductions. The distribution of cases to Prognostic groups shows only a small increase in the numbers in better groups. CONCLUSION The updated survival figures overall and for each Prognostic group for the NPI are presented.
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Affiliation(s)
- R W Blamey
- The Breast Institute, Nottingham City Hospital, Nottingham NG5 1PB, UK.
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Chakrabarti J, Evans AJ, James J, Ellis IO, Pinder SE, Macmillan RD. Accuracy of mammography in predicting histological extent of ductal carcinoma in situ (DCIS). Eur J Surg Oncol 2006; 32:1089-92. [PMID: 16872800 DOI: 10.1016/j.ejso.2006.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 01/27/2006] [Accepted: 05/26/2006] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Accuracy of mammography in predicting pathological extent of ductal carcinoma in situ (DCIS). BACKGROUND AND AIMS Mammographic extent is the main determinant for offering wide local excision (WLE) for DCIS. It is recognized that this is not always accurate. Patients who prove to have larger lesions than predicted require further surgery. The aim of this study was to define the degree of variance between mammographic (MMG) and pathological (path) measurements of DCIS and to analyse the factors predicting a significant discrepancy. METHODS The pathological and mammographic data for 174 cases of DCIS were reviewed. RESULTS The mammographic size was bigger than the histological size in 97 (55.7%) and there was >10mm difference in 18 (10.3%) cases. The histological size was bigger than the mammographic size in 69 (39.7%) cases and >10mm difference was found in 30 (17.2%) cases. There was a significant relationship between larger MMG size, MMG size measured in two dimensions (MMG bi-dimensional product) and MMG-path size discrepancy (p<0.01). In addition, the larger the size discrepancy, the greater the chance of requiring more than one therapeutic procedure (p<0.01). There was no significant correlation between age, histological grade, mammographic density and shortest distance from nipple with degree of mammographic-pathological size discrepancy.
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Affiliation(s)
- J Chakrabarti
- Department of Breast Surgery, Nottingham Breast Institute, Nottingham City Hospital, University of Nottingham, Hucknall Road, Nottingham NG5 1PB, UK.
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Lee AHS, Pinder SE, Macmillan RD, Mitchell M, Ellis IO, Elston CW, Blamey RW. Prognostic value of lymphovascular invasion in women with lymph node negative invasive breast carcinoma. Eur J Cancer 2006; 42:357-62. [PMID: 16377180 DOI: 10.1016/j.ejca.2005.10.021] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [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: 08/15/2005] [Revised: 10/14/2005] [Accepted: 10/16/2005] [Indexed: 11/19/2022]
Abstract
This study aimed to test the hypothesis that lymphovascular invasion adds prognostic information to histological grade and tumour size in node-negative invasive carcinoma of the breast. Lymphovascular invasion was assessed in haematoxylin and eosin tumour sections from 2760 patients with node-negative invasive breast carcinoma treated with definitive surgery. Patients were divided into two groups: 990 in the no adjuvant therapy series (diagnosed in 1974-1988) with median follow-up of 13 years; and 1765 in the selective adjuvant therapy series (1988-2000) with median follow-up of 6.8 years. Lymphovascular invasion was identified in 19% of tumours and was associated with larger tumour size, higher histological grade and younger age. Overall, survival was associated on multivariate analysis with lymphovascular invasion, histological grade and tumour size in both patient series, and with histological type in the no adjuvant therapy series. In conclusion, lymphovascular invasion is an independent prognostic factor in node-negative breast cancer and should be considered in decisions about adjuvant treatment in this group of women.
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Affiliation(s)
- A H S Lee
- Department of Histopathology, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
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Abstract
BACKGROUND Central breast tumors are difficult to manage using breast-conserving treatment. Mastectomy has often been cited as the favored option for these tumors, because lumpectomies that remove the nipple-areola complex often result in poor cosmesis. This article describes the use of therapeutic mammaplasty (a term used to describe breast reduction techniques utilized to treat breast cancer) for centrally sited breast tumors. METHODS The techniques can be broadly divided into two categories: (1) wedge excision, involving wedge excision and a form of wedge closure, and (2) advancement flaps with nipple reconstruction. RESULTS These techniques were used in 11 patients. Excision margins were complete in all cases except one, due to extensive ductal carcinoma in situ. There have been no other complications and no cases of recurrence to date. CONCLUSIONS When compared with mastectomy and total reconstruction, therapeutic mammaplasty has cosmetic, functional, and recovery time advantages. The techniques described need further evaluation and long-term follow-up. However, they can be added to the repertoire of techniques already established for breast-conserving surgery.
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Affiliation(s)
- S J McCulley
- Department of Plastic Surgery and Breast Surgery, Nottingham City Hospital, Nottingham, United Kingdom.
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Taylor I, Carpenter R, Royle GT, Purushotham AD, Macmillan RD, George WD. Breast-conserving surgery and tumour bed positivity in patients with breast cancer. Br J Surg 2005. [DOI: 10.1002/bjs.1800810648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- I Taylor
- Department of Surgery, University College London Medical School, 67–73 Riding House Street, London W1P 7LD, UK
| | - R Carpenter
- Department of Surgery, University College London Medical School, 67–73 Riding House Street, London W1P 7LD, UK
| | - G T Royle
- Department of Surgery, University College London Medical School, 67–73 Riding House Street, London W1P 7LD, UK
| | - A D Purushotham
- Department of Surgery, Western Infirmary, Glasgow G11 6NT, UK
| | - R D Macmillan
- Department of Surgery, Western Infirmary, Glasgow G11 6NT, UK
| | - W D George
- Department of Surgery, Western Infirmary, Glasgow G11 6NT, UK
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McCulley SJ, Macmillan RD. Planning and use of therapeutic mammoplasty--Nottingham approach. ACTA ACUST UNITED AC 2005; 58:889-901. [PMID: 16043150 DOI: 10.1016/j.bjps.2005.03.008] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [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: 07/04/2004] [Revised: 01/24/2005] [Accepted: 03/12/2005] [Indexed: 12/25/2022]
Abstract
Therapeutic mammaplasty, the use of reduction mammaplasty and radiotherapy to surgically treat breast cancer, is an established technique for selected breast cancers and can extend the role of breast conserving surgery. Most frequently described is the use of a wise pattern reduction for tumours that lie within the expected mammaplasty excision. However, mammaplasty techniques can be safely adapted to treat patients with cancers in all areas of the breast. An approach to selection and planning surgery is presented which has evolved from the experience of other units and our first 50 clinical cases over a 3-year period. The outcomes of these 50 cases are found in the accompanying article. Technique will vary depending upon the tumour position. Breast cancers may lie within the normal excision site of a recognised mammaplasty method (scenario A) or outside of the expected excision sites (scenario B). In scenario A, a range of recognised techniques can be performed without adaptation to widely excise the tumour and re-shape the breasts. In scenario B the techniques need to be adapted. Three decisions are needed for planning in scenario B; the skin incision, the nipple-aereola complex (NAC) pedicle orientation and finally the method of filling the cancer defect. The latter can be achieved by either extending the nipple pedicle or by creating a secondary pedicle within the breast dissection. Either method will move tissue that is normally excised into the cancer defect. For central tumours an inferior pedicle is usually used to both fill the defect and re-create the nipple.
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Affiliation(s)
- S J McCulley
- Breast Reconstruction Service, Department of Plastic Surgery, Nottingham City Hospital, UK.
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Abstract
This is a descriptive analysis of 50 consecutive cases of therapeutic mammaplasty, the use of reduction mammaplasty and radiotherapy to treat breast tumours. Breast cancers may lie within the normal excision site of a recognised mammaplasty method (scenario A) or outside of the expected excision sites (scenario B), then requiring a modified mammaplasty. A third group are central tumours requiring removal of the nipple. This series includes 13 scenario A, 27 scenario B and 10 central tumours. Wise pattern skin incision was used in 29 (58%) and vertical in 14 (28%). Seven different pedicles were employed but inferior (11), superior (9) and superio-medial (19) comprised the majority (78%). In the 27 scenario B cases an extension of the nipple aereolar pedicle was used to fill the tumour defect in 19 (70%) and a secondary pedicle in 8 (30%). There were no incomplete excisions of invasive tumour but incomplete excision of DCIS requiring mastectomy occurred in 4 (8%) patients. There are no deaths or recurrences to date (mean follow-up 13 months, range 3-32). Complications have occurred in 8 (16%) with a return to theatre for one complication (2%) and the four patients (8%) requiring mastectomy. No patient has had a delay in adjuvant treatment. Cosmetic outcome was deemed good/excellent in 63%, satisfactory in 33%, poor in 4%. Follow-up is restricted to 3-32 months.
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Affiliation(s)
- S J McCulley
- Breast Reconstruction Service, Department of Plastic Surgery, Nottingham City Hospital, UK.
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Asgeirsson KS, Rasheed T, McCulley SJ, Macmillan RD. Oncological and cosmetic outcomes of oncoplastic breast conserving surgery. Eur J Surg Oncol 2005; 31:817-23. [PMID: 16043322 DOI: 10.1016/j.ejso.2005.05.010] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [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: 03/31/2005] [Revised: 05/12/2005] [Accepted: 05/18/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast-conserving surgery and radiotherapy is firmly established as a good and safe option for most women with early breast cancer. The important outcome measures of breast conservation are survival, local recurrence, cosmesis and patient satisfaction. Partial breast reconstructive techniques may improve cosmesis and patient satisfaction without compromising the oncological outcomes. METHODS A search of the Medline and Pubmed databases of studies on breast conserving surgery where partial breast reconstructive techniques were employed. The keywords used were breast conserving surgery, oncoplastic breast surgery, partial breast reconstruction and reduction mammoplasty. The oncological and cosmetic outcomes of these studies were analysed. RESULTS Studies on partial breast reconstructive techniques often lack oncological outcomes and long-term results are not available. On intermediate follow-up (up to 4.5 years) local recurrence rates vary from 0 to 1.8% per year. Cosmetic failure rates vary from 0 to 18%. To date, detailed studies are small and outcome measures vary. CONCLUSIONS Breast surgeons should be aware of the range of surgical techniques that may enhance the aesthetic results of breast-conserving surgery as well as expand the indications for its use. There is a need for routine assessment of oncological and cosmetic outcomes and long-term results of partial breast reconstructive techniques in relation to these outcomes are awaited.
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Affiliation(s)
- K S Asgeirsson
- Nottingham Breast Institute, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
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Purushotham AD, Macmillan RD, Wishart GC. Advances in axillary surgery for breast cancer—time for a tailored approach. Eur J Surg Oncol 2005; 31:929-31. [PMID: 16109469 DOI: 10.1016/j.ejso.2005.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 07/20/2005] [Indexed: 10/25/2022] Open
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Asgeirsson KS, Holroyd B, Morgan DAL, Robertson JFR, Blamey RW, Pinder SE, Macmillan RD. Selective use of post-mastectomy flap irradiation in high-risk breast cancer patients. Breast 2005; 14:298-303. [PMID: 16085236 DOI: 10.1016/j.breast.2005.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/19/2004] [Revised: 02/10/2005] [Accepted: 02/23/2005] [Indexed: 11/24/2022] Open
Abstract
The incidence of local recurrence after mastectomy can be reduced by chest wall radiotherapy. However, only a minority of patients are at substantial risk. No UK national guidelines exist for the use of mastectomy flap radiotherapy. This study evaluated a protocol, whereby only high-risk patients were treated with post-mastectomy flap radiotherapy; identified histologically by grade, vascular invasion and nodal status. All women treated by simple mastectomy for invasive breast cancer at the Nottingham Breast Unit from January 1993 to December 1995 were studied (n=292). Postoperative flap radiotherapy was given to 147 high-risk women (50.3%). Median follow-up was 76 months. Overall, 12 women (4.1%) developed a chest wall recurrence; six were single spot recurrences and the remaining six were either multiple spot (n=3) or field change (field change dermal invasion, n=3). The chest wall recurrence rate was 2.7% in those treated with radiotherapy. A low rate of local recurrence has been achieved with selective use of mastectomy flap radiotherapy.
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Affiliation(s)
- Kristjan S Asgeirsson
- The Nottingham Breast Institute, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK
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46
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Rampaul RS, Bagnall M, Burrell H, Pinder SE, Evans AJ, Macmillan RD. Randomized clinical trial comparing radioisotope occult lesion localization and wire-guided excision for biopsy of occult breast lesions. Br J Surg 2004; 91:1575-7. [PMID: 15505875 DOI: 10.1002/bjs.4801] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.6] [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: 11/08/2022]
Abstract
Abstract
Background
Accurate localization of impalpable breast lesions that require biopsy is important. This randomized trial compared radioisotope occult lesion localization (ROLL) with the standard hooked-wire technique.
Methods
Ninety-five patients were randomized to receive either ROLL or wire localization of an occult breast lesion. Correct placement of isotope was confirmed by mammography and a hand-held γ probe was used to guide the surgical excision. Radiological, surgical and pathological data were compared for accuracy, duration and ease of technique, and histopathological diagnosis. Procedure-related pain was also assessed.
Results
Of the 95 patients entered, 48 were randomized to ROLL and 47 to wire localization. Two ROLL procedures failed. Marking was accurate in 46 of 48 ROLL procedures and 44 of 47 of wire localizations (P = 0·242). Difficulty in localization (Likert score 2·6 for ROLL versus 4·4 for wire localization; P < 0·001) and the degree of surgical difficulty (2·6 versus 4·0; P < 0·001) were significantly less for ROLL. ROLL was associated with less pain (score 2·7 versus 3·6; P = 0·012). There were no significant differences in mean duration of operation, specimen weight, need for intraoperative re-excision or second therapeutic operation.
Conclusion
ROLL and wire-guided localization were similarly effective for breast biopsy, but ROLL was easier for both radiologist and surgeon, and less painful for the patient.
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Affiliation(s)
- R S Rampaul
- Nottingham Breast Institute, City Hospital, Nottingham NG1 5PB, UK
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Hamilton LJ, Evans AJ, Wilson ARM, Scott N, Cornford EJ, Pinder SE, Khan HN, Macmillan RD. Breast imaging findings in women with BRCA1- and BRCA2-associated breast carcinoma. Clin Radiol 2004; 59:895-902. [PMID: 15451348 DOI: 10.1016/j.crad.2004.03.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [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: 10/12/2003] [Revised: 02/27/2004] [Accepted: 03/08/2004] [Indexed: 11/26/2022]
Abstract
AIM To document the breast imaging findings of women with BRCA1 and BRCA2-associated breast carcinoma. MATERIALS AND METHODS Family history clinic records identified 18 BRCA1 and 10 BRCA2 cases who collectively were diagnosed with 27 invasive breast carcinomas and four ductal carcinoma in situ (DCIS) lesions. All underwent pre-operative imaging (29 mammogram and 22 ultrasound examinations). All invasive BRCA-associated breast carcinoma cases were compared with age-matched cases of sporadic breast carcinoma. RESULTS Within the BRCA cases the age range was 26-62 years, mean 36 years. Two mammograms were normal and 27 (93%) abnormal. The most common mammographic features were defined mass (63%) and microcalcifications (37%). Thirty-four percent of women had a dense mammographic pattern, 59% mixed and 7% fatty. Ultrasound was performed in 22 patients and in 21 (95%) indicated a mass. This was classified as benign in 24%, indeterminate in 29% and malignant in 48%. Mammograms of BRCA1-associated carcinomas more frequently showed a defined mass compared with BRCA2-associated carcinomas, 72 versus 36% (73% control group) whilst mammograms of BRCA2-associated carcinomas more frequently showed microcalcification, 73 versus 12% (8% control group; p < 0.001). Thirty-six percent of the BRCA2-associated carcinomas were pure DCIS while none of the BRCA1 associated carcinomas were pure DCIS (p = 0.004). Of those patients undergoing regular mammographic screening, 100% of BRCA2-associated carcinomas were detected compared with 75% of BRCA1-associated carcinomas. CONCLUSION These data suggest that the imaging findings of BRCA1 and BRCA2-associated carcinomas differ from each other and from age-matched cases of sporadic breast carcinoma.
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Affiliation(s)
- L J Hamilton
- Nottingham Breast Institute, Nottingham City Hospital, Nottingham, UK
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48
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Cid JA, Rampaul RS, Ellis IO, Wilson ARM, Burrell HC, Evans AJ, Blamey RW, Macmillan RD. Woman feels breast lump – surgeon cannot: the role of ultrasound in arbitration. Eur J Cancer 2004; 40:2053-5. [PMID: 15341978 DOI: 10.1016/j.ejca.2004.05.003] [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] [Received: 12/16/2003] [Revised: 04/28/2004] [Accepted: 05/06/2004] [Indexed: 11/21/2022]
Abstract
The role of ultrasound scanning (USS) in patients complaining of a breast lump where the clinical examination (CE) is normal is not clearly defined. To determine this in greater detail, all patients complaining of a breast lump underwent CE. Where no lump could be found, but was still reported by the patient, an USS was performed. All lesions underwent biopsy and/or aspiration, as well as mammography in suspicious cases or those over 40 years of age. This cohort represented 5% of all referrals in the study period. Four hundred and twenty women were prospectively studied in this way. Median follow up is 3.4 years (range 2.5-4.2 years). Twenty two had solid lumps (of which 3 were cancers) and 48 had cysts. Nineteen patients re-presented with symptoms in the same breast (median time = 12 months (range 4.5-20 months), all of which were imaged on USS: 15 cysts and 4 further cancers (3 in the same quadrant as the original lump, one contralateral) were identified. Women with symptomatic breast lumps and a normal CE can be considered a reliable indication that cancer is very unlikely to be present (negative predictive value = 0.98). Ultrasound may be a suitable complimentary investigation, which will relieve symptoms in those with cysts and can detect small clinically--and sometimes mammographically--occult breast cancers.
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Affiliation(s)
- J A Cid
- The Breast Institute, City Hospital, Nottingham, UK
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Raj N, Macmillan RD, Ellis IO, Deighton CM. Rheumatologists and breasts: immunosuppressive therapy for granulomatous mastitis. Rheumatology (Oxford) 2004; 43:1055-6. [PMID: 15258294 DOI: 10.1093/rheumatology/keh246] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Iau PTC, Marafie M, Ali A, Sng JH, Macmillan RD, Pinder S, Denley HE, Ellis IO, Wenzyck P, Scott N, Cross G, Blamey RW. Are medullary breast cancers an indication for BRCA1 mutation screening? A mutation analysis of 42 cases of medullary breast cancer. Breast Cancer Res Treat 2004; 85:81-8. [PMID: 15039599 DOI: 10.1023/b:brea.0000021049.61839.e5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 11/12/2022]
Abstract
Recommended guidelines have limited breast cancer gene ( BRCA1 ) mutation testing to individuals with a personal or family history of early onset breast and/or ovarian cancer, and those with multiple affected close relatives. Such large breast cancer families are rare in the general population, limiting the clinical application of the BRCA1 discovery. Previous reports have suggested an association between medullary breast cancer and BRCA1 mutation carriers. To test the feasibility of using these rare histological subtypes as an alternative to epidemiological factors, 42 cases of medullary cancer unselected for family history were screened for BRCA1 point mutations and large exon rearrangements. The large majority (83%) of these patients did not have significant family of breast or ovarian cancer. Two deleterious mutations resulting in a premature stop codon, and one exon 13 duplication were found. All mutations were detected in patients with typical medullary cancer, who had family history of multiple breast and ovarian cancers. Our findings suggest that medullary breast cancers are not an indication for BRCA1 mutation screening in the absence of significant family risk factors.
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Affiliation(s)
- P T C Iau
- Department of Surgery, National University Hospital, Singapore, Singapore.
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