Postchemotherapy Associated Histopathological Findings in Invasive Breast Carcinoma: A Camouflaged Signature

Abstract

Introduction: Breast cancer is the most common cancer diagnosed in women world-wide. Application of preoperative Neoadjuvant Chemotherapy (NACT) has become a frequently employed therapeutic approach to treat breast cancer patients. Such chemotherapy alters the morphology of both malignant tumour tissue and adjacent benign breast tissue. Aim: To compare the histopathological features in mastectomies done for invasive breast carcinoma among those who received NACT with those who had not received NACT. Materials and Methods: It was a retrospective observational study of invasive breast carcinoma cases conducted at a rural tertiary care referral institute, PES Institute of Medical Sciences and Research (PESIMSR), Kuppam, Andhra Pradesh, India, from January 2013 to April 2015. The histopathological features in mastectomies were evaluated using a modified scoring system and compared between those who received NACT (study group) and those who had not received NACT (control group). Postchemotherapy associated histopathological features were analysed for statistical significance. Frequencies, Chi-square test and crosstabs were the statistical tools used to analyse the data. All statistical calculations were done through Statistical Software Data (STATA) version 14.1. Results: Out of 24 cases analysed, the study group (mean age=53.67 years) and control group (mean age=45.92 years) constituted 12 cases each. In postchemotherapy cases, fibroelastosis (p-value= 0.027) was a significant feature in the malignant tumour tissue. Stromal fibrosis (p-value=0.036), epithelial atypia (p-value <0.0001) and calcification (p-value=0.002) were significant features in the benign breast tissue. Conclusion: In postchemotherapy cases, fibroelastosis was significant histopathological feature in malignant tumour tissue. Stromal fibrosis, epithelial atypia and calcification were significant histopathological features in the benign breast tissue. Such findings may be considered as camouflaged signature of chemotherapy. It may be hypothesised that calcification in the benign breast tissue may indicate a tell-tale sign of cell injury secondary to systemic chemotherapeutic agents.