Archives of Breast Cancer
Volume:8 Issue: 1, Feb 2021

The aim of this study is to evaluate the accuracy of intra-operative specimen mammography (ISM) in surgical margins status assessment and highlight the concordance between the interpretations of the surgeon and the radiologist.

Our cross-sectional study included 130 patients with early breast cancer, surgically treated between October 2013 and September 2017 in the multidisciplinary breast center of the A.O.U. City of Health and Science (which is a complex of several hospitals) in Turin, Italy. All recruited patients underwent breast conservative surgery. Surgical margins were evaluated intraoperatively, using intra-operative specimen mammography. A standard compression intraoperative specimen mammography was obtained by the surgeon using the dedicated radiological equipment (Faxitron®, BioVision). After the surgeon’s evaluation of the margins, Faxitron images were sent to PACS. All ISMs images were analyzed by the same specialized radiologist in remote access to confirm the surgeon evaluation. We used kappa formula to report concordance.

The discordance rate of positive readings between the surgeon and the radiologist was 5.3% while that of negative readings was 6.9%. The concordance rate between radiologist and pathologist assessments was 100%. Intra-operative specimen mammography specificity was 94% (95% CI: 88–97), and sensitivity was 47% (95% CI: 38–56), with PPV found to be 53% (95% CI: 95% 44-62) and NPV determined to be 92% (95% CI: 86–96), when the assessment was made by the surgeon.

Intra-operative specimen mammography is a helpful tool to identify infiltrated margins and to reduce the rate of secondary surgeries by recommending targeted re-excisions of corresponding orientations in order to obtain a final negative margin status. In our experience, not only radiologists but also surgeons could correctly read Faxitron® intra-operative specimen mammography.

To optimize screening abbreviated breast MRI (ABMR) operations, patient throughput times of ABMR were compared to breast ultrasound (US) and full protocol breast MRI (FPMR).

Patient throughput times (mean ± standard error) and its subcomponents were analyzed for 95 ABMRs, 90 breast US exams, and 50 FPMRs. Total patient throughput was measured from registration time to the time of the last acquired image. Actual exam time was time difference between the first and last acquired images and pre-examination time was the calculated difference between throughput and actual exam times.

ABMR total patient throughput time was shorter than FPMR (55.7 ± 1.7 vs. 63.1 ± 2.0 min; difference, 7.4 min, 13%; p<0.001), but longer than breast US (39.1 ± 1.3 min; difference, 16.6 min, 30%; p<0.001). ABMR had shorter actual scan times than FPMR (13.4 ± 0.14 vs. 18.6 ± 0.25 min; p<0.001), but longer than US (9.6 ± 0.46 minutes; p<0.001). There was no difference in the preexamination times between ABMR and FPMR (42.3 ± 1.7 vs. 44.6 ± 1.9 min; p = 0.357); pre-examination times were longer for both MR exam types compared to US (29.5 ± 1.3 minutes; p<0.001).

ABMR patient throughput times are faster than FPMR, but these gains are limited as they have no impact on pre-examination activities which comprise the lengthiest components of the patient flow process. US patient flow currently remains faster than ABMR; however, comparable ABMR times could be achieved by further omitting certain sequences and optimizing pre-examination processes.

Breast carcinoma is the most common malignant tumor and leading cause of cancer related death in women worldwide. Apart from traditional markers, estrogen receptor, progesterone receptor and Her-2neu, which are important for prognostication and staging purposes, a novel marker cyclooxygenase-2 (COX-2) is being studied extensively. We intend to study the spectrum of COX-2 expression in normal breast tissue, ductal carcinoma in situ (DCIS) adjacent to invasive cancer, and in invasive cancer and compare COX-2 expression with histological prognostic parameters and hormone receptor status.

The present study is a prospective study that was conducted in the department of Pathology, SGT Medical College and Hospital, Gurugram (2019- 2020). Fifty patients, aged between 21 and 70, suffering from primary breast cancer constituted the study group. Various histological prognostic parameters were assessed. Immunohistochemical profile of the tumor was assessed. COX-2 score was correlated with various clinicopathologic parameters.

Among the total of 50 patients suffering from invasive breast carcinoma, 94 percent (47/50) of cases showed the same COX-2 expression level in normal breast epithelium and corresponding tumor areas and this correlation was statistically significant. The correlation between the level of COX-2 expression in tumor and DCIS was highly significant.

Inhibition of COX-2 may represent a potential target for preventing breast cancer oncogenesis and as an adjuvant treatment following surgery to reduce local recurrence.

The optimal number of sentinel lymph nodes (SLNs) to be removed is controversial based on the false negative rate and prognosis. We investigated factors related to the number of SLNs and the possibility of optimizing the number of SLNs.

We retrospectively reviewed 167 cases in which 0.3 or 0.5 ml of ferucarbotran was sub-dermally injected without massage from July 2016 to November 2018. Sentinel lymph node biopsy (SNB) was conducted using both radioisotope (RI) and superparamagnetic iron oxide (SPIO). The removed nodes with a value of ≥0.5 μT on a magnetometer were considered to be SLNs (SPIO nodes). The total SPIO node count in each case was calculated.

There was a significant correlation between the number of SPIO nodes and total count of SPIO nodes (rs=0.821, p<0.0001). With RI and SPIO methods, the average number of removed nodes in the age≥75 years and BMI≥25 subgroups was significantly lower than that in the age<75 years and BMI<25 subgroups. The number of SPIO nodes was significantly influenced by the injected dose. The average number of SPIO nodes in the age ≥75 years and BMI≥25 subgroups after injection of 0.5 ml was almost the same as that of the age <75 years and BMI<25 subgroups after injection of 0.3 ml.

Obesity and old age seemed to be associated with slow lymphatic flow; however, increasing the dose increased the number of SPIO nodes. Thus, optimization of the number of SLNs seems possible.

Pathological complete response (pCR) following neoadjuvant systemic treatment(NAST) for breast cancer is associated with improved prognosis; however, a large proportion of patients have residual disease. Oestrogen Receptor (ER) and HER2 status have been shown to affect likelihood of achieving pCR, with ER positive tumors being more treatment resistant. As hormone receptor status is heterogeneous within tumors, we postulated that, following NAST, ER expression would change in patients with residual disease, as the ER negative cells within the tumor are more treatment sensitive.

A retrospective case series of patients treated with NAST prior to surgery at our institution was conducted. Information collected included demographic data, tumor grade, hormone receptor and HER2 status both before and after treatment, and pCR rates.

Of the 44 patients included, half achieved pCR. HER2 status (P=0.01), and subtype (P=0.008) were significantly associated with pCR. HER2 positive/ER negative tumors were most likely to undergo pCR. Approximately 80% of residual disease was ER positive. Higher levels of ER expression were also associated with increasing residual cancer burden (RCB) class (P=0.037). There was no trend between change in ER or HER2 expression following NAST. Median change in ER expression was 80% to 90% (P= 0.89), HER2 intensity changed from 3.0 to 2.2 (P=0.67) following treatment.

Consistent with the literature, we have shown associations between ER and HER2 status and PCR, and between ER expression and residual disease burden. Our study was not able to demonstrate a significant trend in hormone and HER2 expression.

Bone-only metastatic breast cancer is believed to be non-lifethreatening, and mild therapy is frequently selected to avoid adverse events of drug therapy. However, the prognoses of such patients are not well studied.

Patients who received drug therapies for metastatic breast cancer between 2004 and 2016 at our institution were divided into the “Bone-only metastasis”, “non-visceral”, and “visceral” groups based on the mode of the first metastasis, and the efficacy of the first-line therapy and survival of these patients were compared.

There were 131 eligible patients, and the bone-only metastasis, nonvisceral, and visceral groups included 26, 25, and 80 patients, respectively. The median survival time (MST) of the overall survival (OS) in each group was 35.1, 34.9, and 37.4 months, respectively (p=0.71). The clinical benefit rates of first-line therapy in the bone-only metastasis, non-visceral, and visceral groups were 66.7%, 45%, and 69.3%, respectively, and the MST of the time to treatment failure (TTF) in each group was 6.3, 5.5, and 5.8 months, respectively, showing that the efficacy of first-line therapy did not significantly differ among the groups. In the bone-only metastasis group, patients with <5 metastases tended to have a good prognosis, and those with a low nuclear grade and long first-line therapy duration had a significantly better prognosis than others.

The patients with bone-only metastasis had a similar prognosis and treatment response to those with other modes of metastasis, and the patients with a good response to the first-line therapy had a good prognosis.

This study aimed to compare the recurrence rate of breast cancer between women treated with breast-conserving therapy (BCT) with/without radiotherapy and those treated with total mastectomy using 18F-fluorodeoxyglucose 18 positron emission tomography/computed tomography (F-FDG PET/CT).

The current study retrospectively included 588 patients suffering from breast cancer who had been referred to the PET/CT department of Masih-eDaneshvari Hospital in Tehran between April 2013 and September 2019. Data of all female patients with breast cancer were extracted from the recorded hospital files. Based on the treatment plan, patients were divided into two groups: BCT with/without radiotherapy (n=168) and total mastectomy (n=420). Local, 18 locoregional, and distant metabolically active lesions were determined in F-FDG PET/CTand compared between groups.

BCT and total mastectomy were comparable regarding local (28.5% vs. 25.7%, P=0.200) and locoregional (21.4% vs. 22.8%, P=0.712) recurrence, while distant recurrence was significantly higher with total mastectomy (88.5% vs. 64.2%, P<0.001). Also, lymph node invasion (42.9% vs. 60%m P<0.001) and positive PET/CT(78.5% vs. 88.5%, P=0.002) were significantly higher with total mastectomy. According to multivariate analysis, age, clinical stage, and positive margin are independently correlated with the rate of distant metastasis.

According to our analysis, breast-conserving therapy could be a suitable choice of surgery in selected patients since local and locoregional recurrence rate did not significantly differ between patients who underwent breastconserving surgery compared to those who were treated with total mastectomy. Higher rate of distant metastasis in patients with total mastectomy seems to be influenced by many confounding variables such as age, higher stage of diagnosis and positive margin rather than type of surgery.