Prognostic Factor In Breast Carcinoma Research Articles

Vascular Endothelial Growth Factor Expression by Immunohistochemistry as a Possible Indicator of Prognosis in Invasive Breast Carcinoma of No Special Type.

Angiogenesis, the formation of new blood vessels from preexisting vascular network, is essential for tumor growth and spread. Vascular endothelial growth factor (VEGF) is a potent angiogenic growth factor. To assess the expression of VEGF in invasive carcinoma of no special type and its correlation with all the known prognostic factors of breast carcinoma. Descriptive. Mastectomy specimens were studied noting the clinical details. The formalin-fixed tissues were subjected to routine processing and hematoxylin and eosin sections and studied extensively for all the histological prognostic factors. Representative sections from each case with the tumor were subjected to immunohistochemistry (IHC) staining with VEGF, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2/neu) antibodies. Descriptive statistics, Chi-square tests, contingency table analysis using SPSS for Windows. One hundred and twelve cases of invasive carcinoma of special type were studied to evaluate various clinicopathological parameters. The association of VEGF with clinicopathological parameters and all the known prognostic factors was studied to note its significance. VEGF overexpression was observed in 69% of the cases. It was noted that larger tumor size, higher histological grade, lymphovascular invasion, nodal involvement, tumor necrosis, high microvessel density, ER negativity, PR negativity, and HER2/neu positivity had a significant statistical association with VEGF overexpression. We conclude that incorporating VEGF as a biomarker along with the known factors into a prognostic index will not only help predict clinical outcome more accurately, but also determines the patient who can be benefited with combinational therapy including anti-VEGF factors.

Prediction of Oncotype DX Recurrence Score by Evaluating the Peritumoral Tumor Budding in Early-stage Breast Carcinoma.

The Oncotype DX Recurrence Score (ORS) predicts the likelihood of recurrence and the benefit of chemotherapy in patients with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative early-stage breast carcinoma (ESBC). Tumor budding (TB) is a poor prognostic factor in breast carcinoma. This study aimed to determine the clinicopathological significance of TB in predicting ORS in patients with ESBC. We included 359 patients with ER-positive, HER2-negative ESBC. The number of peritumoral TB was assessed, and the cases were categorized into TB-low (<10 buds) and TB-high (≥10 buds) groups. Patients with TB-high ESBC (170/359; 47.4%) showed a significantly higher median ORS (15.0 vs. 13.0) than those with TB-low tumors (189/359; 52.6%). Multivariate analysis revealed that high TB level was an independent predictive factor for higher ORS in patients with ESBC. High TB in ESBC independently predicted higher ORS. TB may serve as a surrogate marker for predicting ORS in patients with ESBC.

Expression of FOXP3 of Tumor-Infiltrating Lymphocytes in Invasive Breast Cancer: Its Relationship to Histopathological Parameters and Overall Survival

BACKGROUND: Forkhead box P3 protein (FOXP3) is expressed in both tumor cells and tumor-infiltrating lymphocytes (TILs) and is reported to be associated with differences in clinical outcomes. Recent literature shows that FOXP3 positive (FOXP3+) T regulator cells (Tregs) influence anti-tumor immunity in solid tumors.&#x0D; АIM: To explore FOXP3+ Tregs expression related to various prognostic factors in breast carcinoma (BC) in the central Indian population. Our study is also helpful in correlating the role of FOXP3+ Tregs in the survival of invasive ductal BC with different histopathological presentations.&#x0D; MATERIALS AND METHODS: This is a retrospective and prospective observational study in which FOXP3+ Tregs was counted in the peritumoral area by immunohistochemistry in 47 consecutive cases of BC operated on and diagnosed already. The patients were followed for 48 to 69 months for disease progression.&#x0D; RESULTS: High-grade tumors are prevalent (n = 30) in the study area irrespective of the stage of clinical presentation. Patients who could adhere to their treatment plan remained free of adverse outcomes until the end of our follow-up period of 69 months (p = 0.001). No molecular subtype in our study showed specific predilection towards a high Tregs count in the peri-tumoral area. No other clinical or pathological parameters significantly correlated with FOXP3 +Treg count, including overall survival and disease-free survival.&#x0D; CONCLUSION: The study shows that luminal human epidermal growth factor receptor 2 negativ and human epidermal growth factor receptor 2 enriched BC show comparatively high FOXP3+ Tregs count. There is no relation with tumor grade, TNM stage, important immune markers, or overall survival and disease-free survival.

Molecular subtypes of invasive breast carcinoma of no special type, their correlation with histopathological features, Ki 67 index and tumor budding: A retrospective comparative study.

Tumor budding (TB), poorly differentiated clusters (PDCs), and Ki 67 index are proven adverse prognostic factors in breast carcinoma. Though the relation of Ki 67 index with molecular subtypes of breast carcinoma have been extensively studied, there is very limited information on the role of TB and PDCs. To grade TB, PDCs, and Ki 67 index and assess histological features and relationship of all these with molecular subtypes of invasive breast carcinoma of no special type. Retrospective study of 148 cases from 1/1/2019 to 30/12/2019. Division of molecular groups - Luminal A, Luminal B, Her2 neu positive, and triple-negative breast carcinomas (TNBC), and Ki 67 index grades based on St Gallen criteria, intratumoral and peritumoral TB and PDC grades as per the International Tumor Budding Consensus Conference (ITBCC) criteria for colon and correlation between these and other histological features with the molecular subtypes were done. Chi-square test, univariate and multivariate logistic regression models were used. Significant correlation was seen between TB and lymphovascular emboli, Luminal B tumors with high-grade TB and PDCs, Her 2 neu positive and TNBC tumors with low-grade TB, circumscribed tumor margins, tumor necrosis, and Luminal B, Her 2 neu positive and TNBC tumors with larger tumor size and high nuclear grades. TB and PDCs are useful in the prognostication of Luminal A and B tumors when the Ki 67 index values are low/intermediate. Her 2 neu positive and TNBC tumors have a high nuclear grade with necrosis and no association with TB or PDCs.

The Significance of Topoisomerase II Alpha in Invasive Breast Carcinoma.

BackgroundTopoisomerase II alpha (Top 2 A) protein has been shown to be a proliferation marker associated with tumour grade. The current study evaluated the prognostic impact of Top 2 A protein on luminal breast cancer and its utility as an independent prognostic marker. Immunohistochemical expression of Top 2 A in breast cancer and its correlation with the tumour type, size, lymph node metastases, grade and ER/PR positivity.MethodologyEthics committee approval was taken and 65 cases of Invasive breast carcinoma presenting to the Department of Pathology at a tertiary care centre in South India were studied. Patient details including age, tumour type, tumour size, tumour grading, estrogen receptor (ER)/progesterone receptor (PR)/human epidermal growth factor receptor 2 (HER2/neu) status and pathologic stage was studied. Immunohistochemistry (IHC) work-up for Top 2 A expression was done and evaluated.ResultsOf the 65 histological sections of breast cancers, 29/65 showed nuclear positivity for Top 2 A. Node positive tumours 17/65 stained positive for Top 2 A. Stage I tumours 2/65, stage II tumours 12/65 and stage III 14/65 stained positive for Top 2 A. Among the HER2/neu-positive tumours, 22/65 stained for Top 2 A and among ER/PR-positive 9/65 cases were positive for Top 2 A. Triple-negative tumours 5/65 stained for Top 2 A.ConclusionHigher Top 2 A expression was seen in higher stage tumours. HER2/neu-positive tumours significantly showed a correlation with Top 2 A positivity. Therefore, Top 2 A expression can be considered an individual prognostic factor in breast carcinoma.

Immunohistochemical assessment of PTEN expression and itsassociation with tamoxifen resistance in ER positive breast cancers

Introduction: Although Estrogen Receptor (ER) positivity is a good prognostic factor in breast carcinoma (BC), a subset of patients experiences poor disease-free survival (DFS). Mutation in phosphatase and tensin homologue deleted on chromosome ten (PTEN) is identified as a poor prognostic feature in BC. This study was designed to find out the impact of lost or poor PTEN expression on ER positive BC, in terms of the recognized prognostic factors and survival outcome to find out its association with tamoxifen resistance. Methods: This was a cross sectional study with a follow up component. BC tissue blocks submitted to our unit from 2006 to 2012 were selected. From the laboratory data, patients who had ER positive BC, undergone mastectomy, treated with tamoxifen were selected. All clinicopathological parameters, DFS and overall survival (OS) were analysed against lost or poor PTEN expression. Clinicopathological features were compared using Chi-square test. Kaplan-Meier model with log-rank test was used for the survival analysis. Results: A total of 130 BC patients satisfied the inclusion criteria. PTEN expression was lost or poor in 82.3% (n=107) patients. PTEN expression had a positive association with the level of ER expression (p=0.011) and a negative association with Nottingham prognostic index (NPI) (p=0.045) and pathological stage (p&lt;0.048). Only 12.1% (n=16) patients had recurrences and 7.69% (n=10) had died over a period of 51 months of mean follow up. There was no significant association between PTEN expression and survival. Conclusions: This study showed that there is a statistically significant association between lost or poor PTEN expression and low ER expression, high NPI and stage 3 in ER positive BC. Further studies including larger study sample with a longer follow up are recommended to find out the association of PTEN with the survival in ER positive BC treated with tamoxifen.

Correlation of ER, PR, Her2neu and Ki67 with other Prognostic factors in Breast Carcinoma

Background:In females, breast carcinoma is the most common malignancy accounting for 23% of all malignant tumours. Various predictive and prognostic factors affect tumour progression. In addition to estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptor (Her2neu), recently Ki67, a proliferative marker has been recognized as an important predictive and prognostic marker in many studies. The aim of the study was to find the correlation of ER, PR, Her2neu and Ki67 tumour markers with menopausal status, tumour size, histopathological grade, mitotic index, lymphovascular invasion and lymph node metastasis. Methods:The present study was conducted on 50 cases of breast carcinomas. The histopathological grading of the breast carcinoma was done according to the Nottingham modification of the Bloom Richardson grading system. All the cases underwent immunohistochemistry for ER, PR, Her2neu and Ki67 expression. Correlation of ER, PR, Her2neu and Ki67 with various prognostic factors was done. Results:The expression of ER and PR decreased as the grade of the tumour increased. Ki67 proliferative index increased as the grade of the tumour increased. Ki67 proliferative index also increased as the mitotic count increased. None of these markers showed a correlation with other prognostic factors. Conclusion: The present study concludes that ER, PR reveals inverse relationship and Ki67 showed a direct relationship with the grade of the tumour. Increased Ki67 proliferative index was associated with increased mitotic activity and less expression of ER, PR; thus carrying a poor prognosis.

CMTM5/7 are biomarkers and prognostic factors in human breast carcinoma

The CKLF-like MARVEL transmembrane domain-containing family (CMTM) is the protein product of at least one splice variant of each gene contained a Marvel (MAL and related proteins for vesicle trafficking and membrane link) domain, involved in a variety of cellular processes and the pathogenesis of diseases, including tumorigenesis. However, the diverse expression patterns and prognostic values of eight CMTMs have yet to be elucidated. We analyzed the expressions and impacts on survival of different CMTM factors in BC patients to determine their potential diagnosis and prognosis values in BC. In the current study, we examined the transcriptional and survival data of CMTMs in patients with breast carcinoma (BC) from ONCOMINE, GEPIA, Kaplan-Meier Plotter, and cBioPortal databases. It was found that CMTM5/7 were down-regulated, whereas CMTM1/6 were up-regulated in BC patients compared with the normal tissues. In survival analyses through the Kaplan-Meier plotter database, increased mRNA expressions of CMTM5/6/7 and decreased mRNA expression of CMTM4 were associated with better relapse-free survival (RFS) of BC patients. These data provided CMTM5/7 as new biomarker and prognostic factors in BC.

Peritumoral Fat Content Correlates with Histological Prognostic Factors in Breast Carcinoma: A Study Using Iterative Decomposition of Water and Fat with Echo Asymmetry and Least-Squares Estimation (IDEAL).

Purpose:To correlate peritumoral fat content using iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) with histologic prognostic factors in breast carcinoma.Methods:This study consisted of 100 patients who were diagnosed with invasive carcinoma of breast and underwent breast MRI including IDEAL before surgery. The scan time of IDEAL fat fraction (FF) map imaging was 33 s. Four regions of interests (ROIs), which are a distance of 5 mm from the tumor edge, and one ROI in the mammary fat of the healthy side were set on the FF map. Then average peritumoral FF values (FFt), average FF values in the healthy side (FFh), and peritumoral fat ratio (pTFR: defined as FFt/FFh) were calculated. Histologically, the presence of lymph node metastasis and the MIB-1 index were evaluated.Results:FFt and pTFR for breast carcinoma with lymph node metastasis (79.27 ± 10.36 and 0.897 ± 0.078) were significantly lower than those without (86.23 ± 4.53 and 0.945 ± 0.032) (P < 0.001 and P = 0.005). Spearman rank correlation suggested that the FFt correlated with the MIB-1 index (r = −340, P = 0.001).Conclusion:Quantification of peritumoral fat using IDEAL-iron quantification is associated with the histologic prognostic factors, and may be a practical tool for therapeutic strategy of breast carcinoma.

Correlation of diffusion weighted apparent diffusion coefficient values with immunochemical prognostic factors of breast carcinoma

Context: Classic prognostic markers in breast cancer are tumor size and grade, lymph node status, molecular markers, including estrogen receptor (ER), progesterone receptor (PR), Ki-67 index, human growth factor receptor 2 (HER2) protein, and angiogenic molecular markers. Purpose of present study is to assess the utility of apparent diffusion coefficient (ADC) values in the prognosis of breast cancer by correlating them with molecular biomarkers. Aim: To correlate the ADC values of DWI of Breast cancer with immunochemical prognostic factors. Settings and Design: Retrospective observational study. Materials and Methods: Ours is a retrospective study of 30 female cases of histologically proven breast carcinoma who underwent magnetic resonance imaging (MRI) of breast in Tertiary healthcare centre, Andhra Pradesh. Molecular prognostic factors data were available for 20 cases which were further analyzed. Statistical Analysis Used: Correlation between the ADC value of the breast tumour and molecular prognostic markers was analyzed using Student's t test. Results: Mean ADC of Ki-67 index positive cancers (0.755 × 10 - 3 ± 0.158 × 10 - 3mm2/s) was significantly lower than Ki-67 index negative cancers (0.929 × 10-3 ± 0.117 × 10 - 3mm2/s) suggesting statistically significant correlation between ADC value and Ki67 index. There is no significant correlation between ADC value and ER, PR, and HER2 expression status. Conclusion: Our study showed statistically significant association between ADC values and Ki-67 index. Thus ADC values may be of use in providing prognostic information about disease.

Plasma D-Dimer Levels Correlated With Advanced Breast Carcinoma in Female Patients: A Prospective Study at Baghdad Teaching Hospital

Abstract- Advanced breast cancer is a common disease among female gender in the world. There is a correlation between cancer and hypercoagulation. In a cancer state, there is an increase in the level of cross-linked fibrin degradation product (d-dimer) which indicates systemic activation of fibrinolysis and hemostasis. So, there is a relation between increase d-dimer value and advanced breast disease. To study the relation between preoperative plasma d-dimer level and tumor extension, choose the proper option of treatment, and to decrease morbidity and mortality in patients with breast carcinoma, a prospective study (cohort study) was done at Baghdad teaching hospital (department of surgery) from Jan 2014 to Jan 2016. Seventy patients were categorized into two equal groups, group one with breast carcinoma, and group two with benign breast tumor. Plasma d-dimer levels were compared for each group and in relation to (tumor size, stage, grade, lymphovascular invasion, and lymph nodes involvement). The d-dimer level was normal in group two (&lt;0.25 mg/l) and high in group one in other words, the d-dimer level was increasing in advanced breast carcinoma group with enlarged tumor size, higher stage and grade, lymphovascular invasion and lymph nodes’ involvement. Plasma d-dimer levels were a good prognostic factor in breast carcinoma especially in advanced breast carcinoma, and it could be considered a factor for clinical stage progression lymphovascular invasion, and metastasis.

Diffusion-Weighted Imaging of Breast Cancer: Correlation of the Apparent Diffusion Coefficient Value with Pathologic Prognostic Factors.

The aim was to evaluate relationship between apparent diffusion coefficient (ADC) values with pathologic prognostic factors in breast carcinoma (BC). 83 patients were enrolled in this study. Prognostic factors included age, tumor size, expression of estrogen receptor (ER) and progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), nuclear grade (NG), lymph node involvement and histologic type. The relationship between ADC and prognostic factors was determined using Independent sample t-test, ANOVA, Pearson correlation and relative operating characteristics (ROC) analysis. There was no significant difference between ADC and prognostic factors, including age, tumor size, ER, HER2 and histologic type. The PR-positive tumors (p=0.03) and axillary lymph node involvement (p=0.000) showed a significant association with lower ADC values. The ADC values were significantly lower in high-grade tumors than low-grade tumors (p=0.000). ROC analysis showed an optimal ADC threshold of 0.66 (×10-3 mm2/s) for differentiating low-grade tumors from high-grade tumors (sensitivity, 85.5%; specificity, 81%; area under curve, 0.90). The lower ADC values of BC were significantly associated with positive expression of PR, LN positivity and high-grade tumor. Especially, ADC values were valuable in predicting NG subgroups.

Correlation of VEGF expression with prognostic factors of breast carcinoma

Background: Breast carcinoma is the most common malignant tumour and leading cause of cancer death among women worldwide. VEGF being a powerful mediator of angiogenesis, plays a major role in local growth as well as metastasis of many solid tumours including breast carcinoma.&#x0D; Objective: This study aimed to evaluate the significance of VEGF expression in breast cancer and its correlation with prognostic parameters. Materials and methods: This study was conducted over a period of one year (February 2015 to January 2016). VEGF expression was evaluated in 57 histologically diagnosed cases of breast carcinoma with known ER and HER-2/neu status.&#x0D; Result: Among 57 cases 52(91.2%) were positive for VEGF. Positive ER expression was seen in 39 cases which is 64.8% of total cases. 54% of the total cases were positive for HER-2/neu. VEGF expression was positively correlated (P value &lt;0.05) with tumour grade, tumour size and negatively correlated with ER (p&lt;0.005) and HER-2/neu (p&lt;0.005). Significant correlation also found with tumour type (p&lt;.005).&#x0D; Conclusion: Considering the observations of the current study, it can be concluded that VEGF may play a crucial role in the pathogenesis of breast carcinoma and has a positive correlation with biologically aggressive tumour. So consideration of this biomarker (VEGF) is to be regarded as a prognostic parameter and critical evaluator of targeted chemotherapy&#x0D; Bangladesh Journal of Medical Science Vol.18(3) 2019 p.513-518

Practical approaches to automated digital image analysis of Ki-67 labeling index in 997 breast carcinomas and causes of discordance with visual assessment.

The Ki-67 labeling index (LI) is an important prognostic factor in breast carcinoma. The Ki-67 LI is traditionally calculated via unaided microscopic estimation; however, inter-observer and intra-observer variability and low reproducibility are problems with this visual assessment (VA) method. For more accurate assessment and better reproducibility with Ki-67 LI, digital image analysis was introduced recently. We used both VA and automated digital image analysis (ADIA) (Ventana Virtuoso image management software) to estimate Ki-67 LI for 997 cases of breast carcinoma, and compared VA and ADIA results. VA and ADIA were highly correlated (intraclass correlation coefficient 0.982, and Spearman’s correlation coefficient 0.966, p<0.05). We retrospectively analyzed cases with a greater than 5% difference between VA and ADIA results. The cause of these differences was: (1) tumor heterogeneity (98 cases, 56.0%), (2) VA interpretation error (32 cases, 18.3%), (3) misidentification of tumor cells (26 cases, 14.9%), (4) poor immunostaining or slide quality (16 cases, 9.1%), and (5) Estimation of non-tumor cells (3 cases, 1.7%). There were more discrepancies between VA and ADIA results in the group with a VA value of 10–20% compared to groups with <10% and ≥20%. Although ADIA is more accurate than VA, there are some limitations. Therefore, ADIA findings require confirmation by a pathologist.

Correlation of HER2/neu receptors and other prognostic factors in breast carcinoma

Background: Breast cancer is the most common malignancy and the leading cause of cancer related death among women all around the world. Evaluation of prognostic factors including biomarkers is highly recommended for the best management and therapeutic decision of breast cancer patients. Aim was to study the correlation of HER2/Neu receptors and other prognostic factors in breast carcinoma.Methods: Patients who are clinically diagnosed as carcinoma breast a detailed history will be taken. Patients were assigned TNM staging according to AJCC classification and posted for surgery than to find out the receptor status from that specimen.Results: In 60 cases, there is no significant correlation and association between the prognostic factors (age, menstrual status, tumour size, side of disease, nodal positivity, pathological subtypes, histological grading except ER receptor positivity PR receptor positivity) and HER2neu receptor positivity. Significant association noted between the HER2NEU receptor positivity and ER, PR receptor negativity. ER AND PR receptor status it shows that a significant proportion of PR receptor activation is independent on ER receptor activation. And also this independent PR receptor positive status give false positive results depends upon staining pattern ,transport method of tissue specimen.Conclusions: Our study results indicate the importance of ER, PR and HER-2/neu expression as prognostic factors for therapeutic decision.

Plasma d-dimer level correlated with advanced breast carcinoma in female patients.

BackgroundAdvanced breast cancer is a common disease among female in the world. There is a correlation between cancer and hyper coagulation. In a cancer state, there is an increase in the level of cross-linked fibrin degradation product (d-dimer)which indicates systemic activation of fibrinolysis and hemostasis. So, there is a relation between increase d-dimer value and advanced breast disease.ObjectiveTo confirm the relation between increase d-dimer levels and advanced breast carcinoma in female patients.Patients and methodsA prospective study (cohort study) done in Baghdad teaching hospital (department of surgery) from Jan 2014 to Jan 2016. Seventy patients were categorized intotwo equal groups, group 1 with breast carcinoma, group 2 with benign breast tumor. Plasma d-dimer levels compared for each group, and in relation to (tumor size, stage, grade, lympho-vascular invasion, and lymph nodes involvement).ResultsD-dimer level was normal in group two (<0.25) mg/l and high in group one in other words, d-dimer level was increasing in advanced breast carcinoma group with enlarge tumor size, high stage, grade, lympho-vascular invasion and lymph nodes involvement.ConclusionsPlasma d-dimer levels was good prognostic factor in breast carcinoma specially in advanced breast carcinoma and its considered factor clinical stage progression lympho-vascular invasion and metastasis.

Evaluation of lymphatic vessel invasion by immunohistochemistry in breast carcinoma

Background and Objectives: Breast carcinoma, the most common malignant tumor and the leading cause of cancer death in women, affects Iranian women at least one decade earlier. Lymphatic vessel invasion (LVI) is one of the most important prognostic factors in breast carcinoma. The aim of this study was to compare the results of detecting lymphatic invasion in immunohistochemistry (IHC) method with routine histologic evaluation. Materials and Methods: A total of 116 breast cancer specimens were evaluated. IHC staining for D2–40 marker was performed on paraffin-embedded blocks of tumor samples to detect LVI. Results: Sensitivity, specificity, positive, and negative predictive values of H and E staining for detection of the lymphatic invasion were 41%, 66%, 54.8%, and 53.5%, respectively. Kappa coefficient between H and E and D2–40 stainings was 0.078. The most common sites of lymphatic invasions were intratumoral area and tumor periphery. Conclusions: It seems that D2–40 staining is necessary for accurate diagnosis of LVI in breast cancer. Furthermore, evaluation of intratumoral area and tumor periphery can probably increase the chance of finding lymphatic invasion.

Correlation of quantitative parameters on dynamic contrast-enhanced MRI with prognostic factors of breast carcinoma

Objective To investigate the correlation between parameters obtained from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and prognostic factors (including enhanced morphology, tumor size, histological grade, nuclear grade) of breast carcinoma. Methods One hundred and thirteen breast cancer cases with 120 lesions confirmed histopathologically were retrospectively analyzed. All the patients underwent the DCE-MRI before the surgery, and the immunohistochemistry after the operation was performed to get the histological and nuclear grade. The volume transfer constant(Ktrans), rate constant (kep), and volume of extravascular extracellular space per unit volume of tissue(ve) were calculated through the DCE-MRI postprocessing. One hundred and three invasive ductal carcinomas were examined with the immunohistochemistry to get results of the histological and nuclear grade. Accordingly, the 103 lesions were divided in two subgroups: the tumors of histological grade Ⅰ, Ⅱ (low histological grade) and tumors of grade III (high histological grade); tumors of nuclear grade Ⅰ,Ⅱ (low nuclear grade) and tumors of grade Ⅲ (high nuclear grade). All the tumors were divided into mass-like type and non mass-like type according the enhanced morphology, as well as size ≤20 mm type and size >20 mm type respectively. Correlations between parameters and enhanced morphology, tumor size, histological grade, nuclear grade were analyzed through Mann-Whitney U test, the correlation between the tumor size and quantitative parameters was tested with Spearman correlation. Results Mean Ktrans was higher in tumors with mass-liketumors (n=92) than with non mass-like tumors(n=28), and the differences was statistically significant (P 0.05). There was no significant differences between tumor size≤20 mm(n=40) and size>20 mm (n=52) in mean Ktrans ,kep and ve respectively (P>0.05) .The mean maximal size of mass-like tumors was (2.38±0.95) cm, and there was no significant correlations between the tumors size and Ktrans (r=0.238, P=0.038), kep and ve (r values were 0.223 and 0.070, respectively, P values were 0.052 and 0.547 respectively) . Mean Ktrans, kep was higher in tumors with a high histological grade (n=22) than with a low histological grade(n=52), also was higher in tumors with a high nuclear grade(n=15) than with a low nuclear grade (n=56), with statistically significant differences (P 0.05). Conclusion There is correlation between parameters obtained from DCE-MRI and prognostic factors of breast cancers, with higher Ktrans and kep, or lower ve, indicating poor prognostic factors. Key words: Breast neoplasms; Magnetic resonance imaging; Prognostic factors

Immunohistochemical detection of human cytomegalovirus, Epstein-Barr virus and human papillomavirus in invasive breast carcinoma in Egyptian women: A tissue microarray study

Background and aim: Breast cancer is the commonest malignant tumor and a common cause of cancer death in women all overthe world. Some recent studies attributed breast cancer to viral infection. This study aimed to evaluate the expression of HCMV,EBV and HPV in invasive carcinoma of the breast among the Egyptian women by immunohistochemistry and whether there is arelationship between the prognostic factors of breast carcinoma and these viruses. Patients and methods: This retrospective study included 107 selected cases of invasive breast carcinoma. Slides cut from tissuemicroarray prepared blocks were stained immunohistochemically for HCMV, EBV and HPV antigens. The association of suchviruses with the clinicopathological features, tumor recurrence and patient death was evaluated statistically. Result: HCMV, EBV and HPV were present in 43.9%, 10.3% and 24.3% of cases respectively. HCMV was associatedsignificantly with the tumor grade, mitotic count (P = .01), IDC, ER, PR, Her2/neu and molecular subtype (P = .032, .002, .02,.005, .003) respectively. EBV was associated with the tumor size, stage and histological type (P = . 025, .005, .009) respectively.HPV wasn’t associated with any of the clinicopathological characteristics. None of these viruses was associated with the tumorrecurrence or patient death. Conclusion: HCMV and EBV might be contributing factors for the development and behavioural alteration of breast carcinoma,representing potential tools for the detection of specific therapies for this cancer. Further studies on a larger number of casesusing other techniques such as CISH for specific typing of the viruses especially HPV can add more information.

Correlation of the SUVmax of FDG-PET and ADC values of diffusion-weighted MR imaging with pathologic prognostic factors in breast carcinoma

PurposeTo correlate both primary lesion maximum standardized uptake values (SUVmax) of FDG-PET/CT, and apparent diffusion coefficient (ADC) values of diffusion-weighted imaging (DWI) with clinicopathologic prognostic factors in patients with breast carcinoma. Materials and methods214 patients with 216 mass-type invasive breast carcinomas underwent whole-body FDG-PET/CT and 3-Tesla breast MRI including DWI before initial therapy. The primary tumor’s SUVmax and ADC values were measured using FDG-PET/CT and DWI, respectively. Histologic analysis parameters included tumor size, expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67, nuclear grade, histology subtype, and axillary lymph node (LN) metastasis. The relationships among SUVmax, ADC values, and pathologic prognostic factors were evaluated. ResultsThe mean SUVmax and ADCmean were 5.63±3.79 (range, 1.2–24.17) and 894±204×10−6mm2/s (range, 452–1550×10−6), respectively. There was a significant but weak inverse correlation between the SUVmax and ADCmean values (correlation coefficient r=−0.30, p<0.0001). SUVmax was associated with numerous prognostic factors such as tumor size (p<0.0001), expression levels of ER (p=0.00041), PR (p=0.00028), HER2 (p=0.00021), and Ki-67 (p<0.0001), nuclear grade (p<0.0001), histology subtype (p=0.00061), axillary LN metastasis (p<0.0001), and TNM staging (p<0.0001). Meanwhile, ADCmean value was associated with tumor size (p=0.013), expression of Ki-67 (p=0.0010), histology subtype (p=0.00013), axillary LN metastasis (p=0.00059), and TNM staging (p=0.0011). ConclusionsPrimary tumor SUVmax on FDG-PET/CT has a stronger relationship with known prognostic parameters and may be a more useful for predicting the prognosis of breast carcinoma than ADC values.