Cáncer de mama invasivo según subtipos moleculares en la provincia Pinar del Río / Invasive breast cancer according to molecular subtypes in the Pinar del Río province

RESUMEN Introducción: el cáncer de mama es una de las enfermedades más frecuente en las féminas de varios países. Objetivo: caracterizar el cáncer de mama invasivo según subtipos moleculares en Pinar del Río, en el periodo 2013-2015. Métodos: estudio observacional descriptivo, de corte transversal, desarrollado en el Hospital Oncológico III Congreso de la provincia Pinar del Río, entre 2013 y 2015. De un universo de 452 pacientes con diagnóstico de cáncer de mama, fue seleccionada intencionalmente una muestra de 198, se cumplieron los criterios de inclusión. El análisis de historias clínicas permitió la obtención de información que dio salida a las variables estudiadas, se recurrió a la estadística descriptiva para el análisis de los resultados. Se respetó la ética médica. Resultados: los tumores se localizaron en la mama izquierda en 67 % de los casos, con predominio de tumores de menos de 2 centímetros en el 51,5 % de estos. En el 25,8 % de los pacientes ocurrió metástasis a cadenas ganglionares, con predominio de invasión numérica del subtipo receptor del factor de crecimiento epidérmico humano (HER2) en 38,1 %, este subtipo molecular fue también el de mayor grado de diferenciación histológica (grado III) con 91,7 % del total. Conclusiones: la adecuada localización, determinación del tamaño tumoral, invasión hacia cadenas ganglionares axilares del cáncer de mama, así como la determinación del grado de diferenciación histológica, apoyado en estudios inmunohistoquímicos, permiten el correcto accionar médico al dirigir la terapéutica a seguir en dependencia de las características mostradas por estos estudios.

ABSTRACT Introduction: the research responds to the need to broaden and diversify the psychological counseling offered to the population of Pinar del Río through television, with emphasis on families that are in situations of immigration. Objective: to design the television program Conversemos (Let's Talk), as a proposal of psychological counseling directed to families in situations of immigration, in order to contribute to family satisfactory functioning. Methods: a cross-sectional study was carried out that combined descriptive and explanatory elements, with the application of historical-logical methods, modeling, structural-systemic, interview, survey and documentary analysis. A diagnosis was developed in the telecenter of Pinar del Río province, Cuba. Results: it was corroborated that the motivation of those involved on the subject of family in situations of immigration was satisfactory, but not the satisfaction with its current treatment, which was low. Knowledge level of the specialists was high, but the level of knowledge of the directors and the audience was limited. The TV-program Let's Talk was designed to offer to Pinar del Río audience a space for counseling that would develop skills and resources to cope successfully with the immigration problem. Conclusion: the psychological counseling offered by Pinar del Río telecenter to the family in situations of immigration was insufficient. There was a high level of motivation towards the subject on the part of the audience and the specialists, who had adequate knowledge on the subject, but limited level of knowledge on the part of the audience and the directors of the telecenter, which determined low levels of satisfaction in all people involved.

Localización con semilla radioactiva (LSR) de lesiones no palpables de la mama: Desarrollo e implementación del programa en la República Argentina / Radioactive Seed Localization for Nonpalpable Breast Lesions: Program Development & Implementation in Argentina

El intervencionismo en mama se inició con la localización preoperatoria de lesiones no palpables. En una segunda etapa, el desarrollo de técnicas de biopsias en las tres modalidades (mamografía, ultrasonido y resonancia magnética), reforzaron las indicaciones de localización de lesiones con histología ya confirmada. La técnica de localización en Argentina se basó casi exclusivamente en la inserción de alambres con arpones e inyección de carbón. A partir del año 2001, se ofreció como alternativa a las localizaciones con arpones la inserción de semilla de Iodo-125, considerando las ventajas para la paciente, el cirujano y el sistema hospitalario al desacoplar los turnos de quirófano y servicios de imágenes, otorgando acceso a cualquier cuadrante con incisiones cosméticas. La provisión del isótopo es la clave para instalar y atender la demanda de los usuarios, una vez que han conocido los méritos del procedimiento. En todos los ámbitos y distintos países, se verificó una lenta incorporación a la rutina de localización de lesiones con material radioactivo, primariamente por las regulaciones fundamentales y justificadas para la adquisición del isótopo. En nuestro medio y en una labor conjunta con la Autoridad Regulatoria Nuclear (ARN), logramos finalmente, en el año 2017, el reconocimiento de la práctica. Revisamos la bibliografía, describimos la técnica y la logística para lograr autorización de aquellos centros interesados en aplicar un procedimiento universalmente adoptado por sus ventajas respecto a los métodos tradicionales.

Diagnostic intervention in breast disease started with preoperative localization of non- palpable lesions. Later, with the histological diagnosis obtained through biopsy techniques in mammography, ultrasound and magnetic resonance imaging, the localization of lesions has become a must. Traditionally, in Argentina, the localization technique was exclusively based on the insertion of harpoon-shaped guided wires and carbon suspension. Since 2001, the iodine-125 radioactive seed localization has emerged as a reliable and advantageous alternative for the patient, the surgeon and the hospital system, reducing scheduling conflicts between the breast imaging department and the surgical department, and allowing access to any quadrant with cosmetic incisions. The isotope provision is the key to satisfying the users demand, once they have known the merits of the procedure. The implementation of radioactive material for the localization of lesions has been tardy in all fields and in different countries, mainly due to justified regulations related to the acquisition of the isotope. As a result of joint efforts with the Autoridad Regulatoria Nuclear (Nuclear Regulatory Authority), the practice finally gained its deserved recognition in 2017. We conducted a review of the existing literature and described the technique and the logistics to obtain the approval of the sites that were interested in the deployment of a widely used procedure that has proved to be more advantageous than traditional methods.

Hormone receptor-negative as a predictive factor for pathologic complete response to neoadjuvant therapy in breast cancer / Receptor hormonal negativo como fator preditivo para resposta patológica completa ao tratamento neoadjuvante de câncer de mama

ABSTRACT Objective To define a predictive factor for pathologic complete response, compare the oncologic outcomes associated with the degree of pathologic response after neoadjuvant chemotherapy, and to analyze pathologic complete response as a prognostic factor for overall survival and progression-free survival. Methods A retrospective study of patients admitted to Hospital Estadual Mário Covas and Hospital Anchieta from 2008 to 2012, with locally advanced breast cancer. Hormone receptor status, HER2 status, histologic and nuclear grade, age upon diagnosis and histological type of the tumor were analyzed. Pathologic evaluation of the tumor was subdivided into pathologic complete response, defined by the absence of tumor; intermediate response, considered as a favorable stage; and poor response, considering low-responder patients. Data obtained were submitted to statistical analysis. Results The study included 243 patients. There was an association of pathologic complete response with HER-2 negative, histological grade 3, stage III, hormone receptor negative, positive lymph node, older age and more advanced tumors. However, after multivariate analysis the only predictor of pathologic complete response was the presence of negative hormone receptor. By analyzing the prognostic factors, hormone receptor negative was considered as an independent risk factor, and pathologic complete response was considered as an independent protective factor. Conclusion Hormone receptor negative is predictive of pathologic complete response and is an isolated risk factor for lower progression-free survival and overall survival. Pathologic complete response is a protective factor for these same survival analyses.

RESUMO Objetivo Definir um fator preditivo para resposta patológica completa, comparar os resultados oncológicos associados com o grau de resposta patológica, após quimioterapia neoadjuvante, e analisar a resposta patológica completa como fator prognóstico para sobrevivência global e livre de progressão de doença. Métodos Estudo retrospectivo de pacientes admitidas no Hospital Estadual Mário Covas e Hospital Anchieta, no período de 2008 a 2012, com câncer de mama localmente avançado. Foram utilizados status dos receptores hormonais, proteína HER2, grau histológico e nuclear, idade do paciente ao diagnóstico e tipo histológico do tumor. A avaliação patológica do tumor foi subdividida em resposta patológica completa, definida com ausência de tumor; resposta intermediária, considerada como um estádio favorável; e resposta ruim, considerando os pacientes pouco respondedores. As informações obtidas foram submetidas à análise estatística. Resultados Foram incluídas 243 pacientes. Verificou-se associação de resposta patológica completa entre HER-2 negativo, grau histológico 3, estadiamento III, receptor hormonal negativo, linfonodo positivo, maior idade e tumores mais avançados. Porém, após análise multivariada, o único fator preditivo de resposta patológica completa foi presença de receptor hormonal negativo. Ao analisar fatores prognósticos, receptor hormonal negativo permaneceu como variável independente de risco, e resposta patológica completa, como variável independente de proteção. Conclusão O receptor hormonal negativo é fator preditivo isolado de resposta patológica completa e fator de risco para menor sobrevida livre de doença e sobrevida global. Já a resposta patológica completa é fator protetor para estas mesmas análises de sobrevivência.

Criteria for prediction of metastatic axillary lymph nodes in early-stage breast cancer / Critérios para predição de metástases axilares em câncer de mama em estádio clínico inicial

PURPOSE: To estimate the likelihood of axillary lymph node involvement for patients with early-stage breast cancer, based on a variety of clinical and pathological factors. METHODS: A retrospective analysis was done in hospital databases from 1999 to 2007. Two hundred thirty-nine patients were diagnosed with early-stage breast cancer. Predictive factors, such as patient age, tumor size, lymphovascular invasion, histological grade and immunohistochemical subtype were analyzed to identify variables that may be associated with axillary lymph node metastasis. RESULTS: Patients with tumors that are negative for estrogen receptor, progesterone receptor, and HER2 had approximately a 90% lower chance of developing lymph node metastasis than those with luminal A tumors (e.g., ER+ and/or PR+ and HER2-) - Odds Ratio: 0.11; 95% confidence interval: 0.01-0.88; p=0.01. Furthermore, the risk for lymph node metastasis of luminal A tumors seemed to decrease as patient age increased, and it was directly correlated with tumor size. CONCLUSION: The molecular classification of early-stage breast cancer using immunohistochemistry may help predicting the probability of developing axillary lymph node metastasis. Further studies are needed to optimize predictions for nodal involvement, with the aim of aiding the decision-making process for breast cancer treatment. .

OBJETIVO: Estimar a probabilidade de acometimento linfonodal em pacientes com câncer de mama inicial, baseado em fatores clínicos e patológicos. MÉTODOS: Foi realizada uma análise retrospectiva de 1999 a 2007 dos bancos de dados do hospital. Um total de 239 pacientes foram diagnosticados com câncer de mama em estádio inicial. Fatores preditivos como idade, tamanho do tumor, presença de invasão linfovascular, grau histológico e subtipo imunoistoquímico foram analisados para identificar possíveis variáveis associadas com a presença de metástases axilares. RESULTADOS: Pacientes com tumores negativos para receptor de estrogênio, receptor de progesterona e HER2 tiveram aproximadamente 90% menos chance de terem metástases axilares do que pacientes com tumores luminais A (por exemplo, ER+ e/ou PR+ e HER2-) - Odds Ratio: 0,11; intervalo de confiança de 95%: 0,01-0,88; p=0,013. Além disso, o risco de metástases axilares para tumores luminais A diminuiu com o aumento da idade e se correlacionou diretamente com o tamanho do tumor. CONCLUSÃO: A classificação molecular do câncer de mama em estádio inicial utilizando a imunoistoquímica pode ajudar a predizer a probabilidade de encontrar metástases axilares. Novos estudos são necessários para otimizar essa predição, auxiliando no processo de decisão do tratamento relacionado ao câncer de mama. .

Expression of miR-185 in breast cancer and its clinical significance / 中国医师杂志

Objective To investigate the expression of miR-185 in breast cancer and its clinical significance.Methods miR-185 expression was detected in 132 cases of breast cancer and 51 cases of benign breast lesions.The correlations of miR-185 ex pression with the clinicopathologic characteristics,overall survival,and disease-free survival of breast cancer patients were analyzed.Results miR-185 was down-regulated in the breast cancer tissues relative to control tissues.The down expression levels of miR-185 cases were found to be significantly associated with tumor node metastasis (TNM) stage,local relapse,and distant metastasis (P ＜ 0.05).Conclusions miR-185 was associated with carcinogenesis,progression,and prognosis of breast cancer and it might be used as a potential target of therapy and a biomarker of diagnosis and prognosis of breast cancer in the future.

MicroRNA181b/c inhibits the metastasis of breast cancer by targeting glycoprotein serglycin / 中国医师杂志

Objective To investigate the relationship of glycoprotein serglycin (SRGN) expression with invasion and metastasis of breast cancer cells,and the role of microRNA in the regulation of SRGN expression.Methods Real-time quantitative polymer ase chain reaction (PCR) and Western blot were used to detect the differences in SRGN expression between higher metastasis Michigan cancer foundation-7 (MCF-7)/5-Fu breast cancer cell lines and weaker metastasis MCF-7 cell line.The siRNA interference experiment and in vitro Transwell experiment were used to detect effect of SRGN on the ability of invasion and metastasis of breast cancer cells.Bioinformatics software was used to predict miRNAs targeting SRGN,and integrated microRNA differentially expressed chip data between breast cancer cell MCF-7 versus MCF-7/5-Fu.The miRNA quantitative PCR was used to determine the differences of candi date miRNA expression.After transfection of microRNA minics,Western blot was used to test candidate microRNA target SRGN.Transwell experiment was used to test the effects of candidate microRNAs on tumor cell invasion and metastasis.Results SRGN was increased significantly in MCF-7/5-Fu cells,and the invasion and metastasis of tumor cells were inhibited when SRGN was interfered.In addition,miR181 b/c expressed in MCF-7/5-Fu cells was reduced significantly,negatively correlated with SRGN expression,and targeted SRGN expression.It inhibited invasion and metastasis of tumor cells.Conclusions MicroRNA181b/c inhibits metastasis of breast cancer by targeting SRGN.

Expression and significance of Wnt1 and β-catenin proteins in breast invasive ductal carcinoma / 中国医师杂志

Objective To investigate the expressions of Wnt1 and β-catenin proteins in mammary cancer and its relationship with clinical pathological characteristics,and explore its role in the pathogenesis of breast cancer.Methods Immunoshistochemisty (SP method) was used to detect the expressions of Wnt1 and β-catenin proteins in adjacent tissue of breast cancer (n =15),breast hyperplasia tissues (n =25),and breast in vasive ductal carcinoma (n =80).SPSS 17.0 statistical software was used for analysis,such as count data with x2 test and correlation analysis with Spearman test,with significance level of α =0.05.Results The positive rate of Wnt1 and β-catenin in breast cancer group [62.5％ (50/80) and 68.8 (55/80)] was significantly higher than that in hyperplasia group [28％ (7/25) and 20％ (5/25)]and in borderline group [13.33 (2/15) and 13.33 (2/15)] with a significant difference (P ＜ 0.01).Positive expression of Wnt1 and abnormal expression of β-catenin in breast invasive ductal carcinoma were related to lymphatic metastasis (x2 =5.10,4.87,P ＜ 0.05).Abnormal expression of β-catenin was also related to the histological grading of breast invasive ductal carcinoma (x2 =5.61,P ＜ 0.05).The expressions of Wnt1 and β-catenin proteins in invasive ductal carcinoma showed a positive correlation (r =0.313,P ＜ 0.01).Conclusions The high level expression of Wnt1 protein and the abnormal expression of β-catenin protein might play an important role in breast carcinogenesis,and was related to lymph node metastasis.

Analysis of the risk factors for brain metastasis among patients with metastatic breast cancer / 中国医师杂志

Objective This study aimed at retrospective analysis of some metastatic breast cancer cases,investigated the recurrence of brain metastases of metastatic breast cancer in patients with risk factors,and provided a reference for the implementation of prevention strategies in the treatment plan and a reasonable choice.Methods A total of 796 breast cancer cases was visited,of whom 456 patients with recurrent metastatic breast cancer,in which 61 patients were with brain metastasis.The follow-up data were analyzed with SPSS13.0 software.x2 was used to test the age,estrogen receptor (ER),progesterone receptor (PR),cerbB-2 expression,lymph node metastasis,and brain metastasis.The COX proportional hazard model was used to analyze the recurrence and metastasis in patients with single-factor,multi-factor analysis,in order to obtain the independent prognostic factors.Results The x2 tests that group age ≤ 35 years,hormone receptor-negative,CerbB-2 (2 +)/(3 +) has a higher risk than another group (x2 =24.92,8.28,4.02,P ＜0.01 orP ＜0.05).COX univariate analysis showed that patient age,tumor size,ER and PR expression,CerbB-2 expression,lung metastases were looked.as the first metastatic site and hormone therapy.Those were significant factors whether the patient suffered from brain metastasis (P ＜ 0.05).COX multivariate analysis showed that age,ER and PR expression,CerbB-2 expression,and lung metastases were looked as the first metastatic site acted as an independent prognostic factor for brain metastasis (P ＜0.05).Conclusions Age,ER and PR expression,CerbB-2 expression,lung metastases as the first metastatic site are the independent prognostic factors for brain metastasis.

Relationship between TIC of DCE-MRI and angiogenesis in breast cancer / 中国医师杂志

ObjectiveTo study the clinical application of magnetic resonance imaging (MRI) and dynamic contrast enhancement in the old breast cancer patients.MethodsEighty cases of elderly patients with suspected breast cancer were detected by dynamic enhanced MRI,dynamic contrast enhanced MRI,and pathological examination.Results(1) Among 80 cases of suspected breast cancer patients,MRI scan found that the TIC curve of 80 patients (81 lesions) was entered a type curve.(2)DCE-MRI scan findings were highly consistent with histopathological diagnosis with a significant correlation ( r =0.935,P ＜0.05).(3)The micro-vessel density( MVD; 34.74 ± 12.05) in breast carcinoma - bearing tissues was significantly higher than the normal tissues adjacent to carcinoma ( 18.36 -± 3.16) ( t =6.47,P ＜ 0.05 ).(4)The value of DCE-MRI scan maximum enhancement linear slope (SS) and enhanced peak PH were 2.38 ±0.40 and (619.22 ± 123.53 ) HU,respectively.A significantly positive correlation was found between SS and MVD ( r =0.72,P ＜ 0.05) and between PH and MVD ( r =0.66,P ＜ 0.05),respectively.A significantly negative correlation was found between the signal intensity peak time (Tpeak; 56.10 ± 10.13 )and MVD ( r =- 0.53,P ＜ 0.05).ConclusionsDCE-MRI can indirectly reflect the status of angiogenesis in breast cancers.It would be an important approach for the non - traumatic early detection and diagnosis of breast cancer.

Age pattern of the occurrence of breast cancer in the northwest of Iran.

Breast cancer represents 27% of the cancers and 19% of the cancer deaths in female population. The aim of this study was to document the age pattern of the incidence of breast cancer in Iranian female population in the northwest region of the country. The study subjects were 1764 patients with breast cancer diagnosed/registered in the six university clinics between 1988 and 2008 in the northwest of Iran. The highest occurrence rates were observed for the birth year cohorts 1940-1949 (for 59-69 years old), 1950-1959 (for 49-58 years old), and 1960-1969 (for 39-48 years old). Among these three cohorts, the highest rate was observed in 1950-1959 birth year cohort (284.38 per 100,000 female populations, 95% CI: 260-310). This rate was significantly higher compared with the similar rates of other birth cohorts. There was no statistically significant difference between various years in terms of the average age at the diagnosis of breast cancer in our study setting. Despite the previous research reports, we found no significant difference between the mean ages at diagnosis of breast cancer from 1988 to 2008 in Iranian female population.

Pathological features of tubular carcinoma of 29 cases breast / 临床与实验病理学杂志

Purpose To investigate clinicopathological features,diagnosis and differential diagnosis of tubular carcinoma of the breast.Methods Morphological observation and immunohistochemistry were applied in 29 cases of tubular carcinoma of the breast, and the literatures were also reviewed.Results The tumors were composed of open tubules, infiltrating haphazardly in the cellular desmoplastic stroma. The neoplastic tubules were enclosed by a single layer of epithelial cells with insignificant atypia or rare mitoses.The tumors were often associated with lobular neoplasm, columnar cell lesion, ductal atypical hyperplasia or carcinoma in situ. Immunostaining displayed that myoepithelial cells were absent or incomplete.Conclusions Tubular carcinoma of the breast is a peculiar subtype of breast carcinoma with good prognoses, which is easily confused with microglandular adenosis, radial sclerosing lesions,or low grade invasive ductal carcinoma.Immunohistochemistry is useful for the differential diagnosis.