Biopsy Proven Breast Cancer Patients Research Articles

Association of comorbidities with breast cancer: An observational study

Background: The aim of this study was to describe the prevalence of comorbidity in newly diagnosed female breast cancer patients in north-west India. The second end point of the study was compliance for multimodality treatment. Comorbidity assessed by counting the number of coexisting diseases diagnosed in a cancer patient or by using a comorbidity index that combines the number and severity of the diseases. The most widely used index is the Charlson Comorbidity Index (CCI). Materials and Methods: The data of female patients with breast cancer were recorded, having comorbidities during the cancer registration or comorbidities diagnosed during the treatment at the host institute between January and December 2012. The patients were distributed on the basis of physical parameters such as age, stage, tumor grade, hormone receptor status, ECOG status at diagnosis and CCI. Scores of CCI are summed to provide a total score to predict mortality. Results: During the period of January to December 2012, 156 biopsy-proven breast cancer patients were included in the study. During this period, female breast cancer patients enrolled were 13.94% out of total patient enrollment. The most prevalent comorbidities associated with breast cancer are hypertension (21.8%), chronic obstructive pulmonary disease (COPD) (19.9%), rheumatologic disease (18.6%), and diabetes mellitus (16.7%), all four conditions have been reported in around 75% of the cases. The planning of multimodality management in comorbidity arm was significantly lower (P > 0.01) as compared to patients without comorbidity. Conclusions: The planning of multimodality management in comorbidity arm was significantly lower as compared to patients without comorbidity. Because of the comorbid condition, the definitive treatment of breast cancer was not given so this will also affect the treatment of breast cancer. When the CCI score increases with an increase in the number of comorbidities will decrease survival.

Impact of magnetic resonance imaging on preoperative planning for breast cancer surgery

To review the impact of preoperative breast magnetic resonance imaging on the management of planned surgery, and the appropriateness of any resulting alterations. Retrospective review. A private hospital in Hong Kong. PATIENTS; For the 147 consecutive biopsy-proven breast cancer patients who underwent preoperative magnetic resonance imaging to determine tumour extent undergoing operation by a single surgeon between 1 January 2006 and 31 December 2009, the impact of magnetic resonance imaging findings was reviewed in terms of management alterations and their appropriateness. The most common indication for breast magnetic resonance imaging was the presence of multiple indeterminate shadows on ultrasound scans (53%), followed by ill-defined border of the main tumour on ultrasound scans (19%). In 66% (97 out of 147) of the patients, the extent of the operation was upgraded. Upgrading entailed: lumpectomy to wider lumpectomy (23 out of 97), lumpectomy to mastectomy (47 out of 97), lumpectomy to bilateral lumpectomy (15 out of 97), and other (12 out of 97). Mostly, these management changes were because magnetic resonance imaging showed more extensive disease (n=29), additional cancer foci (n=39), or contralateral disease (n=24). In five instances, upgrading was due to patient preference. In 34% (50 out of 147) of the patients, there was no change in the planned operation. Regarding 97 of the patients having altered management, in 12 the changes were considered inappropriately extensive (due to false-positive magnetic resonance imaging findings). In terms of magnetic resonance imaging detection of more extensive, multifocal, multicentric, or contralateral disease, the false-positive rate was 13% and false-negative rate 7%. Corresponding rates for sensitivity and specificity were 95% and 81%, using the final pathology as the gold standard. Preoperative magnetic resonance imaging had a clinically significant and mostly correct impact on management plans. Magnetic resonance imaging should be included as part of the preoperative investigation in patients planned for breast-conserving surgery, in whom there are doubts about the extent of the tumours based on conventional assessment.

Evaluation of human LOX-12 as a serum marker for breast cancer

The high concentration of prostaglandins has been associated with chronic inflammatory diseases and several types of human cancers. This is due to the over expression of inflammatory enzymes like Cyclooxygenase (COX), Lipoxygenase (LOX) etc. The aim of this study was to quantify the LOX-12 with clinicopathological parameter of breast cancer patients and its response after chemotherapy to establish serum LOX-12 as a prognostic marker. This case-controlled study was performed on 86 biopsy proven breast cancer patients. Blood and tissue samples were collected from the patients. Serum LOX-12 of the study group was quantified by Surface Plasmon Resonance (SPR) and ELISA techniques by antibody–antigen interaction strategy. A significant increase in LOX-12 levels was observed in breast cancer patients (Mean±SD=40.54±13.61ng/ml) as compared to healthy controls (Mean±SD=13.42±2.4ng/ml) (p<0.0001). Serum LOX-12 levels were significantly higher (p<0.002) in patients with lymph node involvement. More than 75% patients had shown significant (p<0.0001) reduction of LOX-12 levels after chemotherapy. This was also confirmed by ELISA. This study for the first time had co-related the quantity of serum LOX-12 with breast cancer and also with the effect of chemotherapy.

Abstract P4-08-11: Surface Plasmon Resonance (SPR) Analysis of COX-2 Expression for Early Detection and Progression of Breast Cancer and Evaluation of a Novel Class of Peptides as Its Inhibitor

Abstract Background: Cyclooxygenase-2 (COX-2) over expression has been observed in different cancers. Till date, COX-2 expression in breast cancer has been studied using RT-PCR and immunohistochemistry. The aim of this study was to use surface plasmon resonance (SPR) technology for determining the expression levels of COX-2 in breast cancer and design peptide inhibitors to evaluate their enzyme inhibition in vitro. Patients and methods: This case-controlled study was performed on 84 biopsy proven breast cancer patients having invasive ductal carcinoma and 40 age, sex and ethnicity matched healthy subjects. Blood and tissue samples were collected and serum and tissue lysate was prepared. Serum and tissue levels of COX-2 were evaluated using SPR where samples were allowed to flow over anti-COX-2 antibody immobilized sensor chip to obtain the respective RUs. Similarly, standard curve of COX-2 was prepared from cloned, expressed and purified protein to deduce the concentrations in different samples. To evaluate enzyme inhibition, fifteen peptides were synthesized using the solid and solution-phase peptide synthesis based on the active site structure of COX-2 and enzyme activity was evaluated spectrophotometrically. Results: A significant increase in COX-2 levels in breast cancer patients 11.23-30.77μg/ml (Mean±SD=14.55±5.74) as compared to normal controls 2.13-5.16µg/ml (Mean±SD=3.71±0.86) (P&amp;gt;0.0001) was observed. Serum COX-2 levels were significantly higher (P&amp;lt;0.0061) in patients with lymph node involvement. More than 65% patients showed significantly (P&amp;lt;0.0025) reduced COX-2 levels after chemotherapy. This was confirmed by western blot to check tissue level expression and spectrophotometrically to determine the activity of COX-2 at different stages. In addition, the peptides showed significant in vitro enzyme inhibition, and had a KD ranging from 1 X 10-8 to 1X10-10. Conclusion: SPR is a useful proteomic technique for early detection and monitoring progession of breast cancer and peptides are a novel class of COX-2 inhibitors that can be further developed for anti-tumor therapy. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-08-11.

Selective Sentinel Node Plus Additional Non‐Sentinel Node Biopsy Based on an FDG‐PET/CT Scan in Early Breast Cancer Patients: Single Institutional Experience

This study was designed to determine whether a preoperative fluorodeoxyglucose (FDG) positron emission tomography (PET) integrated with computed tomography (CT) (FDG-PET/CT) could be used as a guide for axillary node dissection (AND) or sentinel lymph node biopsy (SNB) in breast cancer patients. Between February 2007 and April 2008, we performed FDG-PET/CT scans in 137 biopsy-proven breast cancer patients planning to have an SNB to select patients for either AND (PET/CT N+) or SNB (PET/CT N0). In performing SNB, we also performed additional non-SNB (ADD), which was enlarged at the lower axilla. Twenty-seven patients with positive scans underwent complete AND as a primary procedure, and 110 patients with negative scans underwent SNB + ADD. There were 8 cases of false negative scans, and no case of false positive scan. The overall sensitivity, specificity, positive predictive value, and overall accuracy of FDG-PET/CT in predicting axillary metastasis were 77.1%, 100%, 100%, and 94.2%, respectively. In a subset of 110 patients with SNB + ADD, 104 patients had histologically negative SN, and 6 patients had positive SN in frozen section. Among 110 SNB + ADD cases, there were only 8 cases (7.3%) of positive axillary basins in permanent biopsy, including two cases of late positives that had micrometastases in the SN only. Through selective SNB + ADD based on an FDG-PET/CT, we have spared 27 unnecessary SNBs (true positive scans). FDG-PET/CT is a specific imaging modality for predicting axillary node metastasis, and allows for a selective approach to either AND or SNB. A selective SNB + ADD based on an FDG-PET/CT reduced both unnecessary SNBs and positive axillary basins, enhancing the identification rates of SN and the accuracy of SNB.

Image Feature Extraction in the Last Screening Mammograms Prior to Detection of Breast Cancer

Image feature extraction was utilized to retrospectively analyze screening mammograms taken prior to the detection of a malignant mass for early detection of breast cancer. The mammograms of 58 biopsy proven breast cancer patients were collected. In each case, the mammograms taken 10 to 18 months prior to cancer detection were evaluated. For each of the two mammographic projections of the abnormal breast, two regions were marked: 1) region one, which corresponded to the site where the malignant mass subsequently developed and 2) a region which appeared similar to region one on the same mammogram. On each projection of the normal breast a third region which corresponds to region one but on the opposite breast was also marked (mirror-image site). Sixty-two texture and photometric image features were then calculated for all of the marked areas. A stepwise discriminant analysis showed that six of these features could be used to best distinguish between the normal and abnormal regions. The best linear classification function resulted in a 72% average classification. At its current stage, the system can be used by a radiologist to examine any pattern in a mammogram. The regions which are flagged by the system have a 72% chance of developing a malignant mass by the time of the next screening. Therefore, further evaluation of these patients (e.g., a screening examination sooner than the normal one year interval) could result in earlier detection of breast cancer. The ultimate goal is to run the system automatically over the whole mammogram and flag any suspicious area.

Relationship of Serum Adiponectin and Resistin Levels with Breast Cancer Risk

Obesity is one of the well-known risk factors of breast cancer. We evaluated the relationship between serum adiponectin and resistin levels and breast cancer risk in 41 biopsy-proven breast cancer patients and 43 age- and body mass index-matched controls. The mean serum adiponectin level was lower in the breast cancer group than the control group (6.93±3.2 µg/mL, vs. 7.60±3.5 µg/mL), but this difference did not reach statistical significance (p=0.37). There was a statistically significant difference in serum resistin levels between the groups (breast cancer group 5.23±6.9 ng/mL vs. control 1.46±2.0 ng/mL; p<0.001). The risk of breast cancer was significantly increased in the highest tertile group for serum resistin level compared to the lowest tertile group (adjusted odds ratio 2.77 [95% CI 1.40-5.50]). The lymph node metastasis was significantly increased in the patients with less than the median adiponectin level (p=0.017). In the patients whose resistin level was higher than the median, the frequency of tumor with the highest histological grade was significantly increased (p=0.025). In conclusions, both the low serum adiponectin levels and high resistin levels are likely to be associated with increased breast cancer risk in Korean women.

Evaluation of 5'-nucleotide phosphodiesterase isozyme-V as a predictor for liver metastasis in breast cancer patients.

5'-nucleotide phosphodiesterase isozyme-V (5'-NPD-V) was evaluated in 85 biopsy proven breast cancer patients as a potential marker for early liver metastasis. It correctly predicts liver metastasis in 6/7 (85.7%) patients with abnormal radiologic liver scan and 2/2 other patients with palpable liver. Serum glutamic-oxaloacetic transaminase (SGOT), lactic dehydrogenase (LDH), alkaline phosphatase (AP) and total bilirubin (B) were also determined in 79 of these patients as routine liver function tests (LFT). Forty-one out of 79 from this group had all four markers all within normal limits. Yet of the 41 patients, 12 patients were found positive for 5'-NPD-V. Of these 12, one was found to have liver metastasis at surgery and one had abnormal liver scan. Five other patients had liver dysfunction and one had been diagnosed as an alcoholic. Four others had no evidence of either liver problems or liver metastasis, but follow-up data were lacking. This retrospective study, therefore suggests that there is a definite advantage to include the 5'-NPD-V in the liver profile studies for breast cancer patients, although a positive 5'-NPD-V may only indicate liver repair or liver regeneration. Long-term prospective studies of these tests with breast cancer patients should be worthwhile. No relation was found between 5'-NPV-V and axillary lymph node involvement or the estrogen receptor status of the excised tumor. Thus there is no evidence currently that the appearance of the 5'-NPD-V in serum is related to lymph node metastases or hormonal control.