The role of contrast-enhanced mammography in the preoperative evaluation of invasive lobular carcinoma of the breast

AIM

To assess the performance of contrast-enhanced mammography (CEM) in the preoperative staging of invasive lobular carcinoma (ILC) of the breast.

MATERIALS AND METHODS

The present study was a multicentre, multivendor, multinational retrospective study of women with a histological diagnosis of ILC who had undergone CEM from December 2013 to December 2021. Index lesion size and multifocality were recorded for two-dimensional (2D) mammography, CEM, and when available magnetic resonance imaging (MRI). Comparison with histological data was undertaken for women treated by primary surgical excision. Pearson correlation coefficients and Bland-Altman's analysis of agreement were used to assess differences with a significance level of 0.05.

RESULTS

One hundred and fifteen ILC lesions were included, 46 (40%) presented symptomatically and 69 were screening detected. CEM demonstrated superior sensitivity when compared to standard mammography. The correlation between the histological size measured on the surgical excision specimen size was greater than with standard mammography (r=0.626 and 0.295 respectively, p=0.001), with 19% of lobular carcinomas not visible without a contrast agent. The sensitivity of CEM for multifocal disease was greater than standard mammography (70% and 20% respectively, p<0.0001). CEM overestimated tumour size by an average of 1.5 times, with the size difference increasing for larger tumour. When MRI was performed (n=22), tumour size was also overestimated by an average of 1.3 times. The degree of size overestimation was similar for both techniques, with the tumour size on CEM being on average 0.5 cm larger than MRI.

CONCLUSION

CEM is a useful tool for the local staging of lobular carcinomas and could be an alternative to breast MRI.

Filling Linnean shortfalls increases endemicity patterns: conservation and biogeographical implications for the extreme case of Liolaemus (Liolaemidae, Squamata) species

Linnean shortfalls, or the discrepancy between formally described species and the number of existing species, imply noteworthy biodiversity conservation constraints. The case of Argentinian reptiles is unique in this context. The genus Liolaemus represents ~60% of the Argentine reptile fauna and has a current species description rate of 3.25 spp./year, leading to a significant increase in the number of known species. Filling Linnean shortfalls within this genus has revealed an extraordinary recent evolutionary radiation that strongly modifies the spatial accumulation patterns of richness and endemism, mainly in the Patagonian steppe and Monte ecoregions of Argentina. Thus, while 40 years ago none of the studied species was considered endemic at the ecoregional level, today the genus represents an essential element to define the southernmost terrestrial ecoregions of the world. Furthermore, the remarkable decrease in the average extent of occurrence (EOO) of Liolaemus species implies an increased extinction risk in light of threats caused by humans. Based on the thresholds for the IUCN Red List B1 criteria, and 11 well-studied clades of Liolaemus, we show that, while in 1980 87% of the described species would not qualify as threatened based on EOO, today 80% of the species have an EOO smaller than 20 000 km2. Therefore, they may qualify as threatened based on the B1 EOO thresholds, which demonstrates the importance of the recent increase of knowledge regarding the taxonomy, systematics and genetics of the group.

Priority areas for conservation of and research focused on terrestrial vertebrates

Effective conservation policies require comprehensive knowledge of biodiversity. However, knowledge shortfalls still remain, hindering possibilities to improve decision making and built such policies. During the last 2 decades, conservationists have made great efforts to allocate resources as efficiently as possible but have rarely considered the idea that if research investments are also strategically allocated, it would likely fill knowledge gaps while simultaneously improving conservation actions. Therefore, prioritizing areas where both conservation and research actions could be conducted becomes a critical endeavor that can further maximize return on investment. We used Zonation, a conservation planning tool and geographical distributions of amphibians, birds, mammals, and reptiles to suggest and compare priority areas for conservation and research of terrestrial vertebrates worldwide. We also evaluated the degree of human disturbance in both types of priority areas by describing the value of the human footprint index within such areas. The spatial concordance between priority conservation and research areas was low: 0.36% of the world's land area. In these areas, we found it would be possible to protect almost half of the currently threatened species and to gather information on nearly 42% of data-deficient (DD) species. We also found that 6199 protected areas worldwide are located in such places, although only 35% of them have strict conservation purposes. Areas of consensus between conservation and research areas represent an opportunity for simultaneously conserving and acquiring knowledge of threatened and DD species of vertebrates. Although the picture is not the most encouraging, joint conservation and research efforts are possible and should be fostered to save vertebrate species from our own ignorance and extinction.

Global trends of habitat destruction and consequences for parrot conservation

Human advance on natural habitats is a major cause of biodiversity loss. This transformation process represents a profound change in wooded environments, disrupting original communities of flora and fauna. Many species are highly dependent on forests, especially parrots (Psittaciformes) with almost a third of their species threatened by extinction. Most parrot species occur in tropical and subtropical forests, and given the forest dependence of most species, this is the main reason why habitat loss has been highlighted as the main threat for the group. Such habitat loss acts in synergy with other important threats (e.g., logging and poaching), which become especially problematic in certain developing countries along tropical latitudes. In this study, we used available information on parrot distributions, species traits, IUCN assessment, habitat loss and timber extraction for different periods, and distribution of protected areas, to determine conservation hotspots for the group, and analyze potential changes in the conservation status of these species. We detected four conservation hotspots for parrots: two in the Neotropics and two in Oceania, all of them facing different degrees of threat in regard of current habitat loss and agricultural trends. Our results suggest that the future of the group is subject to policymaking in specific regions, especially in the northeastern Andes and the Atlantic Forest. In addition, we predicted that agricultural expansion will have a further negative effect on the conservation status of parrots, pushing many parrot species to the edge of extinction in the near future. Our results have conservation implications by recommending protected areas in specific parrot conservation hotspots. Our recommendations to mitigate conservation risks to this group of umbrella species would also benefit many other coexisting species as well.

Climate change threatens micro-endemic amphibians of an important South American high-altitude center of endemism

Species inhabiting broad altitudinal gradients are particularly exposed to the effects of global climate change (GCC). Those species reaching mountain tops are the most negatively affected. Here, using ecological niche models we estimated the climate change exposure of endemic amphibians of the most important extra-Andean mountain system of Argentina: the Sierras Pampeanas Centrales. Our results pinpoint that micro-endemic amphibians of this mountain system are heavily exposed to the effects of GCC, with important constraints of suitable climatic conditions for the six analyzed species. Among the most important findings, our models predict a high probability of a total disappearance of suitable climatic conditions for two of the species, currently restricted to mountain tops. This high exposure, in synergy with their very restricted ranges, and other important human induced threats (as fish invasion and emergent diseases), pose a serious threat to these endemic species, which can enter into the “extinction pathway” in a near future if no concrete conservation actions are taken. Our findings provide additional evidence of the great negative impact of GCC in high-altitude centers of endemism.

Curso modelado de nicho ecológico, version 1.0

El conjunto de ideas, métodos y programas informáticos que se conoce como “Modelado de Nicho Ecológico” (MNE)—y el relacionado “Modelado de Distribución de Especies” (MDS)—han sido objeto de intensa exploración e investigación en las últimas décadas. A pesar de existir al menos cuatro síntesis publicadas, este campo ha crecido tanto en complejidad, que la formación de nuevos investigadores es difícil. Hasta ahora, dicha formación se ha hecho de manera presencial en cursos organizados por universidades o centros de investigación, de los que hemos formado parte como instructores. Sin embargo, el acceso a este tipo de cursos especializados es restringido, por un lado, porque los cursos no se ofrecen en todas las universidades, y por otro, porque normalmente se imparten en inglés. Para facilitar el acceso a una mayor comunidad de científicos de habla hispana, presentamos un curso en español, completamente digital y de acceso gratuito, que se realizó vía Internet durante 23 semanas consecutivas en 2018. Aunque las barreras intrínsecas al uso de Internet pueden dificultar la accesibilidad a los materiales del curso, hemos usado diversos formatos para la divulgación de los contenidos académicos (video, audio, pdf) con el objetivo de eliminar la mayor parte de estos problemas.

Abstract P3-12-07: Conservative breast reconstruction: Outcomes of 146 consecutive cases of prepectoral, subcutaneous implant-based breast reconstruction in a single-Institution series

Aims. To evaluate acute and late toxicity-related factors among breast cancer (BC) patients who underwent prepectoral breast reconstruction (BR).

Methods. We performed a retrospective analysis of BC patients who underwent therapeutic or prophylactic mastectomy from October 2012 to May 2016 at our Center. We recorded individual patient-related features (i.e. age, body mass index [BMI], smoke-history, comorbidity, BRCA-carrier), BC-related treatments characteristics (i.e. axillary surgery, adjuvant radiotherapy [RT], adjuvant chemotherapy, primary systemic therapy [PST], endocrine therapy, and use of trastuzumab). Toxicity profile was evaluated in terms of complications related to BR; we recorded acute and late toxicity data and prosthesis/implant explant rate.

Results. We analyzed 146 consecutive BC patients treated with subcutaneous BR, 117 therapeutic and 29 prophylactic mastectomies. Thirty-seven patients received postmastectomy RT. Significant factors related to acute toxicity were: previous RT (34.5% [RT] vs 8.5% [no RT]; p=0.001), BMI (31.3% [BMI ≥25] vs 8.8% [&lt;25]; p=0.003), previous breast surgery (22.2% [surgery] vs 8.7% [no surgery]; p=0.027), and diabetes (100% [diabetes] vs 11.9% [no diabetes]; p=0.002). Factors significantly correlated to implant/prosthesis explant were: current or previous smoking exposition (13.8% [smokers] vs 2.6% [non-smokers]; p=0.029) and PST (18.8% [PST] vs 3.5% [no PST]; p=0.022); axillary lymph node dissection (ALND) was significantly related to late toxicity (5.7% [ALND] vs 0%; p=0.04). At a 3-year median follow up, three deaths, five locoregional recurrences (LRR), and fourteen distant metastasis (DM) occurred among 117 patients treated by therapeutic mastectomy. Overall survival was 78.1%, LRR free-survival was 95%, and DM free-survival was 71.6%. Postmastectomy RT was not significantly related to acute, late toxicity, and explant occurrence.

Conclusions. In our experience prepectoral subcutaneous implant-based BR is a safe and effective approach, with low rates of acute toxicity. Major risk factors were evidenced for patients previously treated with RT or surgery, and in case of diabetes or BMI ≥25; postmastectomy RT seems not to be related to higher rate of toxicity. ALND seems to be the only factor significantly related to late toxicity. PST, and smoking exposition were significantly associated with higher rate of implant/prosthesis explant. However, further investigations and mature follow-up are warranted to confirm these encouraging results.

Citation Format: Meattini I, Bernini M, Saieva C, Desideri I, Scotti V, Salvestrini V, Visani L, Mariotti M, Delli Paoli C, Olmetto E, Maragna V, Orzalesi L, Sanchez L, Nori J, Bianchi S, Livi L. Conservative breast reconstruction: Outcomes of 146 consecutive cases of prepectoral, subcutaneous implant-based breast reconstruction in a single-Institution series [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-07.

Abstract P4-16-04: Oral ibandronate for osteopenic breast cancer patients receiving adjuvant aromatase inhibitors: secondary 5-year survival outcomes analysis of the single-center phase 2 BONADIUV trial

Background. Several randomized trials demonstrated aromatase inhibitors (AI) superiority in terms of disease-free survival (DFS) compared to tamoxifen treatment for postmenopausal hormone receptor-positive breast cancer (BC) patients. Anyway, AI toxicity profile is a concern due to estrogen suppression. Pivotal trials demonstrated a significant bone mineral density (BMD) loss due to AI, with a consistent 5-year risk of bone fractures, thus impacting on patients' quality of life. Bisphosphonates represent an effective treatment in postmenopausal osteoporosis fractures prevention. However, an adequate patient's selection for adjuvant bisphosphonates treatment during AI endocrine therapy is still a challenge. Final results of BONADIUV trial presented at San Antonio Breast cancer Symposium in 2016 showed that treatment with ibandronate, as compared to placebo, significantly improved BMD change in osteopenic women treated with adjuvant AI, and consistently protected patients' bone loss. We present the secondary 5-year analysis on survival outcomes of the trial.

Patients and methods. The BONADIUV trial is a single-blind, randomized, placebo-controlled phase 2 study designed to evaluate the impact of ibandronate treatment on BMD in osteopenic women taking AI. Between January 2011 and May 2014, 171 osteopenic patients (lumbar spine [LS] and/or trochanter -1&lt; T-score &lt;-2.5), were randomized in a 1:1 ratio to receive either placebo or oral monthly ibandronate (150 mg). Treatment duration was 2 years, with 6-months evaluation. Primary endpoint was the mean BMD difference between the two arms at a 2-year follow up. Secondary analysis on survival outcomes (overall survival [OS] and invasive DFS [iDFS]) have been performed at 5-year median follow-up time. ClinicalTrials.gov identifier: NCT02616744.

Results. At the database cutoff time for the present analysis on May 4, 2018, median follow up was 63.3 months (mean 61.2; range 2.7-87.3) for whole series, 64.9 months (range 33.8-84.0) for the placebo arm, and 62.2 months (range 24.2-87.3) for the ibandronate arm. Ten patients in the placebo group and 17 patients in the ibandronate group withdrew the allocated arm before any follow up data collection, and so were excluded from the analysis, performed on 144 patients (72 patients per arm). At the database cutoff time, the OS rate was 97.2% in the placebo group and 100% in the ibandronate arm. We observed four loco-regional relapse (three in the placebo arm, one in the ibandronate arm; p=0.33), three distant metastases (none in the placebo arm, three in the ibandronate arm; p=0.075), and three contralateral BC (one in the placebo arm, two in the ibandronate arm; p=0.65). The number of iDFS events did not differ between groups: four in the placebo group and six in the ibandronate group (p=0.56). Up to data cutoff, two deaths have occurred; none in the placebo arm and two in the ibandronate arm (p=0.15). The OS rate did not differ between arms.

Conclusions. The secondary analysis of survival outcomes showed no difference between arms in terms of OS and iDFS rates. Further large investigations and mature follow-up from the published ones are awaited.

Citation Format: Meattini I, Scotti V, Desideri I, Saieva C, Visani L, Salvestrini V, Cecchini S, De Feo ML, Mariotti M, Olmetto E, Delli Paoli C, Francolini G, Bernini M, Orzalesi L, Sanchez L, Nori J, Bianchi S, Livi L. Oral ibandronate for osteopenic breast cancer patients receiving adjuvant aromatase inhibitors: secondary 5-year survival outcomes analysis of the single-center phase 2 BONADIUV trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-16-04.

Abstract P6-09-07: Triple negative apocrine carcinomas as a distinct subtype of triple negative breast cancer: A case-control study

Introduction. Invasive apocrine carcinoma of the breast is a rare type of breast cancer (BC), pure apocrine carcinoma constitutes &lt;1% of all BC. Mammary apocrine epithelium has a characteristic steroid receptor profile that is negative for full length estrogen receptor-alpha and progesterone receptor and is androgen receptor positive. Conflicting data are available on the outcome of this type of disease: few studies reported significantly different prognosis of triple negative (TN) apocrine carcinomas when compared to most non-apocrine triple negative (NA-TN) tumors. The aim of this study is to report our long-term experience in a single-center series of TN apocrine tumors.

Methods. We analyzed clinical and pathological features of a series of TN apocrine carcinomas treated at our Centre in a 15-year period. Clinical and pathological characteristics and outcomes have been compared with a control series of NA-TN tumors treated during the same follow up period. Local relapse-free survival (LRFS), distant metastases-free survival (DMFS), and overall survival (OS) have been evaluated and compared between groups of patients.

Results. Forty-five TN apocrine carcinomas were analyzed. The mean age at diagnosis was 60 years (range 34-83 years). The proportions of apocrine tumor grades varied, with G1 being seen in 6.8% of patients, G2 in 51.1%, and G3 in 40.1%. The majority of apocrine carcinomas had small tumor size (T1: 72.7%; T2: 27.3%), and negative axillary nodal status (66.7%). The series was compared to a homogenous control group of 45 NA-TN patients. The mean age was 54 years (range 32-79 years), affected by high grade (G3: 53.7%), small tumor size (T1: 87.5%; T2: 12.5%), and mostly negative axillary nodal status (82.9%). LRFS in the apocrine group was 85% and 78% at 5- and 10-year, respectively. LRFS in the NA-TN group was 90% and 79% at 5- and 10-year, respectively. No difference was evidenced between groups (HR 1.44 95%CI 0.62-3.79; p=0.39). DMFS in the apocrine group was 85% and 85% at 5- and 10-years, respectively. DMFS in the NA-TN group was 85% and 75% at 5- and 10-year, respectively. DMFS was significantly better in the apocrine group (HR 0.69 95%CI 0.28-1.62). OS in the apocrine group was 86% and 83% at 5- and 10-year, respectively. OS in the NA-TN group was 86% and 63% at 5- and 10-years, respectively. OS was significantly better in the apocrine group (HR 0.57 95%CI 0.26-1.18).

Conclusions. Apocrine carcinomas represent a clinic-pathological distinct group of triple-negative BC, characterized by significantly more favorable clinical prognosis in terms of long-term disease-related morbidity or mortality when compared to NA-TN tumors.

Citation Format: Meattini I, Pezzulla D, Carta GA, Becherini C, Perna M, Grassi R, Garlatti P, Desideri I, Scotti V, Bernini M, Sanchez LJ, Orzalesi L, Nori J, Bianchi S, Livi L. Triple negative apocrine carcinomas as a distinct subtype of triple negative breast cancer: A case-control study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-09-07.

SEMINARIOS EN LÍNEA SOBRE ANÁLISIS ESPACIALES CON ÉNFASIS EN MODELOS DE NICHO ECOLÓGICO

En 2016 implementamos un sistema de seminarios de enseñanza en formato de videos libres y accesibles desde internet, con la finalidad de dar a conocer de forma sencilla y en castellano, las bases conceptuales y aplicaciones de la ecología espacial y los modelos de nicho ecológico en estudios de ecología, conservación biológica, epidemiología y agrobiodviersidad, así como su implementación para el diseño de políticas públicas de los recursos naturales. Cada seminario fue desarrollado por uno o varios expertos y se discutieron conceptos, métodos y diferentes herramientas disponibles para elaborar modelos de distribución de especies. Este manuscrito reúne los resúmenes de los seminarios en línea, dando referencias clave para cada tema y el enlace al video correspondiente. Los videos están disponibles de forma libre en YouTube o en formato .mp4 bajo solicitud.

Abstract P1-10-04: Accelerated partial breast irradiation versus whole breast irradiation: Health-related quality of life analysis from a phase 3 trial

Background. Accelerated partial breast irradiation (APBI) represents a valid option for selected early breast cancer (BC); potential advantages of APBI include shorter treatment time, improved safety profile, and a cost reduction compared with standard fractionation.

We reported the final analysis of quality of life (QOL) results from a phase 3 randomized trial comparing standard adjuvant radiotherapy (50 Gy in 25 fractions, plus 10 Gy boost) to APBI using IMRT technique (30 Gy in 5 daily fractions). The 5-year results have been recently published showing equivalence in terms of local control (ClinicalTrials.gov, NCT02104895).

Methods. Overall 205 patients (105 APBI and 100 WBI) fully completed the given questionnaires at time 0 (RT start), time 1 (RT end), and time 2 (2-year follow up). Patients were asked to compile two specific questionnaires on QOL, the EORTC QLQ-C30 as a reliable and valid measure of the QOL of cancer patients in multicultural clinical research settings, and the BR23 module as a supplementary questionnaire for assessing QOL issues relevant to patients with BC. The statistical software SPSS (SPSS Inc, Chicago, IL, USA) for Windows (version 22), and STATA (StataCorp LP, College Station TX77845, USA) for Windows (version 12) were used. Chi-squared test or Mann Whitney U test were used to compare the individual characteristics of the patients between two arms. Mean and standard deviations (SD) were calculated for all QOL domains, and all scores were compared between APBI and WBI arms using the Mann Whitney test due to non-parametric distribution of data. The Kruskal-Wallis test was used to compare the scores between age groups.

Results. Mean values (and SD) of QLQ-C30 scores according to arm in the series of 205 BC patients at time 2 (time 0 vs time 2), showed significant improvement in favor of APBI in terms of global health status (mean 75.5 vs 59.5, SD range 13.3-22.0; p&lt;0.0001), main functional (p&lt;0.01), and symptom scales (p&lt;0.01). Concerning the BR23 module, APBI showed significantly better outcome in terms of body image perception (mean 89 vs 72.1, SD 13.2-26.6; p&lt;0.0001) and future perspective (84.8 vs 57, SD 23.1-28.5; p&lt;0.0001) among functional scales; breast (6.1 vs 18.9, SD 6.6-18.2; p&lt;0.0001) and arm symptoms (11.7 vs 19.6, SD 13.4-19; p=0.002) among symptom scales.

Conclusions. Women treated with APBI reported a significantly better QOL outcome as compared with women treated using WBI. QOL improvement was evidenced in terms of functional, symptoms, and global health status/QOL scales, both at the end of radiation and at a 2-year follow-up time.

Citation Format: Meattini I, Saieva C, Desideri I, Miccinesi G, Francolini G, Meacci F, Muntoni C, Scotti V, De Luca Cardillo C, Marrazzo L, Simontacchi G, Pallotta S, Sanchez L, Casella D, Bernini M, Orzalesi L, Nori J, Bianchi S, Livi L. Accelerated partial breast irradiation versus whole breast irradiation: Health-related quality of life analysis from a phase 3 trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-10-04.

Abstract P2-09-12: A single-blind, randomized, placebo-controlled phase II study to evaluate the impact of oral ibandronate on bone mineral density in osteopenic breast cancer patients receiving adjuvant aromatase inhibitors: Final results of the single-center BONADIUV trial

Background. Several randomized trials demonstrated aromatase inhibitors (AI) superiority in terms of disease-free survival compared to tamoxifen treatment for postmenopausal hormone receptor-positive breast cancer (BC) patients. Anyway AI toxicity profile due to estrogen suppression is a concern. Pivotal trials demonstrated a significant bone mineral density (BMD) loss due to AI, with a consistent risk of fractures, thus impacting on patients' quality of life.

Bisphosphonates represent an effective treatment in postmenopausal osteoporosis fractures prevention. Several studies demonstrated that upfront bisphosphonates therapy prevents bone loss in postmenopausal women receiving adjuvant AI for early-stage BC. However an adequate patients selection for adjuvant bisphosphonates treatment during AI endocrine therapy is still a challenge.

We present the final results of the BONADIUV trial, a single-blind, randomized, placebo-controlled phase 2 study designed to evaluate the impact of ibandronate treatment on BMD in osteopenic women taking AI.

Methods. Between January 2011 and May 2014, 561 patients underwent a baseline BMD assessment before starting AI as planned adjuvant treatment. Overall 171 osteopenic patients (lumbar spine [LS] and/or trochanter -1&lt; T-score &lt;-2.5), were randomized in a 1:1 ratio to receive either placebo or oral monthly ibandronate (150 mg). All patients receive oral supplementation of calcium and vitamin D3. Study duration was 2 years. Exclusion criteria were: premenopausal status at time of randomization; comorbidities with increased risk of osteoporosis; body mass index &lt;18; chronic use of steroids; previous use of bisphosphonates; psychiatric disorders. Primary endpoint was the mean BMD difference between the two arms at a 2-year follow up. ClinicalTrials.gov identifier: NCT02616744. A total of 72 patients per arm of treatment were needed to obtain an 85% statistical power in order to detect a 2% BMD mean difference between the two arms. Considering a 10% dropout, at least 158 patients were required.

Results. A total of 171 patients were randomized in the study. Overall 27 patients (15.8%) withdrew the protocol (17 ibandronate vs 10 placebo arm): the final analysis was performed on 144 patients (72 patients per arm). P-value from Wilcoxon test showed no significant difference between arms at baseline both for LS (p=0.94) and trochanter (p=0.83).

At 2-year, osteopenic patients treated with ibandronate gained +18.7% and +15.5% at the LS and trochanter BMD, respectively. Patients treated with placebo lost -13.3% at the LS, and gained +2.9% at the trochanter.

Trochanter p-value from covariance analysis showed a mean BMD change significantly in favor of ibandronate arm at 1-year (p=0.012), and borderline at 2-year (p=0.087). Concerning LS, the mean BMD change was significantly in favor of ibandronate arm both at 1-year (p=0.002) and 2-year (p&lt;0.0001).

Conclusions. Final results of our study showed that treatment with ibandronate, as compared to placebo, improved BMD change in osteopenic women treated with adjuvant AI, and consistently protected patients' bone loss.

Citation Format: Livi L, Saieva C, Desideri I, Scotti V, De Luca Cardillo C, Carta G, Cecchini S, Orzalesi L, Sanchez LJ, Casella D, Bernini M, Nori J, Bianchi S, De Feo ML, Meattini I. A single-blind, randomized, placebo-controlled phase II study to evaluate the impact of oral ibandronate on bone mineral density in osteopenic breast cancer patients receiving adjuvant aromatase inhibitors: Final results of the single-center BONADIUV trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-09-12.

Impact of molecular subtypes classification concordance between preoperative core needle biopsy and surgical specimen on early breast cancer management: Single-institution experience and review of published literature

BACKGROUND

Core needle biopsy (CNB) plays a crucial role as diagnostic tool for breast cancer (BC). The characterization of biomarkers status before surgical treatment is crucial when primary systemic therapy is a therapeutic option. The aim of this analysis was to report concordance between preoperative CNB and surgical specimen (SS) in evaluating biomarkers and molecular subtypes.

METHODS

Data have been collected from a cohort of 101 patients affected by early BC treated at Careggi Florence University Hospital, between January 2014 and March 2015. The conformity between molecular subtype classification was tested using kappa (κ) test.

RESULTS

Mean age was 57.5 years (range 29-86). There was concordance between the estrogen receptor (ER) assessment on CNB and SS in 95 cases (94.1%). Concordance of the progesterone receptor (PgR) assessment was observed in 89 cases (88.1%). Concordance for detecting immunohistochemistry-assessed BC molecular subtypes was 87.1% (κ = 0.78). Concerning Ki-67 evaluation, we report a concordance rate of 88.1% (κ = 0.68). The evaluation of luminal A plus luminal B/HER negative subgroup showed a κ-value of 0.65.

CONCLUSIONS

CNB showed good accuracy in evaluating hormonal receptors status, HER2, and BC molecular subtypes. Evaluation of Ki67 status was less accurate than other biomarkers; therefore, we recommend that it should be detected both on CNB and SS samples, especially in hormonal positive HER2 negative tumors, in order to avoid a misclassification of tumor subtypes that could lead to an omission of potential effective systemic therapy.

Phyllodes tumours of the breast diagnosed as B3 category on image-guided 14-gauge core biopsy: analysis of 51 cases from a single institution and review of the literature

AIMS

Image-guided 14-gauge (G) core biopsy (CB) has been shown to be an accurate method providing histological diagnosis of breast lesions. The purpose of this study was to evaluate the reliability of image-guided 14-G CB in the diagnosis of phyllodes tumours (PT) reported as B3 category and its accuracy in distinguishing this lesion from fibroadenomas (FA).

MATERIALS AND METHODS

The records of 10 000 image-guided 14-G CB of the breast performed from January 2001 to August 2011 at the Diagnostic Senology Unit of Careggi University Hospital were reviewed; 2554 (25.5%) were fibroepithelial lesions: 56 of them (2%) were diagnosed as PT and reported as B3 category. The database of the Pathological Anatomy Unit of Careggi University Hospital was then searched to verify the histological diagnosis after surgical excision. Fifty-one cases of PT diagnosed as B3 category in 51 women were included in the present study.

RESULTS

Of the 51 cases of PT diagnosed as B3 category on 14-G CB, 39 (76.5%) lesions were confirmed as PT on SE (30, 4 and 5 as benign, borderline and malignant PT respectively) with a PPV of 76.5%. Twelve lesions (23.5%) were diagnosed as FA after surgical excision.

CONCLUSIONS

Our study shows that 14-G CB is a valuable tool, in a preoperative setting, in diagnosing PT.

Abstract P1-01-25: Predictive factors of micrometastases in the sentinel node of patients affected by invasive early breast cancer

Aim: nodal metastatic involvement is the most important prognostic indicator in breast cancer. Sentinel node biopsy led to an increase in the detection of micrometastases. The aim of our analysis was to identify predictive factors of micrometastases and macrometastases of sentinel node.

Materials and Methods: between January 2000 and December 2006, 675 patients were treated with breast surgery and sentinel node evaluation at University of Florence (Florence, Italy). Estrogen receptor status, progesterone receptor status, and Ki-67 labeling index determined with the MIB1 monoclonal antibody were assessed. HER2 immunohistochemistry (IHC) expression was scored as follows: 0, no staining or faint membrane staining; 1+, faint membrane staining in &gt;10% of tumor cells, incomplete membrane staining; 2+, weak to moderate membrane staining in &gt;10% of tumor cells; and 3+, intense circumferential membrane staining in &gt;10% of tumor cells. HER2 scores of 0 and 1+ were considered negative. HER2 IHC 3+ and fluorescent in situ hybridization (FISH) – amplified tumors were considered positive. All IHC 2+ tumors and indeterminate tumors were tested for gene amplification by FISH. The sentinel node was examined by hematoxylin and eosin. The patients were divided into three groups based on AJCC TNM staging: sentinel node negative (n = 601); micrometastases if tumor deposit more than 0.2 mm but &lt;2 mm (n = 20), and macrometastases if tumor deposit more than 2 mm (n = 53).

Results: at the logistic regression with polytomous analyses (outcome micrometastases or macrometastases), age (p = 0.048), menopausal state (p = 0.013), breast quadrant (p = 0.005), lymph vascular invasion (p = 0.0001), post-surgical T stage (p = 0.0001), histotypes (p = 0.023), HER2 status (p = 0.02), Ki-67 proliferative index (p = 0.001) and nuclear grade (p = 0.024) were significantly correlated with sentinel node macrometastases. Sentinel node biopsy technique (cytological aspiration versus histological biopsy) was not associated with micrometastases (p = 0.89) or macrometastases (p = 0.48) occurrence. The only feature significantly associated with micrometastases in sentinel node was the lymph vascular invasion (p = 0.0001).

Conclusion: the presence of micrometastases remained fairly constant over time if compared to macrometastases. In our experience the only feature significantly associated with micrometastases in sentinel node is the lymph vascular invasion.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-25.

Treatment of invasive male breast cancer: a 40-year single-institution experience

PURPOSE

We conducted a retrospective analysis to evaluate the management and outcome of invasive male breast cancer treated in a single-institution over a period of 40 years.

MATERIALS AND METHODS

We reviewed the clinical and pathological features of 60 male patients affected by breast carcinoma treated at our Radiotherapy Unit between 1971 and 2011. Tumours were classified according to histological type and the updated 2010 TNM classification of malignant tumours.

RESULTS

At a median follow-up of 8.9 [range, 0.6-20; standard deviation (SD), 4.98] years, 32 patients (53.3%) were alive and 16 patients died (26.7%) due to disease progression and 12 (20%) due to other causes. At univariate analysis for overall survival, pathological tumour size (p=0.031), histological subtype (p=0.013) and nodal status (p=0.006) emerged as significant predictors of death. At multivariate analysis, independent death predictors were advanced pathological tumour size (p=0.016), positive nodal status (p=0.003) and invasive cribriform histological type (p=0.0003).

CONCLUSIONS

In consideration of the rarity of the disease, many issues are still being debated, and future collaborative studies are required. However, our experience confirms the prognostic role of greater pathological tumour size and positive nodal status as unfavourable features for survival in male breast cancer.

Pegylated liposomal doxorubicin (Caelyx®) and oral vinorelbine in first-line metastatic breast cancer patients previously treated with anthracyclines

Doxorubicin is highly effective and widely used in breast cancer; however, its use is limited by cardiotoxicity related to its cumulative dose. In previous studies, pegylated liposomal doxorubicin (PLD) has shown an acceptable toxicity profile with minimal cardiotoxicity. Between June 2006 and October 2009, 27 metastatic breast cancer patients were treated with first-line PLD and vinorelbine at the University of Florence, Radiotherapy Unit. PLD (30 mg/m²) was administered on day 1, and oral vinorelbine (60 mg/m²) was administered on days 1 and 8 of a 4-week cycle. All patients were previously treated with anthracycline-based adjuvant chemotherapy. Median age was 52 years (range 38-69) and median time to metastasis was 78.5 months. There were no treatment interruptions or discontinuation for cardiac toxicity and no treatment-related deaths. Grade 3 hematological toxicity was observed in 18.6% of patients, and 3.7% had grade 3 non-hematological adverse events. With a median follow-up of 13.2 months (range 3-33), median response duration was 6.1 months, and median PFS was 5.3 months. The overall clinical benefit rate was 55.5%. Our experience adds to evidence supporting the activity and cardiac safety of PLD and vinorelbine in metastatic breast cancer patients previously treated with anthracycline-based adjuvant chemotherapy.

P2-12-14: Prognostic Value of HER2 Positivity and Negative Hormonal Status in Patients with Small Tumor (&lt;1cm) and Node-Negative Breast Cancer

Introduction. Human epidermal growth factor receptor 2 (HER2) amplification has become the prototype biomarker to develop tailored biological treatment. Many studies suggested that HER2 positivity is an independent predictor of disease recurrence and breast cancer mortality. Trastuzumab has been introduced into clinical practice for high-risk HER2−positive patients who have completed the standard adjuvant treatment.

However, small (&lt;1cm), node-negative tumors remain a subgroup of HER2−positive patients who are currently ineligible for trastuzumab treatment, as clinically they have been deemed to have no requirement for standard adjuvant chemotherapy.

The aim of our analysis was to evaluate the prognostic factors of local and distant recurrence in patients diagnosed with T1a-b, node-negative, HER-2 positive breast cancer.

Materials and methods. A total of 704 patients were diagnosed at Florence University between November 1999 and December 2008 with node-negative, invasive BC that were 1 cm or smaller. Patients with ductal carcinoma in situ, with recurrent BC at presentation and patients that received adjuvant chemotherapy were excluded from analysis.

Results. Mean follow-up was 4.9 years (0.5−10.8 years); we recorded a total of 19 recurrences, including 10 distant recurrences. Mean time to local relapse occurrence was 3.8 years (0.4−7.3 years); mean time to distant metastases diagnosis was 4.4 years (1.4−7.6 years). Among all patients, the recurrence-free survival (RFS) was 93.7%.

The only parameter that emerged as significant predictor of events is the age (p=0.02).

The distant recurrence-free survival (DRFS) rate was 96.5%. Patients who had HER2−positive BC had worse DRFS than patients who had HER2−negative BC (92.0% v 96.9%; p=0.045). In addition to HER2, also HR status was significantly associated with DRFS (p=0.026). Patients who had HR negative status had worse DRFS than patients who had HR positive status (91.4% v 97.4%; p=0.045).

Conclusions. Patients with T1a-b, node-negative, breast cancer have a low risk of distant and local recurrence. Women with HER2−positive and negative hormonal status have a significant risk of distant recurrence and should be considered for anti-HER2 adjuvant therapy.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-14.

Climate change and American Bullfrog invasion: what could we expect in South America?

Background

Biological invasion and climate change pose challenges to biodiversity conservation in the 21^st century. Invasive species modify ecosystem structure and functioning and climatic changes are likely to produce invasive species' range shifts pushing some populations into protected areas. The American Bullfrog (Lithobates catesbeianus) is one of the hundred worst invasive species in the world. Native from the southeast of USA, it has colonized more than 75% of South America where it has been reported as a highly effective predator, competitor and vector of amphibian diseases.

Methodology/Principal Findings

We modeled the potential distribution of the bullfrog in its native range based on different climate models and green-house gases emission scenarios, and projected the results onto South America for the years of 2050 and 2080. We also overlaid projected models onto the South American network of protected areas. Our results indicate a slight decrease in potential suitable area for bullfrog invasion, although protected areas will become more climatically suitable. Therefore, invasion of these sites is forecasted.

Conclusion/Significance

We provide new evidence supporting the vulnerability of the Atlantic Forest Biodiversity Hotspot to bullfrog invasion and call attention to optimal future climatic conditions of the Andean-Patagonian forest, eastern Paraguay, and northwestern Bolivia, where invasive populations have not been found yet. We recommend several management and policy strategies to control bullfrog invasion and argue that these would be possible if based on appropriate articulation among government agencies, NGOs, research institutions and civil society.

Radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy: analysis of 49 cases from a single-centre and review of the literature

The purpose of this study was to evaluate the reliability of image-guided 14-gauge needle core biopsy in the diagnosis of radial scar without associated atypical epithelial proliferation, by comparison with definitive histological diagnosis on surgical excision. The records of 8792 consecutive image-guided 14-gauge needle core biopsy of the breast performed from January 1996 to December 2009 were reviewed. Forty-nine cases of radial scar without associated atypical epithelial proliferation were identified and compared with definitive histological diagnosis on surgical excision. The definitive histological diagnosis on surgical excision confirmed the results of image-guided 14-gauge needle core biopsy in 36 of 49 cases (73.5%), in 9 cases (18.3%) radial scar was associated with atypical epithelial proliferation, while 4 cases out of 49 cases were upgraded to carcinoma (3 cases of ductal carcinoma in situ and one case of invasive lobular carcinoma), with an underestimation rate of 8.2%. A diagnosis of radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy does not exclude a malignancy on surgical excision; consequently during the multidisciplinary discussion further assessment by surgical excision or vacuum-assisted excision, as recently reported, needs to be considered to obtain a definitive histological diagnosis.

Concomitant adjuvant chemo-radiation therapy with anthracycline-based regimens in breast cancer: a single centre experience

PURPOSE

This study was done to evaluate the toxicity related to concurrent radiotherapy and anthracycline (AC)-based chemotherapy in the adjuvant treatment of early breast cancer and to investigate the impact of treatment interruptions and the feasibility of this uncommon therapeutic approach.

MATERIALS AND METHODS

From September 2002 to December 2007, 60 patients were treated at our Centre. The mean age at presentation was 48.5 (range 38-64) years. All patients underwent conservative surgery, and radiotherapy to the entire breast (mean dose 50 Gy; range 46-52 Gy). AC-based regimens consisted of four cycles of AC (doxorubicin plus cyclophosphamide) or four cycles of epirubicin (EPI) followed by four courses of cyclophosphamide, methotrexate and 5-fluorouracil (CMF).

RESULTS

Concomitant treatment caused acute skin G3 toxicity in 8.9% of patients and one case of G4 toxicity (1.7%). Concerning cardiac assessment, six of the 56 evaluable patients (10.7%) developed an asymptomatic decline of left ventricular ejection fraction >10% and <20% of the baseline value. Radiotherapy was temporarily stopped in 21.3% and chemotherapy in 57.1% of patients.

CONCLUSIONS

In our experience, concomitant chemotherapy did not emerge as a significant factor in radiotherapy interruption. Moreover, no severe cardiac events were recorded.

Postmastectomy radiotherapy in breast cancer adjuvant treatment

Radiotherapy (RT) plays an important role in the management of locally advanced breast cancer (BC). Postmastectomy RT has been shown to significantly reduce the risk of loco-regional failure and to improve disease free survival in high-risk women with BC. Many trials have shown a significant benefit in local control, disease-free and overall survival with the addition of RT for patients with stage II and III breast cancer. New perspectives are evaluating multiple biological variables that nowadays should be considered in clinical oncology for the prescription of postmastectomy radiation therapy. Tailored randomized trials are now ongoing to clarify the "grey zone" represented by the intermediate-risk group of patients (1-3 lymph nodes involved). We reviewed the major studies offered by literature with emphasis on the principal debated issues.

Reptilia, Iguania, Liolaemidae, Liolaemus goetschi Müller and Hellmich, 1938: distribution extension

Liolaemus goetschi Müller and Hellmich, 1938 is a poorly known Patagonian lizard. Two specimens were collected in the central-western portion of Río Negro Province, Argentina, located 82 km west and 110 km south of the known distribution for the species in its type locality.

Role of ultrasound and sonographically guided core biopsy in the diagnostic evaluation of ductal carcinoma in situ (DCIS) of the breast

PURPOSE

The aim of this study was to evaluate the role of ultrasound (US)-guided core biopsy in the diagnosis of ductal carcinoma in situ (DCIS) and to correlate the histological results on percutaneous biopsy and surgical excision.

MATERIALS AND METHODS

Out of 2,423 consecutive core biopsies performed under US guidance, we evaluated 65 lesions with a histological diagnosis of DCIS. All patients underwent mammography, high-frequency broadband US and percutaneous breast biopsy with a 14-gauge needle and a mean number of five samples (range 4-7 passes). Surgical excision was performed in all cases, and the histological results on the surgical specimen were correlated with those on core biopsy samples. The sonographic features of DCIS lesions were described, comparing pure DCIS (those confirmed by definitive histology) and DCIS with invasive component at surgical excision.

RESULTS

Twenty-seven out of 65 DCIS at core biopsy were found to have an invasive or microinvasive component at surgical excision, leading to rate of histological underestimation of core biopsy of 41.5%. The most frequent sonographic appearances were: (a) mass without microcalcifications (47.4% of pure DCIS, 63% of DCIS with invasive component); (b) mass with microcalcifications (23.7% of pure DCIS, 22% of DCIS with invasive component); (c) isolated microcalcifications (10.5% of pure DCIS); (d) ductal abnormalities (18.4% of pure DCIS, 15% of DCIS with invasive component).

CONCLUSIONS

Due to the high underestimation rate of core biopsy, caution is mandatory in the case of DCIS diagnosis on core biopsy. Although some histological features (such as stromal fibrosis, periductal inflammatory infiltrate, high nuclear grade) can suggest the presence of an invasive component, the sonographic appearance of DCIS cannot be used to predict the cases that are underestimated on US-guided core biopsy. Nevertheless, a sonographically detectable solid component, either inside dilatated ducts or associated with microcalcifications, and a size greater than 20 mm are frequently associated with the presence of an invasive component.