Cases Of Invasive Breast Cancer Research Articles

Current status and challenges in HER2 IHC assessment: scoring survey results in Japan.

This study aimed to assess the concordance of human epidermal growth factor receptor 2 (HER2) expression scoring by immunohistochemistry (IHC) among practicing pathologists in Japan, given the challenging nature of scoring and the critical role of HER2 status in breast cancer management. Whole slide images (WSI) from 20 invasive breast cancer cases (1 representative WSI per case) selected to represent a diverse IHC scores and staining patterns were used in an online survey involving seven reference pathologists who established consensus HER2 IHC scores (0 to 3 +) decided by majority interpretation. Participating pathologists nationwide scored the same 20 WSI cases online using the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) 2018 guidelines. Deidentified case metadata were registered in the uPath system. A total of 144 participating pathologists responded. The scoring results of the participating pathologists most commonly agreed with the consensus IHC score, followed by a ± 1 point deviation and no survey responses with > 1 point deviation. The mean percentage of agreement with the consensus score for all 20 cases was 63.4%. In cases where the reference pathologists' scores were discordant, the participating pathologists also showed a lower concordance rate. This study highlighted the current status of HER2 expression scoring by IHC for breast cancer among pathologists in Japan. These findings underscore the challenges in HER2 IHC scoring cases and emphasize the need for improved standardization and training, especially in the evolving landscape of HER2-targeted therapies.

Consumption of aspartame and risk of breast cancer in the Nurses' Health Studies.

Debate persists regarding the potential carcinogenicity of aspartame as suggested by experimental studies. Therefore, we prospectively evaluated whether aspartame consumption is associated with breast cancer risk in the Nurses' Health Study (NHS) and Nurses' Health study II (NHSII). We used Cox models to calculate HRs and 95% CIs. During up to 30 years of follow-up with 4-yearly assessments of intake, we documented 10,814 invasive breast cancer cases. Overall, there was no association between aspartame consumption and invasive breast cancer risk (HR per 200 mg/day [approximately one 12 oz serving of diet soda] = 1.00 (95% CI 0.98, 1.03). We observed similar lack of associations after excluding cases occurring in the first 10 years of follow-up (n = 3,125) (HR per 200 mg/day 1.00, 95% CI 0.97, 1.03). In these cohorts, aspartame consumption did not increase breast cancer risk.

Epidermal growth factor receptor (EGFR) and vascular endothelial growth factor A (VEGF-A) expressions in Ethiopian female breast cancer and their association with histopathologic features.

Epidermal growth factor receptor (EGFR) and vascular endothelial growth factor receptor (VEGF) play important role in breast tumor growth, invasion, metastasis, patient survival and drug resistance. The aim of this study was to evaluate the protein expression status of EGFR and VEGF-A, as well as their association with hormone receptor status and histopathological characteristics in the invasive type of female breast cancer among Ethiopians. The primary breast tumor tissues were obtained from 85 Ethiopian invasive breast cancer cases that underwent modified radical mastectomy (MRM) from June 2014 to June 2015. Their FFPE blocks were analyzed for EGFR and VEGF protein expressions using immunohistochemical techniques. The expressions were also correlated with histopathologic features. Epidermal growth factor receptor over-expression was observed in 22% of the tumor samples. VEGF-A expression was negative in 13.41%, low in 63.41%, moderate in 20.73%, and high in 2.44%. EGFR expression, but not VEGF-A, showed a significant inverse correlation with both estrogen receptor (ER) (P = 0.01) and progesterone receptor (PR) statuses (P = 0.04). EGFR and VEGF expressions did not show significant association with tumor size, grade, lymph node status or age at diagnosis. Epidermal growth factor receptor expression was most likely associated with ER and PR negative tumors. Assessments of multiple molecular markers aid to understand the biological behavior of the disease in Ethiopian population. It might also help to predict which group of patients might get more benefit from the selected treatment strategies and which are not.

Immunohistochemical Expression of Cyclin D1 in Invasive Breast Carcinoma

Objective: This study was conducted to determine the immunohistochemical expression of cyclin D1 in invasive breast carcinoma and its association with already established prognostic parameters like estrogen receptor (ER), progesterone receptor (PR), HER2/Neu, and Ki67 status. Study Design & Setting: Cross sectional Observational. Department of Pathology, Armed Forces Institute of Pathology, Rawalpindi Methodology: The study included 350 cases of invasive breast cancer diagnosed between January 2023 and December 2023. Data collected included patient age, histological subtype, molecular subtypes, tumor size, and the presence of estrogen (ER) and progesterone (PR) receptors, as well as HER2/Neu and Ki67 status. Patients who had undergone chemotherapy, received radiation to the breasts, or experienced relapse were excluded from the study. Immunohistochemistry was conducted using a Cyclin D1 antibody to assess Cyclin D1 expression in tissue samples. The expression levels were categorized as negative, weak, moderate, strong staining in tumor cells. Data analysis was performed using SPSS 29.0, and statistical comparisons were made between Cyclin D1 staining and ER, PR, HER2/Neu, and Ki67 status. Results: Cyclin D1 moderate to strong staining was seen in 173/352 (49.14%) cases of invasive BC. Cyclin D1 expression was slightly statistically significantly associated with ER (x2 = 7.78, P value <0.051) and Ki67 positivity (÷2 = 7.27, P value <0.064). Conclusion: Cyclin D1 has the potential to serve as a prognostic marker. Incorporating it into the routine IHC workup for breast cancer could enhance patient management, especially with the development of new targeted therapies that inhibit the Cyclin D-CDK4/6 axis.

The Landscape of Breast Cancer Molecular and Histologic Subtypes in Canada.

Purpose: To characterize the histologic and molecular subtype distribution of, and survival from, breast cancer (BC) among Canadian women overall, and by stage and age at diagnosis. Methods: Invasive BC cases from the Canadian Cancer Registry for women aged 15-99 years between 2012 and 2017 in Canada, excluding Quebec, were examined using pre-existing mortality linkages. Stage at diagnosis, molecular, and histologic subtypes, and 5-year net survival (NS) by age, subtype, and stage were determined. Results: 107,271 women with BC were included. Luminal A was the most common subtype, present in increasing proportions as women aged, up to a maximum of 55% of cases in 70-74. Ductal and luminal A were most likely to be diagnosed at stage I, while HER2+ had the highest proportion of diagnosis at stage III; triple negative (TN) and unknown had the highest proportion of stage IV. For all stages combined, luminal A had a five-year NS of 98%, while TN was 74%. NS for stage I BC was 99-100% for all subtypes, excepting TN, which was 96%. Survival decreased with advancing stage, most markedly for TN, for which stage III was 47% and stage IV 7%. Survival by equivalent stage and subtype was comparable across age groups but declined in older age categories. Conclusions: The varying natural histories of BC subtypes and histologies can inform prognoses, health system economics, and screening practices. The NS of 96% or greater for stage I, regardless of subtype, highlights the importance of early detection for all subtypes of BC, especially in aggressive subtypes.

Health-related quality of life among women diagnosed with in situ or invasive breast cancer and age-matched controls: a population-based study

PurposeA breast cancer (BC) diagnosis may negatively affect health-related quality of life (HRQoL). However, there are few comparisons of HRQoL at several time points for women with BC, and particular when subdivided into invasive and in situ tumors. The purpose of this study was to investigate various aspects of HRQoL in women recently diagnosed with invasive BC or ductal carcinoma in situ (in situ) compared to age-matched BC free controls in a population-wide sample recruited through the Cancer Registry of Norway.MethodsThis cross-sectional study utilized HRQoL data collected in 2020–2022 from a digital survey including 4117 cases (3867 women with invasive BC and 430 with in situ) and 2911 controls. HRQoL was assessed ≥ 21 days after diagnosis, using EORTC QLQ-C30. This includes scores assessing global quality of life (gHRQoL) and HRQoL functions and symptoms. Multivariable regression analyses were used to compare HRQoL between cases and controls and to identify factors associated with gHRQoL and fatigue. Additionally, HRQoL 14 months after diagnosis was analyzed in 1989 of the included cases and in 1212 of the controls. Score differences of ≥ 10 points were considered clinically relevant and thus presented in the results.ResultsInvasive BC cases had lower gHRQoL, role- and social functioning in addition to more fatigue than controls. In situ cases had lower role—and social functioning than controls. Invasive BC cases scored worse than in situ on all domains, but the differences were not considered clinically relevant. Physical activity was associated with better gHRQoL and less fatigue in invasive BC, in situ and controls. Both invasive BC and in situ cases improved their role- and social functioning scores from diagnosis to 14 months follow-up, however no improvement was seen for fatigue.ConclusionWomen with invasive BC and in situ reported lower role- and social functioning scores than controls right after diagnosis with improvements 14 months after diagnosis. Physical activity was associated with better gHRQoL and less fatigue and should, whenever possible, play a key role in the care for BC patients.

Trajectories of long-term exposure to PCB153 and Benzo[a]pyrene (BaP) air pollution and risk of breast cancer

BackgroundWhile genetic, hormonal, and lifestyle factors partially elucidate the incidence of breast cancer, emerging research has underscored the potential contribution of air pollution. Polychlorinated biphenyls (PCBs) and benzo[a]pyrene (BaP) are of particular concern due to endocrine-disrupting properties and their carcinogenetic effect.ObjectiveTo identify distinct long term trajectories of exposure to PCB153 and BaP, and estimate their associations with breast cancer risk.MethodsWe used data from the XENAIR case–control study, nested within the ongoing prospective French E3N cohort which enrolled 98,995 women aged 40–65 years in 1990–1991. Cases were incident cases of primary invasive breast cancer diagnosed from cohort entry to 2011. Controls were randomly selected by incidence density sampling, and individually matched to cases on delay since cohort entry, and date, age, department of residence, and menopausal status at cohort entry. Annual mean outdoor PCB153 and BaP concentrations at residential addresses from 1990 to 2011 were estimated using the CHIMERE chemistry-transport model. Latent class mixed models were used to identify profiles of exposure trajectories from cohort entry to the index date, and conditional logistic regression to estimate their association with the odds of breast cancer.Results5058 cases and 5059 controls contributed to the analysis. Five profiles of trajectories of PCB153 exposure were identified. The class with the highest PCB153 concentrations had a 69% increased odds of breast cancer compared to the class with the lowest concentrations (95% CI 1.08, 2.64), after adjustment for education and matching factors. The association between identified BaP trajectories and breast cancer was weaker and suffered from large CI.ConclusionsOur results support an association between long term exposure to PCB153 and the risk of breast cancer, and encourage further studies to account for lifetime exposure to persistent organic pollutants.

Overexpression of cytoplasmic poly(A)-binding protein 1 as a biomarker for the prognosis and selection of postoperative regimen in breast cancer.

The dysregulation of the cytoplasmic poly(A)-binding protein 1 (PABPC1) is involved in a variety of tumors but little is known about its role in human breast cancer. Therefore, the effect of PABPC1 in the prognosis and regimen selection in breast cancer patients was evaluated. A total of 791 cases of invasive breast cancer were included in this study, although only 416 were involved in subsequent analyses after the propensity score matching (PSM) test. PABPC1 expression was detected by immunohistochemistry. The relationship between PABPC1 expression and clinicopathological factors, postoperative regimens, and outcomes was determined. In the total 791 cases, 583 cases were positive for PABPC1, but only 212 (26.8%) showed high PABPC1 expression (PABPC1-HE). The overall survival (OS) and disease-free survival (DFS) of PABPC1-HE patients after PSM were significantly worse than those in patients with PABPC1 low expression (PABPC1-LE), regardless of age, molecular type, tumor size, nodal status, or pStage. Postoperative chemotherapy (CT) increased the OS of PABPC1-HE patients but not that of PABPC1-LE patients. Among patients receiving endocrine therapy, those in the PABPC-LE group had an extended OS, while CT or chemoradiotherapy (CT/CRT) only significantly extended the OS time of PABPC-HE patients. CT/CRT did not significantly extend the survival of PABPC1-LE HER2-positive patients but extended the OS of PABPC1-HE HER2-positive patients. However, the OS of patients treated with CT/CRT + trastuzumab therapy was significantly longer than that of other patients under other therapies in the PABPC1-HE group, suggesting that PABPC1-HE might be sensitive to trastuzumab-based therapy. The multivariate analysis revealed that PABPC1-HE was an independent prognostic factor for both poor OS and DFS in breast cancer except luminal A type. Our results revealed that PABPC1 might be considered as a biomarker to help in subtyping, as well as in the prognosis and regimen selection of breast cancer patients.

Ultrasound-based deep learning radiomics nomogram for differentiating mass mastitis from invasive breast cancer

BackgroundThe purpose of this study is to develop and validate the potential value of the deep learning radiomics nomogram (DLRN) based on ultrasound to differentiate mass mastitis (MM) and invasive breast cancer (IBC).Methods50 cases of MM and 180 cases of IBC with ultrasound Breast Imaging Reporting and Data System 4 category were recruited (training cohort, n = 161, validation cohort, n = 69). Based on PyRadiomics and ResNet50 extractors, radiomics and deep learning features were extracted, respectively. Based on supervised machine learning methods such as logistic regression, random forest, and support vector machine, as well as unsupervised machine learning methods using K-means clustering analysis, the differences in features between MM and IBC were analyzed to develop DLRN. The performance of DLRN had been evaluated by receiver operating characteristic curve, calibration, and clinical practicality.ResultsSupervised machine learning results showed that compared with radiomics models, especially random forest models, deep learning models were better at recognizing MM and IBC. The area under the curve (AUC) of the validation cohort was 0.84, the accuracy was 0.83, the sensitivity was 0.73, and the specificity was 0.83. Compared to radiomics or deep learning models, DLRN even further improved discrimination ability (AUC of 0.90 and 0.90, accuracy of 0.83 and 0.88 for training and validation cohorts), which had better clinical benefits and good calibratability. In addition, the information heterogeneity of deep learning features in MM and IBC was validated again through unsupervised machine learning clustering analysis, indicating that MM had a unique features phenotype.ConclusionThe DLRN developed based on radiomics and deep learning features of ultrasound images has potential clinical value in effectively distinguishing between MM and IBC. DLRN breaks through visual limitations and quantifies more image information related to MM based on computers, further utilizing machine learning to effectively utilize this information for clinical decision-making. As DLRN becomes an autonomous screening system, it will improve the recognition rate of MM in grassroots hospitals and reduce the possibility of incorrect treatment and overtreatment.

Effect of decalcification on immunohistochemical staining of trichorhinophalangeal syndrome type 1

AbstractTo evaluate the effect of different decalcification solutions on the immunohistochemical staining of trichorhinophalangeal syndrome type 1 (TRPS1), and to provide a reliable basis for the accurate diagnosis of bone metastasis of breast cancer. Due to the limited biopsy samples of bone metastatic cancer, 20 cases of invasive breast cancer were selected to simulate bone metastatic biopsy, dividing into four groups: undecalcified group, 30% formic acid group, 10% hydrochloric acid group and 10% nitric acid group. Immunohistochemical staining was performed after treatment for 2, 6, 18 and 24 h. There was no change in the proportion and intensity of TRPS1 cells in the formic acid decalcification group within 18 h, but decreased significantly after 24 h. The staining intensity of TRPS1 and the proportion of stained cells were significantly decreased in the hydrochloric acid decalcification group since 2 h treatment. The percentage and intensity of positive cells in the nitric acid decalcification group changed little or no change within 6 h, and then gradually decreased with the extension of time. Another three invasive breast cancer samples were used to compare the effects of different decalcification solutions on the same case. In brief, we conclude that the effect of 30% formic acid decalcification on TRPS1 staining is small when the time is less than 18 h. 10% nitric acid decalcification should be controlled within 6 h, which has little effect on TRPS1 staining, and 10% hydrochloric acid decalcification will lead to significantly less positive TRPS1 staining, so it is not recommended for breast bone metastasis tissue decalcification.

Prediction of Abnormal Growth of Breast Cancer Cell Using Support Vector Machine

Abstract: Breast cancer is a serious health concern that affects millions of women worldwide. Early detection of breast cancer is crucial for effective treatment and improved survival rates. Artificial intelligence (AI) has shown great promise in the field of medical imaging and has been increasingly used for breast cancer detection. Cancer is one of the most dangerous diseases to humans, and yet no permanent cure has been developed for it. Breast cancer is one of the most common cancer types. According to the National Breast Cancer foundation, in 2020 alone, more than 276,000 new cases of invasive breast cancer and more than 48,000 non-invasive cases were diagnosed in the US. To put these figures in perspective, 64% of these cases are diagnosed early in the disease’s cycle, giving patients a 99% chance of survival. In this paper we develop a system for diagnosis, prognosis and prediction of breast cancer using AI. This will assist the doctors in diagnosis of the disease. In this research work, we systematically reviewed previous work done on detection and treatment of breast cancer using genetic sequencing or histopathological imaging with the help of deep learning and machine learning We use of AI for breast cancer detection, including studies that have used mammography, ultrasound, and magnetic resonance imaging (MRI) as imaging modalities. AI can also improve the accuracy and efficiency of breast cancer screening and diagnosis, as well as the challenges that must be addressed to ensure the successful integration of AI into clinical practice. However, further research and development are needed to optimize AI algorithms and ensure their safety and effectiveness in clinical practice. Breast cancer detection has emerged as a critical area of research, leveraging the power of Artificial Intelligence (AI) to enhance diagnostic accuracy and efficiency. Utilizing AI technologies, particularly deep learning, enables the development of robust and precise models for early breast cancer detection. These models analyze mammographic images, identifying subtle patterns indicative of malignancies that may escape human eye detection. Transfer learning, employing pre-trained neural network architectures, has demonstrated significant success in leveraging existing knowledge for improved performance. The integration of convolutional neural networks (CNNs) and image processing techniques empowers AI models to discern subtle abnormalities, aiding in the timely identification of potential breast tumors. Additionally, AI-driven diagnostic tools can streamline radiologists' workflow, providing rapid and reliable assessments, ultimately contributing to early intervention and improved patient outcomes. As these technologies continue to evolve, the synergy between AI and breast cancer detection promises to revolutionize screening methods, fostering a paradigm shift towards more accurate, efficient, and accessible diagnostic practices in the realm of breast health.

Invasive micropapillary type male breast cancer: a case report

Male breast cancer is rarely seen and peaks at the age of 71. Hyperestrogenism, gonadal dysfunction, obesity, and alcohol are among the risk factors for male breast cancer. In hereditary cases, BRCA2 mutation is often observed. The most common symptom is a painless mass that is palpable behind the nipple. Most male breast cancers are ductal carcinomas (81%), papillary carcinomas (13%), and mucinous carcinomas (6%). The invasive micropapillary carcinoma of the breast is important due to its high rate of lymphnode metastasis, recurrence, and distant metastasis. Mortality is 50% higher in men with lymphnode involvement compared to non-involved cases. Furthermore, as the number of affected lymphnodes increases, the prognos is worsens. In this study, we examined a case of invasive micropapillary type male breast cancer with clinical presentation as a palpable mass, lymphnode involvement, and aimed to highlight the radiological considerations that need attention.

Random effects models of tumour growth for investigating interval breast cancer.

In Nordic countries and across Europe, breast cancer screening participation is high. However, a significant number of breast cancer cases are still diagnosed due to symptoms between screening rounds, termed "interval cancers". Radiologists use the interval cancer proportion as a proxy for the screening false negative rate (ie, 1-sensitivity). Our objective is to enhance our understanding of interval cancers by applying continuous tumour growth models to data from a study involving incident invasive breast cancer cases. Building upon previous findings regarding stationary distributions of tumour size and growth rate distributions in non-screened populations, we develop an analytical expression for the proportion of interval breast cancer cases among regularly screened women. Our approach avoids relying on estimated background cancer rates. We make specific parametric assumptions concerning tumour growth and detection processes (screening or symptoms), but our framework easily accommodates alternative assumptions. We also show how our developed analytical expression for the proportion of interval breast cancers within a screened population can be incorporated into an approach for fitting tumour growth models to incident case data. We fit a model on 3493 cases diagnosed in Sweden between 2001 and 2008. Our methodology allows us to estimate the distribution of tumour sizes at the most recent screening for interval cancers. Importantly, we find that our model-based expected incidence of interval breast cancers aligns closely with observed patterns in our study and in a large Nordic screening cohort. Finally, we evaluate the association between screening interval length and the interval cancer proportion. Our analytical expression represents a useful tool for gaining insights into the performance of population-based breast cancer screening programs.

Abstract PO4-16-01: EZH2 is Overexpressed in Invasive Carcinoma and DCIS in both BRCA1 and BRCA2 Mutation Carriers

Abstract Background The transcriptional repressor EZH2 (Polycomb Group Protein Enhancer of Zeste Homologue 2) is overexpressed in multiple neoplasms including breast cancer where it associates with high proliferation, aggressive features and poor prognosis and is of interest as a potential therapeutic target. EZH2 nuclear expression in breast cancer has been shown to correlate specifically with high tumor grade and basal-like histologic features but has not been well studied in cancers from BRCA carriers. Here we evaluate the expression of EZH2 protein in BRCA-associated invasive breast carcinomas and precursor lesions. Methods Eighteen cases of invasive breast cancer in consented BRCA carriers (8 BRCA1 and 10 BRCA2) treated at Dana Farber Cancer Institute from 2001-2019 were reviewed by two pathologists (TAD and RBPP). Histopathologic features (histologic subtype, nuclear grade, mitotic score) and presence of precursor lesions were recorded. Immunohistochemistry for EZH2 was performed on freshly cut formalin-fixed paraffin-embedded tissue sections (1-3 sections/case) using a monoclonal antibody against EZH2 (D2C9, Cell Signaling). Nuclear EZH2 expression was scored as negative (score=1, no staining); weak (score 2, < 25%); moderate (score=3, 25–75%); and strong (score=4, >75%), of any intensity following published criteria. EZH2 overexpression was defined as scores 3 and 4. Results The majority of the invasive carcinomas showed grade III histology (13/18, 72%), as expected. Of 8 BRCA1 cases, 6 were classified as grade III (75%), 1 as grade II, and 1 as grade I (7 cases of invasive ductal carcinoma and 1 case of invasive tubular carcinoma). Of 10 BRCA2 cases, 7 were classified as grade III (70%) and 3 as grade II (30%) (5 cases of invasive ductal carcinoma and 5 cases of invasive carcinoma with ductal and lobular features). The majority of cases (13 of 18, 72%) showed high expression of EZH2 in the invasive carcinoma (6 BRCA1 and 7 BRCA2 cases; 2 grade II and 11 grade III). Of 13 cases with EZH2 overexpression, 6 were ER+/PR+/HER2- and 7 were triple negative, with 9 invasive ductal carcinomas and 4 invasive carcinomas with ductal and lobular features. Of 5 cases with no/low EZH2 overexpression, 1 was ER+/PR+/HER2-, 3 were ER+/PR-/HER2- and 1 was triple negative, with 3 invasive ductal carcinomas, 1 invasive carcinoma with ductal and lobular features and 1 invasive tubular carcinoma. In all cases with adjacent ductal carcinoma in situ (DCIS) (n=14), the pattern of EZH2 expression in the DCIS was identical to that seen in the invasive carcinoma (11 high and 3 low expression). Overexpression of EZH2 was not observed in any other precursor lesions (LCIS, ADH, ALH) or in normal tissue. Conclusion EZH2 protein overexpression is seen in the majority of invasive carcinomas in BRCA carriers, both in BRCA1 and in BRCA2. In all cases, the associated DCIS shows the same pattern of expression as the invasive carcinoma, suggesting that overexpression occurs early in tumorigenesis, while tumor cells are still confined within the ducts. The high rate of overexpression of EZH2 in BRCA1- and BRCA2-associated tumors suggests a potential role for EZH2 as a target and/or a biomarker in these cancers. Citation Format: Tabata Alves Domingos, Roberto Bonfim Pimenta Peixoto, Rodrigo Fonseca Abreu, Ashka Patel, Krishan Taneja, McKenna Moore, Celina Kleer, Deborah Dillon. EZH2 is Overexpressed in Invasive Carcinoma and DCIS in both BRCA1 and BRCA2 Mutation Carriers [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-16-01.

Abstract PO1-24-03: The clinicopathological and prognostic significance of HER2-low breast cancer: A comparative analysis between HER2-low and HER2-zero subtypes

Abstract Background: HER2-low breast cancer (BC) is a newly defined subset of HER2-negative BC that has a HER2 immunohistochemical (IHC)-1+ or 2+/ISH negative phenotype. Recent clinical trials have demonstrated the clinical benefits of novel HER2 directing ADCs in treating this group. It is uncertain whether HER2-low BC represents a distinct biological/clinical subgroup or if the HER2-low categorization has any prognostic significance. We retrospectively investigated the clinicopathological and prognostic significance of HER2-low BC and compared it with HER2-0 BC. Methods: Primary BC patients who underwent surgery from January 2000 to March 2023 were enrolled in this retrospective study. A total of 10,215 invasive BC cases with Stage I-III were analyzed. The HER2 status was divided into 3 groups: HER2-0, HER2-low, and HER2-positive (3+ or 2+ with positive ISH). The clinicopathological factors investigated were age, nodal status, tumor size, nuclear grade (NG), ER/PgR (cutoff points; 1% and 10%), and the Ki-67 index value (cutoff points: 15% and 30%). The pCR rate in patients who underwent neoadjuvant chemotherapy (NAC) was examined. The disease-free (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method and tested with the log-rank procedure. Uni- and multivariate analyses for recurrent factors were performed using the Cox proportional hazard model. Results: 1. The HER2 status was classified as follows; HER2-0 in 1,227 cases (12.0%), HER2-low in 7,209 cases (70.6%), and HER2-positive in 1,779 cases (17.4%). In the recurrent cases, HER2-low was observed in 648 cases (66.1%), and in cases treated with NAC, HER2-low was observed in 544 cases (52.7%). 2. The HER2 status significantly correlated with age, tumor size, lymph nodal status, ER, PgR, NG, and the Ki-67 index value. A comparison between HER2-low and HER2-0 revealed that patients with HER2-low tumors were significantly more likely to be under 50 years of age and had more positive nodes. Moreover, HER2-low was significantly associated with positive ER/PgR, lower NG, and lower Ki-67 index values. 3. There was no significant difference in terms of DFS between the three HER2 groups. However, a difference was observed between the three groups in terms of OS. HER2-0 had the lowest OS rate. Moreover, there was a significant difference in OS after recurrence between HER2-0 and HER2-low. 4. When the DFS for the ER status was examined, a significant difference between the HER2 status in cases with ER < 1.0% and ER>10% was observed. Moreover, the DFS in the HER2-low cases was equivalent to the DFS in the HER2-0 cases. However, the DFS in HER2-low was lower in the ER 1-10% group. Although all the HER2 groups showed a significant difference in OS, HER2-low in the ER 1-10% group had the lowest OS, and HER2-0 in the ER>10% group had the lowest OS and was significantly different from HER2-low in the same group. 5. A multivariate analysis revealed that there was no significant difference between HER2-low and HER2-0 as a prognostic factor after recurrence. 6. The pCR rate for NAC was lowest in the HER2-low group, and the pCR rate in the HER2-low group was significantly lower than the HER2-0 group. 7. The DFS after NAC was significantly better in all the pCR cases, regardless of the HER2 status. However, the DFS was significantly lower in the HER2-low non-pCR cases. Conclusion: HER2-low accounted for 70% of the cases. There were more cases with positive ER/PgR, lower NG, and lower Ki-67 index values in the HER2-low group. The HER2-low group had a significantly better OS than the HER2-0 group. However, the response to NAC was low in the HER2-low group and this group had the poorest prognosis among all the non-pCR cases. These findings indicate that HER2-low has a different biology and prognosis compared to HER2-0 and it may be a new subtype. Citation Format: Reiki Nishimura, Yoshitaka Fujiki, Tetsuhiko Taira, Toshiko Miyaki, Shuichi Kanemitsu, Daisuke Yotsumoto, Megumi Teraoka, Junko Kawano, Naomi Gondo, Reiko Mitsueda, Shinichi Baba, Yasuyo Ohi, Yoshiaki Rai, Yoshiaki Sagara, Yasuaki Sagara. The clinicopathological and prognostic significance of HER2-low breast cancer: A comparative analysis between HER2-low and HER2-zero subtypes [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-24-03.

Abstract PO5-08-11: Genetic Landscape of Early Breast Cancer in an Ashkenazi Jewish Cohort

Abstract Background: The Ashkenazi Jewish (AJ) population exhibits a distinctive mutation profile in BRCA1 and BRCA2 (BRCA1/2), characterized by 3 common founder mutations: BRCA1 185delAG, BRCA1 5382insC, and BRCA2 6174delT. These 3 mutations are associated with 10% of invasive breast cancer (BC) cases among AJ women. However, the frequency of non-founder pathogenic variants in BRCA1/2 and other BC-related genes in AJ women with BC remains unclear. Methods: This retrospective study included AJ patients diagnosed with stage I-II human epidermal receptor growth factor 2 negative BC between 2004-2022 at the Weill Cornell Breast Center. We collected clinicopathological characteristics and genetic information to determine the frequency of predisposing mutations in BC and non-BC related genes in AJ patients with early BC. We also analyzed the clinicopathological characteristics and outcomes of patients with and without germline mutations in these genes. Results: The study included 232 self-identified AJ patients, with 98% being females. The median age at BC diagnosis was 62 years (IQR: 50-70). Stage I and II cancers accounted for 68% and 32% of cases, respectively. Hormone receptor positivity (HR+) was observed in 71% of patients, while 29% had triple-negative tumors. Genetic testing was performed on 88% (n=203) of the patients, while 5% of patients declined to undergo genetic testing. Among the tested patients, 12% (n=25/203) had pathogenic variants in BRCA1 or BRCA2, with 44% and 16% of these corresponding to the BRCA1 and BRCA2 founder mutations, respectively. Testing beyond BRCA1/2 genes was conducted on 154 patients, and only 6% (n=9/154) were found to have pathogenic variants in CHEK2, while no mutations were detected in other prevalent BC-related genes, including PALB2 and ATM. Fourteen-percent of patients had pathogenic mutations in other genes including APC, CFTR, FH, DIS3L2, FANCC, MUTYH, NF1 and VHL. The frequency of pathogenic BRCA1/2 variants was inversely proportional to the age at BC diagnosis: 50% (n=8/16), 21% (n=8/39), 15% (n=6/40), and 3% (n=3/108) of patients diagnosed at age < 40, 40-49, 50-59, and >60 years, respectively, had a pathogenic variant in either BRCA1 or BRCA2. The frequency of founder mutations varied according to age at diagnosis: 63%, 75%, 17%, and 100% for patients aged < 40, 40-49, 50-59, and >60 years, respectively. Patients with BRCA1/2 mutations exhibited higher-risk clinicopathological features compared to those without mutations, including a higher proportion of high histological grade (88%), and triple-negative tumors (76%). Mastectomy was the primary surgical treatment for 56% and 23% of patients with and without BRCA1/2 mutations, respectively. No difference in disease-free survival was found between patients with and without BRCA1/2 mutations with a median follow up of 3 years (IQR: 1-4). Conclusions: In our cohort, 17% of AJ patients with early BC carried a pathogenic variant in a BC-related gene, with BRCA1/2 being the most commonly affected genes. The proportion of pathogenic variants in BRCA1/2 showed an inverse correlation with the age at BC diagnosis, reaching up to 50% in patients diagnosed under the age of 40. These findings contrast with the lower prevalence of pathogenic variants in BRCA1/2 (38%) reported in the existing literature for this age group. Additionally, 8% of patients had pathogenic variants in other tested cancer genes carrying a genetic predisposition to colorectal cancer (CRC). These findings contribute to our understanding of the genetic landscape of early BC in the AJ population and emphasize the importance of comprehensive genetic testing, particularly among young patients. These results also suggest the need for earlier and more frequent CRC screening in a population of BC patients that may not be adhering to recommended guidelines. Furthermore, our study provides insight into how this genetic landscape may vary when analyzing late-stage BC in women of AJ heritage. Citation Format: Laura Munoz Arcos, Eleonora Nicolò, Maira Pires, Letizia Pontolillo, Leticia Varella, Tessa Cigler, Eleni Andreopolu, Anne Moore, Ashley Schreier, Carlos Munoz-Zuluaga, Lisa Newman, Georgia Syrnioti, Massimo Cristofanilli. Genetic Landscape of Early Breast Cancer in an Ashkenazi Jewish Cohort [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-08-11.

Abstract PO4-26-05: Dual HER2 Testing With Both Immunohistochemistry (IHC) and ISH (In Situ Hybridization): Long Term Analysis of Dual Testing in a Single Academic Institution

Abstract Background: HER-2 critically guides therapies and is prognostic in breast cancer (BC). Current ASCO/CAP guidelines for immunohistochemistry (IHC) define 3+ as positive, 0 and 1+ as negative, and 2+ as equivocal, with additional testing recommended. Current guidelines for in situ hybridization (ISH) define a HER-2/CEP17 ratio of ≥2.0, with an average HER-2 copy number of ≥4.0 signals/cell as ISH positive. With < 4.0 copies HER-2/cell, and for various other ISH groups that are borderline, further specific additional testing is recommended. Data suggest that HER-2 copy number does have clinical relevance in HER-2+ BC, however most clinical trials evaluating HER-2 targeted therapeutics have defined HER-2+ as specifically a HER-2/CEP17 ratio ≥2.0. Limited studies have explored HER-2 copy number and its clinical implication in the HER-2 1+, and 2+ ISH negative population, recently described as HER-2 low. Further, the guidelines for HER-2 testing have changed twice over the past decade, and little is known about the impact of these changes. Design: From 2001- March 2023, all new invasive BC cases tested at University of Vermont (UVM) for HER-2 with both IHC and ISH were analyzed. All testing was performed on formalin-fixed paraffin-embedded tissue, using the HercepTest kit (Dako Corp, Carpinteria, California) (2001-2012) 4B5 Rabbit Monoclonal Antibody (Ventana) (2013-2023) for IHC and the INFORM dual ISH DNA probe (Ventana) for CISH. Interpretation was performed using published criteria at the time of original testing, and all cases with both IHC and CISH testing were independently analyzed by two experienced reviewers. Results: 2734 cases had dual testing with IHC and CISH. 2407 patients (88%) had a HER-2/CEP17 ratio < 2.0, of these, 6.4% had a HER-2 copy number ≥4 and < 6. Only 12% of cases overall had a ratio ≥ 2.0. In IHC 0 and 1+ cases with HER-2/CEP17 ratio of < 2, 0.4% and 4.3% have excess HER-2 copies/cell (defined as ≥ 4), respectively, compared to 13.8% for IHC 2+. For IHC 2+ cases, only 13.6% overall demonstrate amplification, with however, again, an additional 13.8% having excess copy number. Interestingly, 9.6% of the IHC 3+ cases had a ratio of < 2.0, however 50% of those demonstrate HER-2 amplification. Overall, 6.4% of HER-2 non-amplified cases with a ratio < 2.0 have an excess HER-2 copy number. In our full institutional pathology database, 11.2% of cases are HER2+, by either IHC or ISH. Lastly, 43% of cases overall, at UVM, from 2018 – March 2023 would fall into the current classification as HER-2 low (IHC 1+, or IHC 2+ and ISH negative), as well. Additionally, we have evaluated the change in IHC and ISH results that occurred with the changes in the ASCO/CAP guidelines in both 2013 and 2018, further data will be available for presentation. Conclusion: In this large single institutional analysis of dual HER-2 testing, only 12% of cases demonstrate HER-2 amplification, and overall in our institutional pathology database, from 2001 – March 2023, 11.2% of cases are HER-2+ by either IHC or ISH. In our dual tested cohort, only 13.6% of IHC 2+ cases demonstrate amplification, and 13.8% are non-amplified, but have excess HER-2 copy number. We demonstrate a numerical increase in the rate of amplification, and copy number in non-amplified cases, associated with IHC score. In all cases tested with IHC at UVM from 2018 – March 2023, we find 43% of cases meet the current criteria for HER-2 low. Finally, the ASCO/CAP guideline changes from 2013 to 2018 had modest impact on the overall percentage of HER-2+ cases in our series, further data on this impact will be available for presentation. Table. Simultaneously tested IHC and CISH data for new invasive breast cancer cases Citation Format: Xiaocao Xu, Abiy Ambaye, Kara Landry, Peter Kaufman. Dual HER2 Testing With Both Immunohistochemistry (IHC) and ISH (In Situ Hybridization): Long Term Analysis of Dual Testing in a Single Academic Institution [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-26-05.

Overexpression of WT1 in all molecular subtypes of breast cancer and its impact on survival: exploring oncogenic and tumor suppressor roles of distinct WT1 isoforms.

Breast cancer is a highly heterogeneous solid tumor, posing challenges in developing targeted therapies effective for all mammary carcinoma subtypes. WT1 emerges as a promising target for breast cancer therapy due to its potential oncogenic role in various cancer types. Previous works have yielded inconsistent results. Therefore, further studies are needed to clarify the behavior of this complex gene in breast cancer. In this study, we examined WT1 expression in both Formalin Fixed Paraffin Embedded breast tumors (n = 41) and healthy adjacent tissues (n = 41) samples from newly diagnosed cases of ductal invasive breast cancer. The fold change in gene expression between the tumor and healthy tissue was determined by calculating 2-∆∆Ct. Disease-free survival analysis was computed using the Kaplan-Meier method. To identify the expression levels of different WT1 isoforms, we explored the ISOexpresso database. Relative quantification of the WT1 gene revealed an overexpression of WT1 in most cases. The percentage of patients surviving free of disease at 8years of follow-up was lower in the group overexpressing WT1 compared to the group with down-regulated WT1. Interestingly, this overexpression was observed in all molecular subtypes of invasive breast cancer, underscoring the significance of WT1 as a potential target in all these subtypes. The observed WT1 down-expression in a few cases of invasive breast cancer, associated with better survival outcomes, may correspond to the down-regulation of a particular WT1-KTS (-) isoform: the WT1 A isoform (EX5-/KTS-). The co-expression of this WT1 oncogenic isoform with a regulated WT1- tumor suppressor isoform, such as the major WT1 F isoform (EX5-/KTS +), could also explain such survival outcomes. Due to its capacity to adopt dual roles, it becomes imperative to conduct individual molecular expression profiling of the WT1 gene. Such an approach holds great promise in the development of personalized treatment strategies for breast cancer.

Breast Cancer Detection Using Deep Learning

The most frequently occurring cancer among Indian women is breast cancer. The second major cause of women's death is breast cancer (after lung cancer). 246,660 of women's new cases of invasive breast cancer are expected to be diagnosed in the US during 2016 and 40,450 of women’s death is estimated. The number of breast cancer cases is steadily growing especially with increasing number of ageing population. Breast cancer is a type of cancer that starts in the breast. Cancer starts when cells begin to grow out of control. Breast cancer cells usually form a tumour that can often be seen on an x-ray or felt as a lump. The screening practice using mammography needs to be better and potentially efficient. There is always room for advancement when it comes to medical imaging. Early detection of cancer can reduce the risk of death for cancer patients. Breast cancer can spread when the cancer cells get into the blood or lymph system and are carried to other parts of the body. This overview looks at the results of a proposed system for automatically diagnosing breast cancer using several convolutional neural network (CNN) designs and compares them to those achieved using machine learning (ML) techniques. All buildings were built from a large database. Validation tests were conducted in order to provide quantifiable results using the performance parameters of each approach. Functions like VGG16 and ResNet50 are used in this model to improve the accuracy of the model. The cause of Breast Cancer includes changes and mutations in DNA. Women are seriously threatened by breast cancer with high morbidity and mortality. The breast cancer dataset is publicly available on the UCI Machine Learning Repository and therefore the implementation phase dataset is going to be partitioned as 80% for the training phase and 20% for the testing phase then apply a significant performance in respect of all parameters.

CASE REPORT OF CARCINOMA OF BREAST

Breast cancer occurs more frequently in the left breast than the right. The left breast is 5%-10% more likely to develop cancer than the right breast. 1 in 8 U.S. women (about 12%) will develop invasive breast cancer over the course of her lifetime. In 2020, an estimated 276,480 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S., along with 48,530 new cases of non-invasive (in situ) breast cancer. About 2,620 new cases of invasive breast cancer are expected to be diagnosed in men in 2020,[1].