Modified Radical Mastectomy Specimens Research Articles

Immunohistochemical expression of CD44 in invasive breast carcinoma

Background: In India, breast cancer forms the most common malignancy, accounting for 28.2% of all female cancers. Breast cancer consists of phenotypically diverse group of diseases. Due to different relapse abilities, doubling times, and different infiltrative capacities, it is important to identify potential biomarkers that could be used to screen high-risk patient and predict breast cancer prognosis in conjunction with classical pathological parameters. Aims and Objectives: The present study was conducted to evaluate immunohistochemical expression of CD44 in breast carcinoma and to correlate CD44 expression with other clinicopathological parameters and molecular classification of carcinoma breast. Materials and Methods: The present study was a prospective descriptive study conducted on 100 cases of carcinoma breast diagnosed on modified radical mastectomy specimens that were submitted to the Department of Pathology, Pt. B. D. Sharma, PGIMS, Rohtak, Haryana, over the period of 2 years. Results: Out of 100, 64 cases (64%) were CD44 positive. Out of these 64 cases, 9 (9%) cases were 1+, 34 (34%) cases were 2+, and 21 (21%) cases showed 3+ positive expression of CD44 in tumor cells. Loss of CD44 expression was seen in 36 (36%) cases. A statistically significant association of CD44 was seen with multifocality of the tumor, negative estrogen receptor/progesterone receptor (ER/PR) expression, and molecular subtypes. No statistically significant association of CD44 was seen with age, side of tumor, lymph node metastasis, lymphovascular invasion, ductal carcinoma in situ and Ki67, and HER2neu expression. Conclusion: A high CD44 expression in breast carcinoma correlates with aggressive tumor characteristics such as multifocality, negative ER/PR expression, and belonging to the basal subtype which is associated with poor prognosis. Conversely, low CD44 expression is linked to Luminal A and Luminal B subtypes which have good prognosis. These indicate the role of CD44 as a prognostic biomarker in the carcinoma breast.

Carcinoma Breast Presenting with Concurrent Extensive Lymph Nodal Sarcoidosis

Sarcoidosis is a systemic disease characterized by noncaseating granulomas involving any organ. Concurrent carcinoma breast with sarcoidosis is a rare occurrence. A 51-year-old female presented with right breast lump and was diagnosed with infiltrating ductal carcinoma with lymph nodal (LN) metastases (estrogen receptor, progesterone receptor positive, and HER2neu negative). Baseline fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan revealed breast mass with multiple LNs. Biopsy of iliac and internal mammary LNs indicated granulomatous lymphadenitis. A possible diagnosis of sarcoidosis was considered. End of chemotherapy (4 EC, 12 paclitaxel), FDG PET/CT revealed a complete metabolic response in breast mass. Most lymph nodes were resolved. Modified radical mastectomy specimen was negative for breast malignancy with granulomatous lymphadenitis in LNs.

Concordance Between Core Needle Biopsy and Surgical Specimens in Determining Molecular Biological Subtypes of Breast Cancer by Immunohistochemistry

Background: Breast carcinoma is the most common malignancy among women around the world. Core needle biopsy provides samples that are adequate in size thus allowing a histological diagnosis of breast carcinomas. CNB specimens can also be used for the immunohistochemical (IHC) assays of hormone receptors. Aims: To evaluate the concordance of ER, PR, HER2 Neu and Ki-67 in core needle biopsy and surgical specimens obtained by Modified radical mastectomy (MRM). Methods: A cross-sectional observational study was conducted in the Department of Pathology in association with the Department of Surgery at Murshidabad Medical College and Hospital for a duration of one and a half years. Patients undergoing Core needle biopsy of the breast who have been diagnosed with breast carcinoma on the basis of histopathology report and subsequently planned for MRM who have given consent for the study were included in this study. The samples were classified according to the immunohistochemical staining into four molecular subtypes: Luminal A, Luminal B, HER 2 Neu enriched, and triple-negative subtype depending on the expression of ER, PR, HER 2 Neu, and Ki-67. Result: The most common molecular subtype of breast carcinoma in both CNB and MRM specimens was the Triple-negative subtype. Conclusion: CNB has been found to be a reliable diagnostic tool that can help in determining Histopathological biomarkers for ER, PR positive, and HER2 Neu positive or negative tumors and it has also been found that retesting these markers again on the surgical specimens may not be necessary. Keywords: Core needle biopsy, Breast carcinoma, Molecular subtyping, Immunohistochemistry

Pathological response of different molecular subtypes of locally advanced breast carcinoma to neoadjuvant chemotherapy

Background: This study was done on modified radical mastectomy (MRM) specimens of patients with locally advanced breast carcinoma (LABC) who were categorized into molecular subgroups based on Immunohistochemistry and underwent neoadjuvant chemotherapy (NACT). The purpose of the study was to look for the pathological response of the tumor to the NACT. The molecular subtypes include Luminal A, Luminal B, Human epidermal growth factor receptor 2 (HER2) enriched, and triple negative. For HER2 enriched subtype, trastuzumab was also given along with the chemotherapy regimen. Aims and Objectives: The primary objective of this study is to find out the pathological complete response (pCR) in various molecular subgroups of breast carcinoma following NACT. The secondary objective is to describe the cellular changes in tumor tissue following NACT. Materials and Methods: This is a descriptive study done on MRM specimens of patients with LABC received in histopathology lab of Government Medical College, Kottayam to look for the pCR of the tumor following NACT. Gross examination and histopathology study of the specimen including axillary lymph nodes were done. The trucut biopsies of these cases with immunohistochemistry study were reviewed for confirming the grade and molecular subtype. pCR was assessed based on Chevallier system. Results: Of the 131 MRM specimens studied, overall pathologic complete response rate was 24.4% and the pathologic complete response rate in Luminal A subtype, Luminal B subtype, HER2 enriched tumors, triple negative tumors were 23.6%, 24%, 33%, and 20%, respectively. Conclusion: 33% of HER2 enriched subtype showed a pCR, i.e., no residual foci of neoplasm seen in the MRM specimens following NACT. Following NACT, change in tumor cellularity, changes in the morphology of neoplastic cells, changes in the surrounding breast tissue, and a change in grade of tumor were also noticed.

Comparison of 10% Buffered Formalin Fixation and Carnoy's Solution in Revealing the Axillary Lymph Node Counts in Modified Radical Mastectomy Specimens

Comparison of 10% Buffered Formalin Fixation and Carnoy's Solution in Revealing the Axillary Lymph Node Counts in Modified Radical Mastectomy Specimens

Cytological Grading of Breast Carcinomas and Its Prognostic Implications.

IntroductionDetermining the histological grade of breast carcinomas before mastectomy is necessary to decide about neoadjuvant chemotherapy. Core needle biopsies used for this purpose often under-grade the tumour. The grade obtained from fine needle aspiration cytology samples will help in such situations and whenever biopsy is not done, as in a resource-poor setup. Many studies are being done to find out the cytological grading system that correlates well with histological grading.MethodsThis study was done between 2016 and 2019 including the cases in which both modified radical mastectomy and fine needle aspiration of the tumour had been done. Robinson’s cytological grading was done in Papanicolaou and haematoxylin & eosin (H&E) stained cytology smears and correlated with modified Bloom-Richardson histologic grading done in modified radical mastectomy specimens. We also studied the prognostic significance of Robinson’s method by studying the association between cytological grade and lymph node metastasis.ResultsSixty cases were studied. The two methods had the same grade in 49 (81.7%) cases. They showed a significant positive correlation (Spearman correlation coefficient 0.848, p-0.0001), significant association (Chi-square test, p-0.0001), and substantial agreement (kappa value 0.72). Multiple regression analysis showed chromatin score and nucleoli score as the most influential parameters. Lymph node metastasis showed significant association with cytological grade (p-0.0003), cell dissociation score (p-0.0001), nucleoli score (p-0.01), and chromatin score (p-0.04).ConclusionRobinson’s cytological grading is a simple, reliable adjunct/alternative to core needle biopsies for grading breast carcinomas before mastectomy. Hence, it can be made a part of routine cytology reporting of breast carcinomas. Further long-term studies will help in confirming its prognostic significance.

A Study of Molecular Subtypes of Carcinoma Breast by Immunohistochemistry at Tertiary Care Center, Jaipur

Introduction: Breast cancer is one of the most common malignant tumors and one of the leading causes of cancer related death amongst females worldwide. The clinical significance of molecular classification of carcinoma breast remains to be established. Molecular subtyping using immunohistochemistry can provide additional prognostic and predictive information. Aim and objectives: To identify morphological variants of carcinoma breast and to determine various proportions of molecular subtypes of carcinoma breast by immunohistochemistry. Materials and Methods: A descriptive type of observational study was done at SMS Medical College, Jaipur. 65 Modified Radical Mastectomy specimens received in the department were included in the study. The surgical specimens were then evaluated histopathologically and immunohistochemically for ER, PR, HER2/neu, and Ki67 markers. Results: Out of 65 breast carcinoma cases the most common histological type encountered in our study was Invasive ductal carcinoma of no special type (NST) (83.09%) followed by medullary carcinoma (4.63%) and invasive lobular carcinoma (3.09%) and a single case each of tubular, cribriform, metaplastic, lymphoepithelioma like carcinoma, carcinoma with apocrine differentiation and oncocytic carcinoma. The cases were further classified into molecular subtypes using protein expression patterns in IHC. The proportion of tumors found were Luminal A (32.31%), Luminal B (18.46%), HER2/neu overexpressed (13.84%), and Triple-negative (35.39%). Conclusion: The most common molecular subtype found in our study was Triple negative. The use of IHC markers in the clinical setting could determine the prognosis and benefit the patients with targeted therapies.

Comparison of Breast Cancer Aggressiveness in Young and Older Patients

Objective: To compare aggressiveness of breast cancer in young and old patients. Study Design: Cross-sectional Place and Duration of Study: Department of Histopathology, King Edward Medical University, Lahore from 1st January 2016 to 31st December 2018. Methodology: One hundred and fifty women were divided into young (<40 years) and adult (>40 years) group depending upon their age. Women with breast cancer within 20-80 years were enrolled. Modified Radical-Mastectomy specimens as well as lumpectomy having axillary-clearance were sent to pathological laboratory. Biopsies were fixed in formalin in addition to hematoxylin, eosin staining. Data was documented and aggressiveness of breast cancer within both groups was evaluated on the basis of factors as tumor size, tumor type, lymph nodes, metastasis, tumor staging and tumor grading. Results: A significant variance in young and adult cases tumor grade, lymph node involvement and tumor size. The young patients had 12.90% cases of metastasis than old only having 4.5% (p<0.05). Similarly high tumor stage and aggressive tumors were also seen in young patients when compared with old. Conclusion: Young patients with breast cancer are more prone towards aggressive carcinoma than older patients. Keywords: Breast cancer. Metastasis, Tumor grade

Histopathological Grading and Staging of Invasive Ductal Carcinoma in Modified Radical Mastectomy Specimens

Background: Breast carcinoma is the most common malignancy in females associated with high mortality rate. Objective: The purpose of present study was to describe the histological grade and histopathological stage of invasive ductal carcinoma of breast among female patients and to determine the association of tumor size and histological grade withnodal metastasis. Methods: This is an analytical cross sectional study, conducted in the Department of Pathology Fatima Jinnah Medical University Lahore, Pakistan from September, 2019 till February, 2020. Female patients of all age groups who were diagnosedwith invasive ductal carcinoma and underwent modified radical mastectomy were included in the study. Tissue processed and Hematoxylin and Eosin staining was performed. All the sections were examined under the light microscope by myself and two other consultant pathologists independently. Histological grading of invasive ductal carcinoma was done by following Modified Scarff Bloom Richardson grading system and histopathological staging was done according to CAP protocols. Results: Total of 60 female patients diagnosed with invasive ductal carcinoma were included in the present study. Mean age of the patient calculated was 48.17± 13.12 years with age range from 26 to 90 years. Size of the tumor ranged from 1cm to 10cm. On microscopy, histological grade III was the most frequent grade (36, 60%). Out of total 60 cases n=43(71.6%) were diagnosed with regional lymph node metastasis and T2N1Mx( 17,38.3%) was the most frequent stage of the tumor. Statistically no significant association of tumor size and histological grade was observed with regional lymph node metastasis (p >0.05).

Aggressiveness of Breast Carcinoma in Young Pre-Menopausal Patients

Background: Breast cancer is the most commonly diagnosed malignancy in female population. Aim: To determine and compare the frequency of aggressiveness of breast cancer in pre and post-menopausal patients. Study design: Cross sectional study Place and duration of Study: Department of Histopathology, K.E. Medical University Lahore from 1st January 2016 to 31st December 2018. Methodology: One hundred and fifty female patients diagnosed with breast cancer to assess the aggressiveness of breast cancer in young - premenopausal patients. Post-Surgical Modified Radical Mastectomy specimens were submitted and evaluated for grade, stage, involved lymph nodes, tumor size and metastasis. Results: Sixty four percent of the tumors were left sided and the invasive ductal carcinoma was the most dominant histologic type (96%). Ninety two patients were premenopausal while 58 were post-menopausal. Nodal positivity in patients less than 40 years was more pronounced (74.2% versus 56.8%, p=0.029). Conclusion: Young premenopausal patients represent high risk group for advanced breast cancer. Key words: Breast Cancer, Young, Premenopausal, Post-menopausal, Invasive Ductal Carcinoma

Evaluation of Immunohistochemical Expression of Topoisomerase II Alpha Protein in Patients with Breast Cancer and Its Correlation with Different Prognostic Factors

Background: There are indications to support the knowledge about the prognosis of breast cancer. One of these markers is regarded as a prognostic factor and related to the proliferation rate. Topoisomerase IIα (TOP2A), encoded by the TOP2A gene, is a molecular target for anthracycline therapy. Aims: The aim of this article is to establish any association of the status of topoisomerase IIa immunohistochemistry with different prognostic clinicopathological and molecular parameters in breast cancer. Settings and Design: A cross-sectional retrospective study was carried out in the Department of Pathology and Forensic Medicine, Faculty of Medicine, Babylon University, during the period from January 2020 through December 2020. Materials and Methods: Fifty cases with invasive breast carcinoma have been obtained from surgical modified radical mastectomy specimens from the Laboratory of Histopathology in Al-Kafeel Specialized Hospital, Karbala for the last 3 years (2017–2019). Different clinicopathological variables were estimated. The expression of TOP2A was stained by using the PathnSitu PolyExcel Detection System of Immunostaining. Statistical Analysis Used: Immunostaining with TOP2A expression used a cut-off value of 10%. The results were considered statistically significant if the P-value was ≤ 0.05. Results: Fifty cases of TOP2A overexpression were classified as follows: 28 cases (56%) had 3+ expression, 4 cases (8%) with 2+ expression, and 4 cases (8%) with 1+ expression, whereas 14 cases had no expression of TOP2A (28%). TOP2A overexpression was shown to be associated with a higher grade (P = 0.023) and molecular subtypes (P = 0.057), but not with other clinicopathological parameters (age of patients, type of histology, number of lymph nodes involved, tumor size). Conclusion: According to these results, TOP2A plays a major role in the aggressive nature of tumors. This may support the suggestion to be used as a prognosis marker.

THE RELEVANCE AND IMPORTANCE OF TUMOR INFILTRATING LYMPHOCYTES (TILS) IN BREAST CANCER

Tumor infiltrating lymphocytes (TILs) were evaluated in many cancers like ovarian tumors, endometrial tumors, colon cancer and melanoma. Now there is increasing trend in evaluating TILs in breast cancer. Tumor infiltrating lymphocytes gives the patients immune response to the tumor. 100 cases of Modified radical mastectomy specimen were chosen from surgical pathology records. The representative formalin fixed paraffin embedded tissue samples were collected. Detailed history regarding Patients age, sex, side of the breast involved , Grade and neoadjuvant chemotherapy were assessed for 100 cases. Tumor Infiltrating Lymphocytes are evaluated with Immuno HistoChemistry CD45 and CD3 for 100 cases , in which 93% cases were Infiltrating Ductal carcinoma-NOS cases and 07 % cases are of special types like Mucinous, Metaplastic, Apocrine, and Medullary carcinoma. Results: In our study, Highest incidence of breast carcinoma occur in the age group of 41-50 years. Infiltrating Ductal Carcinoma NOS is the most common primary malignant neoplasm of breast constituting 93% of cases. Most of the malignant tumors are left sided. Forty seven percent of cancers are presented in the size range of 2-5cms. Majority of the tumors are of Grade II accounting for 63.5% of all cases. TILs were evaluated with three variables 0- 10 % 20- 40 % and 50- 90 %.Younger the age, more the TILs. Neo adjuvant chemotherapy had significant correlation with TILs (P= 0.05).

Expression of vimentin in breast carcinoma and its correlation with histopathological parameters

Background and Objectives: Despite various treatment and diagnostic options, Breast cancer remains one of the top cancer in women both in developed and the developing world. In such a scenario, Immunohistochemistry plays an important role in pathology of breast disease which contributes for solving diagnostic problems and for determining prognosis and response to therapy. There is growing list of IHC markers available, the present study highlights the importance of vimentin a mesenchymal marker in breast carcinoma cases. Objectives of the Study: 1) To assess the expression of vimentin in various types of breast carcinomas. 2) To find out the correlation between expression of vimentin and prognostic markers such as tumor size, tumor grade and lymph node status. Materials and Methods: The study included 50 cases of modified radical mastectomy specimens received in the Department of Pathology, during December 2017 to May 2019. After collecting the history, the specimens were examined, fixed in 10% formalin and sections were studied by hematoxylin and eosin and immunohistochemically. Results: In the present study majority of the patients were in the age group of Keywords: Breast carcinoma, Lymph node status, Tumor size, Tumor grade, Vimentin.

Breast adenomyoepithelioma with ductal carcinoma in situ: An unusual entity

Adenomyoepithelioma is a rare biphasic tumor characterized by the proliferation of inner glandular epithelial cells and outer myoepithelial cells. These tumors have a low-grade potential for local recurrence and malignant transformation. Here, we present the case of a 51-year-old female who presented with a right breast lump for 1 month. Mammography was suggestive of BIRADS 4/5 for the right breast while BIRADS 1 for the left breast. FNAC was reported as benign breast disease, whereas, trucut biopsy of the same lesion was suggestive of invasive ductal carcinoma with ductal carcinoma in situ (DCIS). A final diagnosis of adenomyoepithelioma with DCIS component was confirmed on the right modified radical mastectomy. We, hereby, describe an extremely unusual case of biphasic breast adenomyoepithelioma that depicted benign features on FNAC and features of an invasive ductal carcinoma on trucut biopsy. Its distinct histomorphology with a characteristic epithelial-myoepithelial immunohistochemical profile on modified radical mastectomy specimen led to a definitive diagnosis of adenomyoepithelioma with DCIS.

Evaluation of p53 in breast cancer and its correlation with various histological prognostic factors

Carcinoma of the breast is the most common non-skin malignancy in women. The p53 gene is one of the most commonly mutated genes described in human neoplasia. Mutant p53 protein has greater stability and longer half time than the wild type protein that can be detected by Immunohistochemistry. This study was conducted to evaluate the expression of p53 in breast carcinoma and its correlation with various histological prognostic markers to determine its significance as a prognostic marker in breast cancer. The prospective study included 52 modified radical mastectomy specimens diagnosed as breast cancer in the Department of Pathology at SRMSIMS, Bareilly between November 2016 and April 2018. Routine H&E staining and immunohistochemical analysis for ER, PR, Her2/neu and P53 was carried out in all the cases. Majority of the cases belonged to the age group 30-39 years and the most common cancer type was infiltrating ductal carcinoma. Significant correlation of p53 was observed with ER and PR expression, however no significant correlation could be found with tumor type, grade, size, type of margin, necrosis, stromal response, lymphovascular invasion, lymph node status and Her2/neu status.P53 was found to have a significant inverse correlation with ER and PR expression only. The results do not resolve whether detectable p53 protein expression represents a random product of dedifferentiation or an important feature of the malignant phenotype, playing a key role in tumor behavior.

Histomorphological evaluation of Breast carcinoma – A study of 15 cases

Purpose/Objective: Breast cancer occurs in any of the cells of the mammary gland and exhibits a wide scope of morphological features, different immunohistochemical profiles, and unique histopathological subtypes that have specific clinical course and outcome. This study was conducted to assess various histomorphological variants of breast carcinoma. Material and Methods: Total of fifteen cases of modified radical mastectomy specimens were prospectively assessed from January 2019 to June 2019 in pathology department of Dr B.R. Ambedkar Medical college and hospital, Bangalore. Observation: Out of 15 cases, Invasive ductal carcinoma NOS was most common variant accounting for 10 cases (66.66%) followed by 1 cases of Invasive Lobular Carcinoma breast, 1 case of Invasive micropapillary carcinoma, 1 case of Medullary carcinoma, 1 case of Metaplastic breast carcinoma. The histological grading of breast carcinoma was done on the basis of Elston – Ellis modification of Scarff - Bloom - Richardson grading system. We found that Grade 2 tumours were more common accounting to 9 cases (60%) followed by Grade 1 tumour (26.66%). Conclusion: This study emphasizes on the importance of assessment of histopathological variants of breast carcinoma in not only in establishing the final diagnosis, but also in predicting the prognosis by histological typing, staging and grading of breast carcinoma. Keywords: Breast carcinoma, MRM, Histomorphology, WHO, Staging, Grading.

A study on clinico-pathological assessment of response to neoadjuvant chemotherapy in breast carcinoma.

Neoadjuvant chemotherapy (NACT) has become a strategy in the multidisciplinary treatment approach to breast cancer. Since clinical and radiological responses do not correlate well with residual tumor after treatment, pathological evaluation of tumor response to chemotherapy is essential for accurate assessment. The aim of this study is to assess clinicopathological response to NACT in patients with invasive breast carcinoma. Single institution, retrospective study was conducted for 4 years. The study included 95 cases with the clinical diagnosis of locally advanced breast cancer and invasive breast carcinoma on histopathological examination of core needle biopsy/lumpectomy specimen. These cases were assessed for estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2) receptors and treated with four cycles of NACT (adriamycin-cyclophosphamide) therapy. Histopathological examination of postchemo modified radical mastectomy specimens was performed following standard protocol. The pathological response of tumor to chemotherapy was assessed on Miller-Payne grading (MPG) and residual disease in breast and lymph node (RDBN) level. Data were analyzed in percentages and presented in charts and tables. Histopathological examination of pre-chemo biopsy specimens revealed invasive ductal carcinoma No special type (NST) in maximum, 89 (93.7%) cases. Majority 43 (45.3%) cases were HER2-positive followed by estrogen receptor-positive and/or progesterone receptor positive and HER2-positive type seen in 23 (24.2%) cases and 22 (23.1%) cases were triple negative. Sixteen (16.8%) and 76 (80%) cases showed pathological complete response (pCR) and partial pathological response, respectively, to NACT on MPG; 12 (12.6%) and 83 (87.4%) cases showed pCR and residual disease, respectively, on RDBN level. Majority 37.5% and 50% of cases showing pCR on MPG and RDBN level, respectively, were triple negative. This study highlights the clinicopathological response to NACT in carcinoma breast patients and identifies the molecular subtypes of these patients likely to respond to NACT.

Does tumor stroma ratio of breast cancer trucut biopsy determine response to neoadjuvant therapy?

We examined the prognostic value of Tumor stroma ratio (TSR) in breast tumor core biopsy (TCB) specimen to determine response to neoadjuvant therapy (NAT) prior to modified radical mastectomy (MRM). This was a retrospective analysis of patients with breast cancer who underwent TCB before NAT between August 2016 and July 2018. TSR in TCB was studied independently by 2 pathologists ( VM, VS) defined as stroma rich (TSR≤50%) or stroma poor (TSR>50%). MRM specimen of these patients were subsequently studied .Residual cancer burden (RCB) was calculated using the MD Anderson RCB calculator, categorized as complete (0), good (1) Partial (2) and no response (3). Statistical analysis was done to assess correlation of TSR to RCB. A total of 62 patients were analyzed. Mean(SD) age was 48(11) years.Twenty eight (45%) and 34 (55%) patients were stroma rich and stroma poor respectively. Twenty six (42%) patients were responders and 36 (58%) non-responders to NAT. Among stroma rich patients, only 3 (10%) were responders (Class 0 &1)and 25 (90%) non-responders(Class2&3)to NAT, among stroma poor patients 23 (68%) responded well and 11 (32%) did not.TSR had a moderate negative correlation with RCB (-0.6). On univariate analysis, only TSR had a significant effect on RCB class (<0.001). TSR on TCB is a useful prognostic factor to determine response of breast carcinoma patients to neoadjuvant therapy.It is cost effective, simple and quick. Larger multi-centric studies would be useful to study its clinical implications.

Evaluation of axillary lymph node metastasis in relation to size and metastatic status of sentinel lymph node in carcinoma breast

Background: Sentinel lymph node (SLN) is the first node in the nodal basis of a tumor and the most likely site for earliest lymph node metastasis. Modified radical mastectomy with axillary lymph node dissection (ALND) has been the standard of care for carcinoma breast. The SLN is the only involved node in majority (40-70%) of the patients undergoing ALND for a positive SLN biopsy. ALND is associated with significant morbidities like seroma, infection, lymphedema and nerve injury. The purpose of this study was to evaluate the axillary node metastasis with respect to the size and tumoral load of positive SLN.Methods: Thirty patients of biopsy proven early breast carcinoma underwent SLN biopsy with methylene blue dye followed by modified radical mastectomy (MRM). After measuring the size of the SLN with Vernier caliper, SLN and MRM specimen were sent for histopathological examination. Status of non-sentinel ALNs was compared with the size and tumoral load of SLN.Results: Among 30 patients, 5 patients had positive SLN. Patients with positive SLNs were younger (mean 36 vs. 52 years), had larger diameter (10.8 vs. 7.4 mm, p&lt;0.03) with higher number of non-sentinel ALN metastasis (35% vs. 4.86%). Macrometastasis in positive SLN was associated with higher risk of metastasis to non-sentinel ALNs.Conclusions: A SLN size of more than 7.5mm has higher risk of harboring metastasis. A SLN size higher than 10mm and macrometastasis is associated higher risk of metastasis to non-sentinel ALNs.

Histopathological Evaluation of Carcinoma Breast with Significance of Histological Grading and other Morphological Prognostic Factors at a Tertiary Health Care Institute

Background: Breast carcinoma is the second common malignancy among women. Pathological prognostic factors in breast cancer are now widely used to predict prognosis of breast carcinoma and to plan its effective management. Aim and Objectives: To analyze the spread and extent of various histological patterns of carcinoma breast, to do grading and staging of the tumors and to correlate above factors with the prognosis. Material and Methods: The present study was a prospective study of histopathological findings of modified radical mastectomy specimens received in the department of pathology of Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik over a period of 2 years and 3 months that is from June 2015 to September 2017. A total of 45 mastectomy specimens were analyzed in this period, using standard histopathology technique. Positive status of Axillary lymph nodes and other prognostic factors were analyzed. Nottingham Prognostic Index (NPI) was used to assess the prognosis. Follow up of all the patients was kept. Results: Out of 45 total cases, the most common histologic type was Invasive Ductal Carcinoma (NOS) (86.67%). The largest tumor size was 14.5cm. Maximum tumors were of Grade II. Out of the 45 cases, 31 (68.88%) cases showed tumor metastasis in axillary lymph nodes. 48.88% of the patients showed poor prognosis category with score greater than 5.4. Conclusion: After keeping follow up with the patients we came to a conclusion that, the lymph node status, tumor size, histologic pattern, histologic grade, necrosis and presence or absence of blood vessel invasion remains the best independent prognostic indicators.