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Objective To analyze the differences in the treatment patterns,clinical characteristics,treatment outcomes and prognostic factors between breast cancer patients with ductal carcinoma in situ (DCIS) and ductal carcinoma in situ with microinvasion (DCIS-MI).Methods Clinical data of 866 female patients including 631 DCIS cases and 235 DCIS-MI cases treated in our institution between 1999 and 2013 were retrospectively analyzed.The local control (LC),disease-free survival (DFS) and overall survival (OS) rates were calculated by Kaplan-Meier survival analysis.The prognostic factors were identified by Log-rank test.Results Similar LC,DFS and OS rates were obtained between two groups (all P＞ O.05).The univariate analysis demonstrated that Her-2-positive patients had worse OS and DFS than Her-2-negative counterparts.Patients undergoing breast-conserving surgery without radiotherapy had lower LC and DFS rates compared with those receiving radical mastectomy.Conclusions DCIS and DCIS-MI patients have similar clinical prognosis in terms of OS,LC and DFS.Her-2 positive is an unfavorable prognostic factor for DFS and OS.The LC and DFS rates in the breast-conserving surgery alone group are worse than those in the mastectomy group.
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RESUMEN El Cáncer de mama Bilateral, es una entidad clínico patológica especial de presentación del cáncer de mama. Por lo que realizamos la presentación de un paciente con esta rara afección así como una revisión del estado actual de esta enfermedad.
ABSTRACT Bilateral breast cancer is a special pathological clinical entity presenting breast cancer. So we made the presentation of a patient with this rare condition as well as a review of the current status of this disease.
RESUMO O câncer de mama bilateral é uma entidade clínica patológica especial que apresenta câncer de mama. Por isso, fizemos a apresentação de um paciente com esta condição rara, bem como uma revisão do estado atual desta doença.
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Objective To analyze the changes in treatment patterns,clinical characteristics,treatment outcomes and prognostic factors of ductal carcinoma in situ (DCIS).Methods Clinical data of 617 female patients admitted to our institution between 2000 and 2013 were retrospectively analyzed.KaplanMeier survival analysis was adopted to calculate the local control (LC),disease-free survival (DFS) and overall survival (OS) rates.Log-rank test was utilized to identify the prognostic factors.Results Along the number of DCIS patients was gradually increased year by year,the proportion of breast conservative surgery was also elevated.However,mastectomy remained the primary surgical method.A total of 374 patients underwent mastectomy,160 cases received breast conservative surgery plus radiotherapy and 83 underwent breast conservative surgery alone.Postoperatively,366 patients (83.6％) with positive hormone receptor received hormone therapy and 45 patients (7.3％) underwent chemotherapy.The median follow-up time was 47 months.The 5-year LC,DFS and OS rates were 98.4％,97.5％ and 98.9％,respectively.Univariate analysis demonstrated that Her-2-positive patients obtained worse OS (P=0.019).Although mastectomy group had more adverse factors compared with breast conservative surgery with or without radiotherapy groups,similar survival results were obtained among three groups.Mastectomy yielded better LC and DFS compared with breast conservative surgery alone.Conclusions DCIS patients obtain favorable clinical prognosis between the breast conservative surgery and mastectomy groups.The LC rate in the mastectomy group is better than that in the breast conservative surgery group.
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Breast ductal carcinoma in situ (DCIS) comprises a heterogeneous group of lesions with different forms of clinical and pathological presentation. Postoperative radiotherapy is usually performed in DCIS patients who underwent conservative breast surgery. The objective of the present study was to describe indications and clinical evidences of radiotherapy for breast DCIS patients
O carcinoma ductal in situ (CDIS) de mama compreende um grupo heterogêneo de lesões com diferentes formas de apresentação clínica e patológica. A radioterapia pós-operatória é normalmente realizada nas pacientes com CDIS submetidas à cirurgia conservadora de mama. O presente estudo teve o objetivo de apresentar as indicações e as evidências para a utilização da radioterapia na abordagem do CDIS de mama.
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ABSTRACT INTRODUCTION: According to the cancer stem-cell theory, tumors originate from a small population of cancer stem cells, which lose the mechanism of self-regulation and begin to differentiate and proliferate indefinitely. The CD44+/CD24- phenotype may be considered a stem-cell marker in breast cancer. OBJECTIVE: To evaluate the correlation between CD44+/CD24- phenotype and different molecular subtypes of breast cancer in invasive ductal carcinoma samples. METHODS: The expression of CD44, CD44v6, and CD24 markers was investigated in 133 cases of invasive mammary carcinoma with immunohistochemistry. CD44+/CD24- phenotype was identified and correlated with the molecular subtypes and classical prognostic factors such as age, histological grade, tumor size, and lymph node status. RESULTS: Eighteen (14%) cases were positive for CD44+/CD24- (CD44+/CD24- or CD44v6+/CD24-) phenotype; among these, 11.1%, 27.8%, 38.9%, and 22.2% were luminal, luminal B-human epidermal growth factor receptor 2 (HER2), HER2, and triple-negative subtype, respectively. CD44+/ CD24- phenotype was more common in HER2 subgroup (p = 0.0197). CONCLUSION: CD44+/CD24- phenotype was correlated with molecular subtypes of breast cancer. The highest expression of CD44+/CD24- phenotype was reported in patients with HER2+ disease, a molecular subtype associated with more aggressive behavior and worse prognosis.
RESUMO INTRODUÇÃO: De acordo com a teoria das células-tronco tumorais, os tumores são originários de uma pequena população de células-tronco que perdem o mecanismo de autorregulação e começam a se diferenciar e proliferar indefinidamente. O fenótipo CD44+/CD24- pode ser considerado um marcador de células-tronco tumorais no câncer de mama. OBJETIVO: Avaliar a correlação entre o fenótipo CD44+/CD24- e os diferentes subtipos moleculares do câncer de mama em amostras de carcinoma ductal invasor. MÉTODOS: A expressão dos marcadores CD44, CD44v6 e CD24 foi investigada em 133 casos de carcinoma mamário invasor por meio de imuno-histoquímica. O fenótipo CD44+/CD24- foi identificado e correlacionado com os subtipos moleculares e os fatores prognósticos clássicos, como idade, grau histológico, tamanho do tumor e status do linfonodo. RESULTADOS: Dezoito (14%) casos foram positivos para o fenótipo CD44+/CD24- (CD44+/CD24- ou CD44v6+/CD24-), sendo 11, 1%, 27, 8%, 38, 9% e 22, 2% dos subtipos luminal, luminal B-human epidermal growth factor receptor 2 (HER2), HER2 e triplo negativo, respectivamente. O fenótipo CD44+/CD24- foi mais comum no subgrupo HER2 (p = 0, 0197). CONCLUSÃO: O fenótipo CD44+/CD24- foi correlacionado com os subtipos moleculares do câncer de mama. A maior expressão do fenótipo CD44+/CD24- foi encontrada em pacientes com doença HER2+, subtipo molecular associado a um comportamento mais agressivo e a um pior prognóstico.
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Primary lymph node hemangioma is a rare entity with only a few cases having been reported in the literature. This article describes a case of a 68-year-old female patient with breast cancer who underwent modified radical mastectomy with a subsequent histopathological evaluation that revealed invasive ductal carcinoma histological grade III according to Nottingham's Combined Classification. Among the 14 resected lymph nodes, the presence of vascular proliferation (intranodal) was observed in one of them, consistent with primary nodal hemangioma. Thus, knowledge about this clinical entity is important in order to establish the correct differential diagnosis with malignant primary neoplasms and metastasis, in which therapeutics and prognosis are very different
Hemangioma linfonodal primário é uma entidade rara, sendo que poucos casos foram descritos na literatura. Neste artigo foi relatado o caso de uma paciente de 68 anos com neoplasia mamária à direita e que foi submetida à mastectomia radical modificada com posterior avaliação histopatológica, que evidenciou carcinoma ductal invasor de grau histológico III, conforme Classificação Combinada de Nottingham. Dentre os 14 linfonodos ressecados, foi observada em 1 deles a presença de proliferação vascular (intranodal) consistente com hemangioma nodal primário. Dessa forma, o reconhecimento dessa entidade clínica torna-se imprescindível para a realização de diagnóstico diferencial de neoplasias malignas primárias ou metastáticas, que apresentam terapêuticas e prognósticos totalmente distintos
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SummaryObjective:the aim of this study was to investigate the addition of elastography to the BI-RADS® lexicon for the classification of breast lesions.Methods:a total of 955 consecutive patients who were subjected to breast percutaneous biopsy from January 2010 to December 2012 were retrospectively assessed. Overall, 26 patients who did not present with masses on conventional ultrasound were excluded. The patients were classified according to the fifth edition of the breast imaging and reporting data system (BI-RADS®) lexicon, which includes elastographic findings. The BI-RADS®classification is based on the same classification principles that have been suggested by the author, which classify lesions as soft, intermediate, or hard.Results:the addition of elastographic findings to the BI-RADS® lexicon improved the sensitivity (S), specificity (SP), and diagnostic accuracy (DA) of ultrasound in the assessment of breast lesions, which increased from 93.85, 72.07, and 76.64 to 95.90, 80.65, and 91.39%, respectively.Conclusion:these findings suggest that the addition of elastography to the BIRADS ® lexicon will improve the SP and DA of ultrasound in the screening of breast lesions.
ResumoObjetivo:investigar o impacto da adição da descoberta da elastografia das lesões mamárias à classificação segundo o léxico BI-RADS®.Métodos:estudo retrospectivo com 955 pacientes consecutivas, submetidas à biópsia mamária percutânea no período de janeiro de 2010 a dezembro de 2012. Foram excluídas 26 pacientes que apresentaram lesão não nodular ao ultrassom convencional. As lesões foram classificadas conforme proposta da 5ª edição do léxico BI-RADS®, que inclui os achados de elastografia. A classificação BI- -RADS® é baseada nos mesmos critérios propostos pelo autor, que classifica as lesões como macias, intermediárias e rígidas.Resultados:a adição dos achados da elastografia ao léxico BI-RADS® melhorou a sensibilidade (S), a especificidade (E) e a acurácia diagnóstica (AD) do ultrassom na avaliação das lesões mamárias, de 93.85, 72.07 e 76.64% para 95.90, 80.65 e 91.39%, respectivamente.Conclusão:os achados sugerem que a adição dos achados da elastografia ao léxico BI-RADS® pode melhorar a S, a E e a AD do ultrassom no rastreamento de lesões mamárias.
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Female , Humans , Breast Diseases , Elasticity Imaging Techniques/methods , Ultrasonography, Mammary/methods , Biopsy, Needle/methods , Breast Diseases/classification , Breast Diseases/pathology , Breast/pathology , Data Accuracy , Predictive Value of Tests , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Objective: To conduct a Meta-analysis to analyze the short-term and long-term preventive effects of whole breast irradiation combined with tumor bed boost on short- and long-term local recurrence rates and local recurrence rate of ipsilateral invasive breast cancer in patients with breast ductal carcinoma in situ (DCIS) after breast conserving-surgery (BCS). Methods: A computer-based online search of PubMed, China Journal Full-text Database (CJFD), China Biology Medicine disc (CBMdisc), Embase and Cochrane Library was performed to include eligible studies in accordance with the inclusion and exclusion criteria. Newcastle Ottawa Quality Assessment Scale was used for quality assessment of included articles. RevMan 5.3 software was used for Meta-analysis. Results: A total of 14 non-randomized controlled trials (13 were cohort study, and 1 was nonsimultaneous controlled trial) involving 8679 patients with breast DCIS were included. The results of this Meta-analysis showed that no statistically significant differences between whole breast irradiation and whole breast irradiation combined with tumor bed boost in terms of 5-year local recurrence rate [odds ratio (OR) = 0.92, 95% confidence interval (CI): 0.46-1.82; P = 0.81], 7-year local recurrence rate (OR = 0.70, 95% CI: 0.45-1.09; P = 0.11), ≥ 10-year local recurrence rate (OR = 0.95, 95% CI: 0.79-1.15; P= 0.62) and the local recurrence rate of ipsilateral invasive breast cancer (OR = 0.89, 95% CI: 0.62-1.29; P = 0.55). Conclusion: As compared with whole breast irradiation, the whole breast irradiation combined with tumor bed boost in patients with DCIS after BCS can not obviously decrease the 5-year, 7-year and ≥ 10-year local recurrence rates, as well as the local recurrence rate of ipsilateral invasive breast cancer.
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Objective To explore the serum metabonomic difference between breast fibroadenoma patients and breast invasive ductal carcinoma patients using nuclear magnetic resonance 1H(1HNMR) spectroscopy, and to discuss the possibility of using it for differentiation of benign and malignant breast tumor before operation, Methods Eight clinically diagnosed breast fibroadenoma patients and 8 breast invasive ductal carcinoma patients were recruited and their sera were collected; 1HNMR was used to obtain the metabonomic characteristics, The data were processed using Simca-P software and analyzed with principle component analysis(PCA) and orthogonal signal correction partial least squares discrimination analysis(OPLS-DA), Results PCA and OPLS-DA analyses showed great differences in serum metabonomics between breast fibroadenoma and breast invasive ductal carcinoma, Compared with breast fibroadenoma patients, patients with invasive ductal carcinoma had higher levels of lipid, lactate and phosphocholine lglycerolphospholine, and lower levels of glutamine, taurine, creatine, and glucose, Conclusion Distinct difference exists in serum metabonomic profiles between breast adenoma patients and breast invasive ductal carcinoma patients, which may serve as the potential biomarkers to differentiate malignant tumors from benign ones in clinic.
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PURPOSE: The aim of our study is to evaluate the factors affecting surgical margin positivity among patients with invasive ductal breast cancer who underwent breast-conserving surgery (BCS) after preoperative diagnostic core biopsy. METHODS: Two hundred sixteen patients with stage I, II invasive ductal breast carcinoma who had histological diagnosis with preoperative tru-cut biopsy and underwent BCS were included in the present study. Potential factors that affect the positive surgical margin were analyzed. In univariate analysis, the comparisons of the factors affecting the surgical margin positivity were made by chi-square test. Logistic regression test was used to detect the independent factors affecting the surgical margin positivity. RESULTS: Positive axillary lymph node (odds ratio [OR], 8.2; 95% confidence interval [CI], 3.01 to 22.12), lymphovascular invasion (LVI; OR, 3.9; 95% CI, 1.62 to 9.24), extensive intraductal component (EIC; OR, 6.1; 95% CI, 2.30 to 16.00), presence of spiculation (OR, 5.1; 95% CI, 2.00 to 13.10) or presence of microcalcification in the mammography (OR, 13.7; 95% CI, 4.04 to 46.71) have been found to be the independent and adverse factors affecting surgical margin positivity. CONCLUSION: Considering decision making for the extent of the excision and for achieving negative surgical margin before BCS, positive axillary lymph node, LVI, EIC, spiculation or microcalcification in mammography are related as predictor factors for positive surgical margin.
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Humans , Biopsy , Biopsy, Large-Core Needle , Breast , Breast Neoplasms , Decision Making , Logistic Models , Lymph Nodes , Mammography , Mastectomy, SegmentalABSTRACT
Objective: To investigate the expression of Let-7c in patients with invasive ductal carcinoma of the breast cancer and its correlation with the clinicopathologic features of the patients. Methods: The expression of Let-7c was examined in 40 tissues of invasive ductal carcinoma of the breast cancer and their matched non-tumor adjacent tissue specimens by stem-loop real-time RT-PCR. The correlation of the expression with the clinicopathological features of breast cancer, such as the clinical staging, lymphatic metastasis, and proliferation index, was analyzed. Results: The stem-loop realtime RT-PCR was sensitive and specific in detecting Let-7c expression. Expression of Let-7c in breast cancer tissues was significantly lower than that in the adjacent normal tissues (P10%) (P=0.030) and the status of Estrogen/Progesterone receptor (P=0.040/0.034) in breast cancer patients. There was no significant association of Let-7c expression with menopause condition, breast cancer TNM clinical stage, or lymphatic metastasis(P>0.05). Conclusion: Our results suggest Let-7c may play an important role in the development of breast cancer and the level of Let-7c expression may be a potential parameter in forecasting the progression and prognosis of breast cancer patients.
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Objective: To investigate the histopathologic features of rim enhancement MRI of breast infiltrating ductal carcinoma (IDC). Methods: Routine and dynamic contrast enhanced MRI was used to examine 65 patients with breast lumps. Thirty of the 65 patients who were pathologically confirmed to have breast IDC were included in the present study. The manifestations of dynamic contrast enhanced MRI and the histopathologic parameters of the masses (the size of cancer nest, stroma type, microvessel density and degree of fibrosis) were observed. And the relationship of MR findings with the above-mentioned histopathologic features was analyzed. Results: Peripheral rim enhancement was obvious in IDC and a type-III (washout) time/signal intensity course was the dominant type (17/30,56.7%). The average enhancement rate during the first post-contrast minute(ΔSI1 %) was higher than 75% in IDC. The 30 IDCs fell into small (13,43%), medium(12,40%), and large (5,17%) groups according to the size of cancer nest; and into delicate(5,17%), narrow(16,53%), and broad(9,30%) groups according to the cancer stroma type. Early rim enhancement was associated with a small cancer nest (P<0.05), a high ratio of peripheral-to-central microvessel density, and a low ratio of peripheral-to-central fibrosis (P<0.01). Delayed rim enhancement was significantly associated with narrow stroma (P<0.05). Conclusion: Rim enhancement and washout sign on contrast-enhanced MR imaging of the breast IDC are associated not only with angiogenesis, but also with various histological features of the cancinoma, including the size of cancer nests, width of stroma, and degree of fibrosis.
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A paraffin injection is regarded as to be a simple and effective method of breast augmentation. However, there are few reports on the long-term complication of a paraffin injected breast. The generation of breast cancer from a paraffinoma of the breast is rare, even though there is no clear evidence to suggest any relationship between a paraffin injection and breast cancer. We encountered a case of infiltrative ductal carcinoma arising from paraffinoma tissues. A 49-year-old woman had undergone bilateral breast augmentation by paraffin injection 20 years earlier. She presented with bilateral diffuse painless palpable masses with reddish discoloration and painful swelling in her left breast. She had been managed with a bilateral simple mastectomy including the mass. After discharge, the pathology report showed infiltrative ductal carcinoma of the left breast mass. The patient was readmitted for additional surgery, and she underwent a modified radical mastectomy. Ultrasonography is a useful diagnostic tool for detecting a breast mass, particularly in a dense breast. However, ultrasonography has a limitation in the case of a paraffinoma. Through this case, it is necessary to review the radiological (mammography, ultrasonography, magnetic resonance imaging, plain film) appearances and the histopathological feature to help make an accurate diagnosis and to differentiate between a carcinoma and a paraffinoma. In rare cases, a breast ductal carcinoma can be combined with a paraffinoma. Therefore, a paraffinoma must be carefully managed due to the potential risk of a carcinoma.
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Female , Humans , Middle Aged , Breast Neoplasms , Breast , Carcinoma, Ductal , Diagnosis , Magnetic Resonance Imaging , Mastectomy, Modified Radical , Mastectomy, Simple , Paraffin , Pathology , UltrasonographyABSTRACT
A paraffin injection is regarded as to be a simple and effective method of breast augmentation. However, there are few reports on the long-term complication of a paraffin injected breast. The generation of breast cancer from a paraffinoma of the breast is rare, even though there is no clear evidence to suggest any relationship between a paraffin injection and breast cancer. We encountered a case of infiltrative ductal carcinoma arising from paraffinoma tissues. A 49-year-old woman had undergone bilateral breast augmentation by paraffin injection 20 years earlier. She presented with bilateral diffuse painless palpable masses with reddish discoloration and painful swelling in her left breast. She had been managed with a bilateral simple mastectomy including the mass. After discharge, the pathology report showed infiltrative ductal carcinoma of the left breast mass. The patient was readmitted for additional surgery, and she underwent a modified radical mastectomy. Ultrasonography is a useful diagnostic tool for detecting a breast mass, particularly in a dense breast. However, ultrasonography has a limitation in the case of a paraffinoma. Through this case, it is necessary to review the radiological (mammography, ultrasonography, magnetic resonance imaging, plain film) appearances and the histopathological feature to help make an accurate diagnosis and to differentiate between a carcinoma and a paraffinoma. In rare cases, a breast ductal carcinoma can be combined with a paraffinoma. Therefore, a paraffinoma must be carefully managed due to the potential risk of a carcinoma.
Subject(s)
Female , Humans , Middle Aged , Breast Neoplasms , Breast , Carcinoma, Ductal , Diagnosis , Magnetic Resonance Imaging , Mastectomy, Modified Radical , Mastectomy, Simple , Paraffin , Pathology , UltrasonographyABSTRACT
PURPOSE : E-cadherin is a tumor suppressor adhesion molecule that has an anti-invasive role and it is often considered as a useful marker for differentiating the lobular types from the ductal types of breast cancer. Yet the biological functions of E-cadherin in the invasive ductal types of breast cancers are unclear. METHODS : The E-cadherin expression was assessed immunohistochemically in 84 case of surgically resected invasive ductal carcinoma. Only the membranous expression of E-cadherin was considered and its expression was categorized as positive (>95% stained) or negative (<95% stained). The relationship between the E-cadherin expression and tumor size, the lymph node status, the histologic grade, the ER and PR status, The HER2/neu and p53 expressions was studied by performing prospective aspect. RESULTS : We analyzed 84 invasive ductal carcinomas for the E-cadherin expressions. Variable degrees of E-cadherin expression were noted in 79 cases and the complete absence of its expression was noted in 5 cases(5.9%) which showed all HER2/neu positive and p53 negative. Positive expression of E-cadherin was noted in 66cases(78.5%). Significant associations were found between the E-cadherin expression and the tumor size and the estrogen receptor status. The expression of E-cadherin was not found to be related to the lymph node status, histologic grade, the progesteron receptor status, the HER2/neu and p53 expressions. CONCLUSION: We confirmed that there was a strong correlation between the negative membrane expressions of E-cadherin and the T-stages and a negative estrogen receptor status. E-cadherin immunostaining appears to have a minimal prognostic value and it can be efficiently used for determining tumor progression of invasive ductal carcinomas of the breast.