Inflammatory Carcinoma Research Articles

Integrative homeopathic treatment and pharmacopuncture with Viscum album in canine mammary carcinoma: Case report.

Inflammatory mammary carcinoma is a highly aggressive tumor that affects dogs, characterized by progressive disease and a high mortality rate. Affected dogs have diffuse swollen mammary glands with little demarcation between tissues, making the region firm, in the form of plaques, hot and painful on palpation with possible thickening of the skin and sero-bloody secretion. Acupuncture is considered as an adjunctive treatment modality, as it improves the quality of life of cancer patients, in addition to controlling these metabolic changes. This paper reports the case of a female dog treated with pharmacopuncture in association with the Viscum album. The animal arrived with normocardia, eupnea, pale mucous membranes and a lump in the breast region. Preoperative and imaging exams were carried out, followed by a pan-hysterectomy and partial mastectomy procedure, with sample collection for histopathological analysis. A Grade II Mixed Tumor Carcinoma was diagnosed and then the pharmacopuncture treatment with Viscum album was proposed. Sessions were held weekly for 9 months and there was an improvement in the clinical and physical aspect of the animal. The growing development of medicine associated with new treatment techniques promotes better results and favorable quality of life for animals. As a prophylactic measure of the disease, castration remains the best option, especially when used before the first heat.

Novel Alhagi maurorum leaves mediated synthesis of titanium nanoparticles for human breast carcinoma applications: a preclinical trial study

IntroductionIn this study, titanium nanoparticles (TiNPs) were synthesized in an aqueous medium using Alhagi maurorum extract as a stabilizing and reducing agent.Material and methodsUltraviolet–visible spectrophotometry (UV-Vis), Fou�rier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy dispersive X-ray spectrometry (EDS) were the techniques to characterize the biosynthesis of TiNPs. To survey the anti-human breast cancer effects of TiNPs, MTT assay was used on the common breast cancer cell lines, i.e., breast cancer (breast adenocarcinoma (MCF7), infiltrating ductal cell carcinoma (Hs 319.T), inflammatory carcino�ma of the breast (UACC-732), and metastatic carcinoma (MDA-MB-453)) cell lines. TiNPs’ crystal size was measured as 16.08 nm. SEM images exhibited a uniform spherical morphology in size range of 12.16 to 43.46 nm for the biosynthesized nanoparticles respectively.ResultsThe cell viability of breast carcinoma cells decreased dose-de�pendently in the titanium nanoparticles’ presence. The IC50 values of A. mau�rorum and titanium particles on the MCF7 cell line were 680 and 359 µg/ml, on the Hs 319.T cell line were 507 and 191 µg/ml, on the UACC-732 cell line were 477 and 217 µg/ml, and on the MDA-MB-453 cell line were 507 and 191 µg/ml, respectively. TiNPs had high anti-breast cancer activities dose-dependently against MCF7, Hs 319.T, UACC-732, and MDA-MB-453 cell lines.ConclusionsThe best result of anti-breast cancer effects was seen in the case of the Hs 319.T cell line.

Bilateral erythematous swelling of the breasts in a pregnant patient

Mastitis is an infectious or noninfectious inflammation of the mammary glands. The most important differential diagnosis of mastitis is an inflammatory carcinoma, which can be excluded by imaging and a biopsy. Noninfectious mastitis can also occur during pregnancy and knowledge of the possible differential diagnoses is essential for appropriate diagnostics and treatment.

Methotrexate in the Treatment of Idiopathic Granulomatous Mastitis

Even though idiopathic granulomatous mastitis (IGM) is a benign breast lesion of the mammary grand, it poses a problem of diagnosis as it is a rare entity. Because it resembles breast abscess or inflammatory carcinoma, patients undergo surgical excision leading to breast scarring and disfigurement. In this work, we carried a prospective study of cases of IGM managed over the past 7 years from 2009 to 2015. Among 4200 patients who were treated for breast swelling, 40 cases of IGM were diagnosed. We present the clinical data of our IGM patients and results of treatment with corticosteroids and methotrexate. The mean age of presentation was 33 years, and the median duration of steroid and methotrexate treatment was 3 and 6–9 months, respectively. The diagnosis of IGM was confirmed by core needle biopsy in all the patients. With this combination therapy, all the patients showed complete resolution of IGM and the recurrence was observed in only 2 patients. Our study demonstrates that a combination of corticosteroids (prednisolone) and methotrexate is an ideal choice of treatment for IGM rather than the surgical excision. The combination of low doses of corticosteroids with methotrexate could significantly prevent the side effects of high doses of corticosteroids.

Impact of patient's clinical features on the recurring lung metastases of breast cancer

Aim: The aim of this study was to investigate the clinical features affecting on the recurrence of lung metastases of breast cancer.Materials and Methods: Data of 92 patients who had undergone pulmonary metastasectomy of breast cancer were examined interms of recurrence, age, type of primary breast cancer, disease free interval (DFI), PET/CT findings, side of metastasectomy andnumber of resected lung metastases.Results: Solitary and unilateral pulmonary metastases presenting lower SUV following longer period of DFI were less involved inrecurrence whereas invasive lobular and inflammatory carcinomas were more inclined to develop relapsing lung metastases. Agewas not a risk factor for recurrence.Conclusion: Identifying high risk patients for recurrence contributes to prevention of repeating and excessive surgeries.

Canine Inflammatory Mammary Carcinoma as a Promising Model for Cancer Pathology and Anticancer Drug Development: Lessons from a Case Series

Canine Inflammatory Mammary Carcinoma as a Promising Model for Cancer Pathology and Anticancer Drug Development: Lessons from a Case Series

Oxidation-Specific Epitopes in Non-Alcoholic Fatty Liver Disease.

An improper balance between the production and elimination of intracellular reactive oxygen species causes increased oxidative stress. Consequently, DNA, RNA, proteins, and lipids are irreversibly damaged, leading to molecular modifications that disrupt normal function. In particular, the peroxidation of lipids in membranes or lipoproteins alters lipid function and promotes formation of neo-epitopes, such as oxidation-specific epitopes (OSEs), which are found to be present on (lipo)proteins, dying cells, and extracellular vesicles. Accumulation of OSEs and recognition of OSEs by designated pattern recognition receptors on immune cells or soluble effectors can contribute to the development of chronic inflammatory diseases. In line, recent studies highlight the involvement of modified lipids and OSEs in different stages of the spectrum of non-alcoholic fatty liver disease (NAFLD), including inflammatory non-alcoholic steatohepatitis (NASH), fibrosis, and hepatocellular carcinoma. Targeting lipid peroxidation products shows high potential in the search for novel, better therapeutic strategies for NASH.

Role of PAP Smear Cytology and p16 Immunocytochemistry for Detection of Cervical Lesions of Cervix: A Hospital-Based Study

Pap-smear-based cytology is used widely in detecting cervical precancerous lesions and still needs further standardization. Co-expression of p16 can be used as an additional biomarker for detection of cervical lesions. The aim of the study was to assess the diagnostic value of Pap smears and detection of the p16 proteins in women with cervical lesions. Totally 66 cases of cervical smear were taken, out of whom 14 samples were cytologically normal, 16 samples were inflammatory, 15 samples had low squamous intraepithelial lesions (LSIL), 11 samples had high squamous intraepithelial lesions (HSIL) and 10 samples had cervical squamous cell carcinoma (SCC). The expression of p16 was evaluated by immunohistochemical method. The immunostaining results of p16 were classified into four categories: negative, 1+, 2+ and 3+. There was a significant increase in the expression of p16 (P < 0.001) from cytologically normal to SCC. The expression of p16 (P = 0.01) was significantly increased in inflammatory, LSIL, HSIL and squamous cell carcinoma, and the results were compared with those of Pap smear cytology. The result of p16 was compared with that of Pap smear cytology and can improve the diagnostic accuracy of cervical lesions. p16 expressions increase from inflammatory to LSIL, HSIL and SCC.

Leiomyosarcoma of Urinary Bladder, A Review of Two Cases

Abstract Introduction/Objective Leiomyosarcomas of the urinary bladder are rare smooth muscle tumor, and constitute 1% of all bladder malignancies. Although rare, leiomyosarcoma is a clinically significant disease, presenting as a high-grade advanced malignancy with associated substantial morbidity and mortality, if not treated early. The diagnosis can be delayed because of the asymptomatic presentation until the tumor reaches an advanced stage. Methods We present two cases of leiomyosarcoma of the urinary bladder. First case: a 63 years old female with a history of cervical carcinoma treated with radiation, 25 years ago, followed by uncomplicated clinical course, until recent development of vesicovaginal fistula. During her work up with cystoscopy, a large bladder mass was identified. Second case: a 71 years old female with a history of treated breast cancer, who presented with recurrent history of cystitis and hematuria. Cystoscopy revealed a nodular mass in the right posterior bladder wall. Results Microscopically, both lesions were highly cellular with infiltrative, interlacing fascicles of spindle cells and associated mitosis, cellular atypia and necrosis. Immunohistochemistry revealed positive expression of muscle- specific actin, desmin, and caldesmon; with negative expression of ALK-1, EMA, Cytokeratins and GATA3, in both the cases. Other spindle cell lesions including, leiomyoma, inflammatory myofibroblastic tumor and sarcomatoid carcinoma were included in the differential diagnosis, and ruled out by morphology and immunohistochemistry. Conclusion Our cases highlight the importance of awareness of the occurrence of leiomyosarcomas, a rare manifestation in bladder. Although rare, but they present with a poor outcome. The differential diagnosis of spindle cell lesions is extensive, including close benign and malignant mimics, the treatment of all being very different. Immediate radical cystectomy has been associated with longer survival rates for leiomyosarcoma. Leiomyosarcoma, being aggressive, with associated high recurrence rate and metastatic potential, an early correct diagnosis would aid in the institution of proper management.

A RARE CASE OF DIAGNOSTICALLY CHALLENGING LUNG TUMOR

SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Inflammatory myofibroblastic tumor (IMT) and pulmonary sarcomatoid carcinoma (PSC) are rare tumors and account for less than 1% of primary lung malignancies [1]. We present a diagnostically challenging case of lung neoplasm that was initially diagnosed as IMT but was later found to be PSC. CASE PRESENTATION: A 56-year-old Hispanic male with diabetes mellitus type 2, hypertension, and smoking history was found to have a left lung mass while undergoing treatment for STEMI. He reported diminished appetite, 12 lbs. weight loss, and cough with pink sputum over the last 4-5 months. Lab results showed prominent leukocytosis and normocytic anemia. Treatment with wide spectrum antibiotics was stated for obstructive pneumonia. CT of the chest revealed a necrotic appearing 9x8 cm mass in the left upper lobe of the lung extending to the left hilum with invasion to the left superior pulmonary vein and extension into the left atrium (Pictures 1,2). CT guided lung and mediastinum biopsy initially favored bronchoalveolar carcinoma, but further analysis indicated IMT negative for ALK and ROS markers. Hence, patient was referred for tumor resection but another CT guided lung biopsy at the referred hospital was inconclusive for IMT. A surgical lung biopsy then revealed PSC positive for CD56 marker (Image 3). Neoadjuvant chemotherapy with cisplatin and etoposide, and radiation were started. Debulking surgery was planned later. Six months later patient experienced complex partial seizures, and a 1 cm lesion in the right anterolateral frontal lobe was discovered on MRI (Image 4). Mass resection confirmed it as metastatic PSC. Numerous bilateral cerebral hemispheric hemorrhagic metastases were diagnosed in the following three months. Patient expired 10 months from the date of PSC diagnosis. DISCUSSION: While IMT is a benign mesenchymal neoplasm mixed with inflammatory cells, PSC is carcinoma with at least 10% mesenchymal sarcoma-like elements. Treatment for both is surgical resection, but while recurrence after surgery is rare for IMT (2%), PSC has a poor prognosis with a 5-year survival rate of 20%-36%, compared to 91% for IMT [1,4]. It is very difficult to diagnose PSC and IMT on small biopsy specimens because it may not contain the mesenchymal/heterologous component, resulting in under-detection of PSC [2,4], which was also the reason for multiple biopsies in our patient. Also, spindle cell subtype of PSC may have prominent inflammatory stroma that could be mistaken for IMT [3,5]. CONCLUSIONS: An adequate specimen through surgical resection is critical for diagnosis IMT and PSC due to the heterogeneous composition of the tumors. Inadequate biopsy specimen may lead to misdiagnosis and treatment delay. Reference #1: Weissferdt A. Pulmonary Sarcomatoid Carcinomas: A Review. Adv Anat Pathol. 2018;25(5):304–313. Reference #2: Borczuk AC. Uncommon Types of Lung Carcinoma With Mixed Histology: Sarcomatoid Carcinoma, Adenosquamous Carcinoma, and Mucoepidermoid Carcinoma. Arch Pathol Lab Med. 2018;142(8):914-921. Reference #3: Travis WD. Sarcomatoid neoplasms of the lung and pleura. Arch Pathol Lab Med. 2010 Nov;134(11):1645-58. Sagar AES, Jimenez CA, Shannon VR. Clinical and Histopathologic Correlates and Management Strategies for Inflammatory Myofibroblastic tumor of the lung. A case series and review of the literature. Med Oncol. 2018;35(7):102. Surabhi VR, Chua S, Patel RP, Takahashi N, Lalwani N, Prasad SR. Inflammatory Myofibroblastic Tumors: Current Update. Radiol Clin North Am. 2016;54(3):553-63. DISCLOSURES: No relevant relationships by Olga Grigorieva Olson, source=Web Response No relevant relationships by Faizan Malik, source=Web Response No relevant relationships by dushyant pawar, source=Web Response

Genetic polymorphisms and expression of NLRP3 inflammasome-related genes are associated with Philadelphia chromosome-negative myeloproliferative neoplasms

Inflammation plays a crucial role in the initiation, progression and prognosis of Philadelphia chromosome-negative myeloproliferative neoplasms (MPN), which could be clinically subdivided into polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). Nucleotide binding domain (NOD)-like receptor protein 3 (NLRP3) inflammasomes affect inflammatory diseases and carcinomas by excessive production of cytokines. To investigate a possible association of NLRP3 inflammasome signaling with MPN, we investigated the expression of selected inflammasome-related genes from bone marrow cells of 67 MPN patients as well as gene polymorphisms in NLRP3 (rs35829419), NF-κB1 (rs28362491), CARD8 (rs2043211), IL-1β (rs16944), and IL-18 (rs1946518). It showed that inflammasome-related genes (NLRP3, NF-κB1, CARD8, IL-1β, and IL-18) were highly expressed in BM cells from MPN patients and the increased expression was associated with JAK2V617F mutation, white blood cell counts and splenomegaly. Analysis of genetic polymorphisms in 269 MPN patients and 291 healthy controls demonstrated that NF-κB1 (rs28362491) was associated with MPN and increased expression of NF-κB1, NLRP3 and IL-1β. This research provided novel biomarkers and potential targets for MPN.

Effects of doxorubicin associated with amniotic membrane stem cells in the treatment of canine inflammatory breast carcinoma (IPC-366) cells

BackgroundTumours in mammary glands represent the most common neoplasia in bitches, as in humans. This high incidence results in part from the stimulation of sex hormones on these glands. Among mammary tumours, inflammatory carcinoma is the most aggressive, presenting a poor prognosis to surgical treatment and chemotherapy. One of the most widely used chemotherapy drugs for breast cancer treatment is doxorubicin (DOXO). Alternative therapies have been introduced in order to assist in these treatments; studies on treatments using stem cells have emerged, since they have anti-inflammatory and immunomodulatory properties. The aim of this study was to evaluate the effects of DOXO and canine amniotic membrane stem cells (AMCs) on the triple-negative canine inflammatory mammary carcinoma cell line IPC-366.MethodsFour experimental groups were analysed: a control group without treatment; Group I with DOXO, Group II with AMC and Group III with an association of DOXO and AMCs. We performed the MTT assay with DOXO in order to select the best concentration for the experiments. The growth curve was performed with all groups (I-III) in order to verify the potential of treatments to reduce the growth of IPC-366. For the cell cycle, all groups (I-III) were tested using propidium iodide. While in the flow cytometry, antibodies to progesterone receptor (PR), estrogen receptor (ER), PCNA, VEGF, IL-10 and TGF-β1 were used. For steroidogenic pathway hormones, an ELISA assay was performed.ResultsThe results showed that cells treated with 10 µg/mL DOXO showed a 71.64% reduction in cellular growth after 72 h of treatment. Reductions in the expression of VEGF and PCNA-3 were observed by flow cytometry in all treatments when compared to the control. The intracellular levels of ERs were also significantly increased in Group III (4.67% vs. 27.1%). Regarding to the levels of steroid hormones, significant increases in the levels of estradiol (E2) and estrone sulphate (S04E1) were observed in Groups I and III. On the other hand, Group II did not show differences in steroid hormone levels in relation to the control. We conclude that the association of DOXO with AMCs (Group III) promoted a reduction in cell growth and in the expression of proteins related to proliferation and angiogenesis in IPC-366 triple-negative cells.ConclusionsThis treatment promoted ER positive expression, suggesting that the accumulated oestrogen conducted these cells to a synergistic state, rendering these tumour cells responsive to ERs and susceptible to new hormonal cancer therapies.

Utility of Bolus in Post Mastectomy Radiation

The most common site of local recurrence after mastectomy is within skin and subcutaneous tissues anterior to the pectoralis muscles. The application of tissue-equivalent bolus can improve dose to the skin, which is often significantly below prescription dose in modern radiation treatment plans. However, practice surveys have shown a great degree of international heterogeneity in use of bolus (Vu 2007). The American Radium Society (R) Appropriate Use Criteria (TM) Breast Cancer Committee examined the evidence for use of bolus in post mastectomy radiation. A PRISMA systematic review of available evidence through June 2019 was performed. The Committee reached a Delphi consensus on the appropriateness of bolus use in 3 different clinical variants. Of 26 articles identified using the search terms, 18 were included as evidence. No randomized data for the effect of bolus application on local recurrence for modern photon treatment plans has been published. Several comparative retrospective studies show equivalent rates of recurrence with or without bolus (Abel 2017; Tieu 2011; Uematsu 1993; Turner 2016). Low rates of recurrence (4%-9%) and low rates of grade 2 acute dermatitis (9-10%) were reported without bolus. Probability of grade 2 dermatitis increased with Dmax greater than 5311 cGy (Shiba 2018). Dosimetric evaluation suggests that adequate dose to the skin can be achieved with application of 1 cm bolus in 15 out of 25 treatment days (Andic 2009). Alternatively, 2 mm brass mesh bolus could be applied daily, necessitating only one treatment plan (Ordonez-Sanz 2014; Manager 2016), but, due to risk of neutron formation, should not be used with higher energy photon beams (>10 MV). The Delphi consensus revealed that application of bolus to the chest wall was considered usually appropriate but the omission of bolus from cases involving reconstruction may be appropriate. There was a significant amount of the heterogeneity in the rating of appropriateness for the omission of bolus. Bolus use should be customized to the patient’s skin dose and the patient’s risk of skin recurrence. Some patients may have acceptable skin dose in their PMRT plan without bolus, so treatment plans with and without bolus should be evaluated. Patients with inflammatory carcinoma, positive anterior skin margins or poor skin dose without bolus may benefit more from more aggressive use of bolus while patients with breast reconstruction or poor skin healing may be at greater risk of toxicity with bolus. Aggressive use of bolus may include 1 cm bolus every other day or ≤0.5 cm daily. Less aggressive bolus may use 0.5 cm bolus every other day or no bolus. Removal of bolus after appearance of grade 2 acute dermatitis may help prevent progression to grade 3 toxicity and prevent treatment interruptions. Additional randomized evidence is greatly needed to resolve noted international and Committee heterogeneity regarding bolus use.

Exploration of the developmental process of vasculogenic mimicry in canine inflammatory mammary carcinoma

Canine inflammatory mammary carcinoma (CIMC) similar to human inflammatory breast cancer is a very aggressive, metastatic type of cancer. Previous studies have introduced a new type of tumor angiogenesis called vasculogenic mimicry that may play an important role in the progression of inflammatory mammary cancer. The purpose of this study is to investigate the development process of vessels by neoplastic cells in CIMC. Patient dog, 14-year old Shit-Tzu female, had a hard and somewhat movable dark-reddish mammary tumor, sized 6.2 cm in diameter. Bloody dark turbid exudate was released from the tumor. In addition to histological examination, immunohistochemistry for pancytokeratin, VCAM-1, MECA-32, TWIST-1, and Ki-67 was respectively performed using the ABC method. Histologically, the inflammatory mammary carcinoma was characterized by tubular solid tumor emboli within the lymphatic vessels surrounded by desmoplastic fibrous connective tissue. Some of the neoplastic cells were transforming into elongate or spindle shapes and forming small vessel-like structures in the solid tumor mass. The neoplastic cells were immunoreactive for VCAM-1 and MECA-32, but showed low immunoreactivity for Ki-67. Immunoreactive neoplastic cells for VCAM-1 and MECA-32 suggested the possibility that the neoplastic cells transform into endothelial cells of vessels by epithelial-mesenchymal transition, further supported by serial morphological changes identified by histological investigation and immunohistochemistry for TWIST-1. The high capacity of the neoplastic cells forming the vasculatures in CIMC explains the high ratio of metastasis to other regions, even though Ki-67 index was not so high.

Chitosan-coated magnetic solid lipid nanoparticles for controlled release of letrozole

In present study, magnetic solid lipid nanoparticles (MSLNs) with chitosan (CHI) coating were defined, and the rapid delivery of Letrozole (LTZ) to cancer cells by both active and passive targeting were evaluated. LTZ loaded MSLNs were fabricated using the modified solvent evaporation-ultrasonic combination method. The physicochemical parameters were optimized to achieve a suitable drug delivery system. Afterward Fourier transform infrared spectroscopy (FTIR), differential scanning calorimeter (DSC) and X-ray diffraction (XRD) used as characteristic analyses. DPPH free radical scavenging test was carried out to evaluate the antioxidant capacities of LEC (Lecithin), MSLNs, LTZ, LTZ + MSLNs, and BHT (Butylated hydroxytoluene). DPPH test indicated similar antioxidant activities for LTZ + MSLNs and BHT. For the determining of anti-breast cancer potentials of LEC, MNPs, LTZ, and LTZ + MSLNs, MTT assay was used on the normal cell line (HUVEC), breast adenocarcinoma (MCF7), breast carcinoma (Hs 578Bst), infiltrating ductal cell carcinoma (Hs 319.T), infiltrating lobular carcinoma of breast (UACC-3133), inflammatory carcinoma of the breast (UACC-732), and metastatic carcinoma (MDA-MB-453) cell lines. The desired and favorable particle size and surface charge nanocarrier for targeting cancer cells was obtained. The effect of LFPMF on drug release of the drug delivery system distinctly demonstrated. The findings showed that MSLN loaded with LTZ increased chemotherapy efficiency. LTZ encapsulated MSLN can act as a suitable and promising candidate for targeted and controlled therapy for cancer.

Actinomycosis of male breast: a rare case report

Actinomyces is a commensal of gastrointestinal and genital tract that may cause subacute or chronic granulomatous inflammation. Primary actinomycosis of breast is an extremely rare disease. It may present as a mass or as discharging fistulae. It is often diagnosed after biopsy. It may mimic inflammatory carcinoma or mastitis. Treatment is with a prolonged course of antibiotic. Authors present a case of a 70-year-old male with a palpable breast lump, that was suspected to be malignant. Wide local excision was performed, histopathology confirmed the diagnosis of actinomycoses breast. Patient was given antibiotics post operatively.

An AN OBSERVATIONAL STUDY OF SLN MAPPING IN PATIENTS OF LOCALLY ADVANCED BREAST CANCER FOLLOWING NCT

Background : Locally advanced breast carcinoma (LABC) includes a wide range of clinical scenarios- advanced primary tumors (T4), advanced nodal disease and inflammatory carcinomas(1). Traditionally, treatment of LABC included a combination of Chemotherapy, Radiation and Surgery(2). However, there has been a shift to Neoadjuvant Chemotherapy in recent times.(3)&#x0D; Histological status and the number of axillary lymph nodes with metastasis is one of the most important prognostic factors and most powerful predictor of recurrence and survival in patients of breast carcinoma and remains so, even after neo-adjuvant chemotherapy. (3) Information derived from the sentinel lymph node is considered valuable, with less discomfort to the patient when compared with axillary dissection.(4) However, its role in detecting nodal metastasis after neo-adjuvant chemotherapy in LABC is still debatable and definitive studies to evaluate its role are still evolving. (5)&#x0D; Materials and Methods: Patients of LABC were evaluated using ultrasonography (USG) of axilla. Neo-adjuvant chemotherapy (NACT) was administered and patients were reassessed by USG of axilla. Thirty patients with node negative axillary status were subjected to Sentinel lymph node mapping using isosulfan blue followed by Modified Radical Mastectomy and Axillary Lymph Node Dissection. Histopathological evaluation of stained and unstained lymph nodes done and the data, thus obtained, was statistically analysed.&#x0D; &#x0D; Results: Sentinel lymph node biopsy performed using Isosulfan Blue dye alone, after neo-adjuvant chemotherapy predicts the status of axillary lymph nodes with low accuracy.&#x0D; &#x0D; Conclusions: Further studies would be required to establish the role of sentinel lymph node biopsy in patients with LABC after NACT.

Abstract P5-06-09: Comparative analysis of proposed strategies for incorporating biologic factors into breast cancer staging

Abstract Background: Tumor biology is an important prognostic factor in breast cancer. The 8th edition AJCC pathologic prognostic stage incorporates biologic factors (grade, ER, PR, and HER2 status) along with anatomic staging to improve risk stratification. Additional staging models have been proposed including Bioscore and Risk Score. The Bioscore assigns a score of 0-7 based on anatomic stage, ER, HER2, and grade. The Risk Score assigns a score of 0-3 to each anatomic stage group, with 1 point assigned for ER-negative, HER2-negative, or grade 3 status. The objective of this study was to compare the performance of these models in a large, population-based cohort of breast cancer patients. Methods: The Surveillance, Epidemiology and End Results Program (SEER) database was used to identify primary stage I-IV breast cancer patients diagnosed in 2010. Patients were excluded for inflammatory carcinoma, neoadjuvant therapy, and missing data on receptors or tumor grade. 5-year disease specific survival (DSS) estimates were calculated using Cox regression for each staging model: AJCC anatomic stage, AJCC pathologic prognostic stage, Bioscore and Risk Score. Harrell concordance index (C-index) and Akaike Information Criterion (AIC) were used to compare each model in predicting DSS, with higher C-index and lower AIC indicating better predictive value and model fit. Results: 21,901 patients were included with a median age was 60 years. Median follow up was 52 months. All four staging models stratified DSS survival, with stepwise increases in hazard ratios and decrease in DSS for each increase in risk category (Table). The C-index of each model with biologic factors was higher than for anatomic stage, with the Risk Score having the highest C-index (0.832 for the anatomic stage; 0.856 for pathologic prognostic stage; 0.855 for Bioscore; and 0.864 for Risk Score). AIC was lowest for Risk Score (27315 for anatomic stage; 26874 for prognostic stage; 27120 for Bioscore; and 26753 for Risk Score), suggesting the best model fit for staging. Discussion: Staging models incorporating biologic factors perform better than anatomic staging alone. The Risk Score has the lowest AIC and may be the easiest to use as it simply assigns 1 point each for ER-negative, HER2-negative, and grade 3 tumors to each anatomic stage. In addition, the Risk Score has the added benefit of being the only staging system to stratify stage IV disease. We advocate for consideration of the Risk Score as an alternative to the pathologic prognostic stage for ease of use, optimal communication with patients and providers, and to standardize future clinical trials. Table. 5-yr estimates of DSS in 21,464 breast cancer patients in 4 models of breast cancer stagingAnatomic Stage5-yr DSSPrognostic Stage5-yr DSSBioscore5-yr DSSRisk Score5-yr DSSIA98.6IA98.7098.9IA098.9IB96.3IB93.7199.1199.2IIA94.5IIA90.1297.5297.1IIB92IIB84.2393.2392.8IIIA83.3IIIA80.5488.3IIA096.7IIIB73.2IIIB72.3570.2197.7IIIC68.6IIIC53.3656.2291.0IV38.8IV38.8732.2386.8IIB096.6194.7290.4380.4IIIA092.8190.0274.9365.2IIIB096.0180.3269.6353.9IIIC063.3178.0268.2339.7IV061.7147.5230.3310.8 Citation Format: Olga Kantor, Jiangong Niu, Hui Zhao, Sharon H Giordano, Kelly K Hunt, Tari A King, Elizabeth A Mittendorf, Mariana Chavez-MacGregor. Comparative analysis of proposed strategies for incorporating biologic factors into breast cancer staging [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-06-09.

Comparative Analysis of Proposed Strategies for Incorporating Biologic Factors into Breast Cancer Staging

Tumor biology is an important prognostic factor in breast cancer. This study aimed to compare three staging systems incorporating both biologic factors and anatomic staging (AJCC 8th-edition pathologic prognostic staging, Bioscore, and Risk Score) in a large population-based cohort. The Surveillance, Epidemiology and End Results program was used to select patients with primary stages 1-4 breast cancer diagnosed in 2010. Patients with inflammatory carcinoma, those with missing data for biologic factors, and those with stages 1-3 disease not treated with surgery were excluded from the study. Estimates of 5-year disease-specific survival (DSS) were calculated using the Kaplan-Meier method. The Harrel concordance index (C-index) and the Akaike Information Criterion were used to compare each model in terms of predicting DSS. The study included 21,901 patients with a median age of 60years. The median follow-up period was 52months. All the staging models stratified DSS, with a stepwise decrease in DSS for each increase in risk category or score. The C-index of each model incorporating biologic factors was higher than the C-index for anatomic staging alone (C-index: 0.832 vs. 0.856 for AJCC pathologic prognostic staging, 0.856 for Bioscore, and 0.864 for Risk Score, all p < 0.001). The staging systems incorporating biologic factors did not differ significantly in terms of model fit. Staging systems incorporating biologic factors perform better than anatomic staging alone. Implementation of the AJCC 8th-edition pathologic prognostic staging was an important initial step in the inclusion of tumor biology in staging. Given its simplicity and ease of use, the Risk Score should be given consideration as an alternative staging system.

Therapeutic and Diagnostic Challenge of Idiopathic Granulomatous Mastitis: A Case Report and Review of the Literature

Idiopathic Granulomatous mastitis (IGM) is a chronic benign inflammatory disease of the breast that may mimic breast cancer. It is most common in parous young fertile women, although it can occur in nulliparous. It affects mostly women of childbearing age with a history of breastfeeding. IGM is an idiopathic disease due to the influence of some environmental factors in genetically predisposed subjects. Several pathogenic hypothesis have been proposed in the last years (autoimmune, hormonal, infective genesis). Because the clinical presentation can mimic infectious mastitis or inflammatory carcinoma, the disease course is often protracted. The diagnosis is made by histopathology. Ultrasound, mammography, and magnetic resonance imaging are not specific; however, ultrasound and mammography should be done to exclude other pathologies. There is no universal treatment of GM. We report in this manuscript one case of IGM through which we mention a therapeutic and diagnostic challenge with a brief review of the literature. The management was successful despite the long way made by the patient before she acceded to a proper treatment.