Stage Breast Cancer Research Articles

Preliminary results of sentinel lymph node biopsy using blue dye for early breast cancer staging: A single-centre experience in Addis Ababa, Ethiopia

Preliminary results of sentinel lymph node biopsy using blue dye for early breast cancer staging: A single-centre experience in Addis Ababa, Ethiopia

Trends in Immediate Lymphatic Reconstruction.

Background and objective Immediate lymphatic reconstruction (ILR) is emerging as a useful adjunctafter axillary lymph node dissection (ALND), leading to a decrease in lymphedema rates from 30to 3-13% in breast cancer patients.ILR requires coordination between two surgical specialties for oncologic ALND and microsurgical axillary lymphatic anastomosis. This study aimed to assess the trends in the frequency of ILR performed after ALND at our institution. Methods This study involved aretrospective review of breast cancer patients undergoing ALND with and without ILRat our institution (2017-2022). Data on patient demographics, tumor characteristics, and treatments received were gathered and analyzed. Results A total of 316 patients underwent ALNDat our institution and 30.7% (97/316) of them received ILR. There was no significant difference in clinical breast cancer stages between patients who underwent ALND with or without ILR (p>0.05). Neoadjuvant chemotherapy was given to 51.1% (112/219) of patients with ALND only compared to 60.8% (59/97) of patients who underwent ALND with ILR (p=0.09). All patients received adjuvant radiation therapy. ILR was performed after ALND in 4.2% (2/47) in 2017, 25.8% (3/58) in 2018, 17.6% (12/68) in 2019, 35% (21/60) in 2020, 56.9% (41/72) in 2021, and 54.5% (6/11) in 2022. When comparing the first year of the ILR program with the last year of the study period, the odds ratio of receiving ILR after ALND was 1.8 (p=0.04). Conclusions The frequency of performing ILR after ALND in breast cancer patientsat our institution witnessed a substantial increaseduring the study period. The implementation of an established ILR program at an institution can increase procedure uptake accompanied by continued growth in utilization.

Contrast-enhanced Ultrasound Using Intradermal Microbubble Sulfur Hexafluoride in Non-invasive Axillary Staging in Breast Cancer: Are we Missing a Chance?

In the context of surgical de-escalation in early breast cancer (EBC), this study aimed to evaluate the contrast enhancement ultrasound (CEUS) sentinel lymph node (SLN) procedure as a non-invasive axillary staging procedure in EBC in comparison with standard SLN biopsy (SLNB). A subanalysis of the AX-CES study, a prospective single-arm, monocentric phase 3 study was performed (EudraCT: 2020-000393-20). The study included patients with EBC undergoing upfront surgery and SLN resection, with no prior history of locoregional treatment, and weighing between 40-85 kg. All patients underwent the CEUS SLN procedure as a non-invasive axillary staging procedure, with CEUS SLN accumulation marked using blue dye. After the CEUS SLN procedure, all patients underwent the standard mapping procedure. Data on success rate, systemic reactions, mean procedure time, mean surgical procedure, mean procedure without axillary staging, CEUS SLN appearance (normal/pathological), SLN number, and concordance with standard mapping procedure were collected. After the CEUS SLN procedure, 29 LNs among 16 patients were identified and marked. In all cases, CEUS SLN revealed at least one LN enhancement. Six (37.50%) LNs were defined as pathological after the CEUS SLN procedure. Definitive staining of CEUS SLN pathology revealed metastatic involvement in four (66.67%) of the cases. Two SLNs were identified during the CEUS SLN procedure; however, owing to the low disease burden, no change in the surgical plan was reported. The CEUS SLN procedure shows promise as a technique for non-invasive assessment of the axilla, potentially enabling safe axillary de-escalation in EBC by estimating the axillary disease burden.

Assessing the use of the triglyceride-glycemic index (TyG), neutrophil-lymphocyte Ratio (NLR), and platelet-lymphocyte Ratio (PLR) in distinguishing benign and malignant tumors among patients with complaints of breast mass

IntroductionBreast cancer is a prevalent global health concern characterized by uncontrolled cell growth in breast tissue. In 2020, approximately 2.3 million cases were reported worldwide, with 162,468 new cases and 87,090 fatalities documented in India in 2018. Early diagnosis is crucial for reducing mortality. Our study focused on the use of markers such as the triglyceride-glycemic index and hematological markers to distinguish between benign and malignant breast masses. MethodsA prospective cross-sectional study included female patients with breast mass complaints. The target sample size was 200. Data collection included medical history, clinical breast examination, mammography, cytological assessment via fine-needle aspiration cytology (FNAC), and blood sample collection. The analyzed parameters included neutrophil-to-lymphocyte Ratio (NLR), platelet-to-lymphocyte Ratio (PLR), and triglyceride-glycemic index (TyG). Histopathological examination confirmed the FNAC results. Statistical analysis including propensity score matching, Kolmogorov–Smirnov tests, Mann–Whitney U tests, receiver's operator curve (ROC) analysis, and logistic regression models was conducted using SPSS and R Software. Additional validation was performed on 25 participants. ResultsThis study included 200 participants. 109 had benign tumors and 91 had malignant tumors. Propensity score matching balanced covariates. NLR did not significantly differ between the groups, while PLR and TyG index differed significantly. NLR correlated strongly with the breast cancer stage, but not with the BI-RADS score. PLR and TyG index showed moderate positive correlations with the BI-RADS score. ROC analysis was used to determine the optimal cutoff values for PLR and TyG index. Logistic regression models combining PLR and TyG index significantly improved malignancy prediction. ConclusionsTyG index and PLR show potential as adjunctive markers for distinguishing breast masses. NLR correlated with cancer stage but not lesion type. Combining TyG and PLR improves prediction, aiding clinical decisions, but large-scale multicenter trials and long-term validation are required for clinical implementation.

Analysis on status quo and related factors of delays in diagnosis and treatment of breast cancer in Ningxia Hui Autonomous Region.

This study aimed to explore factors contributing to the delays in the diagnosis and treatment of breast cancer (BC) in Ningxia Hui Autonomous Region. We conducted a cohort analysis of 1012 patients with BC diagnosed at the General Hospital of Ningxia Medical University between January 2018 and December 2019. Sociodemographic data were collected through questionnaires, and clinical data were gathered and analyzed from relevant databases. Furthermore, observations were made regarding delays in the diagnosis and treatment of BC, followed by an analysis of the correlations between patient delay and both sociological factors within the population and clinical factors specific to patients with BC. Subsequently, the factors associated with patient delay and system delay were examined using Cox regression analysis, along with the inclusion of neoadjuvant therapy. In the prevention and treatment of BC in Ningxia, the patient delay rate was 33.20%, the diagnosis delay rate was 17.89%, the treatment delay rate was 0.0099% and the system delay rate was 41.60%. There was a higher proportion of patient delay and system delay in aged patients (age ≥ 61 years) with rural registered permanent residence (RPR), multiple clinical symptoms (such as nipple spillage, axillary abnormalities, etc), a T4 tumor size classification, and the initial use of neoadjuvant therapy. Besides, significant positive correlations were observed between patient delay and system delay time with BC stage. Patients aged 51 to 60 and those with molecular types (Limanal1B: ki-67 > 14%, Limanal1B: HER-2 positive) were prone to patient delay, whereas molecular characteristics influenced system delay, unrelated to sociodemographic factors. The study identifies significant age, residency, and tumor molecular subtype correlations with diagnostic and treatment delays in Ningxia's patients with BC, predominantly affecting women aged 41 to 60, especially urban dwellers. These findings underscore the need for targeted interventions to reduce delays and improve BC care in this region.

Impact of the COVID-19 pandemic on the pathologic diagnosis and treatment of breast cancer in a university hospital in Brazil

PurposeThe COVID-19 pandemic has led to the need for extraordinary restrictions and adjustments in health services, which may have compromised cancer screening and oncological treatments. The aim of our retrospective study was to evaluate the impact of the COVID-19 pandemic on breast cancer pathologic diagnosis, presentation, and treatment in a university hospital in Brazil.Materials and methodsWe extracted data from the medical records of all patients who were diagnosed with breast cancer and underwent treatment in a Southeast University Hospital in Brazil from March to December between 2018 and 2021. The primary objective was to compare breast cancer diagnosis, stage, and oncology treatments during the COVID-19 pandemic (2020–2021) with a prepandemic control cohort (2018–2019).ResultsWe collected data for 116 patients and 500 breast surgical specimens. There was a -12% decline in the diagnosis of new cases of breast cancer during the pandemic. The decrease was most pronounced when comparing 2019 and 2020 (-50%), and a recovery in the number of diagnoses was noted in 2021 compared to 2019 (+ 7.1%). In terms of therapeutic surgical approaches, an increase of 29.73% occurred during the pandemic period. The increase was most pronounced when comparing 2018 and 2020 (+ 41.18%). Overall, stage distribution and other tumor characteristics did not show statistically significant differences between the pandemic and prepandemic cohorts.ConclusionsOur results showed a decrease in the number of new breast cancer diagnoses (-12%) during the pandemic compared to the prepandemic period. However, the number of therapeutic surgical approaches performed increased, and a recovery in the number of breast cancer diagnoses during 2021 has been noticed. Concerted measures are needed to minimize the long-term negative impact of the COVID-19 pandemic on delayed diagnosis.

Salivary Tryptophan as a Metabolic Marker of HER2-Negative Molecular Subtypes of Breast Cancer.

Changes in the concentration of tryptophan (Trp) indicate a serious metabolic restructuring, which is both a cause and a consequence of many diseases. This work examines the upward change in salivary Trp concentrations among patients with breast cancer. This study involved volunteers divided into three groups: breast cancer (n = 104), non-malignant breast pathologies (n = 30) and healthy controls (n = 20). In all participants, before treatment, the quantitative content of Trp in saliva was determined by capillary electrophoresis. In 20 patients with breast cancer, Trp was re-tested four weeks after surgical removal of the tumor. An increase in the Trp content in saliva in breast cancer has been shown, which statistically significantly decreases after surgical removal of the tumor. A direct correlation was found between increased Trp levels with the degree of malignancy and aggressive molecular subtypes of breast cancer, namely triple negative and luminal B-like HER2-negative. These conclusions were based on an increase in Ki-67 and an increase in Trp in HER2-negative and progesterone-negative subtypes. Factors under which an increase in Trp concentration in saliva was observed were identified: advanced stage of breast cancer, the presence of regional metastasis, low tumor differentiation, a lack of expression of HER2, estrogen and progesterone receptors and the high proliferative activity of the tumor. Thus, the determination of salivary Trp may be a valuable tool in the study of metabolic changes associated with cancer, particularly breast cancer.

Association between trajectories of adherence to endocrine therapy and risk of treated breast cancer recurrence among US nonmetastatic breast cancer survivors.

Endocrine therapy is the mainstay treatment for breast cancer (BC) to reduce BC recurrence risk. During the first year of endocrine therapy use, nearly 30% of BC survivors are nonadherent, which may increase BC recurrence risk. This study is to examine the association between endocrine therapy adherence trajectories and BC recurrence risk in nonmetastatic BC survivors. This retrospective cohort study included Medicare beneficiaries in the United States (US) with incident nonmetastatic BC followed by endocrine therapy initiation in 2010-2019 US Surveillance, Epidemiology, and End Results linked Medicare data. We calculated monthly fill-based proportion of days covered in the first year of endocrine therapy. We applied group-based trajectory models to identify distinct endocrine therapy adherence patterns. After the end of the first-year endocrine therapy trajectory measurement period, we estimated the risk of time to first treated BC recurrence within 4 years using Cox proportional hazards models. We identified 5 trajectories of adherence to endocrine therapy in BC Stages 0-I subgroup (n = 28,042) and in Stages II-III subgroup (n = 7781). A trajectory of discontinuation before 6 months accounted for 7.0% in Stages 0-I and 5.8% in Stages II-III subgroups, and this trajectory was associated with an increased treated BC recurrence risk compared to nearly perfect adherence (Stages 0-I: adjusted hazard [aHR] = 1.84, 95% CI = 1.46-2.33; Stages II-III: aHR = 1.38, 95% CI = 1.07-1.77). Nearly 7% of BC survivors who discontinued before completing 6 months of treatment was associated with an increased treated BC recurrence risk compared to those with nearly perfect adherence among Medicare nonmetastatic BC survivors.

Dielectrophoretic Characterization and Computational Analysis of Peripheral Blood Mononuclear Cells from MMTV-PyMT Mammary Carcinoma Models for Late Carcinoma Detection

Breast cancer is the leading cancer in women, with 284,200 new cases and an estimated 43,600 deaths in 2021. Early detection and proper treatment can enhance outcomes. This study probes the dielectric properties of peripheral blood mononuclear cells (PBMCs) from MMTV-PyMT mice at 14+ weeks (stage IV) using a microfluidic platform for early breast cancer detection. The central hypothesis is that changes in subcellular components like the cytoskeleton, membrane, cytoplasm, and extracellular matrix at carcinoma onset regulate dielectric properties (conductivity, permittivity), affecting bioelectric signals that aid cancer detection. This is based on preliminary data showing unique PBMC dielectric properties from WT and PyMT tumor-bearing mice, identifying bioelectric signals regulating human adenocarcinoma cells. We hypothesize isolated PBMCs are altered in cancer compared to healthy bodies, evident in the MMTV-PyMT mouse model for analyzing human breast cancer mechanisms. Although specific PBMC change mechanisms are not investigated, we hypothesize these alterations can be detected using dielectrophoresis, a dielectric characterization technique utilizing non-uniform electric fields to manipulate and separate normal and cancer cells based on differing electrophysiological plasma membrane properties. Our results present dielectric properties of murine PyMT and WT PBMCs exhibiting unique cellular behavior, with numerical simulations validating these results. These unique characteristics can discriminate between cancer and non-cancer cells. This novel, label-free, rapid (~2 min), low-cost cell sorting technology detects and separates early and late breast cancer stages, leading to preclinical development and future clinical trials. The long-term goal is a non-invasive tool to determine breast cancer at earliest stages without false positives/negatives of standard mammography screening

Complementary and Alternative Medicine Use and Its Impact on the Delayed Presentation and Advanced Stage of Breast Cancer in Newly Diagnosed Indian Women

Abstract Introduction Complementary and alternate medicine (CAM) use is highly prevalent among Indian cancer patients. However, such studies from the perspective of Indian patients with breast cancer (BC) are lacking. Objective The aim of this study was to evaluate the incidence of CAM use and its impact on the presentation of patients with BC. Materials and Methods This retrospective study was performed in the Department of Radiation Oncology over a period of 6 months (January to June 2019) and involved review of hospital-record of 229 newly-diagnosed patients with BC. Univariate and multivariate binary logistic regression analysis was done to evaluate the association of CAM use with the BC stage and various clinicodemographic variables. Results Of 229 patients, 96 (41.92%) used CAM. The CAM use was significantly associated with rural residence (odds ratio [OR]: 4.092; 95% confidence interval [CI]: 2.27–7.35), illiteracy (OR: 6.417; 95% CI: 1.83–22.45), delayed presentation by 3 to 6 (OR: 12.964; 95% CI: 2.94–57.00) and more than 6 months (OR: 40.667; 95% CI: 9.26–178.46), and advanced stage at diagnosis (OR: 10.786; 95% CI: 5.15–22.58). Similarly, advanced stage at diagnosis was significantly associated with rural residence (OR: 2.78; 95% CI: 1.59–4.84), illiteracy (OR: 7.20; 95% CI: 1.86–22.79,), and delayed presentation by 3 to 6 (OR: 6.41; 95% CI: 2.81–14.61) and more than 6 months (OR: 17.55; 95% CI: 7.26–42.45). Conclusions CAM use was highly prevalent among the patients with BC and significantly associated with advanced stage at diagnosis. Moreover, both CAM use and advanced stage at diagnosis were significantly associated with rural residence, low educational status, and delayed presentation.

Serum Prolactin Levels as a Novel, Practical Marker for Predicting Malignant Diseases of the Breast.

Background and objective Prolactin (PRL) has a high specificity toward breast cancer (BC), making it a valuable marker in both diagnosis and prognosis. In this study, we aimed to compare serum PRL levels between pre- and post-menopausal women with BC, as well as normal reference values. We also investigated the association of various risk factors with PRL levels in women with BC. Methods The study involved adult women diagnosed with BC based on clinical features and tissue histopathology receiving treatmentat a tertiary care center in Pune, India. General and demographic information, anthropometric measurements (height, weight, and BMI), menstrual status (age at menarche and menopausal state), clinical presentation (signs and symptoms), duration of symptoms, and parity were recorded by using a pre-tested proforma based on hospital records or in-person interviews. Serum PRL was measured by the RIA method (sandwich assay). Results A total of 67 women (average age: 47.5 ± 11.8 years; 33 of them post-menopausal) with BC were included in the study. The participants had an average BMI of 24.9 ± 3.5 kg/m2,and 26 (39%) of them wereoverweight. The majority of women had BC stage IIA disease, involvement of the right side or upper outer quadrant, and had attained menarche after 14 years of age; 47 women had aBCduration of >3 months. Seven women were nulliparous, and the remaining had given birth to their first child before the age of 26 years. The average serum PRL level among the participants was 9.27 ± 7.62 ng/mL, with higher levels found in post-menopausal women compared to pre-menopausal women (11.08 vs. 7.51 ng/mL, respectively; p=0.08). Women with a higher stageand greater duration of disease had significantly higher serum PRL levels (p<0.001 for both). When compared with reference values, pre-menopausal women showed significantly lower (6.25 vs. 10.9, respectively; p=0.001) and post-menopausal women showed significantly higher (8.55 vs. 5.95; p=0.004) serum PRL levels. A positive correlation was found between serum PRL and age at the time of birth of the first child (p=0.068). Conclusions Based on our findings, PRL is an important hormone in the development of BC in women. Therapeutic modulation of PRL may be a realistic and novel approach to curing human BC, either administered alone or in combination with conventional treatments.

Breast Cancer Staging Prediction Based on Logistic Regression Model

Breast cancer is one of the most common diseases in women. It is important to diagnose whether a patient’s breast cancer is benign or malignant as early as possible because there are different treatments for different stages. If the spread of cancer and tumors can be controlled early, patient’s suffering can be reduced and survival rates improved. In order to determine if a patient has benign or malignant breast cancer, this article will develop a breast cancer staging prediction model using a popular machine learning approach called logistic regression. The Wisconsin Breast Cancer Diagnosis (WBCD) dataset, provided by the University of Irvine Machine Learning, is the basis for the logistic regression model used in this study. A confusion matrix is utilized to assess the model’s accuracy as well as Type I and Type II errors. The Type I and Type II errors’ percentages are very small, the accuracy of the logistic regression model is 94.958%, which is not very high thus it may not be recommended for people to use and rely on this model to predict breast cancer, people can consider other prediction models. Furthermore, there may be several factors which may lead to the low logistic regression model’s accuracy, such as the size of the database, selection of samples, or the selection of variables.

Educational level and characteristics of invasive breast cancer: findings from a French prospective cohort.

Breast cancer (BC) characteristics are known to influence patients survival. Social differences have been reported by previous studies for those characteristics but questions persist because of inconsistent conclusions. We aimed to investigate the impact of education on BC stage, grade, and hormone receptor (HR) status, while adjusting for potential confounders including a broad set of health behaviors, anthropometric measures, and reproductive factors. In the French E3N cohort, 5236 women developed a primary invasive BC for which there was available information on stage, grade, and HR status. No multivariate analyses was performed for BC stage based on the lack of association in bivariate analyses. Odds ratios and confidence intervals were estimated using multinomial logistic regression models for BC grade or binomial logistic regression models for HR status of BC. Women with a lower education were diagnosed with higher grade BC compared to women with a higher education (1.32 [1.12; 1.57]). This association was slightly attenuated after adjustment for covariates independently and more strongly affected in the fully adjusted model (1.20 [0.99; 1.45]). A significant association was observed between lower education and HR- status of BC (1.20 [1.02; 1.42]) attenuated after adjustment for age at first childbirth (1.12 [0.95; 1.33]). In this cohort, education was associated with BC grade and HR status but not stage at diagnosis. The link between education and BC grade was not entirely explained by the different adjustments. A specific mechanism could be at play and deserves further investigations.

Implementation and Evaluation of a Breast Cancer Disease Model Using Real-World Claims Data in Germany from 2010 to 2020.

Breast cancer is the leading cause of cancer-related mortality among women in Germany and worldwide. This retrospective claims data analysis utilizing data from AOK Baden-Wuerttemberg, a major statutory German health insurance provider, aimed to construct and assess a real-world data breast cancer disease model. The study included 27,869 female breast cancer patients and 55,738 age-matched controls, analyzing data from 2010 to 2020. Three distinct breast cancer stages were analyzed: Stage A (early breast cancer without lymph node involvement), Stage B (early breast cancer with lymph node involvement), and Stage C (primary distant metastatic breast cancer). Tumor subtypes were estimated based on the prescription of antihormonal or HER2-targeted therapy. The study established that 77.9% of patients had HR+ breast cancer and 9.8% HER2+; HR+/HER2- was the most common subtype (70.9%). Overall survival (OS) analysis demonstrated significantly lower survival rates for stages B and C than for controls, with 5-year OS rates ranging from 79.3% for stage B to 35.4% for stage C. OS rates were further stratified by tumor subtype and stage, revealing varying prognoses. Distant recurrence-free survival (DRFS) analysis showed higher recurrence rates in stage B than in stage A, with HR-/HER2- displaying the worst DRFS. This study, the first to model breast cancer subtypes, stages, and outcomes using German claims data, provides valuable insights into real-world breast cancer epidemiology and demonstrates that this breast cancer disease model has the potential to be representative of treatment outcomes.

A novel NIR-II FL/ PA imaging-guided synergistic photothermal-immune therapy: Biomineralizing nanosystems integrated with anti-tumor and bone repair

Advanced stages of breast cancer are frequently complicated by bone metastases, which cause significant cancer-related bone destruction and mortality. However, the early precise theranostics of bone metastasis remains a formidable challenge in clinical practice. Herein,a novel all-in-one nanotheranostic system (ABI NYs) combining NIR-II FL/PA dual-modal imaging with photothermal-immunity therapeutic functionalities in one component was designed to precisely localize bone metastasis microscopic lesions and achieve complete tumor ablation at an early stage. The surface modification of the nanosystem with ibandronate (IBN) facilitates both passive and active targeting, significantly improving the detection rate of bone metastasis and suppressing the bone resorption. Superior photothermal performance produces sufficient heat to kill tumor cells while stimulating the upregulation of heat shock proteins 70 (HSP70), which triggers the immunogenic cell death (ICD) effect and the anti-tumor immune response. These all-in-one nanosystems precisely demonstrated early lesion localization in bone metastases and total tumor ablation with a single integration via “one-component, multi-functions” technique. To sum up, ABI NYs, as novel biomineralizing nanosystems integrated with anti-tumor and bone repair, present a synergistic therapy strategy, providing insight into the theranostics of bone metastases and clinical research.

UTRN as a potential biomarker in breast cancer: a comprehensive bioinformatics and in vitro study

Utrophin (UTRN), known as a tumor suppressor, potentially regulates tumor development and the immune microenvironment. However, its impact on breast cancer’s development and treatment remains unstudied. We conducted a thorough examination of UTRN using both bioinformatic and in vitro experiments in this study. We discovered UTRN expression decreased in breast cancer compared to standard samples. High UTRN expression correlated with better prognosis. Drug sensitivity tests and RT-qPCR assays revealed UTRN’s pivotal role in tamoxifen resistance. Furthermore, the Kruskal–Wallis rank test indicated UTRN’s potential as a valuable diagnostic biomarker for breast cancer and its utility in detecting T stage of breast cancer. Additionally, our results demonstrated UTRN’s close association with immune cells, inhibitors, stimulators, receptors, and chemokines in breast cancer (BRCA). This research provides a novel perspective on UTRN’s role in breast cancer’s prognostic and therapeutic value. Low UTRN expression may contribute to tamoxifen resistance and a poor prognosis. Specifically, UTRN can improve clinical decision-making and raise the diagnosis accuracy of breast cancer.

E-cadherin Expression in Invasive Mammary Carcinoma

Abstract Background: E-cadherin is an adhesion molecule that is frequently expressed in normal epithelial tissues. It is essential for many cellular processes, including organ formation, stratification, and epithelial polarization. Objective: This study examines E-cadherin expression for subclassifying invasive breast cancer. E-cadherin expression also decreased with age, histopathological type, grade, and stage. Materials and Methods: This prospective study included 249 breast cancer patients who underwent surgery at a private facility in Baghdad, Iraq. The patients’ clinical data were analyzed, focusing on age, histopathological type, tumor grade, and tumor stage. Immunohistochemical and histopathological processing and staining were performed to evaluate E-cadherin status in the tumor cells. Results: Mean age of patients 47.92 ± 10.79 years, most age group 40–49 (35.7%), most histopathological type of breast cancer invasive ductal carcinoma (IDC; 81.1%), grade II (67.9%), and stage II (78.3%). Patients have +3 E-cadherin (79.5%). Grade III breast cancer patients have 98% +3 E-cadherin. E-cadherin is unrelated to age, histopathological type, or stage. Conclusion: Decreased E-cadherin expression in breast cancer is associated with higher tumor grade and estrogen receptor status. However, its significance as a prognostic or predictive marker is limited in IDC and special varieties. The study found no significant correlation between E-cadherin expression and age group, histopathological type, or breast cancer stage.

CEM immediately after contrast-enhanced CT: a one-step staging of breast cancer

BackgroundContrast-enhanced mammography (CEM) is a promising technique. We evaluated the diagnostic potential of CEM performed immediately after contrast-enhanced computed tomography (CE-CT).MethodsFifty patients with breast cancer underwent first CE-CT and then CEM without additional contrast material injection. Two independent radiologists evaluated CEM images. The sensitivity of CEM for detecting index and additional malignant lesions was compared with that of mammography/ultrasonography by the McNemar test, using histopathology as a reference standard. Interobserver agreement for detection of malignant lesions, for classifying index tumors, and for evaluating index tumor size and extent was assessed using Cohen κ. Pearson correlation was used for correlating index tumor size/extent at CEM or mammography/ultrasonography with histopathology.ResultsOf the 50 patients, 30 (60%) had unifocal disease while 20 (40%) had multicentric or multifocal disease; 5 of 20 patients with multicentric disease (25%) had bilateral involvement, for a total of 78 malignant lesions, including 72 (92%) invasive ductal and 6 (8%) invasive lobular carcinomas. Sensitivity was 63/78 (81%, 95% confidence interval 70.27–88.82) for unenhanced breast imaging and 78/78 (100%, 95.38–100) for CEM (p < 0.001). The interobserver agreement for overall detection of malignant lesions, for classifying index tumor, and for evaluating index tumor size/extent were 0.94, 0.95, and 0.86 κ, respectively. For index tumor size/extent, correlation coefficients as compared with histological specimens were 0.50 for mammography/ultrasonography and 0.75 for CEM (p ≤ 0.010).ConclusionsCEM acquired immediately after CE-CT without injection of additional contrast material showed a good performance for local staging of breast cancer.Relevance statementWhen the CEM suite is near to the CE-CT acquisition room, CEM acquired immediately after, without injection of additional contrast material, could represent a way for local staging of breast cancer to be explored in larger prospective studies.Key points• CEM represents a new accurate tool in the field of breast imaging.• An intravenous injection of iodine-based contrast material is required for breast gland evaluation.• CEM after CE-CT could provide a one-stop tool for breast cancer staging.Graphical

Internal mammary lymphadenopathy in breast cancer: a narrative review and update.

While the axillary nodal basin is the most common lymphatic drainage pathway of the breast, the internal mammary (IM) lymph node chain plays a significant role in breast cancer staging and treatment. It has been identified as sentinel nodal drainage in approximately 13-37% of patients. Despite this, the data is still limited with regard to diagnosis and management when there is suspicion or confirmation of IM lymph node (IMLN) involvement by metastatic breast cancer. The objective of this publication is to provide a comprehensive assessment of the current body of literature surrounding the diagnosis, management and prognostic value of IMLNs in breast cancer treatment. Review of the literature published regarding IMLN diagnosis, significance, and management was completed in PubMed. Additional focus was placed on reviewing articles published within the past 10 years as foundation for an update regarding the current practice and future directions in this space. Improved imaging techniques, with positron emission tomography-computed tomography and magnetic resonance imaging, have led to increase in the identification of IM lymphadenopathy, yielding surgical staging of the IM nodes nearly obsolete. While IM nodal metastases may play a role in overall survival (OS), it has not been demonstrated to be an independent risk factor for increased locoregional recurrence. IM nodal irradiation (IMNI) therapy has been a mainstay in the treatment of IM disease in the context of breast cancer. IMNI has demonstrated improvement in OS and risk of distant recurrence. Wide variations in radiation practices for patients with IM lymphadenopathy exist internationally, highlighting the lack of clear data driven consensus guidelines. Herein, we provide an updated assessment of the current diagnosis, clinical significance, and management of IM lymphadenopathy for breast cancer patients.

Cancer stages and mortality risk of breast cancer between women with and without disabilities: A national population-based cohort study in Taiwan

BackgroundThe second-most common cause of cancer-related death for women worldwide is breast cancer. However, there is little information about breast cancer among women with disabilities in Taiwan. ObjectivesThis study investigated differences between women with and without disabilities regarding breast cancer stages and evaluated the probability of developing an advanced stage and the mortality risk of breast cancer. MethodsThis study conducted a nationwide retrospective cohort study using the National Health Insurance Research Database and other nationwide databases. Our participants were newly diagnosed breast cancer patients, including women with and without disabilities, between 2004 and 2010. We matched both of them with propensity score matching methods (1:5), and all were followed up until the end of 2016. ResultsThis study included 50,683 participants with breast cancer. After matching, women with disabilities who did not receive breast cancer screening had a more significant proportion of advanced-stage breast cancer (19.95 %) than those without disabilities who did not receive breast cancer screening (16.87 %). After adjusting for related variables, women with disabilities were 1.27 times more likely to have advanced-stage breast cancer than those without disabilities. Additionally, after suffering from breast cancer, individuals with disabilities had a 1.23 times greater mortality risk compared to those without disabilities. ConclusionsAlthough cancer stages were controlled, women with disabilities still had a higher mortality risk of breast cancer. Hence, policymakers should pay more attention to women with disabilities to treat them at an early stage, which can reduce the mortality risk attributable to advanced stages.