Progesterone Receptor Positivity Research Articles

The Relationship of GATA3 and Ki-67 With Histopathological Prognostic Parameters, Locoregional Recurrence and Disease-free Survival in Invasive Ductal Carcinoma of the Breast.

In recent years, GATA-binding protein 3 (GATA3) has been indicated as a marker showing good prognosis in breast cancer. In luminal breast cancer, which has good a prognosis, it shows more significant elevation in small-sized and low-grade tumors. In contrast, Ki-67 is defined as a poor prognostic factor. The aim of this study was to emphasise the prognostic importance of GATA3 and the inverse relationship with Ki-67. In our study, 90 patients with invasive ductal breast cancer were immunohistochemically evaluated for Ki-67 and GATA3 expression. The relationship between GATA3 and Ki-67 expression was examined. In addition, the relationship between these two factors with estrogen, progesterone, human epidermal growth factor 2 receptor antibodies and other prognostic parameters such as disease-free survival and local recurrence was investigated. We accepted the level of ≥5% nüclear reaction as positive for GATA 3. A Ki-67 cut-off value of 20% was accepted as positive. In GATA3 positive breast cancers, good prognostic parameters were seen including high estrogen receptor (ER) positivity, progesterone receptor (PR) positivity, small tumor size and low histological grade as well as low Ki-67 expression. In breast cancers showing high Ki-67 expression, ER, PR, and GATA3 positivity were lower and there was higher human epidermal growth factor receptor 2 (HER2) positivity and high histological grade while the tumor size was larger. Our study has revealed that GATA3 has an inverse relationship with Ki-67, whereas it has a positive releationship with good prognostic factors.

Androgen receptor expression in a Sri Lankan patient cohort with early breast carcinoma

BackgroundAndrogen receptor (AR) expression is emerging as a prognostic biomarker in breast carcinoma (BCa). The study aimed to determine the prevalence of AR expression by immunohistochemical analysis among a cohort of Sri Lankan women with early BCa and to evaluate its association with clinicopathological features including immunohistochemical molecular subtype and early survival.MethodWe studied the clinical and pathological features and immunohistochemical profile of 141 women undergoing primary surgery for early BCa, followed by standard adjuvant therapy. AR status was assessed by immunohistochemistry in all cases. Overall survival (OS) and disease-free survival (DFS) was determined. The relationship between AR expression and clinical and pathological parameters and immunohistochemical molecular subtype was analyzed using Student T test and chi-square tests. Cox regression analysis was used to analyze the prognostic impact of AR expression.ResultsAR expression was seen in 40.8%(95%CI 33.10–49.07%) of the BCa study cohort. None of the clinical data studied showed a significant association with the AR status(p > 0.05). Ductal carcinoma in situ(p = 0.003), oestrogen receptor (ER) (p = 0.001) and progesterone receptor (PR) (p = 0.001) positivity and luminal IHC molecular subtype(p = 0.016) were significantly associated with AR-positive status. AR-negative status was significantly associated with tumour necrosis > 50%(p = 0.031), moderate to extensive lymphocytic infiltrate at the tumour margin(p = 0.025) and basal triple negative breast carcinoma(p = 0.016).The mean duration of patient follow-up was 46.70(95% CI 46.495–46.905) months (3.89 years). On univariate analysis, AR-positivity was associated with better OS among ER-positive tumours(p = 0.047), specifically in postmenopausal women (p = 0.030). In ER-negative tumours, AR positivity was associated with worse DFS (p = 0.036). On multivariate analysis, TNM stage and ER/AR status were predictive of survival. ER-positive/AR-positive (ER+/AR+) tumours demonstrated better OS than ER-positive/AR-negative (ER+/AR-) tumours(p = 0.015). ER-negative/AR-positive (ER−/AR+) tumours (p = 0.014) had a worse DFS than ER-negative/AR-negative (ER−/AR-) tumours.ConclusionsAR prevalence obtained was low. AR positivity was associated with positivity for ER and PR. On multivariate analysis, apart from TNM stage only ER/AR status were predictive of OS and DFS, with concordant expression of ER/AR demonstrating a better, early survival.

Survival Outcomes of Early-Stage Hormone Receptor-Positive Breast Cancer in Elderly Women.

Elderly women (≥ 70years old) form a significant proportion of patients affected by breast cancer (BC); however, the treatment decisions for this patient population are complicated, owing to the presence of comorbidities, limited life expectancy, reduced tolerability of therapy, and limited enrollment in clinical trials. A growing body of evidence suggests equivalent outcomes in elderly patients with hormone receptor-positive early-stage breast cancer receiving primary endocrine therapy only or surgery with subsequent endocrine therapy. Whether these results are reproduced in the larger BC population outside of a clinical trial currently remains unclear. Women ≥ 70years old diagnosed with early-stage invasive breast cancer between January 2008 and December 2013 with tumor size T1 or T2, minimal nodal involvement (N0 and N1), and estrogen and/or progesterone receptor positivity who started endocrine therapy within a year of diagnosis were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked datasets. Endocrine therapy was identified using outpatient prescription fills for anastrozole, exemestane, fulvestrant, letrozole, raloxifene, tamoxifen, and toremifene; the first fill date was used as the treatment initiation date. Surgical intervention included either breast-conserving surgery or mastectomy. Women who received chemotherapy were excluded. Trends in the use of primary endocrine therapy only were assessed using Poisson regression. Multivariable Cox proportional hazard regression was used to estimate the association between undergoing surgery within a year of diagnosis and 5-year all-cause mortality, after adjusting for patient demographics, comorbidities, and clinical cancer characteristics. Similar methods were used to assess 5-year cancer-specific mortality, where noncancer mortality was treated as a competing risk. Overall, 8784 women were included in the analysis: 8006 (91%) received surgery with endocrine therapy and 778 (9%) received primary endocrine therapy alone. The proportion of women not receiving surgery remained consistent between 2008 and 2013 (p = 0.10). The 5-year mortality was 11% (n = 619), and 19% of all deaths were due to cancer causes (n = 117). After adjustment, 5-year mortality was lower among women undergoing surgery (HR 0.59, 95% CI 0.47-0.74, p < 0.0001). Similar results were found when looking at 5-year cancer-specific mortality (HR 0.52, 95% CI 0.30-0.90, p < 0.0001). Elderly breast cancer patients with early-stage hormone-receptor-positive disease receiving primary surgical intervention plus endocrine therapy may have significantly improved survival than those receiving primary endocrine therapy alone. This study suggests the importance of surgical intervention for elderly breast cancer patients and warrants further investigation and comprehensive geriatric assessment to identify subsets of elderly breast cancer patients who may benefit significantly from surgical intervention.

Expression of CD73 is associated with tumor progression and intratumoral inflammation in breast cancer.

CD73 is a lymphocyte differentiation antigen and highly expressed in many human solid tumors. CD73 is known to be associated with tumor progression, but its role in human breast cancer is still under investigation. The aims of this study were to evaluate the expression of CD73 in human breast cancer and to analyze its prognostic significance in breast cancer. A total of 198 patients who underwent surgery for the treatment of primary breast cancer were enrolled. Tissue microarrays (TMA) were constructed with breast cancer tissues and immunohistochemical staining for CD73 was performed on TMA tissue sections. The clinicopathologic characteristics were evaluated from the patient's medical records and pathologic reports. The average age of the patients was 51.7 ± 10.7. Positive expression rate of CD73 for all breast cancer was 25.4%. Positive rate of CD73 expression in invasive breast cancer was 30.9%, which was significantly higher than that of 5.4% of ductal carcinoma in situ. CD73 expression was significantly associated with higher T-stage, node metastasis, positive progesterone receptor status and presence of intratumoral inflammation. There was no significant association between molecular subtypes and CD73 expression. The disease-free survival (DFS) and overall survival (OS) rate at 5 years were 90.1% and 96.6%, respectively. There was no difference in DFS and OS according to CD73 expression. In conclusion, this study showed that CD73 expression is associated with tumor progression and inflammation in breast cancer. Our results suggest that CD73 has a potential as a prognostic marker and a therapeutic target of breast cancer.

Clinico-pathological study of locally advanced breast cancer and their hormone receptor analysis

Background: Breast carcinoma is one of the most common malignant tumor of women. Determination of estrogen receptors (ER) and progesterone receptors (PR) status, prior to therapeutic intervention has become standard practice. Survival and response to hormone therapy are most favorable among women who are receptor positive. The aim of this study is to assess the hormone receptor status in locally advanced breast carcinomas and correlate this reactivity pattern with tumor stage, clinical stage and lymph node metastasis. Objective of the study was to co-relate the locally advanced breast cancer and their hormone receptor analysis.Methods: Patients who visited Department of General Surgery, Hamidia Hospital, Bhopal were assessed clinically, radiologically and histopathologically and then ER and PR study was done, for a total of 50 cases were done.Results: In our study majority of the cases were locally advanced breast cancer (50%) which may be due to the low socio economic status, late presentation, pain tolerance, illiteracy and availability of the resources. Majority of cases were in postmenopausal, clinical stage 3 and histological grade 2. ER positivity 50% and PR positivity 44% and it was found that hormone receptor positivity was high in locally advanced breast cancers 63.5%.Conclusions: Hormone receptor analysis should be an integral part of initial workup of carcinoma breast, as the percentage of hormone receptor positivity is increasing in our population in locally advanced breast cancer. So locally advanced breast cancer can be diagnosed at an early stage by screening and conducting breast awareness programs.

SALL4 promotes tumor progression in breast cancer by targeting EMT.

Sal-like protein 4 (SALL4) is overexpressed in breast cancer and might contribute to breast cancer progression, but the molecular mechanism remains unknown. Here, we found that within a group of 371 ethnic Chinese breast cancer patients, SALL4 was associated with lower grade (P = .002) and progesterone receptor positivity (P = .004) for overall cases; lower Ki67 (P = .045) and high vimentin (P = .007) for luminal cases. Patients with high SALL4 expression in lymph node metastasis showed a significantly worse survival than those with low expression. Knockout of SALL4 in a triple-negative breast cancer cell line MDA-MB-231-Red-FLuc-GFP led to suppressed ability in proliferation, clonogenic formation, migration, and mammosphere formation in vitro, tumorigenicity and lung colonization in vivo. On the other hand, overexpression of SALL4 enhanced migration and mammosphere formation in vitro and tumorigenicity in vivo. Mechanistically, there was a positive correlation between SALL4 expression and mesenchymal markers including Zinc finger E-box binding homeobox 1 (ZEB1), vimentin, Slug, and Snail in vivo. Chromatin immunoprecipitation experiment indicated that SALL4 can bind to the promoter region of vimentin (-778 to -550 bp). Taken together, we hypothesize that SALL4 promotes tumor progression in breast cancer by inducing the mesenchymal markers like vimentin through directly binding to its promoter. Increased SALL4 level in metastatic lymph node relative to the primary site is an important poor survival marker in breast cancer.

Determination of Paraneoplastic neuropathy in newly diagnosed breast tumor patients.

ObjectiveThe presence of paraneoplastic neuropathy in newly diagnosed breast tumor patients will be investigated. Aim of study is conduce of early diagnosis of the disease and new biomarkers responsible for the pathogenesis to be identify.Materials and MethodsThirty-two patients admitted to the Oncology outpatient clinic with newly diagnosed breast cancer were included in the study. After the neurological examination of the patients, Lanss neuropathic pain scale and blood tests were performed. Before chemotherapy all patients underwent electromyography (EMG). Two tubes of 5 cc of venous blood were obtained by screening onconeuronal antibodies.ResultsPatients included in the study; 1 (3.1%) grade 1, 14 (43.8%) grade 2, 17 (53.1%) grade 3 invasive breast cancer was diagnosed. Perineural invasion was detected in 5 (15.6%) patients. Progesterone receptor positivity was found in 26 (81.2%) patients and estrogen receptor positivity was found in 27 (84.4%) patients. In 7 (21.9%) patients, CERBB2 was positive for Ki 67 in 25 (78.1%) patients. Neuropathic findings were present in 6 (18.8%) patients. Sensory neuropathy was detected by electrophsiologic tests in only 2 (6.2%) patients. A total of 12 (37.5%) patients had onconeuroneal antibody positivity. Antibody positivity was significantly higher in patients with high grade tumor (p = 0.008).ConclusionParaneoplastic neuropathies can be confused with neuropathies due to non-cancerous causes both clinically and electrophysiologically. When approaching paraneoplastic neuropathies, pathological findings should be carefully reviewed and evaluated with other findigs.It should be remembered that an underlying breast tumor may be present in women with cancer-related neuropathic complaints.

Identification of plasma hsa_circ_0008673 expression as a potential biomarker and tumor regulator of breast cancer.

ObjectiveCell‐free circular RNAs (circRNAs) are stable and abundantly exist in body fluids. In this study, we aimed to investigate plasma cell‐free circRNAs as a novel class of biomarkers for the diagnosis of breast cancer (BC).MethodsDifferentially expressed circRNAs from 6 normal and 6 BC plasma samples were detected by microarray. Hsa_circ_0008673 was then screened and validated in the plasma of 102 normal and 378 BC samples. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value. The correlations between hsa_circ_0008673 expression and demographic characteristics, tumor features, and prognosis were analyzed. The effects of hsa_circ_0008673 on BC cell proliferation and metastasis were also measured.ResultsOf the top ten up‐regulated (hsa_circ_0008673, hsa_circ_0008500, hsa_circ_0005260, hsa_circ_0003423, hsa_circ_0119881, hsa_circ_0000987, hsa_circ_0007386, hsa_circ_0000091, hsa_circ_0016601, and hsa_circ_0008549) and top ten down‐regulated (hsa_circ_0000826, hsa_circ_0072697, hsa_circ_0004587, hsa_circ_0000471, hsa_circ_0007786, hsa_circ_0001417, hsa_circ_0005982, hsa_circ_0001566, hsa_circ_0003823, and hsa_circ_0003823) circRNAs from microarray, hsa_circ_0008673 was the most significantly up‐regulated circRNA in BC, and represented a good diagnostic value. Hsa_circ_0008673 was remarkably down‐regulated after breast mastectomy. Hsa_circ_0008673 expression was associated with larger tumor size, distant metastasis, positive estrogen receptor (ER) status, and positive progesterone receptor (PR) status. Additionally, hsa_circ_0008673 could serve as a prognostic predicator of overall survival (OS) and disease‐specific survival (DSS). Cell assays proved that hsa_circ_0008673 knockdown contributed to inhibition of tumor cell proliferation and migration.ConclusionPlasma cell‐free hsa_circ_0008673 was up‐regulated in BC, which was associated with poorer prognosis and promoted tumor proliferation and metastasis. Hsa_circ_0008673 is a promising biomarker for tumor diagnosis and prognostic assessment of BC patients.

Patient Characteristics Influence Activated Signal Transducer and Activator of Transcription 3 (STAT3) Levels in Primary Breast Cancer-Impact on Prognosis.

Background: Activated signal transducer and activator of transcription 3 (pSTAT3) is often present in breast cancer, but its prognostic impact is still unclear. We investigated how breast tumor-specific pSTAT3Y705 levels are associated with patient and tumor characteristics and risk of recurrence.Materials and Methods: Primary breast cancer patients without preoperative treatment were included preoperatively. The patients were treated in Lund, Sweden, in 2002–2012 and followed until 2016. Levels of pSTAT3Y705 were evaluated in 867 tumors using tissue microarrays with immunohistochemistry and categorized according to the H-score as negative (0–9; 24.2%), intermediate (10–150; 69.9%), and high (160–300; 5.9%).Results: Patients were followed for up to 13 years, and 137 recurrences (88 distant) were recorded. Higher pSTAT3Y705 levels were associated with patient characteristics including younger age, any alcohol consumption, higher age at first child birth, and smaller body size, as well as tumor characteristics including smaller tumor size, lower histological grade, lymph node negativity, progesterone receptor positivity, and HER2 negativity (all Ptrends ≤ 0.04). Higher pSTAT3Y705 levels were associated with lower risk of early recurrences (LogRank Ptrend = 0.10; 5-year LogRank Ptrend = 0.004) and distant metastases (LogRank Ptrend = 0.045; 5-year LogRank Ptrend = 0.0007), but this was not significant in the multivariable models. There was significant effect modification between tamoxifen treatment and pSTAT3Y705 negativity on the recurrence risk in chemonaïve patients with estrogen receptor positive tumors [adjusted hazard ratio (HR) 0.38; Pinteraction = 0.046].Conclusion: Higher pSTAT3Y705 levels were associated with several patient and tumor characteristics that are mainly associated with good prognosis and a tendency toward lower risk for early recurrences. In the future, these results may help guide the selection of patients for trials with drugs targeting the STAT3 pathway.

Breast-Conserving Surgery is Oncologically Safe for Well-Selected, Centrally Located Breast Cancer.

The aim of this study was to evaluate the long-term survival outcomes of breast-conserving surgery (BCS) in centrally located breast cancer (CLBC) compared with mastectomy in CLBC and BCS in non-CLBC, based on the Surveillance, Epidemiology, and End Results (SEER) database. Female patients aged < 80years with unilateral T1-T2 invasive ductal or lobular breast cancer undergoing BCS or mastectomy were enrolled. The differences in clinical-pathological characteristics were evaluated using Chi square tests. Multivariate logistic regression was used to measure the relationship between predictive variables and performing BCS in CLBC. Survival outcomes were estimated using the Kaplan-Meier method and compared using Cox proportional hazards models. To overcome the effects of baseline differences on survival outcome in patients treated with BCS in the central and upper-outer locations, a 1:1 ratio propensity score matching method was performed. Overall, among 16,522 CLBC patients, 7982 cases (48.3%) underwent BCS between 1998 and 2015. Factors such as older age, Black race, invasive ductal carcinoma (IDC), grade I, small tumor size, none or limited lymph node metastasis, positive progesterone receptor status, and receiving chemotherapy were independently correlated with BCS. BCS was an independent favorable prognostic factor among CLBC patients, based on multivariate Cox analysis. It was also shown that CLBC had similar survival outcomes compared with tumors in the upper-outer quadrant, and had a better breast cancer-specific survival compared with tumors in the lower quadrants, based on multivariate Cox analysis. BCS should be an acceptable and preferable alternative to mastectomy for well-selected, early-stage T1 or T2 CLBC.

Association of triple positivity with prognostic parameters and overall survival in a population-based study of 6,122 HER2-positive breast cancer patients: analysis of real-world clinical practice based on a research database.

Triple-positive breast cancer (TPBC), i.e. HER2-positive (HER2+) and hormone receptors-positive breast cancer, is a specific subgroup of breast cancers. TPBC biology is characterized by strong mutual interactions between signaling pathways stimulated by estrogens and HER2 amplification. The present study aims to carry out a population-based analysis of treatment outcomes in a cohort of hormone receptor (HR) positive and negative breast cancer patients who were treated with anti-HER2 therapy in the Czech Republic. The BREAST research database was used as the data source for this retrospective analysis. The database covers approximately 95% of breast cancer patients treated with targeted therapies in the Czech Republic. The analysis included 6,122 HER2-positive patients. The patients were divided into two groups, based on estrogen receptor (ER) or progesterone receptor (PR) positivity: hormone receptor negative (HR-) patients had both ER- and PR-negative tumors (n=2,518), unlike positive (HR+) patients (n=3,604). HR+ patients were more often diagnosed premenopausal at the time of diagnosis, presented more often at stage I or II and their tumors were less commonly poorly differentiated. The overall survival (OS) was significantly higher in subgroups of HR+ patients according to treatment setting. When evaluated by stages, significantly higher OS was observed in HR+ patients diagnosed at stages II, III, and IV and regardless of tumor grade.

A rapid volume of interest-based approach of radiomics analysis of breast MRI for tumor decoding and phenotyping of breast cancer.

BackgroundRecently, radiomics has emerged as a non-invasive, imaging-based tissue characterization method in multiple cancer types. One limitation for robust and reproducible analysis lies in the inter-reader variability of the tumor annotations, which can potentially cause differences in the extracted feature sets and results. In this study, the diagnostic potential of a rapid and clinically feasible VOI (Volume of Interest)-based approach to radiomics is investigated to assess MR-derived parameters for predicting molecular subtype, hormonal receptor status, Ki67- and HER2-Expression, metastasis of lymph nodes and lymph vessel involvement as well as grading in patients with breast cancer.MethodsA total of 98 treatment-naïve patients (mean 59.7 years, range 28.0–89.4) with BI-RADS 5 and 6 lesions who underwent a dedicated breast MRI prior to therapy were retrospectively included in this study. The imaging protocol comprised dynamic contrast-enhanced T1-weighted imaging and T2-weighted imaging. Tumor annotations were obtained by drawing VOIs around the primary tumor lesions followed by thresholding. From each segmentation, 13.118 quantitative imaging features were extracted and analyzed with machine learning methods. Validation was performed by 5-fold cross-validation with 25 repeats.ResultsPredictions for molecular subtypes obtained AUCs of 0.75 (HER2-enriched), 0.73 (triple-negative), 0.65 (luminal A) and 0.69 (luminal B). Differentiating subtypes from one another was highest for HER2-enriched vs triple-negative (AUC 0.97), followed by luminal B vs triple-negative (0.86). Receptor status predictions for Estrogen Receptor (ER), Progesterone Receptor (PR) and Hormone receptor positivity yielded AUCs of 0.67, 0.69 and 0.69, while Ki67 and HER2 Expressions achieved 0.81 and 0.62. Involvement of the lymph vessels could be predicted with an AUC of 0.8, while lymph node metastasis yielded an AUC of 0.71. Models for grading performed similar with an AUC of 0.71 for Elston-Ellis grading and 0.74 for the histological grading.ConclusionOur preliminary results of a rapid approach to VOI-based tumor-annotations for radiomics provides comparable results to current publications with the perks of clinical suitability, enabling a comprehensive non-invasive platform for breast tumor decoding and phenotyping.

Discordance of immunohistochemical markers between primary and recurrent or metastatic breast cancer: A retrospective analysis of 107 cases.

There is a discordance in the immunohistochemical markers between primary breast cancer and recurrent or metastatic breast cancer. This study aimed to assess the recent trends and prognostic features in the treatment of recurrent or metastatic breast cancerOverall, 107 patients were identified from January 2001 to August 2018 at the Peking Union Medical College Hospital, Beijing, and People's Republic of China to obtain a cohort of breast carcinoma patients who were confirmed to have recurrent or metastatic breast cancer by histopathology. We evaluated patient and tumor characteristics and examined the relationships between these factors and prognosis.The estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2) positivity, and Ki67 index in primary breast cancer were 63.6% (68/107), 58.9% (63/107), 19.8% (21/106) and 75.8% (75/99), respectively, while those in recurrent or metastatic lesions were 60.6% (65/107) (P = .672), 46.7% (50/107) (P = 0.013), 23.8% (25/105) (P = 0.482)and 83.5%(81/97)(P = 0.178), respectively. The discordance rate of HER2 expression was 10.6% (11/104), while that of PR expression was 23.3% (21/90). HER2 was the most stable biomarker. The discordance rates for luminal A and HER2 were as high as 100% and 25%, respectively, while the luminal B and triple negative values were as low as 8.3% and 5.3%, respectively.ER and PR positivity and the Ki-67 index tended to increase due to recurrence or metastases; however, the discordance for PR and Ki-67 was high. PR is more variable than ER in the expression of primary and recurrent or metastatic breast cancer. The expression of HER2 receptor was the most stable and the discordance rate of triple negative breast cancer was the lowest. Therefore, although changes in biomarkers are due to recurrence or metastasis, pathological confirmation and exploration of markers are very important.

Prognostic Factors and Survival of Women with Breast Cancer Under 40 Years Old: A Single-Centre Experience

Objective: This retrospective research aimed to evaluate the results of treatment outcome and clinicopathological features of breast cancer patients under 40 years old. Material and methods: A total of 80 patients who were receiving radiotherapy and/or chemotherapy treatment for breast cancer (<40 years old) were included in the study. Results: First-degree relatives with breast cancer history (p=0.028), oestrogen receptor positivity (p=0.012) and progesterone receptor positivity (p=0.017) were associated with overall survival. No prognostic factors were found in the multivariate Cox regression analysis for overall survival. In multivariate Cox regression analysis, we found breast-conserving surgery type (hazard ratio = 6.104. 95% confidence interval = 1.037–53.928, p=0.045), lymphovascular invasion presence (hazard ratio = 0.127, 95% confidence interval = 0.016–1.025, p=0.005) and curative radiotherapy doses (hazard ratio = 185.976, 95% confidence interval = 5.342–6474.1, p=0.004) as independent prognostic factors for disease-free survival. Overall, survival of 1, 3 and 5 years was 88%, 74% and 65%, respectively. Median was 48±2.6 (42.8–53.19) months. Also, 1-, 3- and 5-year disease-free survival was 85%, 67% and 27%, respectively. Median was 30±1.8 (27.4–32.5) months. Conclusion: Breast cancer patients under the age of 40 years are highly heterogeneous and are a complex patient group. The prognosis is worse in these patients, and prognostic factors and pathological subtypes should be taken into consideration when making treatment decisions.

Fine needle aspiration cytology with the aid of immunocytochemistry on cell-block confirms the diagnosis ofsolid pseudopapillary neoplasm of the pancreas.

To determine the diagnostic efficacy of fine needle aspiration cytology (FNAC) in cases of pancreatic solid pseudopapillary neoplasm (PSPN) with emphasis on the cytomorphological features and to evaluate the contribution of immunocytochemistry on FNAC cell-block (CB) in cases of PSPN. It is a retrospective study in which ultrasound-guided FNAC of pancreatic lesions diagnosed as PSPN between years 2009 and July 2019 were reviewed along with cytohistological correlation. Immunocytochemistry on CB was performed, wherever required. A total of 16 patients with a cytological diagnosis of PSPN of the pancreas were identified. The most common cytological findings were characteristic branching pseudopapillary fragments with central thin, delicate capillaries associated with the amorphous myxoid substance, surrounded by tumour cells with mild pleomorphism. Immunocytochemistry was performed on CB of six cases. The tumour cells revealed nucleocytoplasmic positivity for β-catenin, cytoplasmic positivity for vimentin, membranocytoplasmic positivity for CD10 and nuclear positivity for progesterone receptor in all the cases, while they were negative for chromogranin, CD56, pan-cytokeratin and epithelial membrane antigen. The resected histopathological specimen was available in 10cases, and all were confirmed as PSPN. Although PSPN has a characteristic cytomorphology, cell-block immunocytochemistry on FNA material confirms the diagnosis in problematic cases and excludes other pancreatic tumours, thus helping in appropriate management.

The impact of endogenous estrogen exposure on the characteristics of estrogen receptor (ER) positive, early-stage breast cancer (EBC).

e12605 Background: Menstrual and parity history might impact the risk for ER positive breast cancer. Data on the impact of these factors on other tumor characteristics are limited. Methods: A single center retrospective cohort study comprising all women with ER positive, human epidermal growth factor receptor 2 (HER2) negative, EBC whose tumors were sent to OncotypeDX analysis and were treated in our institute between 2005 to 2012. Data on endogenous estrogen exposure were collected including: age of menarche and menopause, number of deliveries and age of first delivery. Subsequently, data on pre-specified clinical and histopathological features were collected including: tumor size, nodal status, ER and progesterone receptor (PR) staining, grade, Oncotype recurrence score (RS), ki67, lymphovascular and perineural invasion. The impact of endogenous estrogen exposure was evaluated by multiple comparisons including: early age of (&lt;12 years) compared to older age of menarche, nulliparity compared to women who had at least one delivery, multiparty (≥5 deliveries) compared to other, late age of first delivery (≥30 years) compared to other and postmenopausal compared to premenopausal. In postmenopausal women the age of menopause was also assessed using early age of menopause (&lt;45 years) and late age of menopause (&gt;55 years). Results: A total of 620 women were included. 79% were postmenopausal, median age of menarche was 13 (range 9-17) and median number of deliveries was three (range 0-14). Post-menopausal women were more likely to have stronger ER intensity (79% vs. 65%, p=0.002) and less likely to have high (≥31) RS (8% vs. 16%, p=0.021), but PR negativity was significantly more frequent (16% vs. 7%, p=0.007. Additionally, early age of menarche was associated with PR positivity (94% vs. 85%, p=0.039).). No other associations were found between endogenous estrogen exposures and tumor characteristics. Conclusions: These findings suggest that premenopausal women with luminal EBC might have more aggressive disease. Large scale studies are needed to elucidate the impact of endogenous estrogen on luminal breast cancer.

Prognostic and predictive effects of circulating and disseminated tumor cells in breast cancer: A National Cancer Database (NCDB) analysis.

1029 Background: Alongside other biomarkers, circulating tumor cells (CTCs) and disseminated tumor cells (DTCs) could contribute to our growing understanding of the breast cancer (BC) “liquid biopsy”. This study evaluated 1) clinicopathologic factors associated with CTCs and DTCs, 2) the prognostic value of CTCs and DTCs by disease stage, 3), the efficacy of chemotherapy by CTC and DTC status. Methods: We conducted a retrospective analysis of BC using the 2004-2016 National Cancer Database (NCDB). The NCDB defines CTCs as isolated tumor cells (ITCs) found in the blood (using assays such as reverse transcriptase polymerase chain reaction or immunohistochemistry) distant from the breast. DTCs are ITCs found in the bone marrow or other non-regional tissues. To evaluate variables associated with CTCs or DTCs, we used chi-squared and Wilcoxon rank-sum tests (univariate), followed by multivariate logistic regression. Consequently, we included CTC or DTC status in a multivariate, stage-by-stage Cox regression analysis for overall survival (OS). After adjusting for receptor status and staging, we used the Kaplan-Meier method to explore chemotherapy efficacy in CTC- or DTC-positive vs. CTC- or DTC-negative subsets. Results: 4,846 cases reported CTC-status, 1,454 (21.1%) of which were positive. 4,993 cases reported DTC-status, 1,400 (20.3%) of which were positive. Factors associated with positive CTC status were HER2-positivity, progesterone receptor-positivity, lobular histology and N-staging. Factors associated with positive DTC status were being White, HER2-positivity, lobular histology and N-staging. Positive CTC-status was associated with poor OS overall in late-stage (III and IV) (HR 1.477, 95% CI: 1.129-1.931, p = 0.004) but not early-stage BC (0, I, II) (p = 0.110) disease. DTC-status was not associated with OS in early-stage or late-stage subsets. In hormone receptor (HR)-positive disease, chemotherapy was associated with better OS when CTC-status was also positive both in early-stage (p = 0.003) and late-stage (p = 0.023) disease. In a subset of the same BC subtype with negative CTC-status, however, chemotherapy conferred no survival benefit (p = 0.638 for early-stage, p = 0.501 for late-stage). DTC status was not a significant predictor of chemotherapy efficacy in early or late-stage, HR+ disease. Conclusions: This study suggests that CTC-status is a stronger prognostic factor at later stages of BC; yet it can also help guide management of early-stage disease as it appears predictive for chemotherapy benefit.

60P Prognosis and survival of single hormone receptor positive breast cancer comparing to double HR positive and triple-negative breast cancers

Positive estrogen and progesterone receptors (ER, PR) breast cancers (BC) require endocrine therapy and were associated to favorable outcomes. Hormone receptors (HR) status is considered a crucial predictive factor. The ER−PR+ group is reported to be only 1–5% of all BCs and remains poorly understood and was associated to poor outcomes The aim of this study was to compare the clinical outcomes of patients with single HR positive BC to those with ER+PR+ tumors and TNBC.

Correlation between Histopathological Molecular Markers and Magnetic Resonance Imaging of Spiculated Breast Cancers

Bu çalışmanın amacı spiküle ve spiküle olmayan meme kanserinin MRG ve histopatolojik bulguları arasındaki ilişkiyi karşılaştırmaktır. Ocak 2014 ile Ocak 2018 arasında, mamografide BI-RADS kriterlerine göre 50 spiküle ve 40 spiküle olmayan kitle olarak ultrasonografi kılavuzluğunda biyopsi veya lumpektomi/mastektomi yapılan 90 kadın çalışmaya alındı. Meme kanserinin moleküler biyobelirteçlerini tanımlamak için östrojen reseptörü (ÖR), progesteron reseptörü (PR), HER2 ekspresyonu ve Ki67 indeksi kullanıldı. Korelasyonların istatistiksel önemini ölçmek için Pearson ki-kare testi yapıldı. İki grup arasında yaş açısından fark yoktu (p=0.331). Kitlelerin büyüklüğü iki grup arasında farklı değildi (p=0.244). Spiküle kitlelerde T2A görüntülerde (T2AG) daha fazla hipointens sinyal özelliği tespit edildi (p=0.004). MRG'de multifokal veya multisentrik tutulum, kitlesiz boyanma, periferik halkasal boyanma ve aksiller lenf nodu tutulumu açısından iki grup arasında fark yoktu (sırasıyla p=0.237, p=0.622, p=0.096, p=0.295 ve p=0.764). ÖR ve PR pozitifliği spiküle kitlelerde daha yüksekti (sırasıyla p=0.027 ve p=0.03). HER2 pozitifliği ve Ki67 indeksi için iki grup arasında istatistiksel olarak anlamlı bir fark bulunmadı (sırasıyla p=0.571 ve p=0.596).ÖR ve PR pozitifliği spiküle kitlelerde daha fazla olma eğilimindedir. Bu, hastalığın seyrini ve tedavinin etkinliğini tahmin etmede yardımcı olabilir.

Surgical Outcomes for Ductal Carcinoma in Situ: Impact of Preoperative MRI.

Background The role of preoperative MRI for predicting surgical outcomes in patients diagnosed with ductal carcinoma in situ (DCIS) remains uncertain. Purpose To investigate the associations between preoperative MRI and surgical outcomes in DCIS confirmed by using US-guided core-needle biopsy (CNB) and to evaluate clinical-pathologic variables associated with a benefit from MRI. Materials and Methods Women with DCIS confirmed by using US-guided CNB between January 2012 and December 2016 were included in this retrospective study. Propensity score matching using 18 confounding covariates was used to create matched groups with MRI and without MRI, and surgical outcomes were compared. Clinical-pathologic variables were evaluated to determine women who benefited from MRI. Results A total of 541 women (mean age ± standard deviation, 50 years ± 10) were evaluated. Among 430 women who underwent MRI, 67 additional lesions (16%) were depicted, with 25 (37%) of the 67 additional lesions being malignant. Fifty-seven (13%) of the 430 women had a change in surgical plan because of their MRI findings; the change was appropriate for 31 (54%) women. In matched groups, the MRI group was associated with lower odds of positive resection margin (odds ratio [OR], 0.39; 95% confidence interval [CI]: 0.16, 0.93; P = .03) and repeat surgery (OR, 0.33; 95% CI: 0.12, 0.92; P = .03) compared with the non-MRI group. There was no difference in likelihood of initial mastectomy (OR, 1.2; 95% CI: 0.7, 2.0; P = .59) and overall mastectomy (OR, 0.93; 95% CI: 0.5, 1.6; P = .79). In the MRI group, low nuclear grade (90% [28 of 31] vs 69% [275 of 399]; P = .01), progesterone receptor positivity (81% [25 of 31] vs 61% [244 of 399]; P = .03), and human epidermal growth factor receptor 2 negativity (90% [28 of 31] vs 68% [270 of 399]; P = .01) were associated with a benefit from MRI versus no MRI. Conclusion Preoperative MRI depicted additional malignancy and reduced positive surgical margins and repeat surgery for ductal carcinoma in situ confirmed at US-guided biopsy without a higher mastectomy rate. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Pinker in this issue.