Diagnosis Of Invasive Ductal Carcinoma Research Articles

Tumor lysis syndrome following letrozole for locally advanced breast cancer: a case report

BackgroundLetrozole, an aromatase inhibitor, is used to treat breast cancer in postmenopausal women. Tumor lysis syndrome (TLS) is a complication that can trigger multiple organ failure caused by the release of intracellular nucleic acids, phosphate, and potassium into the blood due to rapid tumor cell disintegration induced by drug therapy. TLS is uncommon in solid tumors and occurs primarily in patients receiving chemotherapy. Herein, we report a rare occurrence of TLS that developed in a patient with locally advanced breast cancer following treatment with letrozole.Case presentationAn 80-year-old woman with increased bleeding from a fist-sized left-sided breast mass presented to our hospital. Histological examination led to a diagnosis of invasive ductal carcinoma of the luminal type. The patient refused chemotherapy and was administered hormonal therapy with letrozole. Seven days after letrozole initiation, she complained of anorexia and diarrhea. Blood test results revealed elevated blood urea nitrogen (BUN) and creatinine (Cr) levels, and she was admitted to our hospital for intravenous infusions. On the second day after admission, marked elevations of LDH, BUN, Cr, potassium, calcium, and uric acid levels were observed. Furthermore, metabolic acidosis and prolonged coagulation capacity were observed. We suspected TLS and discontinued letrozole, and the patient was treated with hydration, febuxostat, and maintenance hemodialysis. On the third day after admission, her respiratory status worsened because of acute respiratory distress syndrome associated with hypercytokinemia, and she was intubated. On the fourth day after admission, her general condition did not improve, and she died.ConclusionsAlthough TLS typically occurs after chemotherapy initiation, the findings from the present case confirm that this syndrome can also occur after hormonal therapy initiation and should be treated with caution.

Long-term results of intraoperative multicatheter breast implant (IOMBI) for accelerated partial breast irradiation (APBI) on early breast cancer patients

Background and purposeMulticatheter breast brachytherapy is a standard technique for accelerated partial breast irradiation (APBI) in early breast cancer patients. Intraoperative multicatheter breast implant (IOMBI) followed by perioperative high-dose-rate brachytherapy (PHDRBT) offers a novel and advantageous approach. We present long-term oncological, toxicity, and cosmesis outcomes for a well-experienced single institution. Materials and methodsEligible women aged ≥ 40 years with clinically and radiologically confirmed unifocal invasive or in situ ≤ 3 cm breast tumors underwent IOMBI during breast-conserving surgery. Patients meeting APBI criteria by definitive pathologic results received 3.4 Gy × 10fx with PHDRBT. Patients not suitable for APBI received PHDRBT-boost followed by WBRT. ResultsA total of 171 patients underwent IOMBI during BCS, 120 patients (70.1 %) were suitable for APBI and 51 (29.8 %) for anticipated PHDRBT-boost. The median age was 61 years (range: 40–78), the median tumor size was 1.1 cm (range: 0.2–3.5), with a histological diagnosis of invasive ductal carcinoma in 78.9 % and ductal in situ in 21.1 %. A median of 9 catheters (range: 4–14) were used. For APBI, the median CTV and V100 were 40.8 cc (range: 8.6–99) and 35.4 cc (range: 7.2–94). The median of healthy breast tissue irradiated represents 7.2 % (range: 2.3–28 %) and the median local treatment duration was 10 days (range: 7–16). With a median follow-up of 8.8 years (range: 0.3–16.25), the 8-year local, locoregional, and distant control rates were 99 %, 98.1 %, and 100 %. G1-G2 late-toxicity rate was 53.4 %. Long-term cosmetic evaluation was excellent-good in 90.8 %. ConclusionIOMBI&PHDRBT program reports excellent long-term oncological outcomes, with a reduction from unnecessary irradiation exposure which translates into low long-term toxicity and good cosmesis outcomes, especially on well-selected APBI patients.

Intra and peritumoral PET radiomics analysis to predict the pathological response in breast cancer patients receiving neoadjuvant chemotherapy

ObjectiveThe aim of our study was to evaluate the contribution of 18Fluorine-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) radiomic data obtained from both the tumoral and peritumoral area in predicting pathological complete response (pCR) in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy (NAC). MethodsFemale patients with a diagnosis of invasive ductal carcinoma who received NAC were evaluated retrospectively. The volume of interest (VOI) of the primary tumor (VOI-T) was manually segmented, then a voxel-thick VOI was added around VOI-T to define the peritumoral area (VOI-PT). Morphological, intensity-based, histogram and texture parameters were obtained from VOIs. The patients were divided into two groups as pCR and non-complete pathological response (npCR). A “radiomic model” was created with only radiomic features, and a “patho-radiomic model” was created using radiomic features and immunohistochemical data. ResultsOf the 66 patients included in the study, 21 were in the pCR group. The only statistically significant feature from the primary tumor among patients with pCR and npCR was Morphological_Compacity-T (AUC: 0.666). Between response groups, a significant difference was detected in 2 morphological, 1 intensity, 4 texture features from VOI-PT; no correlation was found between Morphological_Compacity-PT and NGTDM_contrast-PT. The obtained radiomic model’s sensitivity and accuracy values were calculated as 61.9% and 75.8%, respectively (AUC: 0.786). When HER2 status was added, sensitivity and accuracy values of the patho-radiomic model increased to 85.7% and 81.8%, respectively (AUC: 0.903). ConclusionsEvaluation of PET peritumoral radiomic features together with the primary tumor, rather than just the primary tumor, provides a better prediction of the pCR to NAC in patients with breast cancer.

Evaluation of Resection Margin by Intraoperative Frozen Section Biopsy in Breast Conservative Surgery for Early Breast Carcinoma

Background: Breast cancer is currently the second leading cause of cancer deaths in women. Early detection and accurate classification of suspicious masses as benign or malignant is important for arriving at an appropriate treatment plan. Aims: To evaluate the resection margin by intra-operative frozen section in breast conserving surgery for early breast carcinoma. Methods: This cross sectional study was carried out in the department of general surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. A total of 20 patients with early stage breast carcinoma underwent surgery were included in this study. Admitted patients with diagnosis of invasive ductal carcinoma of the breast, patient who gave consent for research purpose, patients diagnosed with stage I & II breast cancer, small (up to 4 cm) unifocal tumor and clinically negative axillary nodes were enrolled in this study. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: It was observed that more than one third (40.0%) patients belonged to age 41-50 years. The mean age was 45.55±10.94 years with ranged from 28 to 75 years. Half (50.0%) patient’s educational level was primary. Majority (85.0%) patient’s occupational statuses were housewife. Majority (90.0%) patients had lump size >2-≤5 cm. The mean lump size was 2.89±0.66 cm with ranged from 1.5 to 4 cm. Three fourth (75.0%) patients had lump in the right breast. Almost two third (60.0%) patients had lump in the upper outer quadrant of breast. Two (10.0%) patients had Grade I and 18(90.0%) had Grade II tumor. Three fourth (75.0%) patients had resected tumor of T2 >2-≤5 cm size. The mean size of resected toumour was 2.65±0.62 cm with ranged from 1.4 to 3.8 cm. The frequency of positive resection margin on frozen section was 3 (15%). Among them 1 (33.3%) patient had positive superior margin and 2 (66.7%) had positive lateral ....

Optimized Bayesian convolutional neural networks for invasive breast cancer diagnosis system

Deep learning (DL) has depicted unprecedented results in the diagnosis of invasive ductal carcinoma (IDC). However, most DL methods are not able to infer the uncertainty in their predictions, and are often too confident which may cause undesirable consequences. The ability of DL models to express their uncertainty in their predictions is particularly important in diagnosing diseases. Therefore, this paper proposes an uncertainty-aware approach called optimized Bayesian convolutional neural network (OBCNN) for the automated detection of IDC from histopathology images and is capable of estimating and inferring the uncertainty in its predictions. The proposed OBCNN employs an approximate Bayesian version of a pre-trained convolutional neural network (CNN) model named ResNet101V2 that is fine-tuned to the histopathology images of IDC. The Bayesian approximation is performed by adding Monte Carlo dropout (MC-dropout) to ResNet101V2 architecture. Due to the effect of MC-dropout on the obtained posterior predictive distribution (PPD), the value of MC-dropout should be chosen carefully because if the MC-dropout value is too large, the predictive distribution (PD) will be very diverse. Whereas if the MC-dropout value is very small, the PD will be very similar. Therefore, an optimization algorithm known as the slime mould algorithm is utilized to set the optimal value of the MC-dropout. During inference, the proposed OBCNN runs for T forward passes to configure the PPD. The mean, standard deviation (SD) and entropy are then calculated over the obtained PD to estimate the predictive uncertainty (PU) of the OBCNN. The proposed OBCNN achieved an accuracy of 93.83%, a precision of 96.14%, a G-mean of 93.04%, False Negative Rate of 4.72%, and False Positive Rate of 9.96 %. The proposed OBCNN has also been compared with recent related work, the comparison’s results demonstrated that OBCNN performed better in the diagnosis of IDC.

Right Common Femoral Vein Invasion: A Unique Case of Inguinal Ectopic Breast Cancer.

Ectopic breast cancer may present anywhere in the milk line, from the axilla to the groin which is extremely rare in the inguinal region. Despite morphologic differences, ectopic breast tissue presents characteristics related to orthotopic breast tissue in terms of function and pathologic degeneration. The case report describes the treatment of a unique ectopic breast carcinoma which was located in the inguinal region with a common femoral vein invasion. We present a unique case of an ectopic breast carcinoma presenting in an unusual anatomic location along the milk line. The study was approved by the local Ethics Committee (protocol no: 12.01.2023-2023/02) Informed consent was obtained from the patient. The patient is surgically treated and supplemented with neoadjuvant chemotherapy,radiotherapy and endocrine therapy. Histopathological examination revealed the diagnosis of invasive ductal carcinoma. The right common femoral vein was reconstructed with bovine pericardial patch after totally removal of the mass. This report alerts the reader to be cognizant of the unusual location of an ectopic breast cancer which was detected in the inguinal region with a common femoral vein invasion and discusses the treatment, suggesting novel therapeutic advice that could bring considerable clinical advantages. A multidisciplinary approach should be warranted in such cases to confirm a complete remission.

Proteomics-Based Identification of Dysregulated Proteins and Biomarker Discovery in Invasive Ductal Carcinoma, the Most Common Breast Cancer Subtype

Invasive ductal carcinoma (IDC) is the most common histological subtype of malignant breast cancer (BC), and accounts for 70-80% of all invasive BCs. IDC demonstrates great heterogeneity in clinical and histopathological characteristics, prognoses, treatment strategies, gene expressions, and proteomic profiles. Significant proteomic determinants of the progression from intraductal pre-invasive malignant lesions of the breast, which characterize a ductal carcinoma in situ (DCIS), to IDC, are still poorly identified, validated, and clinically applied. In the era of "6P" medicine, it remains a great challenge to determine which patients should be over-treated versus which need to be actively monitored without aggressive treatment. The major difficulties for designating DCIS to IDC progression may be solved by understanding the integrated genomic, transcriptomic, and proteomic bases of invasion. In this review, we showed that multiple proteomics-based techniques, such as LC-MS/MS, MALDI-ToF MS, SELDI-ToF-MS, MALDI-ToF/ToF MS, MALDI-MSI or MasSpec Pen, applied to in-tissue, off-tissue, BC cell lines and liquid biopsies, improve the diagnosis of IDC, as well as its prognosis and treatment monitoring. Classic proteomics strategies that allow the identification of dysregulated protein expressions, biological processes, and interrelated pathway analyses based on aberrant protein-protein interaction (PPI) networks have been improved to perform non-invasive/minimally invasive biomarker detection of early-stage IDC. Thus, in modern surgical oncology, highly sensitive, rapid, and accurate MS-based detection has been coupled with "proteome point sampling" methods that allow for proteomic profiling by in vivo "proteome point characterization", or by minimal tissue removal, for ex vivo accurate differentiation and delimitation of IDC. For the detection of low-molecular-weight proteins and protein fragments in bodily fluids, LC-MS/MS and MALDI-MS techniques may be coupled to enrich and capture methods which allow for the identification of early-stage IDC protein biomarkers that were previously invisible for MS-based techniques. Moreover, the detection and characterization of protein isoforms, including posttranslational modifications of proteins (PTMs), is also essential to emphasize specific molecular mechanisms, and to assure the early-stage detection of IDC of the breast.

Human Connections

It was a long day of precepting in resident clinic that ended in a trip to radiology, a late after-hours appointment I had rescheduled a few times because—as we all know—doctors sometimes make the worst patients.It was my first mammogram. I was only 38 after all, 2 years before I was even supposed to begin routine breast cancer screening. As a med-peds primary care physician, I had reviewed the screening guidelines countless times with my internal medicine residents in clinic. I had talked with my pediatrics residents about how breastfeeding reduces the risk of breast cancer. But I could no longer ignore the abnormal area I felt in my breast. As I sat in the cold waiting room, I did not realize at the time that it would also be my last mammogram.I could tell by the way the radiology tech was carefully taking measurements and staring diligently at the screen that it was abnormal. She apologized. “I'm sorry,” she said. “If this was earlier in the day, I could have one of the radiologists look at it right now but it's after 5pm.”So I went home and waited for the next day.Almost at 9am on the dot, I received a call from one of the radiology nurses. “Multiple irregular masses...” The next 2 weeks were filled with additional imaging, including a diagnostic mammogram, targeted ultrasound, and breast MRI, followed by stereotactic and ultrasound guided biopsies. Eventually this all led to a diagnosis of invasive ductal carcinoma of the breast.I felt paralyzed.How could this be? I looked up survival rates depending on the stage of disease. I calculated how old my kids would be if I lived another 3 years, 5 years, 10 years, or 30 years. I asked my husband radiologist to show my imaging to his colleagues.The plan was mastectomy in a few weeks. And I opted for bilateral.My colleagues were amazingly supportive and immediately said I should do telemedicine in the weeks leading up to my surgery. They didn't want me to risk getting COVID-19 while seeing patients and then postponing surgery.This also meant that I fell off the face of the earth. I didn't see my residents anymore. Were they wondering where I was? My colleagues were all aware of what was going on, but I had felt uncertain about whether I would share the news with my residents. About one week before my surgery, I crafted an email to let them know why I had disappeared. I shared my diagnosis, the plan for my treatment, and that I was feeling OK and hoped to return as soon as I could, maybe even before the end of the academic year in time to see our postgraduate year 3 residents graduate.I did not expect the overwhelming emails and texts that I received.I received well wishes, thoughts, and prayers. I received offers for babysitting and homework help for my kids. They shared stories of their own personal or family struggles with illness. They encouraged me to ask for help and even taught me ways to do it. “People around you truly want to help (and I think people feel good when they get to do something) so ask for specific things,” one of my residents wrote. I read and reread this message a few times. So, I started asking for help: “Can you pick up some groceries?” “Could you give me a ride to my doctor's appointment?”It was pure, unadulterated kindness. And it truly got me through a period of anxiety, worry, and stress.A few of my pediatrics residents organized a day when the residents, faculty, and staff dressed in pink, and they sent me a picture to show support. I cried when I saw that picture, and it always stayed close to me throughout my surgery, treatment, and recovery.They offered me hope.I also developed a new level of trust in the residents: not only that they would take good care of my patients while I was gone, but that they would also take good care of me. It was residents who ran to my bedside when a rapid response was called after I had a syncopal episode a few hours postoperative. When I came to, it was a surgery resident who was standing over my bedside squeezing a bag of normal saline to get more fluids into me with my blood pressure of 73/34. It was an internal medicine resident, someone I'd precepted, who saw me in the ER for shortness of breath, a few days after surgery. I trusted them wholeheartedly.In our day-to-day moments teaching residents, we talk about how we impact them: the medical skills we teach them, the educational milestones we help them achieve, and even the career mentoring and life advice we may give them. But what has become clear from my health journey is that residents teach me in ways I may not even realize. I have learned that the teaching moments we share together mean so much more than simply medical education. They are opportunities to form truly meaningful human connections.And for that, I am forever grateful.

Overdiagnosis of lobular carcinoma of breast- A review of histomorphological features and immunohistochemistry: A case series

: Invasive lobular carcinoma (ILC) accounts for 5%–15% of all invasive breast cancers (BCs) and is the second most common type of BC behind invasive ductal carcinoma (IDC) of no special type. ILC of the breast is characterized morphologically by small, noncohesive cells that infiltrate the stroma in a single-file pattern(Indian file pattern). ILC tumours display features associated with a good prognosis, being low grade, oestrogen receptor positive and is mainly associated with the complete loss of E-cadherin (E-cad) expression.To review the cases of invasive lobular carcinoma and to immunohistochemically categorize IDC and ILC.This is a retrospective study including all the modified radical mastectomy cases of invasive lobular carcinoma of breast reported in the department of Pathology of a tertiary care centre from January 2021 to January 2022. Histopathological and immunohistochemical analysis of those cases were reviewed.We encountered 10 cases of invasive lobular carcinoma of breast from January 2021 to January 2022. The average age of the patients was 55.9 years old (35–72). The classic presentation was a breast lump found in 100% of the cases. On physical examination, breast carcinoma was suspected in all the patients. The average size of the tumours was 4.5 cm (1.4– 9cm). Out of those 10 cases, 4 cases were right sided lesion and modified radical mastectomy was performed in all the 10 cases. All the 10 cases were diagnosed as invasive lobular carcinoma on histopathology and review of those cases showed 7 out of 10 cases to be IDC. Those cases showed pitfalls in histomorphological analysis which were later confirmed by immunohistochemistry. The findings are presented in the study.Our study found that there was a histomorphological pitfall in the diagnosis of IDC. In ambiguous cases with histologically equivocal features, a strong, complete, membranous E-cadherin expression may help in resolving the problem and in aiding in the subclassification of invasive breast carcinoma.

Diagnostic Value of Ultrasound Elastography in the Differentiation of Breast Invasive Ductal Carcinoma and Ductal Carcinoma In situ.

Ultrasound elastography (US-E) has been shown superior to the conventional US in diagnosing benign and malignant breast lesions. In contrast, the role of US-E in the differentiation of breast invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS) has been poorly described. This study was designed to examine the diagnostic value of US-E in the differentiation of IDC and DCIS. Medical records of all patients who underwent preoperative US-E evaluation and were diagnosed with IDC or DCIS at our hospital from April-December 2019 were retrieved and analyzed. Those who had prior surgical treatment, chemotherapy or radiotherapy were excluded. Twenty women with DCIS and 111 women with IDC were included in this study. There were no significant differences in age, maximum lesion diameter and tumor volume between the two groups. While shear wave velocity (SWV) inside the lesion and in the surrounding tissue, strain ratio and tumor area ratio were not substantially different between the two groups, SWV at the edge of the lesion was significantly higher in IDC cases, which had an AUC value of 0.66 with a sensitivity of 65.8% and a specificity of 60.0% for the differential diagnosis of IDC and DCIS. Edge SWV is significantly higher in IDC than that in DCIS, which had a moderate diagnostic value for the differentiation of IDC and DCIS, similar to the performance of diffusion-weighted magnetic resonance imaging as reported in the literature. In terms of cost-effectiveness, US-E could be very useful while waiting for further evaluations to determine whether US-E combined with other diagnostic modalities improves the diagnostic performance.

Artificial intelligence enhanced thermal breast imaging in the diagnosis of invasive breast cancer: a study of 2 case reports

Background: Invasive ductal carcinoma (IDC) of the breast is the most common type of breast cancer in women. Imaging by mammography and/or ultrasonography and histo-pathological examination are collectively used to confirm a diagnosis of IDC. However, the standard imaging modalities are resource intensive and hence, have limited feasibility in resource-limited countries. Thermalytix, an affordable, radiation-free test is a novel Artificial Intelligence (AI)-powered breast cancer detection tool that has shown effectiveness in detecting breast cancer in both symptomatic and asymptomatic women. Case Presentation: We describe two cases of symptomatic women who, on Thermalytix, were identified with a lesion suspicious of malignancy and confirmed as IDC on further evaluation by standard of care imaging and tissue diagnosis. Conclusion: Thermalytix, a new AI-based computer diagnostic solution (Computer diagnostic solution), has the potential to identify breast malignancies such as IDC.

Does the number of cell forming tumor budding alter the prognostic value in invasive ductal carcinoma of breast?

The most commonly used definition for tumor budding (TB) is a single or a cell cluster of tumor cells up to 4 cells. However, there are different opinions regarding the number of cell (NOC) forming TB. It has been proven that TB is associated with poor prognostic factors in most tumors. The current study, it was aimed to investigate the prognostic value of NOC forming TB in invasive ductal carcinoma of the breast. 326 cases with the diagnosis of invasive ductal carcinoma were examined. The NOC forming TB was counted from hematoxylin and eosin stained slide under X200 magnification for each case, and scoring five different TB as 1, ≤2, ≤3, ≤4, ≤5, respectively. Receiver operating characteristic (ROC) analysis based on survival was performed for each TB value separately, and the cut-off was determined. All TB values were associated with poor outcome (p<0.001), presence of distant metastasis (p<0.001), high Ki67 proliferation index (p<0.05), advanced stage (p<0.05), presence of lymphovascular invasion (p<0.001), and metastatic axillary lymph node (p<0.001). According to ROC analysis performed to compare the predictiveness of survival, the area under the curve was similar for all TB values. TB was associated with poor prognostic parameters, and the prognostic value of TB was not affected by NOC forming TB. The NOC up to 4 cells which have been accepted for colon carcinomas, could also provide practicality in breast carcinomas.

Biomarker panel for early screening of trastuzumab -induced cardiotoxicity among breast cancer patients in west virginia.

Cardiotoxicity is a well-known pathophysiological consequence in breast cancer patients receiving trastuzumab. Trastuzumab related cardiotoxicity typically results in an overall decline in cardiac function, primarily characterized by reduction in left ventricular ejection fraction (LVEF) and development of symptoms associated with heart failure. Current strategies for the monitoring of cardiac function, during trastuzumab therapy, includes serial echocardiography, which is cost ineffective as well as offers limited specificity, while offering limited potential in monitoring early onset of cardiotoxicity. However, biomarkers have been shown to be aberrant prior to any detectable functional or clinical deficit in cardiac function. Hence, this study aims to develop a panel of novel biomarkers and circulating miRNAs for the early screening of trastuzumab induced cardiotoxicity. Patients with clinical diagnosis of invasive ductal carcinoma were enrolled in the study, with blood specimen collected and echocardiography performed prior to trastuzumab therapy initiation at baseline, 3- and 6-months post trastuzumab therapy. Following 6-months of trastuzumab therapy, about 18% of the subjects developed cardiotoxicity, as defined by reduction in LVEF. Our results showed significant upregulation of biomarkers and circulating miRNAs, specific to cardiac injury and remodeling, at 3- and 6-months post trastuzumab therapy. These biomarkers and circulating miRNAs significantly correlated with the cardiac injury specific markers, troponin I and T. The findings in the present study demonstrates the translational applicability of the proposed biomarker panel in early preclinical diagnosis of trastuzumab induced cardiotoxicity, further allowing management of cardiac function decline and improved health outcomes for breast cancer patients.

A case report of coexistent carcinoma breast with chronic myeloid leukemia

Multiple primary cancers are gradually becoming a regular condition and frequently result in many diagnostic and therapeutic difficulties. In our case report we present a 68-year female with breast lump who was incidentally diagnosed with chronic myeloid leukemia. The fine needle aspiration biopsy (FNAC) of the breast lump lead to the diagnosis of Invasive ductal carcinoma.

A case of axillary traumatic neuroma mimicking local recurrence following cancer surgery and a review of the literature

Traumatic neuroma (TN) is a non-neoplastic proliferative response developing against neuronal injury. Its pathogenesis is unknown: While its overall incidence is low, the incidence of traumatic neuroma development following mastectomy is even lower. Thirty-eight post-mastectomy traumatic neuromas in 30 patients were reported in the literature. Only two of these were in the axillary region, whereas the others had originated from the mastectomy scar tissue. Even though the ultrasonographic examination reveals the features of a benign mass, performing a histopathological examination is a must for definitive diagnosis of the mass and exclusion of local recurrence, mainly when it has developed following cancer surgery. Here, we aimed to discuss in the light of the literature a patient who had undergone mastectomy and axillary dissection with the diagnosis of invasive ductal carcinoma eight years ago and underwent recurrent axillary dissection with the preliminary diagnosis of axillary metastasis.

A Stacked Ensemble-Based Classifier for Breast Invasive Ductal Carcinoma Detection on Histopathology Images

Breast cancer is one of the main causes of death in women. When body tissues start behaves abnormally and the ratio of tissues growth becomes asymmetrical then this stage is called cancer. Invasive ductal carcinoma (IDC) is the early stage of breast cancer. The early detection and diagnosis of invasive ductal carcinoma is a significant step for the cure of IDC breast cancer. This paper presents a convolutional neural network (CNN) approach to detect and visualize the IDC tissues in breast on histological images dataset. The dataset consists of 90 thousand histopathological images containing two categories: Invasive Ductal Carcinoma positive (IDC+) and Invasive Ductal Carcinoma negative (IDC-). For the detection of this disease, we have proposed an ensemble learning-based deep learning model that consists of the multi-model structure having different internal configuration settings of CNN. As a result, the proposed method has significant progress as per present techniques in terms of accuracy as 92.7%. Therefore, the ensemble approach of multi-model CNN can provide the evolution of IDC at different stages, and this would help the pathologist in the cure of cancer. The experimented results show that the proposed ensemble-based approach of multi-model CNN generated the preeminent results with an accuracy of 92.7% as compared to the already existing techniques.

On the Dynamics and Feasibility of Transferred Inference for Diagnosis of Invasive Ductal Carcinoma: A Perspective

It is generally noticed that increasing the number of convolutional layers in generic image classification procedures proves to be detrimental to model performance in terms of validation accuracy and loss. Apart from vanilla CNNs, we have state-of-the-art (SOTA) architectures such as ResNet50 (and its variants) which show that through the use of skip-connections, higher performance metrics are attainable through deeper architectures. However, most evaluative metrics converge on a log scale as we go deeper with diminishing gradient of the metrics&#x2019; curves. Given these two contrasting speculations, in this paper, we implement various vanilla and SOTA CNNs for the diagnosis of one of the most common forms of breast cancer - invasive ductal carcinoma (IDC) - to examine and understand the feasibility of implementation of SOTA CNNs through transferred weights when juxtaposed with vanilla CNNs (and LeNet-5) of varying configurations in terms of their performance metrics and other parameters. In this paper, we solve the dual-objective of studying behavioural aspects of avant-garde CNN models (more specifically, VGG16, VGG19, ResNet50, ResNet50V2, MobileNetV2, and DenseNet121) and proper diagnosis of IDC through intermediate neural activations to critically evaluate and theorize the performance of different models. We notice that among all the models, only VGG16, VGG19, LeNet-5 and a selected vanilla CNN through an optimization procedure were the ones to attain the best metrics, shared amongst them.

A Study Protocol on Assessment of Epidermal Growth Factor Receptor (EGFR) Signalling Pathway as a Predictive Molecular Marker in Triple-Negative Invasive Ductal Carcinoma of Breast

Background: Breast cancer is the leading cause of cancer-related deaths worldwide. The Indian scenario is no different for the breast cancer mortality. Breast cancers have occupied the prominence not only for their incidence but the pace too. The researchers have studied numerous pathways vastly and widely in the past two decades to ascertain the prognosis and treatment outcome determinants popularly called predictive markers for breast cancer. One such cell signalling pathway that has raised the hope by assessing success for breast cancer is the Epidermal Growth Factor Receptor (EGFR) signalling pathway for a molecular subtype of Triple-Negative Breast Cancer (TNBC), which is challenging to treat therapeutically. This study aims to assess the EGFR pathway and its sub pathways in Triple-negative breast carcinoma (TNBC) and correlate the abnormalities of expressions in the EGFR pathway in TNBC for its therapeutic implications.&#x0D; Materials and Methods:  This will be an observational cross-sectional study. Forty cases of TNBC will be selected.  There will be 10 cases each in 31-40 years, 41-50 years, 51-60 years, and 61 years onwards. Cases will undergo histological diagnosis of invasive ductal carcinoma, Immunohistochemistry for ER, PR, and Her2neu, IHC for EGFR, BRAF, Kras, and MAP kinase on histological sections, Polymerase chain reaction( PCR) for Kras. Data will be collected and analyzed using appropriate statistical tests.&#x0D; Results: A significant correlation of EGFR, BRAF, KRAS, and MAP kinase is expected in the pathogenesis of triple-negative invasive ductal carcinoma.&#x0D; Conclusion: The results can be put to the commercial advantage for clinical trials of the new drug development targeting anti-EGFR and other antibodies.

Ultrasound Imaging Morphology is Associated with Biological Behavior in Invasive Ductal Carcinoma of the Breast.

Objectives:Ultrasound (US) is commonly used for diagnostic evaluation of breast lesions. The objective of this study was to investigate the association between US imaging morphology from routine radiologists’ interpretation and biological behavior such as receptor status and tumor grade determined from histopathology in invasive ductal carcinoma (IDC).Material and Methods:This retrospective study included 453 patients with pathology-verified diagnosis of IDC who had undergone US imaging and had surgery over a 5-year period. US and surgical pathology reports were reviewed and compiled. Correlation analyses and age-adjusted multivariable models were used to determine the association between US imaging morphology and receptor status, tumor grade, and germ line mutation of the breast cancer genes (BRCA1 and BRCA2). The odds ratio (OR), area under receiver operating characteristic curve (AUC), and 95% confidence intervals (CI) were obtained.Results:The likelihood for high-grade cancer increased with size (OR: 1.066; CI: 1.042–1.091) and hypo-echogenicity (OR: 2.044; CI: 1.337–3.126), and decreased with angular or spiculated margins (OR: 0.605; CI: 0.393–0.931) and posterior acoustic shadowing (OR: 0.352; CI: 0.238–0.523). These features achieved an AUC of 0.799 (CI: 0.752–0.845) for predicting high-grade tumors. The likelihood for Estrogen Receptor-positive tumors increased with posterior acoustic shadowing (OR: 3.818; CI: 2.206–6.607), angulated or spiculated margins (OR: 2.596; CI: 1.159–5.815) and decreased with US measured tumor size (OR: 0.959; CI: 0.933–0.986) and hypoechoic features (OR: 0.399; CI: 0.198– 0.801), and achieved an AUC of 0.787 (CI: 0.733–0.841). The likelihood for Progesterone Receptor-positive tumors increased with posterior acoustic shadowing (OR: 2.732; CI: 1.744–4.28) and angulated or spiculated margins (OR: 2.618; CI: 1.412–4.852), and decreased with US measured tumor size (OR: 0.961; CI: 0.937–0.985) and hypoechoic features (OR: 0.571; CI: 0.335–0.975), and achieved an AUC of 0.739 (CI: 0.689–0.790). The likelihood for Human epidermal growth factor receptor 2-positive tumors increased with heterogeneous echo texture (OR: 2.141; CI: 1.17– 3.919) and decreased with angulated or spiculated margins (OR: 0.408; CI: 0.177–0.944), and was marginally associated with hypoechoic features (OR: 2.101; CI: 0.98–4.505) and circumscribed margins (OR: 4.225; CI: 0.919–19.4). The model with the aforementioned four US morphological features and achieved an AUC of 0.686 (CI: 0.614–0.758). The likelihood for triple-negative breast cancers increased with hypo-echogenicity (OR: 2.671; CI: 1.249–5.712) and decreased with posterior acoustic shadowing (OR: 0.287; CI: 0.161–0.513), and achieved an AUC of 0.739 (CI: 0.671– 0.806). No statistical association was observed between US imaging morphology and BRCA mutation.Conclusion:In this study of over 450 IDCs, significant statistical associations between tumor grade and receptor status with US imaging morphology were observed and could serve as a surrogate imaging marker for the biological behavior of the tumor.

Our sentinel lymph node experience in patients diagnosed with DCIS and microinvasive breast carcinoma

Aim: Along with the increased availability of radiologic imaging methods, early identification of tumor tissue, and patient surveillance programs; ductal carcinoma in situ (DCIS) and microinvasive DCIS became more commonly identified in the tru-cut biopsy specimens and resected samples of patients. Pathological examinations of the excision materials from these patients reveal invasive tumors, microinvasions or DCIS alone. Recently, it has become debatable whether to perform a sentinel lymph node biopsy (SLNB) in patients diagnosed with DCIS or microinvasive DCIS. In this present study, we evaluated the diagnosis made by examining the excision material, any presence of lymph node metastases, and the relationship of hormone profile to the presence of metastases in the patients diagnosed with DCIS or microinvasive DCIS by the examination of tru-cut biopsy specimens. Based on our study results, we discussed the requirement for SLNB in patients with a tru-cut diagnosis of DCIS or microinvasive DCIS.Materials and Methods: The study included 172 patients, who underwent surgical excision and SLNB after receiving a tru-cut biopsy diagnosis of DCIS and microinvasive DCIS in our hospital from the year 2010 to 2018.Results: Tru-cut biopsy diagnoses were DCIS and microinvasive DCIS in 69.8% (120 patients) and 30.2% (52 patients) respectively. SLNB metastases were identified in 35.8% (n=43) of the DCIS positive patients and 44.2% (n=23) in the microinvasive DCIS positive patients. The diagnosis of invasive ductal carcinoma after mastectomy was made at a rate of 90.0% (n=108) among the DCIS positive patients and 92.3% (n=48) among the microinvasive DCIS positive patients. Conclusion: SLNB metastases were found in 35.8% (n=43) and 44.2% (n=23) of the DCIS positive patients and microinvasive DCIS positive patients, respectively. We conclude that SLNB should be favorably proper to perform in the patients with tru-cut diagnoses of DCIS and microinvasive DCIS because a high rate of SLNB metastases was detected in our DCIS and microinvasive DCIS patients and a high rate of invasive ductal carcinoma diagnosis was made after examining the excision material of these patients.