Invasive Lobular Cancer Research Articles

Comparison of clinicopathological features and prognostic factors between advanced invasive lobular cancer and invasive ductal breast cancer

Comparison of clinicopathological features and prognostic factors between advanced invasive lobular cancer and invasive ductal breast cancer

Results of Short-Term Follow-Up in BI-RADS 3 and 4a Breast Lesions with a Histological Diagnosis of Fibroadenoma at Percutaneous Needle Biopsy

Objective: To evaluate the usefulness of short-term (6 months) follow-up in patients with Breast Imaging Report and Data System (BI-RADS) 3 and 4a lesions, after a diagnosis of fibroadenoma at an image-guided biopsy. Patients and Methods: The data of 318 women with 349 biopsy-proven fibroadenomas, a 6-month follow-up, and a follow-up of ≥ 24 months were retrospectively reviewed. Information on clinical history, lesion characteristics on ultrasound (US), mammography, and magnetic resonance imaging (MRI), BI-RADS classification, and follow-up was collected. The false-negative (FN) rate and the negative predictive value (NPV) for the biopsy were calculated. Results: 43 patients (13.5%) presented with a palpable nodule; 18 (5.7%) had a history of breast cancer. There were 334 lesions visible on US (95.7%), 57 on US and mammography (16.3%), and 15 on mammography only (4.3%); 37 lesions were first detected on MRI. All lesions were stable at 6 months. After an at least 1-year follow-up, 4 lesions changed their features and were excised. Histology showed 1 invasive lobular cancer, 1 ductal carcinoma in situ, 1 phyllodes tumor, and 1 papilloma. The FN rate of the needle biopsy was 1.1% and the NPV was 98.9%. Conclusion: For lesions initially described as BI-RADS 3 and 4a with a histological diagnosis of fibroadenoma after biopsy, short-term follow-up can be avoided.

Meta-analysis of pre-operative magnetic resonance imaging (MRI) and surgical treatment for breast cancer.

Although there is no consensus on whether pre-operative MRI in women with breast cancer (BC) benefits surgical treatment, MRI continues to be used pre-operatively in practice. This meta-analysis examines the association between pre-operative MRI and surgical outcomes in BC. A systematic review was performed to identify studies reporting quantitative data on pre-operative MRI and surgical outcomes (without restriction by type of surgery received or type of BC) and using a controlled design. Random-effects logistic regression calculated the pooled odds ratio (OR) for each surgical outcome (MRI vs. no-MRI groups), and estimated ORs stratified by study-level age. Subgroup analysis was performed for invasive lobular cancer (ILC). Nineteen studies met eligibility criteria: 3 RCTs and 16 comparative studies that included newly diagnosed BC of any type except for three studies restricted to ILC. Primary analysis (85,975 subjects) showed that pre-operative MRI was associated with increased odds of receiving mastectomy [OR 1.39 (1.23, 1.57); p<0.001]; similar findings were shown in analyses stratified by study-level median age. Secondary analyses did not find statistical evidence of an effect of MRI on the rates of re-excision, re-operation, or positive margins; however, MRI was significantly associated with increased odds of receiving contralateral prophylactic mastectomy [OR 1.91 (1.25, 2.91); p=0.003]. Subgroup analysis for ILC did not find any association between MRI and the odds of receiving mastectomy [OR 1.00 (0.75, 1.33); p=0.988] or the odds of re-excision [OR 0.65 (0.35, 1.24); p=0.192]. Pre-operative MRI is associated with increased odds of receiving ipsilateral mastectomy and contralateral prophylactic mastectomy as surgical treatment in newly diagnosed BC patients.

Perforated Gastric Metastasis From Neglected Breast Cancer: A Case Report

Gastric perforation from metastatic breast cancer is a rare complication that is difficult to treat. Herein, we report a case of an 81-year-old female patient with neglected invasive lobular breast cancer causing gastric perforation due to metastasis. She underwent palliative surgical intervention with partial gastric resection. After 6 months, she is doing well. J Med Cases. 2017;8(6):200-202 doi: https://doi.org/10.14740/jmc2838w

Tumor biologic characteristics and clinical outcomes in geriatric patients with breast cancer.

e21526 Background: The probability of dying from breast cancer increases from 0.2% to 2% annually for women once they reach 70 years of age. However there is limited age-related information available about tumor biologic characteristics (TBCs) and clinical outcomes among elderly patients (pts). The purpose of this study was to analyze the impact of TBCs on clinical outcomes in a single institution's geriatric breast cancer pts. Methods: An institutional database of a total of 269 patients with histologically confirmed invasive or in-situ breast cancer with age 65 years or older at the time of diagnosis was reviewed in an IRB approved fashion. Tumors were assessed for Nottingham grade, stage, ER/PR status, HER-2 status, tumor histology, lymphovascular invasion and nodal status. Kaplan-Meyer and Cox proportional hazards methods were used to calculate overall survival (OS). Results: Breast cancer was seen equally in both breasts: left n = 130 (48.3%), right n = 132 (49.1%). Most tumors were located in the upper outer quadrant (n = 122, 45.35%). TNM clinical stage Tlc was identified in 79 pts (29.36%), Tlb in 55 pts (20.44%), T2 in 54 pts (20.07%) and no nodal involvement in 146 pts (54.27%). Nottingham Grade 2 (n = 120, 44.60%) and invasive ductal carcinomas (n = 152, 56.50%) were diagnosed most often. Tumors were more frequently ER+ (n = 237, 88.10%), PR+ (n = 210, 78.06%), and HER2-negative (n = 219, 81.41%). There was no statistically significant increase in OS based on location of tumor (P = 0.9796) and tumor histology (invasive ductal vs invasive lobular cancers, P = 0.1143). Node negative breast cancers were associated with increased OS (P = 0.0014). Grade 2 tumors were associated with increased OS compared to Grade 3 tumors (P = 0.0112). ER+ and PR-negative tumors were associated with decreased OS in both short term and long term follow up (P = 0.0083 &amp; P = 0.0254). Conclusions: In pts 65 years of age or older with newly diagnosed breast cancer, lack of nodal involvement is associated with increased OS. Prognosis for ER+ and PR-negative tumors is worse compared to ER+ and PR+ tumors. Nottingham Grade 2 tumors have better OS compared to Grade 3 tumors. Location of tumor and tumor histology are not associated with increased OS.

Analysis of stage and clinical pathological characteristics of invasive lobular carcinoma with the 8th AJCC Cancer Staging system

Objective To study the meaning of breast cancer staging system by AJCC eighth edition to invasive lobular carcinoma and analysis the clinical pathological characteristics. Methods According to the eighth edition of the AJCC staging to evaluate the TNM stage and prognosis evaluation of invasive lobular carcinoma cancer patient in Peking University Shenzhen Hospital from 2011 to 2016, and compared with others in clinical pathological data. Results There were 21 cases of invasive lobular carcinoma, accounting for 2.7% of all invasive breast cancer. We found that invasive lobular carcinoma shows no significant difference (P>0.05) in ages, menstrual status, molecular features and anatomic staging and prognosis staging with others; histological grade were significantly different (P< 0.05). There were significant differences in the prognosis and staging of invasive lobular carcinoma. Conclusions Eighth AJCC staging system provides a new reference for the clinical treatment of breast cancer, should be evaluated with anatomic stage. Histological grade is relatively good in invasive lobular carcinoma and the prognosis is good, needs more research to the individualized treatment of invasive lobular carcinoma. Key words: Breast neoplasms; 8th AJCC cancer Staging system; Invasive lobular carcinoma; Anatomy; Prognosis

The Pathologic Finding of Combined Lobular Carcinoma in Situ and Invasive Lobular Cancer May Indicate more than Just a High-Risk Marker Role of Lobular Carcinoma in Situ

For years, lobular carcinoma In Situ (LCIS) has been considered a high-risk marker for developing breast cancer. It is well known that ductal carcinoma In Situ is a precursor for the development of invasive ductal carcinoma, and ductal carcinoma In Situ is reported to be present in invasive ductal carcinoma in at least 40 per cent of cases. A similar relationship between LCIS and invasive lobular carcinoma (ILC) remains in question. This study evaluates the incidence of synchronous LCIS and ILC at our institution. This is a retrospective review of our tumor registry database of women diagnosed with LCIS or ILC from 2000 to 2014. Pathology reports were evaluated to determine the incidence of pure ILC and mixed ILC/LCIS. Those with both LCIS/ILC (mixed group) and those with pure ILC (pure group) were compared for age, surgical intervention, lymph node involvement, tumor size, nuclear grade, and margins between these two groups. A total of 182 women were identified with LCIS, ILC, or mixed LCIS and ILC. There were 76 subjects with pure ILC and 90 with mixed LCIS and ILC. The median and age range for each group were 63.6 (range: 40-97) for the mixed and 64.1 (range: 40-86) for pure groups. Tumor size was evaluated for each group and the median tumor size was 2.5 cm (range: 0.1-7.0cm) for the mixed group and 3.0 cm (range: 0.5-12.5 cm) for the pure group. Nodal involvement was present in 35.23 per cent of the mixed group and 46.3 per cent in the pure group. Surgical treatment for each group was similar, with mastectomy being the preferred surgical option over breast conservation therapy in the mixed and pure groups, 67.07 and 64.71 per cent, respectively. Presently, LCIS is considered a marker, or risk factor, for development of future breast cancer. This retrospective study does identify a strong relationship, 54 per cent, between LCIS and ILC at diagnosis. This high percentage of concurrent LCIS and ILC in surgical/pathological specimens supports the notion that LCIS may in fact have a precursory role in development of invasive lobular carcinoma of the breast. Additional studies to further investigate this relationship between LCIS and ILC, including genomic analysis, are presently underway.

Abstract P6-08-07: Gain and amplification of RAC1 GTP-ase in BC: Explaining alterations in patients by experiments using TNBC model

Abstract INTRODUCTION: RAC1-GTPase which transduces signals from cell surface integrins, have been implicated in metastasis. We reported that Wnt-beta-catenin pathway (WP) that signals metastasis (BMC Cancer, 2013), is one of the salient genetic features of Triple-Negative Breast Cancer (TNBC) (PlosOne, 2013).AIM: We demonstrated that TNBC cells acquire integrin-directed metastasis-associated (ID-MA) phenotypes following an upregulation of the WP (Oncotarget, In Press). Here we examined how WP signals are transduced in the context of ID-MA phenotypes in TNBC.METHOD: We documented gain and amplification of RAC1 gene in Breast Invasive Carcinoma subtypes from cBioPortal. The outcome for RFS was studied in the Hungarian ER-ve BC cohort.Mechanistically, we studied fibronectin-directed (1) migration, (2) matrigel- invasion, (3) RAC1 activation, (4) actin dynamics (confocal microscopy) and (5) podia-parameters using pharmacological agents (sulindac sulfide), genetic tools (beta-catenin siRNA), WP modulators (Wnt-C59, XAV939), RAC1 inhibitors (NSC23766, W56) and WP stimulations (LWnt3ACM, Wnt3A recombinant) in a panel of 6-7 TNBC cell lines, RESULTS: The collective percentage of gain and amplification of RAC1 were (1) 31% of total 1105 breast invasive carcinoma samples, (2) 29% of total 594 ER+ve samples, (3) 39% of total 174 ER-ve samples, (4) 38% of total 120 HER2+ve samples and (4)35% of total 82 TNBC samples (brca/tcga/pub2015; Cell 2015).In invasive ductal BC subtypes, gain and amplification of RAC1 were (1) 32% of total 201 Luminal A samples, (2) 37% of total 122 PAM50 Luminal B samples, (3) 47% of total 51 PAM50 Her2-enriched samples and (4) 33% of total 107 PAM50 Basal-like samples. In invasive lobular cancers, gain and amplification of RAC1 were 24% of total 127 samples.Involvement of WP in different TNBC cells was tested following stimulation by LWnt3ACM and Wnt3Arecombinant protein and different inhibitors of WP by both qRT-PCR and WB for beta-catenin, active beta-catenin, cMYC, cyclin D1and WP specific several stem cell markers. The WP attenuation, which (a) decreased cellular levels of beta-catenin, as well as its nuclear active-form, (b) decreased fibronectin-induced migration &amp; invasion, (c) altered actin dynamics and (d) decreased podia-parameters was successful in blocking fibronectin-mediated RAC1/Cdc42 activity. Both Wnt-antagonists and RAC1 inhibitors blocked fibronectin-induced RAC1 activation and inhibited fibronectin-induced ID-MA phenotypes following WP stimulation by LWnt3ACM and Wnt3Arecombinant protein. High expression of RAC1 was associated with poor outcome for RFS with HR=1.48 [CI: 1.15-1.9] p=0.0019 in the Hungarian ER-veBC cohort.CONCLUSION:In TNBC model, the activation of RAC1 signals downstream of WP mediated ID-MA phenotypes. The identification of the functional relationship between RAC1 signaling and the WP activation in the control of ID-MA mechanistically explains how the activation of WP in TNBC is associated with the high metastatic incidences and a dismal outcome. Citation Format: Dey N, Carlson JH, Jepperson T, Willis S, De P, Leyland-Jones B. Gain and amplification of RAC1 GTP-ase in BC: Explaining alterations in patients by experiments using TNBC model [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-08-07.

Breast MRI increases the number of mastectomies for ductal cancers, but decreases them for lobular cancers

PurposeIn this retrospective population-based cohort study, we analyzed breast MRI use and its impact on type of surgery, surgical margin involvement, and the diagnosis of contralateral breast cancer.MethodsAll Dutch patients with cT1–4N0–3M0 breast cancer diagnosed in 2011–2013 and treated with primary surgery were eligible for inclusion. Using multivariable analyses, we analyzed in different categories whether MRI use was related to surgery type, margin involvement, and diagnosis of contralateral breast cancer (CBC).ResultsMRI was performed in 10,740 out of 36,050 patients (29.8%). Patients with invasive ductal cancer undergoing MRI were more likely to undergo primary mastectomy than those without MRI (OR 1.30, 95% confidence interval (CI) 1.22–1.39, p < 0.0001). Patients with invasive lobular cancer undergoing MRI were less likely to undergo primary mastectomy than those without MRI (OR 0.86, 95% CI 0.76–0.99, p = 0.0303). A significantly lower risk of positive surgical margins after breast-conserving surgery was only seen in patients with lobular cancer who had undergone MRI as compared to those without MRI (OR 0.59, 95% CI 0.44–0.79, p = 0.0003) and, consequently, a lower risk of secondary mastectomy (OR 0.61, 95% CI 0.42–0.88, p = 0.0088). Patients who underwent MRI were almost four times more likely to be diagnosed with CBC (OR 3.55, 95% CI 3.01–4.17, p < 0.0001).ConclusionsBreast MRI use was associated with a reduced number of mastectomies and less positive surgical margins in invasive lobular cancer, but with an increased number of mastectomies in ductal cancers. Breast MRI use was associated with a fourfold higher incidence of CBC.

ERBB2 mutation is associated with a worse prognosis in patients with CDH1 altered invasive lobular cancer of the breast.

E-cadherin (CDH1) is a glycoprotein that mediates adhesion between epithelial cells and also suppresses cancer invasion. Mutation or deletion of the CDH1 gene has been reported in 30–60% cases of invasive lobular carcinoma (ILC). However, little is known about genomic differences between ILC with and without a CDH1 alteration. Therefore, we analyzed whole genome sequencing data of 169 ILC cases from The Cancer Genome Atlas (TCGA) to address this deficiency. Our study shows that CDH1 gene was altered in 59.2% (100/169) of ILC. No significant difference was identified between CDH1-altered and -unaltered ILC cases for any of the examined demographic, clinical or pathologic characteristics, including histologic grade, tumor stage, lymph node metastases, or ER/PR/HER2 states. Seven recurrent mutations (PTEN, MUC16, ERBB2, FAT4, PCDHGA2, HERC1 and FLNC) and four chromosomal changes with recurrent copy number variation (CNV) (11q13, 17q12-21, 8p11 and 8q11) were found in ILC, which correlated with a positive or negative CDH1 alteration status, respectively. The prevalence of the most common breast cancer driver abnormalities including TP53 and PIK3CA mutations and MYC and ERBB2 amplifications showed no difference between the two groups. However, CDH1-altered ILC with an ERBB2 mutation shows a significantly worse prognosis compared to its counterparts without such a mutation. Our study suggests that CDH1-altered ILC patients with ERBB2 mutations may represent an actionable group of patients who could benefit from targeted breast cancer therapy.

Axillary assessment in invasive lobular cancers

Axillary assessment in invasive lobular cancers

Preoperative MR Imaging in Women with Breast Cancer Detected at Screening US.

Purpose To determine additional cancer yield of magnetic resonance (MR) imaging in women with breast cancer detected at screening ultrasonography (US) and to identify a subgroup of women who are likely to benefit from preoperative MR imaging. Materials and Methods This study was approved by the institutional review board, and the requirement for informed consent was waived. A retrospective review of 374 women (median age, 48 years; age range, 30-74 years) with breast cancer detected at screening US (invasive, n = 321) who underwent preoperative breast MR imaging between 2007 and 2013 was performed. Cancer yield and positive predictive value of biopsy were calculated. Multivariate logistic regression analysis was performed to identify clinical-pathologic features associated with additional cancer detected at MR imaging. Results Of 374 women, 21 (5.6%; 95% confidence interval [CI]: 3.5%, 8.5%) were diagnosed with additional cancer (positive predictive value of biopsy, 42.0% [21 of 50 women]; 95% CI: 28%, 57%). Index invasive lobular cancer (ILC) histologic type was significantly associated with additional cancer detected at MR imaging (odds ratio, 4.0; 95% CI: 1.2, 13.6; P = .03). In women with index invasive cancer, premenopausal status (odds ratio, 5.7; 95% CI: 1.2, 35.8; P = .03) and lobular histologic type (odds ratio, 3.9; 95% CI: 1.1, 12.3; P = .03) were factors associated with additional cancer detected at MR imaging. Conclusion Preoperative MR imaging helped to detect additional sites of cancer in 5.6% of women with breast cancer detected at screening US. Women with index ILC and premenopausal women are more likely to benefit from preoperative MR imaging. © RSNA, 2016 Online supplemental material is available for this article.

Abstract 1880: Determining the role of E-cadherin in regulating IGF1 signaling in breast cancer: An interaction predicted by large-scale modeling

Abstract Insulin-like growth factor I (IGF1) plays an important role in breast cancer initiation and progression due to its regulation of cell proliferation, migration, and invasion. These characteristics make IGF1R an attractive therapeutic target. While numerous clinical trials have sought to inhibit IGF1R action, these were largely unsuccessful due to a lack of biomarkers for positive therapeutic response, poor patient selection, and potential compensatory signaling by the highly similar insulin receptor (InsR). To identify biomarkers of response, our laboratory identified a set of genes regulated by IGF1 (IGF-sig) that revealed a correlation between activation of the IGF-sig and poor prognosis in estrogen receptor (ER)-negative breast cancer. Further, we showed that ER-negative breast cancer cells are sensitive to IGF1R inhibition both in vitro and in vivo. In an effort to better understand the IGF1 and insulin signaling networks in breast cancer, we performed a reverse phase protein array (RPPA) using 134 antibodies on lysates from twenty-one breast cancer cell lines stimulated with a six point time-course of IGF1 or insulin. We developed a time-dependent model to predict differential mediators of IGF1 and insulin signaling using perturbation analysis. The model predicted that alterations in levels of E-cadherin (CDH1), a major component of the adherens junction, affect IGF1 induced Akt activation. In breast cancer, E-cadherin is genetically lost in invasive lobular cancer (ILC), a subtype that accounts for ∼10-15% of breast cancers. Alternatively, invasive ductal cancers may lose E-cadherin via EMT. I confirmed this in silico prediction, showing that shRNA reduction of E-cadherin enhances the ability of IGF1 to induce Akt signaling, and additionally IGF1R, ERK and S6 ribosomal protein activation. Supporting the clinical relevance of our observations, we found a correlation between loss of E-cadherin (CDH1) mRNA expression and the activation of the IGF-sig in ER-negative tumors within The Cancer Genome Atlas (TCGA). Therefore, we hypothesize that loss of E-cadherin potentiates IGF1 signaling to enhance breast cancer progression, and that loss of E-cadherin expression in ILC and ER-negative tumors may highlight those susceptible to IGF1R inhibition. These studies will investigate how E-cadherin modulates IGF1 signaling and the interaction with EMT with the goal of better defining breast cancers that may respond to IGF1R inhibitors. Citation Format: Alison M. Nagle, Cemal Erdem, YuFen Wang, Kevin Levine, Tiffany Katz, D. Lansing Taylor, Adrian V. Lee, Timothy R. Lezon. Determining the role of E-cadherin in regulating IGF1 signaling in breast cancer: An interaction predicted by large-scale modeling. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1880.

Male breast cancer - a single center experience.

Due to its rarity, male breast cancer remains a poorly characterized disease. The present study obtained retrospective clinicopathological data, treatment patterns and outcomes for all male patients diagnosed with breast cancer in the Oncology Department, Faculty Hospital Trenčín (Trenčín, Slovakia) over the last 20 years from January 1995 to December 2015. A total of 21 patients with male breast cancer were analyzed, with a median patient age of 65.6 years. Two patients were diagnosed with lobular invasive cancer; all others were diagnosed with cancer of a ductal origin. One patient presented with metastatic disease in the pleural cavity. The primary tumors in 8 patients were staged as pT1, whilst 6 patients were staged as pT2 and 7 as pT4. Axillary lymph node involvement was present in 11 patients (52%) and 15 patients were hormone receptor-positive (83%). All but 1 patient underwent mastectomy and surgical staging of the axilla. Adjuvant chemotherapy, radiotherapy and hormone treatment was administered in the same manner as breast cancer treatment in female patients. The median follow-up time was 4.5 years. The 5- and 10-year overall survival rates were 87 and 74%, respectively, and the estimated median disease-free survival for the same population was 9.5 years (95% confidence interval, 6.2-14.6). The survival rates reported in the present retrospective study are comparable with previously published studies. In addition, the current study reported predominant hormone-positive characteristics and rare expression of human epidermal growth factor receptor 2. However, further multi-institutional trials are required to allow for informed treatment decisions in this uncommon disease.

Clinicopathological Characteristics of Mucinous Breast Cancer: A Retrospective Analysis of a 10-Year Study.

BackgroundMucinous breast carcinoma (MC) is a special type of breast cancer that presents with a large amount of extracellular mucin. MC comprises approximately 4% of all invasive breast cancers. This type of tumor has a better prognosis and higher incidence in peri- and post-menopausal patients. Pathologically, there are two main subtypes of MC: pure and mixed. In this study, we describe 10 years of experience with MC at the Zhejiang Cancer Hospital in China, specifically, clinical data, histological findings and immunohistochemical features.MethodsWe identified MC patients who were diagnosed as operable and completed clinical treatment from January 2001 to January 2011. The clinicopathological data included the age at diagnosis, tumor size, TNM stage, presence and number of lymph node (LN) metastases, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2) status and p53 expression. If the tumor was defined as mixed mucinous carcinoma (MMC), IHC was performed on a non-mucinous part, such as invasive ductal and lobular cancer. We evaluated the clinical characteristics of all MC patients using chi-square, one-way ANOVA and LSD tests. We also studied the correlations between all of the clinical parameters and LN metastasis in a binary logistic regression analysis. We used ten consecutive years of data that were collected at Zhejiang Cancer Hospital.ResultsWe identified 48 cases of pure mucinous carcinoma (PMC) and 77 cases of MMC. The 48 PMC cases consisted of 38 PMC-A and 10 PMC-B subtypes. The MMCs were divided into two groups, those with partial mixed mucinous breast carcinoma (pMMC, 58 cases) and those with main mixed mucinous breast carcinoma (mMMC, 19 cases). pMMC was defined by tumors with less than 50% mucinous components, while mMMC was defined by tumors where the mucinous component accounted for 50% to 90% of the tumor. No significant differences in the clinicopathological characteristics were noted between the patients with PMC-A and those with PMC-B. The tumor size was larger in the mMMC than PMC cases (44.84 mm vs. 30.06 mm, p = 0.021). The number of positive LN metastases was greater in pMMC than PMC patients (p = 0.024). The clinical stages were significantly different among the three groups, with the pMMC group having more stage III-IV patients than the other two groups (p = 0.005). The incidence of LN metastasis was also higher in the pMMC cases (pMMC vs. mMMC and PMC, 50% vs. 31.58% and 18.75%, p = 0.003). The PMC patients had much lower p53 expression than the other two groups (PMC vs. pMMC and mMMC, 27.08% vs. 55.17% and 57.89%, p = 0.007). The tumor size (>30mm), p53 expression and less proportion of the mucinous component are associated with risk of LN metastasis.ConclusionBased on the results of this study, we conclude that the tumor size, status of LN metastasis, clinical stage, and p53 mutation rate may differ between MMC and PMC patients. The tumor size (>30mm), p53 mutation and less proportion of the mucinous component should be considered risk factors of LN metastasis in MC patients.

Digital breast tomosynthesis as an adjunct to digital mammography for detecting and characterising invasive lobular cancers: a multi-reader study

To examine the interpretive performance of digital breast tomosynthesis (DBT) as an adjunct to digital mammography (DM) compared to DM alone in a series of invasive lobular carcinomas (ILCs) and to assess whether DBT can be used to characterise ILC. A retrospective, multi-reader study was conducted of 83 mammographic examinations of women with 107 newly diagnosed ILCs ascertained at histology. Consenting women underwent both DM and DBT acquisitions. Twelve radiologists, with varying mammography experience, interpreted DM images alone, reporting lesion location, mammographic features, and malignancy probability using the Breast Imaging-Reporting and Data System (BI-RADS) categories 1-5; they then reviewed DBT images in addition to DM, and reported the same parameters. Statistical analyses compared sensitivity, false-positive rates (FPR), and interpretive performance using the receiver operating characteristics (ROC) curve and the area under the curve (AUC), for reading with DM versus DM plus DBT. Multi-reader pooled ROC analysis for DM plus DBT yielded AUC=0.89 (95% confidence interval [CI]: 0.88-0.91), which was significantly higher (p<0.0001) than DM alone with AUC=0.84 (95% CI: 0.82-0.86). DBT plus DM significantly increased pooled sensitivity (85%) compared to DM alone (70%; p<0.0001). FPR did not vary significantly with the addition of DBT to DM. Interpreting with DBT (compared to DM alone) increased the correct identification of ILCs depicted as architectural distortions (84% versus 65%, respectively) or as masses (89% versus 70%), increasing interpretive performance for both experienced and less-experienced readers; larger gains in AUC were shown for less-experienced radiologists. Multifocal and/or multicentric and bilateral disease was more frequently identified on DM with DBT. Adding DBT to DM significantly improved the accuracy of mammographic interpretation for ILCs and contributed to characterising disease extent.

Possibilities of positron emission tomography in the metastatic breast cancer diagnosis

An analysis of published data on the possibilities of the positron emission tomography method application in complex diagnostic and treatment activities in metastatic breast cancer was performed. The possibilities are described and the method characteristics according to series of studies, in particular with regard to the various localization metastases identification are given. It is noted that, compared with conventional imaging techniques, positron emission tomography is more sensitive and specific method of distant metastases diagnosis. The results of clinical studies on assessment of the method application possibilities in the detection of breast cancer metastases in lymph nodes, various organs and bone metastases are given. It has been shown that the introduction of sodium fluoride into practice allowed to use this agent as bone tissue biomarker, which can be used in positron emission tomography performing. The data that the simultaneous use of positron emission tomography with 18F-fluorodeoxyglucose and computed tomography has a high diagnostic value in relation to the breast cancer distant metastases detection are presented. The method possibilities for the various forms of primary invasive breast cancer identification, including invasive ductal and lobular cancer are considered. The prospects analysis for a further increase of opportunities for positron emission tomography application is performed, in particular, reports on the possibility of so-called hybrid scanning using positron emission tomography and magnetic resonance imaging are considered. It is highlighted that the most important aim of the method use in clinical practice in the prospect may be local-regional recurrence and distant metastasis monitoring after primary treatment for breast cancer.

Role of Breast MRI in Patients with Newly Diagnosed Breast Cancer

The role of breast MRI in patients with newly diagnosed breast cancer is controversial. Preoperative MRI is highly sensitive and accurate in assessing tumor size, extensive intraductal component (EIC), and in detection of additional sites of disease. It also has utility in assessing chest wall, nipple-areolar complex, and nodal involvement. Yet there are conflicting results in whether the use of preoperative MRI improves re-excision rate, local recurrence rate, and ultimately, survival. MRI has also been associated with overestimation of disease and increased mastectomy rates, and may contribute to treatment delay. Nevertheless, certain subgroups of patients may benefit more from preoperative MRI than others, including those with invasive lobular cancer (ILC), dense breasts, and those at elevated risk for breast cancer.

Axillary assessment in invasive lobular cancers

Axillary assessment in invasive lobular cancers

English

For the translation, transcultural adaptation and a pilot test of the instrument were done. Also, the compliance of the breast cancer patients to the treatment was measured. The questionnaire “Cancer Patient Self-Report Questionnaire Non-Adherence” was translated and adapted; and a pilot test with 30 patients was performed. For this study, the questionnaire, Morisky-Green test, was also used. A hundred and thirteen patients diagnosed with breast cancer and who used oral chemotherapy were evaluated. The evaluated patients’ average age was 57 years. 82.5% of them had invasive lobular carcinoma cancer, and almost 50% had a family history of breast cancer. The evaluation of the compliance shows that only 31.85% of the patients completed the medical treatment. Patients who presented adverse reactions were more susceptible to stopping the treatment. The low compliance on the medicated treatment is worrying and shows the need to improve it and further research to identify which factors contribute to the non-compliance to such treatment. Key words: Breast cancer, compliance, oncology.