Infiltrating Breast Carcinoma Research Articles

Correlation between sentinel lymph node biopsy and non-sentinel lymph node metastasis in patients with cN0 breast carcinoma: comparison of invasive ductal carcinoma and invasive lobular carcinoma

BackgroundSome studies have suggested that axillary lymph node dissection (ALND) can be avoided in women with cN0 breast cancer with 1–2 positive sentinel nodes (SLNs). However, these studies included only a few patients with invasive lobular carcinoma (ILC), so the validity of omitting ALDN in these patients remains controversial. This study compared the frequency of non-sentinel lymph nodes (non-SLNs) metastases in ILC and invasive ductal carcinoma (IDC). Materials Methods: Data relating to a total of 2583 patients with infiltrating breast carcinoma operated at our institution between 2012 and 2023 were retrospectively analyzed: 2242 (86.8%) with IDC and 341 (13.2%) with ILC. We compared the incidence of metastasis to SLNs and non-SLNs between the ILC and IDC cohorts and examined factors that influenced non-SLNs metastasis. Results: SLN biopsies were performed in 315 patients with ILC and 2018 patients with IDC. Metastases to the SLNs were found in 78/315 (24.8%) patients with ILC and in 460 (22.8%) patients with IDC (p = 0.31). The incidence of metastases to non-SLNs was significantly higher (p = 0.02) in ILC (52/78–66.7%) compared to IDC (207/460 − 45%). Multivariate analysis showed that ILC was the most influential predictive factor in predicting the presence of metastasis to non-SLNs. Conclusions: ILC cases have more non-SLNs metastases than IDC cases in SLN-positive patients. The ILC is essential for predicting non-SLN positivity in macro-metastases in the SLN. The option of omitting ALND in patients with ILC with 1–2 positive SLNs still requires further investigation.

Analyzing Tumor Budding Scores in Invasive Breast Carcinoma: A Tertiary Care Center Study in South India

ABSTRACT Introduction and Aim: Tumor budding is a distinctive phenomenon which involves the presence of small clusters or individual cancer cells at the invasive front of tumors. Tumor budding has garnered attention due to its potential implications for prognosis, treatment strategies, and our understanding of cancer progression. Our aim is to study the distribution of tumor buds and its scoring in patients with infiltrating breast carcinoma and to associate with other histopathological parameters like the size of the tumor, its grade, lymphovascular invasion, and lymph node metastasis. Materials and Methods: This was a study analyzing the data of 70 resected specimens of primary breast carcinomas and providing a descriptive overview. Tumor budding was recognized, counted, and graded in hematoxylin and eosin slides. The cases were classified as low (0–4), intermediate (5–9), and high (≥10 buds) based on the count of tumor buds. Tumor budding has significant correlation with tumor grade and tumor size. Results: Of the 70 cases, 60 cases (85.71%) were diagnosed as invasive ductal carcinoma NOS. The majority [38 (54.28%)] of the cases showed an intermediate tumor budding score of 5–9/10 HPF. Conclusion: Evaluation of tumor budding allows pathologists and oncologists to gather valuable information about the tumor’s biological aggressiveness and potential for metastasis. It also helps in better risk stratification of patients, enabling a more personalized and tailored approach to treatment planning. In conclusion, assessing tumor budding in breast carcinoma holds significant clinical importance in the management and prognosis of this disease.

Impact of immunohistochemical expression of kinesin family member 18A (Kif18A) and β-catenin in infiltrating breast carcinoma of no special type

BackgroundKIF18A is a regulator of the cell cycle that stimulates the proliferation of cancer cells. The Wnt/β-catenin pathway is involved in different issues’ carcinogenesis and is being examined as a therapeutic target. The relationship between KIF18A and β-catenin in breast cancer was not previously investigated. Therefore, this work aims to study the immunohistochemical expression and correlation of KIF18A and β-catenin in breast-infiltrating duct carcinoma (IDC) and their relation to prognosis.Material and methodsSlides cut from paraffin blocks of 135 IDC and 40 normal breast tissues were stained by KIF18A and β-catenin antibodies. KIF18A cytoplasmic or nucleocytoplasmic staining and β-catenin aberrant expression either nucleo-cytoplasmic or cytoplasmic staining were considered.ResultsNormal breast tissue and IDC showed a significant difference regarding KIF18A and aberrant β-catenin expression. High KIF18A and β-catenin H score values were associated with poor prognostic factors such as high grade, advanced stage, distant metastasis, high Ki67 status, and Her2neu-enriched subtype. There was a significant direct correlation between KIF18A and β-catenin as regards percent and H score values. Prolonged overall survival (OS) was significantly associated with mild intensity and low H score of KIF18A, and low β-catenin H score.ConclusionsKIF18A could be involved in breast carcinogenesis by activating β-catenin. Overexpression of KIF18A and aberrant expression of β-catenin are considered proto-oncogenes of breast cancer development. KIF18A and β-catenin could be poor prognostic markers and predictors of aggressive behavior of breast cancer.

P53 expression correlates with low axillary tumor burden in breast cancer.

The p53 mutation in breast cancer confers a worse prognosis and is usually associated with p53 overexpression (p53+) on immunohistochemistry. Previous studies have shown that p53+ tumors could be associated with low axillary tumor burden (ATB). We aimed to evaluate the association between p53+ and ATB in a large series of breast cancers as an aid to personalizing axillary surgical treatment. We retrieved 1762 infiltrating breast carcinomas from our database that were treated with upfront surgery in Hospital del Mar from 2004 to 2018. We compared p53+ and p53-negative (p53-) tumors in terms of the percentage of cases with high ATB and overall survival. This comparison was made overall and for each immunophenotype. Overall, 18.7% of breast tumors were p53+. High ATB was less common in p53+ tumors than in p53- tumors in the luminal B-Her2-negative immunophenotype (6.2% versus 16.9%, respectively, P =0.025), but not in the other immunophenotypes or overall. Overall survival was worse in patients with p53+ breast cancer (P =0.002). p53+ breast cancers were associated with worse overall survival. However, low ATB was more common in these tumors than in p53- tumors in the luminal B-Her2-negative subtype. Information on p53 expression could be of use to predict ATB in some breast cancer tumors.

Isolated Myelopathy in Occult Breast Carcinoma with Negative Paraneoplastic Antibodies: A Case Report of a Rare Condition

Isolated paraneoplastic myelopathy (IPM) is a rare neurological manifestation of systemic cancer and represents an intermediate-risk phenotype of disease according to the diagnostic criteria for Paraneoplastic Neurologic Syndromes (PNS). Here, we present the case of a 47-year-old woman who developed subacute cervical myelopathy and was then diagnosed with breast cancer. Through this lens, we provide a discussion of current literature on IPM. Over four months, our patient developed progressive tetraparesis, hypoesthesia with C3 level, and urinary retention. The first MRI was negative, but a four-month-control MRI showed a T2-hyperintense spinal lesion (C2–C7 and T2–T4). Cerebrospinal fluid (CSF) analysis was normal. Infective and autoimmune screening, including onconeural, anti-MOG, and aquaporin-4 antibodies, was unremarkable. The total-body CT scan was negative, but total-body PET-CT scan evidenced an enlarged axillary lymph node, with the detection of breast cancer cells at fine-needle aspiration. Despite negative mammography, a breast MRI confirmed a mammary nodule, which was removed, and a ductal infiltrating breast carcinoma diagnosis was made. Her neurological condition partially improved after steroid therapy. Our final diagnosis was probable IPM, according to PNS criteria. This rare condition affects most frequently middle-aged women and is often associated with breast and lung cancer, even if two-thirds of patients’ cancer diagnosis is subsequent to the onset of neurological deficits. Clinical presentation is often subtle, and CSF analysis, neuroimaging, and onconeural autoantibodies could be negative or non-specific. However, if the suspect of paraneoplastic disease is strong, cancer should be searched thoroughly since early diagnosis and treatment are associated with a better outcome.

Pure Mucinous Breast Carcinoma In Young Female: A Rare Entity With Good Prognosis Among Infiltrating Breast Carcinoma S

Pure Mucinous Breast Carcinoma In Young Female: A Rare Entity With Good Prognosis Among Infiltrating Breast Carcinoma S

Orbital Metastases of Breast Cancer in Males

We report a case of orbital metastasis of infiltrative breast carcinoma in a 65-year-old man. The patient was diagnosed with stage four breast cancer one year before, for which a mastectomy was performed. He refused postoperative radiotherapy and chemotherapy at that time. He had a history of lung, liver, and mediastinal metastases. At admission, he presented with blurred vision, diplopia, ocular pain, and mild swelling of the upper lid of the left eye (LE). Computed tomography (CT) of the brain and orbit revealed a front-ethmoidal tissue mass with left orbital and frontal intracranial extension. Ophthalmologic examination revealed exophthalmos on the LE with a downward and outward deviation of the eyeball, proptosis, and intraocular pressure (IOP) of 40 mmHg. The patient's treatment started with topical maximal anti-glaucomatous drops and radiotherapy sessions. After three weeks of follow-up, there was a gradual improvement of local symptoms and signs and a normal IOP.

Association of serum adiponectin levels and ADIPOQ SNP rs2241766 with breast cancer risk in Indian women.

Adiponectin, an adipokine, and its gene polymorphisms have been associated with breast cancer risk in various populations. In this study, we evaluated the association of the circulating levels of adiponectin and adiponectin gene polymorphism SNP rs2241766 with breast cancer and its clinicopathological characteristics in Indian women. A case-control study was carried out with 60 Ductal Infiltrating Breast Carcinoma patients and 60 age-matched healthy controls. Serum adiponectin levels were measured by ELISA. SNP genotyping was done by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism. Serum adiponectin levels were compared using the Mann Whitney U test. The frequency of genotypes was compared using the Chi-square test. The odds ratio was calculated using logistic regression. Lower serum adiponectin level was associated with increased risk of breast cancer in postmenopausal women (OR - 7.69; 95% CI - 2.16-27.43, P = 0.002) but not in the reproductive age group women. There was no association between adiponectin levels with the TNM stage of the tumor, histopathological grade, erbB2, and ER/PR status. The SNP rs2241766 polymorphism was not associated with breast cancer risk but the mutant genotypes TG/GG was found to be significantly associated with the lower histopathological grade of the tumor (X2 (2, N = 60) = 8.62, P = 0.01). Our results suggest that low serum adiponectin levels are associated with an increased risk of breast cancer in postmenopausal women. The TG/GG genotypes of SNP rs2241766 polymorphism were associated with a lower histological grade of the tumor.

Tipos histológicos poco frecuentes de carcinoma infiltrante: carcinomas metaplásicos, carcinomas apocrinos y neoplasias neuroendocrinas de la mama

Metaplastic carcinomas (MCs), primary neuroendocrine cancers of the breast (NECB) and apocrine carcinomas (APCs), have undergone several changes in their definition and nomenclature over the years, and are therefore a group of special interest for discussion and updating.MCs are a heterogeneous group from a histopathological and prognostic point of view, which require appropriate sampling and a wide panel of immunohistochemical techniques to identify them. There are different subtypes with highly variable morphological characteristics and marked intra- and inter-tumoural heterogeneity. These include low-grade adenosquamous carcinoma, fibromatosis-like MC, squamous cell carcinoma, spindle cell carcinoma, MC with heterologous mesenchymal differentiation, and mixed MC. They mostly have a triple-negative immunophenotype and as a group have a poor prognosis, and poor results with the available targeted therapies.APC has a characteristic histological appearance and immunophenotype (RA+, ER-, PR-, HER2+/−, GCFP+, AMACR+), which should show predominantly in the tumor. The molecular profile or apocrine molecular signature (luminal-AR/apocrine molecular carcinoma) does not always coincide with the histopathological diagnóstico of APC. Targeted anti-androgen therapy is a therapeutic target with promising results.NE differentiation can be found in different breast tumors, either of non-special subtype, or in subtypes such as hypercellular mucinous carcinoma or solid papillary carcinoma. The diagnóstico of primary breast NEN requires morphological and immunophenotypic NE differentiation in >90% of tumor cells, first having ruled out the metastatic nature of the lesion. Two types of primary breast NEN are distinguished: NE tumor (NET) and NE carcinoma (NEC), the latter being either large cell or small cell. The prognosis and treatment of these lesions is currently like that of other infiltrating breast carcinomas according to histological grade and stage at diagnóstico.

Development of Histologically Verified Thyroid Diseases in Women Operated for Breast Cancer: A Review of the Literature and a Case Series.

Background: The possible relationships between breast and thyroid diseases have been reported in the literature. The purpose of our study was to evaluate the occurrence of histologically verified thyroid pathologies in women who were diagnosed with breast cancer and, after mastectomy/quadrantectomy complemented by oncological treatment, were thyroidectomized based on their periodic thyroid evaluation. Patients and Methods: Our series consist of 31 women with a mean age of 62.9 ± 10.9 years (range, 45–81) treated for breast cancer (18 right-sided, 11 left-sided, and 2 bilateral), of whom 29 were thyroidectomized, since two women who developed Graves’ disease refused thyroidectomy. These 31 women belong to a cohort of 889 women who referred to the Breast Surgery Unit of our university hospital during the period January 2010 through December 2020. Results: The mean time interval between breast cancer and thyroid pathologies was 48.1 ± 23.4 months (range, 12–95). The final diagnosis at histopathology was infiltrating ductal breast carcinoma in 26 women (with 2/26 patients having bilateral carcinoma) and infiltrating lobular breast carcinoma in the other 5 women. Ten of the twenty-nine thyroidectomized women (34.5%) had a thyroid malignancy on histology: five papillary carcinomas, three papillary micro-carcinomas and two follicular carcinomas. Two of the five women with papillary carcinoma also had histological evidence of chronic lymphocytic thyroiditis/Hashimoto’s thyroiditis, which was also detected in another five women with benign thyroid diseases. Conclusions: We suggest that breast cancer survivors should be made aware of the possible increased risk of thyroid pathologies (including thyroid malignancy) so that they can undergo screening and follow-up.

Axillary dissection 10 years after Z0011.

e12582 Background: Axillary involvement is one of the strongest prognostic factors in breast cancer. Axillary lymphadenectomy (AL) has been considered one of the milestones to reduce relapse risk of local breast carcinoma. Z0011 trial, demonstrated that axillary dissection was not necessary in cases with one or two nodes involved. The authors proposed 3 sentinel nodes to decide if AL should be done. Since in the trials that explored the omission of lymphadenectomy obtained between one and six nodes, there is no consensus about how many lymph nodes should be obtained in the axillary sampling. The objective of this study is to obtain real data about axillary staging in real practice after Z0011 trial. Methods: 197 patients were selected from clinical records of Hospital Universitario de Torrejon. All patients were diagnosed with localized infiltrating breast carcinoma between 2016 and 2021. All were candidates for sentinel node biopsy (SNB) analyzed by OSNA or histopathology analysis. Patients with in situ tumors, those who underwent neoadjuvant chemotherapy We retrospectively reviewed the number of axillary nodes obtained in SNB and if axillary dissection was performed or not. Results: From 197 patients, 150 were included in the study (47 were excluded because were diagnosed with in situ carcinoma, received neoadjuvant chemotherapy or followup was lost). All 150 women were patients with infiltrating breast cancer who underwent conservative surgery or mastectomy and SNB. After surgical treatment, all patients received subsequent therapies indicated in each case (chemotherapy, radiotherapy or hormone therapy). Medium age at diagnosis was 57 years (range 30-87). Median number of sentinel nodes obtained in SNB was 2 (range 1 to 5). 40 patients had tumor infiltration in SNB, but only 15 underwent axillary dissection,10 of them had one node involved, 4 had 2 nodes involved and one had 3 nodes involved, from up to four extracted. 5 patients had more node involved than those found on the sentinel node biopsy, and all had macrometastasis. Capsular rupture was identified in 7 cases. None of the patients had relapse until the time of follow up was closed. Conclusions: Rate of axillary dissection after Z0011 has decreased without increasing risk of loco-regional or distant relapse. During the time of surgery, not always is possible to obtain 3 sentinel nodes, which could involve more aggressive surgery and comorbidities. Techniques of sentinel node identification are needed and further investigation to resolve in which cases axillary dissection is unavoidable.

Carcinoma En Cuirasse Revealing Breast Cancer

Carcinoma en cuirasse is an uncommon skin metastasis with diffuse cutaneous infiltration affecting usually the chest. It is characterized by sclerodermiform induration of the skin. Breast cancer is the most malignant tumor that metastasizes to the skin. We report the case of a man, 79-year-old, with an 18-month history of sclerodermiform infiltration in the left chest. The histological diagnosis was infiltrating breast carcinoma with lung and skin metastasis.

Abstract P3-20-10: Local recurrences after mammary adenectomy with clear retroareolar margin for the treatment of early infiltrating breast carcinomas

Abstract Introduction. Mammary adenectomy (MA) is an evolving surgical procedure for patients with breast cancer (BC). It entails the resection of all gross visible glandular tissue, while preserving the overlying breast skin envelope and the nipple-areolar complex (NAC). For achieving the best oncologic outcomes it is recommended the obtainance of clear surgical margins, mainly the retroareolar, and careful selection of the patients to be treated accordingly. Here, we performed a study aiming to assess the local recurrences rate in patients who underwent MA for BC therapy. Methods. A retrospective cross-sectional study was carried out at a private Service (Clínica Prof. Alfredo Barros). Patients with invasive BC measuring up to 3.0 cm and at least 2.0 cm far from the NAC by resonance magnetic imaging, were elegible, while others with more than 3 foci of neoplasia, nipple discharge or neoadjuvant chemotherapy were excluded. All of them were submitted to MA and selective axillary dissection and reconstruction by immediate prothesis implants, with clear retroareolar margin by intraoperative cytology and frozen section exams, and intra-nipple ducts excision. External radiotherapy was delivered when more than 3 affected axillary lymph nodes were involved. Results. A total of 18 cases were analysed. Patient’s mean age was 51.5 years. The histopathologic subtypes were: invasive carcinoma (NOS) 146 (80.7%), infiltrative lobular 26 (14.4%), micropapilar 3 (1.7%) and others 6 (3.3%). Mean tumor size was observed 1.8 cm (0.4-5.0). Multicentricity/multifocality was observed in 62 cases (34.2%) a total of 144 cases presented positivity for estrogen receptor (86.7%), 144 (79.6%) for progesterone receptor, and 29 were HER2 positive (16.0%). In 98 cases (54.1%) a small padge of skin covering the tumor area was removed. Irradiation was ministered to 50 patients (27.6%). After a mean follow up period of 39.9 months (6-178), ten cases of local recurrences were detected (5.5%). No one case of local relapse was detected in the sub-NAC area Conclusion. Our data indicated that the local recurrences rate after therapeutic MA for well selected BC patients is low and acceptable. 2 Citation Format: Rebeca Neves Heinzen, Alfredo CarlosSimõesDornellas de Barros, Alfredo Jacomo, Marcella Cinquini. Local recurrences after mammary adenectomy with clear retroareolar margin for the treatment of early infiltrating breast carcinomas [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-20-10.

Correlation between Frozen Section and Permanent Histopathologic Diagnoses in Adult Orbital Lesions

Introduction: When indicated, intraoperative use of frozen sections may assist in determining the surgical course or appropriate processing of surgical specimens. Knowing the accuracy of a preliminary frozen section diagnosis is important. The purpose of this study is to determine the rate of correlation between frozen and permanent histopathologic diagnoses of adult orbital lesions, analyze characteristics of discordant cases, and examine the effects of discordance on surgical decision-making. Methods: A 15-year retrospective chart review was conducted at a tertiary care center of all adult patients with orbital lesions for which frozen section and corresponding permanent section tissue diagnoses were obtained. Results: Sixty-five orbital surgeries were performed with a total of 89 frozen sections sampled. In 63 surgeries (96.9%), at least 1 frozen section diagnosis matched the final permanent section diagnosis. Overall, frozen section diagnosis corresponded with permanent section diagnosis in 81 of 89 (91.0%) specimens. Of the 8 (9.0%) specimens from 5 unique patients that did not correlate, the final diagnoses on permanent sections were amyloidosis (5), margin-positive infiltrating breast carcinoma (2), and lymphoid hyperplasia (1). The discrepancy between frozen and permanent sections did not alter care in any patient. Conclusion: Frozen section diagnoses correlate with permanent histopathologic tissue diagnosis in adult orbital biopsies in greater than 90% of cases. Among non-correlated specimens, amyloidosis was the most common diagnosis. Although rare, orbital amyloid disorders may be considered in the differential diagnosis of cases of orbital biopsies with nonspecific findings on a frozen section.

Histopathological Spectrum of Breast Carcinoma in a Tertiary Care Centre and its Association with ABO Blood Grouping and Rh Typing

Background: Globally, breast cancer contributes to 27.7% of the newly diagnosed cases of cancer among women. Early screening and timely diagnosis of the lesions of breast help in alleviating the anxiety among patients. Histopathology is the gold standard in diagnosing the lesions, assessing the adequacy of treatment, and in disease prognosis. Studies have shown that ABO blood type has been associated with risk and survival for several malignancies. However, data for an association with breast cancer are inconsistent.
 Aim: To study the histopathological spectrum breast carcinomas and to investigate the presence of a possible association between breast cancer in women and ABO blood group and Rh factor.
 Materials and Methods: This retrospective descriptive study was done for a period of 4 years on 110 mastectomy specimens histopathologically diagnosed as breast cancers, and clinico-pathological data collected and analysed with records from the Department of Pathology, Saveetha Medical College. Association of breast cancer with ABO blood grouping and Rh typing was studied.
 Results: Left breast was involved in most cases (96.4%). The mean age was 50.86 years, with 41-50 years age group showing peak incidence. Infiltrating breast carcinoma, no special type (89.6%) was the most common histological type. ER and PR positivity was seen in 46.4% and 41.8% of cases respectively. A statistically significant association was seen between hormone receptor status and histological grade. 39.1% cases belonged to O blood group, and Rh positivity was seen in 96.4% of the cases. No association was found between breast cancer and ABO/Rh blood grouping.

A Case with 68Ga-FAPI Positive and 18F-FDG Negative Breast Cancer

A female patient diagnosed of infiltrative breast carcinoma using tru-cut biopsy underwent 18flourine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for staging. The tumor was located in the superior external quadrant of the right breast, and did not exhibit pathological uptake in 18F-FDG PET/CT. Later, gallium-68 (68Ga) fibroblast activation protein-specific inhibitor (FAPI)-04 PET/CT imaging was performed and the primary tumor showed intense radiotracer accumulation. This presumes that 68Ga-FAPI PET/CT imaging is superior to 18F-FDG imaging in detecting the primary tumor in breast cancer, thereby suggesting the replacement of FAPI by 18F-FDG in breast-cancer staging in the future.

Secretory carcinoma of the breast with multiple distant metastases in the brain and unfavorable prognosis: a case report and literature review

BackgroundSecretory carcinoma of the breast is one of the rarest entities, accounting for less than 0.15 % of all infiltrating breast carcinomas. It has characteristic histopathological and molecular features and, in general, a more favorable prognosis. In this case report, we describe a local, advanced secretory carcinoma of the breast with aggressive course and an unfavorable outcome.Case presentationA hard, painless, and palpably bossed mass approximately 12.0 cm in diameter occupied most of the left breast of a 39-year-old woman with fixation to the overlying skin. Breast ultrasonography and magnetic resonance imaging (MRI) scans gave the same grading as BI-RADS IV. A needle biopsy was performed, and the pathological diagnosis was secretory carcinoma. Neoadjuvant chemotherapy (NAC) was then performed, after which ultrasonography and MRI scans revealed chemo-resistance of the tumor to NAC. Left breast mastectomy and axillary lymphadenectomy were subsequently performed. Tumor cells were triple-negative and positive for S-100 and periodic acid-Schiff (PAS) staining. Fluorescence in-situ hybridization (FISH) analysis indicated a fusion arrangement of the ETV6-NTRK3 gene. The patient developed multiple distant metastases in the brain and died of these metastases 19 months after initial diagnosis.ConclusionsSecretory carcinomas of the breast have been described as a low-grade histologic subtype with a favorable prognosis. This case showed chemo-resistance to neoadjuvant chemotherapy, multiple distant metastases, and a final unfavorable outcome. Further research is needed to better understand the behavior and treatment of this rare tumor.

Predominance of the luminal B molecular subtype in a group of women with infiltrating breast ductal carcinoma in the Colombian coffee region: Analysis by immunohistochemistry.

e12571 Background: Breast cancer is the most common cancer in women and constitutes a public health problem due to its high rates of morbidity and mortality. Diagnosis is made through routine histopathology studies that are complemented by phenotypic expression studies of hormone receptors (estrogen and progesterone receptors), human epidermal growth factor 2 (HER2) and cell proliferation index (Ki67) for their subtyping into molecular groups (luminal A, luminal B, Her2, and triple negative), which have different prognostic and therapeutic implications. Globally, a high prevalence of the Luminal A subtype has been reported, predominantly in North America, Europe, and some Latin American countries; however, the reports in the Colombian population are heterogeneous. The objective of this research is to establish an incidence profile of these molecular subtypes in a population of the coffee region in Colombia. Methods: Samples of 377 patients with a diagnosis of infiltrating breast cancer were collected retrospectively between 2015 and 2018. Inclusion criteria included: 1) Availability of personal data (year of diagnosis and age) 2) Infiltrating breast carcinoma. 3) Diagnosis between 2015 and 2018. 4) Study of complete immunohistochemistry and/or in situ hybridization (ISH) markers. Results: The histological subtypes included: NOS infiltrating ductal carcinomas (339 cases; 89.9 %), infiltrating lobular (23 cases; 6.1 %), infiltrating mucinous (6 cases; 1.5 %), infiltrating papillary (1 case; 0.2 %) and mixed patterns: ductal - lobular (3 cases; 0.7 %) and mucinous - ductal (5 cases; 1.3 %), of whom 56.2% (212 cases) correspond to luminal B, 22.2% (84 cases) to Luminal A, 14.8% (56 cases) to triple negative and 6.6% (25 cases) to HER2. Conclusions: These findings contrast with the prevalence reported worldwide. Therefore, in the population of the Colombian coffee region, this predominance of the molecular subtype luminal B should be considered when establishing prognosis and treatment plan by the medical staff.

Ozonotherapy for Treatment of Radiation Therapy-induced Jaw Osteonecrosis and Bisphosphonates: Case Report

Introduction: The inhibition of osteoclastic activity, associated with different treatment modalities in patients with head and neck cancer, make bones unable to respond to repair processes related to physiological traumas or infection and may result in bone necrosis. The present study aims to report a clinical case of osteoradionecrosis in mandible, and how its sequels were controlled by ozonotherapy. Case report: A 73-year-old female patient with infiltrative ductal breast carcinoma with mandibular metastasis was submitted to chemo and radiotherapy at head and neck region associated with bisphosphonate. Three years later, she was diagnosed with hemimandibular osteoradionecrosis that exhibited communication with oral cavity and with a chronic, suppurative and persistent associated infection. It was applied adjuvant therapy with ozone through the cutaneous fistula and the exposed and necrotic bone. Additionally, non-vital bone debridement was proceeded in two surgical steps. The patient is after a 1-year follow-up non-symptomatic. Conclusion: It is supposed that ozonotherapy, due to its antibacterial and immunoregulatory mechanism of action, was an important therapeutic agent for improving the patient’s quality of life.

Abstract PS1-43: Axillary surgery after neoadjuvant chemotherapy in patients treated for an operable breast cancer with a proven initially positive axillary node: Preliminary results of identification and removal of the initially positive axillary node

Abstract BackgroundAlmost half of the patient with initially metastatic axillary node, treated with neoadjuvantchemotherapy (NAC) for a large operable breast cancer, has no axillary lymph node involvementat the time of surgery after NAC. Sentinel lymph node detection (SLND), performed after NAC,has a high false negative rate (FNR) when compared to FNR after primary surgery. GANEA 3 isa French prospective multi institutional ongoing trial, aimed at assessing the impact of targeting,before NAC, the initially positive node and removing it after NAC. The main objective of GANEA3 trial is the accuracy of this initially positive node to predict pathological status of the otheraxillary nodes after NAC. A total of 385 patients are required.ObjectiveThe current abstract assessed preliminary results of the detection rate of the clipped node and thedifferent methods to find it during axillary surgery based on the first 41 patients.Patients and MethodThis study is part of GANEA 3 Trial validated by scientific national board (clinicialtrials.gov:NCT03630913).Inclusion criteria: TNM stage T1-T3 N1 infiltrating breast carcinoma, indication of NAC, andsigned consent form,Exclusion criteria: more than 5 suspicious axillary nodes, inflammatory cancer, local relapse,mental disorder, pregnancy or no contraceptive method, contra-indication to NAC, NACinterrupted due to progressive disease.Design: Patients treated for an early breast cancer with NAC, axillary sonography with fine needlecytology before NAC to select patients with a proven lymph node involvement. Initially positive node identification warranted, for example with a clip. After NAC patients underwent the removalof the clipped node, a SLN detection with the combined method (patent blue and technetium) andan axillary lymph node dissection (ALND). In order to find the clipped node, during surgery thesurgeon attempted to find it with palpation and sonography. Each surgical specimen was then x-rayed before pathological examination.Studied parameters were clipped node and SLND detection rate, and the methods used to find theclipped node.ResultsFrom January 2019, to November 2019, 41 patients were enrolled, from 13 institutions, withinitially positive axillary node clipped, NAC courses and surgery after NAC.Median age was 53 (31-75), pathological subtype infiltrative ductal carcinoma (n=40) andinfiltrative lobular carcinoma (n=1), a median of 7 courses of NAC (1-16).SLN detection rate was 90% (37/41). A median number of 2 sentinel nodes were removed (1-7).The clipped node was removed in 100% of cases. The clipped node was identified by thesurgeon palpation (n=11), an axillary wire (n=13), per operative axillary sonography (n=4),surgical specimen radiography (n=11), the pathologist (n=2).The clipped node was part of SLN in 29 cases (70%). It was part of axillary lymphadenectomyspecimen in 6 cases (14.5%) and was find alone as an isolated node in 6 cases (14.5%).ConclusionThe clipped node was always found after NAC. It was mostly always part of SLN or ALNDspecimens. Further studies are needed in order to help the surgeon to remove only the clippednode. Citation Format: Celine Renaudeau, Roman Rouzier, Pierre Gimbergues, Marian Gutowski, Eva Jouve, Philippe Rauch, Charles Coutant, Christelle Faure, Catherine Uzan, Pierre-François Dupré, Vivien Ceccato, Charlotte N'go, Augustin Reynard, Isabelle Doutriaux, Loic Campion, Jean-Marc Classe. Axillary surgery after neoadjuvant chemotherapy in patients treated for an operable breast cancer with a proven initially positive axillary node: Preliminary results of identification and removal of the initially positive axillary node [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-43.