HistoBCAD: herramienta de código abierto para detección de cáncer de mama en imágenes histopatológicas

RESUMEN Fundamento: la detección y clasificación precisa del cáncer de mama mediante el diagnóstico histopatológico es de vital importancia para el tratamiento efectivo de la enfermedad. Entre los tipos de cáncer de mama, el carcinoma ductal invasivo es el más frecuente. El análisis visual de las muestras de tejido en el microscopio es un proceso manual que consume tiempo y depende del observador. Sin embargo, en muchos países, incluido Cuba, es escaso el uso de herramientas software para asistir el diagnóstico. Objetivo: desarrollar una herramienta software para detectar tejido de cáncer de mama, del subtipo carcinoma ductal invasivo, en imágenes histopatológicas. Métodos: la herramienta se implementó en Python e incluye métodos de detección de carcinoma ductal invasivo en imágenes histopatológicas, basados en algoritmos de extracción de características de color y textura en combinación con un clasificador de bosques aleatorios. Resultados: la herramienta de código abierto brinda una serie de facilidades para la lectura, escritura y visualización de imágenes histopatológicas, delineación automática y manual de zonas cancerígenas, gestión de los datos diagnósticos del paciente y evaluación colaborativa a distancia. Fue evaluada en una base de datos con 162 imágenes de pacientes diagnosticados con carcinoma ductal invasivo y se obtuvo una exactitud balanceada de 84 % y factor F1 de 75 %. Conclusiones: la herramienta permitió un análisis interactivo, rápido, reproducible y colaborativo mediante una interfaz gráfica sencilla e intuitiva. En versiones futuras se prevé incluir nuevos métodos de aprendizaje automático incremental para el análisis de imágenes histopatológicas digitales.

ABSTRACT Background: the accurate detection and classification of breast cancer through histopathological diagnosis is of vital importance for the effective treatment of the disease. Among the types of breast cancer, invasive ductal carcinoma (IDC) is the most common. Visual analysis of tissue samples under the microscope is a manual, time-consuming and observer-dependent process. However, in many countries, including Cuba, the use of software tools to assist diagnosis is scarce. Objective: to develop a software tool to detect IDC subtype breast cancer tissue in histopathological images. Methods: the tool is implemented in Python and includes IDC detection methods in histopathological images, based on algorithms for extraction of color and texture features in combination with a random forest classifier. Results: the open source tool provides a series of facilities for the reading, writing and visualization of histopathological images, automatic and manual delineation of cancer areas, management of patient diagnostic data and collaborative remote evaluation. It was evaluated in a database with 162 images of patients diagnosed with IDC, obtaining a balanced accuracy of 84 % and a F1 factor of 75 %. Conclusions: the tool allowed an interactive, fast, reproducible, precise and collaborative analysis through a simple and intuitive graphical interface. Future versions are expected to include new incremental machine learning methods for the analysis of digital histopathology images.

Analysis of clinicopathological features and survival results in secretory breast carcinoma and invasive ductal carcinoma of breast based on SEER database / 中国医师杂志

Objective:To analyze the differences of clinicopathological features and prognosis between secretory breast carcinoma (SBC) and invasive ductal carcinoma (IDC), and to explore the influence of SBC on the prognosis of breast cancer.Methods:We retrieved data of patients diagnosed with SBC and IDC from The National Cancer Institute′s Surveillance, Epidemiology, and End Results (SEER) database between 1990 and 2016. 109 cases of SBC (SBC group) and 558 814 cases of IDC (IDC group) were collected. The clinicopathological features were compared between SBC and IDC groups. The tendency score matching method was used to match the balance confounding factors according to 1∶4 proportion. The breast cancer-specific survival time (BCSS) and overall survival time (OS) of the two histological types of breast cancer before and after matching were analyzed. The survival curve was drawn using the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate Cox regression analysis was used to determine the independent prognostic factors of breast cancer.Results:There were significant difference in diagnostic age, marital status, sex, histological grade, American Joint Committee on Cancer (AJCC) N stage, estrogen receptor (ER) and progesterone receptor (PR) expression between SBC and IDC group (all P<0.05). The BCSS of SBC group was similar to IDC group, and OS was better than IDC ( P<0.05). Univariate and multivariate regression analysis showed that diagnostic age, race, marriage, sex, location, histological grade, AJCC stage, treatment mode and ER, PR expression were all related factors affecting BCSS and OS (all P<0.05). SBC was an independent prognostic factor for OS ( P<0.05). After propensity score matching according to 1∶4, there was no significant difference in BCSS and OS between the two groups ( P<0.05). Cox regression analysis showed that AJCC T stage and PR negative expression were the influencing factors of BCSS (all P<0.05), and diagnostic age and AJCC T stage were the influencing factors of OS (all P<0.05). SBC was no longer an influencing factor of OS in breast cancer. Conclusions:There was no significant difference in prognosis between SBC and IDC. SBC was not an independent risk factor for breast cancer.

A study on the prediction of prognosis of ductal carcinoma in situ at different pathological stages based on deep learning mammography combined with natural language processing / 中华放射学杂志

Objective:To establish the predictive models for the prognosis of ductal carcinoma in situ (DCIS) at different pathological stages, and to evaluate the predictive performance of the models.Methods:Complete data of 273 patients with confirmed DCIS at different pathological stages who underwent mammography examination in Shenzhen People′s Hospital, Peking University Shenzhen Hospital and Shenzhen Luohu People′s Hospital from November 2014 to December 2020 were retrospectively collected, including 110 cases in the DCIS+ductal carcinoma in situ with microinvasion (DCIS-MI) group and 163 cases in the invasive ductal carcinoma (IDC)-DCIS group. The clinical, imaging and pathological features were analyzed. Mammary Mammo AI fusion model and deep learning-based natural language processing (NLP) structured diagnostic report model were used for image feature extraction. Patients in each group were randomly divided into training set and validation set with a ratio of 6∶4, and the predictors were screened by univariate and multivariate logistic regression analysis. The lowest Akaike information criterion value of each group was selected to construct the final predictive model. The receiver operating characteristic (ROC) curve was drawn to evaluate the performance of each model.Results:Taking estrogen receptor (-) or human epidermal growth factor receptor 2 (3+) as the poor prognostic reference, there were 62 cases considered with poor prognosis and 48 cases with good prognosis in DCIS+DCIS-MI group; while in the IDC-DCIS group, taking the Nottingham prognostic index as the reference, 33 cases were considered with poor prognosis, 73 cases with moderate prognosis, and 57 cases with good prognosis. Four predictive factors were screened to construct the DCIS+DCIS-MI-group predictive model, including DCIS nuclear grade, calcification with suspicious morphology in mammography, DCIS pathologic subtype and DCIS with microinvasion. Five predictive factors were screened to construct the IDC-DCIS-group predictive model, including neural or vascular invasion, Ki67 level, DCIS subtype, DCIS component proportion and associated features in mammography. The area under curve (AUC) for predicting poor prognosis of DCIS+DCIS-MI was 0.92 (95%CI 0.84-1.00) in the training set and 0.90 (95%CI 0.82-0.99) in the validation set; while the AUC for predicting poor prognosis of IDC-DCIS was 0.84 (95%CI 0.76-0.93) in the training set and 0.78 (95%CI 0.64-0.91) in the validation set.Conclusion:The developed models based on deep learning combined with NLP can effectively predict the prognosis of DCIS at different pathological stages, which are beneficial to the risk stratification of patients with DCIS, providing a reference for clinical decision.

Metaplastic breast carcinoma with extensive osseous differentiation

Metaplastic breast carcinoma is a rare subtype of invasive breast carcinoma. Metaplastic carcinoma with osseous differentiation is exceptionally uncommon. Because of the heterogenous microscopy of the lesion, various clinical and radiological features are observed, leading to diagnostic difficulty. Herein, we present a case of a 43-year-old female with a recurrent breast lump, who was clinically diagnosed as a phyllodes tumor. However, histopathological examination revealed metaplastic carcinoma with extensive osseous differentiation.

Diagnostic value of high-frequency ultrasonography for Paget disease of breast / 中国介入影像与治疗学

Objective: To investigate the diagnostic value of high-frequency ultrasound for Paget disease of breast (PDB). Methods :High-frequency ultrasound data of 30 patients with pathology approved PDB were retrospectively analyzed, including 13 cases complicated with invasive ductal carcinoma (IDC). Ultrasonic appearances of PDB with or without IDC were compared. Results: Ultrasonic features of PDB included hypo-echogenicity in nipple, thicken areola skin, mammary nodules, calcification, dilated duct and enlarged axillary lymph nodes. Compared with PDB without IDC, PDB complicated with IDC showed more mammary nodules (P=0.001) and enlarged axillary lymph nodes (P=0.002). No significant difference of breast imaging reporting and data system (BI-RADS) classification, hypo-echogenicity in nipple, thicken areola skin, calcification nor dilated duct rate was found between groups (all P>0.05). Conclusion: PDB have certain ultrasonic characteristics. High-frequency ultrasound is helpful to diagnosis and assessment of PDB.

Câncer de Mama Multifocal: Relato de Caso / Multifocal Breast Cancer: Case Report / Cáncer de Mama Multifocal: Relato de caso

Introdução: O câncer de mama é a neoplasia que mais acomete o sexo feminino, sendo a primeira causa de morte por câncer em mulheres.O carcinoma mamário representa um grupo heterogêneo de doenças. Casos individuais diferem uns dos outros na morfologia, fenótipo e prognóstico. As patologias malignas das mamas podem se manifestar como tumores unifocais, multifocais e/ou multicêntricos. A incidência de tumores multifocais e multicêntricos no câncer de mama varia de 13% a 70%. Relato do caso: Paciente L.C., sexo feminino, 65 anos, com relato de nódulo palpável em mama direita em setembro de 2015. O estudo anatomopatológicodo nódulo mostrou carcinoma intraductal. Realizada quadrantectomia, com anatomopatológico que identificou carcinoma papilífero bem diferenciado intracístico e invasivo damama, associado a componente intraductal cribriforme e papilar, com margens e linfonodo sentinela livres e imuno-histoquímica compatível com perfil triplo-negativo. Em fevereiro de 2019, apresentou duas novas lesões em mama contralateral, identificadas como carcinoma ductal invasivo multifocal com papiloma intraductal associado, e carcinoma ductal invasivo associado a componente intraductal in situ dos tipos papilar, sólido e cribriforme, com imuno-histoquímica com perfis moleculares distintos entre si, sendo uma lesão do tipo luminal A e a outra, luminal híbrido. Conclusão: Este estudo relata um caso de uma paciente que apresentou lesões neoplásicas em ambas as mamas, em tempos distintos e com perfis histológicos e imuno-histoquímicos diferentes. Dessa forma, destacam-se a raridade do caso e a relevância da terapia dirigida a alvos específicos, uma vez que a paciente apresentava lesões com perfis moleculares distintos.

Introduction: Breast cancer is the neoplasm that most affects females, being the first cause of death by cancer in women. Breast carcinoma is a heterogeneous group of diseases. Individual cases differ from each other in morphology, phenotype and prognosis. Malignant breast pathologies can manifest as single, multifocal and/or multicentric tumors. The incidence of multifocal and multicentric tumors in breast cancer varies from 13% to 70%. Case report: Patient L.C., female, 65 years old, with a palpable nodule in the right breast in September 2015. The anatomopathological study of the nodule showed intraductal carcinoma. She underwent quadrantectomy, with anatomopathological examination that identified well-differentiated intracystic and invasive papillary carcinoma of the breast, associated with a cribriform and papillary intraductal component, with free sentinel lymph node and margins and immunohistochemistry compatible with triple negative profile. In February 2019, she presented two new lesions in contralateral breast, identified as invasive multifocal ductal carcinoma, with associated intraductal papilloma, and invasive ductal carcinoma, associated with an in situ intraductal component of the papillary, solid and cribriform types, with immunohistochemistry with different molecular profiles, being one lesion classified as luminal A and the other, hybrid luminal. Conclusion: This study reports a case of a patient who had neoplastic lesions in both breasts, at different times and with distinctive histological and immunohistochemical profiles. Thus, the rarity of the case and the relevance of the therapy aimed at specific targets are highlighted, since the patient presented lesions with different molecular profiles.

Introducción: El cáncer de mama es la neoplasia que más afecta a las mujeres, siendo la primera causa de muerte por cáncer en las mujeres. El carcinoma de mama representa un grupo heterogéneo de enfermedades. Los casos individuales difieren entre sí en morfología, fenotipo y pronóstico. Las patologías mamarias malignas pueden manifestarse como tumores únicos, multifocales y/o multicéntricos. La incidencia de tumores multifocales y multicéntricos en el cáncer de mama varía del 13% al 70%. Relato del caso: Paciente L.C., mujer, 65 años, con un nódulo palpable en el seno derecho en septiembre de 2015. El estudio anatomopatológico de la lesión mostró carcinoma intraductal. La paciente se sometió a una cuadrantectomía, con un examen anatomopatológico que identificó un carcinoma papilar invasivo e intraquístico bien diferenciado de mama, asociado con un componente intraductal cribiforme y papilar, con ganglio linfático y márgens libres y inmunohistoquímica compatible con perfil triple negativo. En febrero de 2019, presentó dos nuevas lesiones en el seno contralateral, identificadas como carcinoma ductal multifocal invasivo, con papiloma intraductal asociado y carcinoma ductal invasivo, asociado con un componente intraductal in situ de los tipos papilar, sólido y cribiforme, con inmunohistoquímica con diferentes perfiles moleculares, siendo una lesión del tipo luminal A y la otra, luminal híbrida. Conclusión: Este estudio reporta un caso de una paciente que tenía lesiones neoplásicas en ambos senos, en diferentes momentos y con diferentes perfiles histológicos e inmunohistoquímicos. Por lo tanto, se destaca la rareza del caso y la relevancia de la terapia dirigida a objetivos específicos, una vez que la paciente presentó lesiones con diferentes perfiles moleculares.

EVALUATION OF LOCAL RECURRENCE OF BREAST CONSERVATION SURGERY AT THE CEARÁ INSTITUTE OF CANCER / Avaliação da recidiva local da cirurgia conservadora de mama no Instituto do Câncer do Ceará

Introduction: Breast cancer is the most common malignant tumor in the world, with the exception of cases of non-melanoma skin cancer. In Brazil, more than 56,000 cases were estimated for 2016. The expected mortality rate remains high because of late diagnosis. Nowadays, conservative surgery is the gold standard treatment. Objective: To evaluate the locoregional recurrence of conservative surgery practiced at the Ceará Institute of Cancer, between 2002 and 2012. Method: A cross ­ sectional study with a descriptive approach using secondary data obtained from the medical records of patients with breast cancer operated at the Ceará Institute of Cancer. Results: The study population consisted of 360 patients. Invasive ductal carcinoma was the most common type (72.8%), followed by ductal carcinoma in situ (16.4%) and invasive lobular carcinoma (4.7%). The other histological types represent 6.4% (cribriform, 0.5%, medullary, 0.6%, micro invasive, 0.3%, mucinous, 1.1%, papillary, 3.1% 8%; and tubular, 0.8%). In the sample, 25 patients had some type of recurrence: 13/360 (3.6%), local or locoregional; and 12/360 (3.3%), distant recurrence. Conclusion: From the data analysis, we can conclude that the conservative surgery practiced at the Ceará Institute of Cancer showed data on recurrence compatible with the international literature

Introdução: O câncer de mama é o tumor maligno que mais acomete mulheres em todo o mundo, excetuando-se os casos de pele não melanoma. No Brasil, estimavam-se mais de 56.000 casos para 2016. A mortalidade esperada ainda é alta devido ao diagnóstico tardio. Na atualidade, a cirurgia conservadora é o padrão-ouro. Objetivo: Avaliar a recidiva locorregional da cirurgia conservadora praticada no Instituto do Câncer do Ceará, no período entre 2002 a 2012. Método: Estudo transversal e descritivo, utilizando dados secundários obtidos nos prontuários médicos de pacientes com câncer de mama operadas no Instituto do Câncer do Ceará. Resultados: A população em estudo foi de 360 pacientes. O carcinoma ductal invasivo foi o tipo mais comum (72,8%), seguido do carcinoma ductal in situ (16,4%) e do carcinoma lobular invasivo (4,7%). Os outros tipos histológicos representam 6,4% (cribiforme, 0,5%; medular, 0,6%; microinvasor, 0,3%; mucinosos, 1,1%; papilífero, 3,1%; e tubular, 0,8%). Na amostra, 25 pacientes tiveram algum tipo de recidiva: 13/360 (3,6%), local ou locorregional; e 12/360 (3,3%), recidiva a distância. Conclusão: Da análise dos dados, podemos concluir que a cirurgia conservadora praticada no Instituto do Câncer do Ceará tem dados de recorrência compatíveis com a literatura internacional

Solitary pancreatic metastasis from breast cancer: case report and review of literature

ABSTRACT CONTEXT: Pancreatic metastases from primary malignant tumors at other sites are rare, constituting about 2% of the neoplasms that affect the pancreas. Pancreatic metastasis from breast cancer is extremely rare and difficult to diagnose, because its clinical and radiological presentation is similar to that of a primary pancreatic tumor. CASE REPORT: A 64-year-old female developed a lesion in the pancreatic tail 24 months after neoadjuvant therapy, surgery and adjuvant radiation therapy for right-side breast cancer (ductal carcinoma). She underwent distal pancreatectomy with splenectomy and left adrenalectomy, and presented an uneventful outcome. The immunohistochemical analysis on the surgical specimen suggested that the lesion originated from the breast. CONCLUSION: In cases of pancreatic lesions detected in patients with a previous history of breast neoplasm, the possibility of pancreatic metastasis should be carefully considered.

Diagnostic value of MRI and mammography in ductal carcinoma in situ of the breast / 中国基层医药

Objective@#To investigate the diagnostic value of MRI and molybdenum target in ductal carcinoma in situ (DCIS).@*Methods@#From June 2014 to June 2018, 58 patients diagnosed as DCIS in Heji Hospital Affiliated to Changzhi Medical College were chosen.MRI and mammography were performed, and the diagnostic potency of the two methods was observed.@*Results@#The coincidence degree of molybdenum target X-ray and MRI diagnosis: the coincidence coefficient kappa=0.452 of molybdenum target X ray and MRI showed that the two diagnostic methods were in general anastomosis.The diagnostic consistency of different examination methods: the diagnostic consistency of molybdenum target combined with MRI (96.6%) was significantly higher than that of molybdenum target X(82.8%), the difference was statistically significant (χ2=5.95, P<0.05), and there was no statistically significant difference compared with MRI(89.7%) (χ2=2.43, P>0.05).@*Conclusion@#Molybdenum target and MRI in diagnosis of DCIS have their own characteristics.Combined application can improve the diagnostic effect.

Intelligent breast full volume ultrasound in differential diagnosis of granulomatous mastitis and invasive ductal carcinoma / 中国医学影像技术

Objective:To explore the value of intelligent breast full volume ultrasound system (IBUS) in differential diagnosis of granulomatous mastitis (GM) and invasive ductal carcinoma (IDC). Methods: Ultrasonographic data of 36 GM patients and 76 IDC patients were analyzed retrospectively. Multivariate Logistic regression model was established to screen out the main ultrasonic features. The value of differential diagnosis of GM and IDC, the diagnostic efficiency of Logistic regression model were evaluated, ROC curve was drawn. Results: Multivariate Logistic regression screened out 5 independent risk factors for differential diagnosis of GM and IDC, including pull and gather sign (odds ratio [OR]=44.33), calcification (OR=23.08), halo ring (OR=20.35), catheter dilatation (OR=19.01) and crater sign (OR=14.40). The accuracy of IBUS in diagnosis of GM and IDC was 91.67%(33/36) and 89.83%(53/59), respectively. Conclusion: IBUS has good diagnostic and clinical value in differential diagnosis of GM and IDC.

Diagnostic value of MRI and mammography in ductal carcinoma in situ of the breast / 中国基层医药

Objective To investigate the diagnostic value of MRI and molybdenum target in ductal carcinoma in situ (DCIS).Methods From June 2014 to June 2018,58 patients diagnosed as DCIS in Heji Hospital Affiliated to Changzhi Medical College were chosen.MRI and mammography were performed,and the diagnostic potency of the two methods was observed.Results The coincidence degree of molybdenum target X-ray and MRI diagnosis:the coincidence coefficient kappa=0.452 of molybdenum target X ray and MRI showed that the two diagnostic methods were in general anastomosis.The diagnostic consistency of different examination methods:the diagnostic consistency of molybdenum target combined with MRI ( 96. 6%) was significantly higher than that of molybdenum target X (82.8%),the difference was statistically significant (χ2 =5.95,P＜0.05),and there was no statistically significant difference compared with MRI (89.7%) ( χ2 =2.43, P >0.05). Conclusion Molybdenum target and MRI in diagnosis of DCIS have their own characteristics.Combined application can improve the diagnostic effect.

Effects of ubiquitin-specific proteases 2-69 on proliferation of breast cancer cells / 中华病理学杂志

Objective@#To investigate the expression and significance of ubiquitin-specific proteases 2-69(USP2-69) in invasive ductal carcinoma of breast.@*Methods@#Twenty-four cases of human breast tissue with invasive ductal carcinoma diagnosed at Huanshan Hospital, Fudan University from 2013 to 2015 were collected, and the expression of USP2-69 mRNA and protein was detected by molecular hybridization, Western blot and immunohistochemistry. USP2-69 was over-expressed in cultured human breast cancer cell line MCF-7 by USP2-69 plasmid transfection. The cellular proliferative activity was investigated in vitro.@*Results@#The USP2-69 mRNA and protein were highly expressed in breast invasive ductal carcinoma, compared to adjacent normal tissues (P<0.01). Ki-67 protein expression was also increased in cases with high USP2-69 protein level. Western blot showed significantly higher USP2-69 protein level in cancer tissue compared to the adjacent normal tissue. In the cultured tumor cells, there was increased S phase fraction, cellular proliferation rate, flat positive clones, cyclin D1 expression and decreased p27 expression in USP2-69-transfected MCF-7 cells.@*Conclusions@#USP2-69 is over-expressed in breast invasive ductal carcinoma, and is closely related to proliferation promoting effects. The data provide an important experimental basis for further study on the molecular mechanism of breast cancer cell proliferation.

SURGICAL TREATMENT OF BREAST CANCER: DATA FROM A RENOWNED INSTITUTION IN THE BRAZILIAN NORTHEAST / Tratamento cirúrgico do câncer de mama: dados de uma instituição de referência do nordeste brasileiro

Introduction: Worldwide, breast cancer is the neoplasia that most affects women, after skin cancer, and accounts for 25% of new cases each year. Over the past 40 years, the survival rate has been increasing in developed countries ­ currently, it is 85% in 5 years ­, while in developing countries it remains between 50 and 60%. As such, routine use of mammography throughout the world is considerably important. Objectives: To describe demographic and pathological characteristics in addition to the surgical approach of patients with invasive breast carcinoma in a renowned institution. Methods: A cross-sectional, descriptive study using secondary data obtained from medical records of breast cancer patients operated on at the Cancer Institute of Ceará (ICC), from 2002 to 2012. Data were analyzed using Epi Info 7.0 software. Results: The study population included 746 patients with primary breast tumors, of which 626 (84%) were invasive. Within the invasive breast tumors, the majority (554 ­ 88.49%) were of the invasive ductal carcinoma (IDC) type. Concerning stages, 351 cases (56.07%) were stage II. The average age of patients was 41 to 50 years old, and T2 tumors measured approximately 2 to 5 cm. The most frequent surgery was a quadrantectomy. A sentinel lymph node biopsy (SNB) was performed in 368 patients (58.78%). Conclusion: O ur c asuistry p rovides i mportant i nformation w ith r egard t o t he p rofile o f p atients s urgically t reated a t a renowned public institution in the Brazilian Northeast. Diagnosing the disease at an advanced stage still occurs at this institution, which results in high rates of mastectomy. Thus, better results tend to be obtained as better screening proposals are provided.

Introdução: O câncer de mama é a neoplasia que mais acomete mulheres em todo o mundo após o câncer de pele, representando 25% dos casos novos a cada ano. Nos últimos 40 anos, a sobrevida vem aumentando nos países desenvolvidos ­ atualmente, é de 85% em 5 anos ­, enquanto nos países em desenvolvimento permanece entre 50 e 60%, tendo o uso rotineiro da mamografia considerável importância em todo o mundo. Objetivos: Descrever as características demográficas, patológicas e as abordagens cirúrgicas de pacientes com carcinoma invasivo da mama em uma instituição de referência. Métodos: Estudo transversal e descritivo, utilizando dados secundários obtidos nos prontuários médicos de pacientes com câncer de mama operadas no Instituto do Câncer do Ceará (ICC), entre os anos de 2002 e 2012. Os dados foram analisados por meio do software Epi Info 7.0. Resultados: A população de estudo correspondeu a 746 pacientes com tumores primários de mama, dos quais 626 (84%) apresentavam-se como invasivos, sendo a maioria (554 ­ 88,49%) do tipo carcinoma ductal invasivo (CDI). No que diz respeito ao estádio, 351 casos (56,07%) eram II. Prevaleceu a faixa etária de 41 a 50 anos, e os tumores T2 mediam aproximadamente 2 a 5 cm. A cirurgia mais frequente foi a quadrantectomia; e a biópsia do linfonodo sentinela (BLS) foi realizada em 368 pacientes (58,78%). Conclusão: Nossa casuística fornece informações importantes sobre o perfil de pacientes portadoras de tumor invasivo da mama tratadas cirurgicamente em uma instituição filantrópica do Nordeste brasileiro, referência no tratamento do câncer. O estadiamento avançado ao diagnóstico ainda é presente nessa instituição, o que determina elevadas taxas de mastectomia. Assim, melhores resultados tendem a ser obtidos à medida que são apresentadas melhores propostas de rastreio de massa.

Tumor neuroendocrino de la mama. Presentación de un caso y revisión de la literatura

Los carcinomas neuroendocrinos primarios de mama son neoplasias raras que representan entre un 2 y un 5 % de los tumores mamarios. Para su diagnóstico se requiere que más del 50 % del tumor presente marcadores neuroendocrinos. Estos tumores que se observan principalmente en mujeres de edad avanzada se presentan como una masa bien delimitada, generalmente no acompañada de adenopatías axilares. El pronóstico de este tipo de cáncer todavía no está muy claro, aunque estudios recientes demuestran que es similar al de los carcinomas ductales infiltrantes convencionales. Se presenta el caso de una paciente de 76 años que acudió a consulta por presentar gran tumoración que ocupaba prácticamente toda la mama derecha sin adenopatías axilares y la cual fue informada mediante biopsia por parafina como un carcinoma neuroendocrino. Este es el primer tumor de esta característica histológica diagnosticado en Cienfuegos, por lo cual se considera de interés científico su publicación.

Primary neuroendocrine carcinomas of the breast are rare neoplasms, accounting for 2 to 5 % of breast tumors. For their diagnosis it is required that more than 50 % of the tumor present neuroendocrine features. These tumors which are observed mainly in elderly women, present as a well-defined mass, usually unaccompanied by axillary lymphadenopathy. The prognosis for this type of cancer is not enough clear yet, although recent studies show that it is similar to that of conventional infiltrating ductal carcinomas. We present the case of a 76-year-old patient who came to the clinic for having a large tumor that occupied almost all of the right breast without axillary lymphadenopathy and which was informed by paraffin biopsy as a neuroendocrine carcinoma. This is the first tumor of this histological characteristic diagnosed in Cienfuegos, reason why its publication is considered of scientific interest.

Correlation between peripheral nutrient artery and expression of C-erbB-2 in breast invasive ductal carcinoma / 中华超声影像学杂志

Objective To evaluate the relation between peripheral nutrient artery and expression of C-erbB-2 in breast invasive ductal carcinoma(IDC) . Methods The peak systolic velocity(PSV) and resistive index ( RI ) of peripheral nutrient artery of tumor in 122 cases with breast IDC and 138 cases with fibroadenoma which proved by operation and pathology were analyzed retrospectively . The C-erbB-2 was measured by immunohistochemical test ,according to the results of immunohistochemical examination ,the masses were divided into negative group( -) ,weakly positive group( + ) ,positive group( + + ) and strong positive group( + + + ) . The relationship between the classification of C-erbB-2 expression and the two factors of peripheral nutrient artery in breast tumor mass were analysed . Results The PSV of trophoblastic artery in IDC group was ( 20 .99 ± 8 .14 ) cm/s , RI 0 .66 ± 0 .07 , the PSV of trophoblastic artery in fibroadenoma group was (15 .56 ± 3 .68)cm/s ,RI 0 .66 ± 0 .07 ,there was significant statistically difference in peripheral nutrient artery of tumor between the breast IDC and fibroadenoma( P < 0 .001) . The RI and PSV of the peripheral nutrient artery in IDC were correlated to the classification of C-erbB-2 expression ( r=0 .323 ,0 .360 ,respectively) ,there was no correlation between the RI and PSV of peripheral nutrient artery in fibroadenoma and the classification of C-erbB-2 expression ( r = 0 .001 ) . Conclusions The spectrum form of peripheral nutrient artery in IDC is high speed and high resistance . The RI and PSV of the peripheral nutrient artery in IDC are correlated to the classification of C-erbB-2 expression .

Association of microRNA-related gene XP05 rs11077 polymorphism and breast cancer / 国际外科学杂志

Objective To investigate the genetic association between XP05 gene rs11077 polymorphism and breast cancer in the Han descent population of Shaanxi province.Methods One hundred and sixteen patients with breast cancer who underwent treatment from January 2015 to January 2017 in Department of Cardiac and Thoracic Surgery of Yan'an People's Hospital and Department of General Surgery of Ankang City Central Hospital were recruited to participate in the study as the observation group.Meanwhile,120 patients without breast cancer were selected as the control group.Collected other clinical data for statistical analysis.Genotype was determined by Polymerase chain reaction-restriction enzyme analysis for the polymorphism of the rs11077.The measurement data was expressed by mean standard deviation,paired samples t test was used for comparison among groups,while categorical data are presented as number and percentage (％) and were compared using the x2 test.The genotype distribution was tested by the Hardy-Weinberg Hardy-Weinberg equilibrium.Relative risks were estimated by adjusted OR and 95％ CI.Results The distribution of XP05 rs11077 genotypes and allelotypes had significant difference between the observation group and the control group (P =0.036,P =0.034).Stratified by tumour pathology,compared with A allelotypes,XP05 rs11077 C allelotypes had a significantly increased risk (OR =2.127,95％ CI:1.105-4.096,P =0.022) of breast cancer for invasive dutal carcinoma.Stratified by axillary lymphnodes metastasis status,compared with A allelotypes,XP05 rs11077 C allelotypes had a significantly increased risk (OR =2.723,95％ CI:1.388-5.341,P =0.003) of breast cancer for axillary lymphnodes metastasis.Conclusion Polymorphism of the XP05 rs11077 may associate with the risk and neoplasm metastasis of breast cancer.

Ki-67 expression and its effect on response to neo-adjuvant chemotherapy in invasive breast cancer / 中华病理学杂志

Objective@#To investigate the response to neoadjuvant chemotherapy (NAC) among different molecular subtypes of breast cancers using molecular classification with Ki-67 (ER+ PR+ HER2+ Ki-67) or without Ki-67 (ER+ PR+ HER2).@*Methods@#One hundred and twenty-seven cases of invasive breast cancer confirmed by core needle biopsy before NAC were collected from January 2007 to December 2009 and diagnosed at West China Hospital, Sichuan University. The cases were classified into different molecular subtypes using molecular classifications with or without Ki-67. Their clinical and pathological response to NAC was evaluated and compared.@*Results@#The different subtypes using both molecular classifications showed significant difference in clinical response(with Ki-67: χ2=22.40, P<0.01; without Ki-67: χ2=9.202, P=0.027)but not pathological(P>0.05) response to NAC. By multivariate analysis, Ki-67 was predictive for a clinical complete response (P=0.041) and clinical overall response (P<0.01); also Ki-67 was the only clinicopathological factor predictive of pathological response(P=0.041).@*Conclusion@#The molecular classification with Ki-67 is better to predict breast cancers responsiveness to NAC than the molecular classification without Ki-67.

Expression of FoxM1 and BCRP in invasive breast carcinoma of no special type and its prognosis significance / 中华病理学杂志

Objective@#To investigate the relationship between expression of FoxM1 and BCRP in invasive breast carcinoma of no special type (IBC-NST) tissues and the clinical pathological characteristics and prognosis of the patients.@*Methods@#Seventy-eight cases of IBC-NST with excision were included. The expression of FoxM1 and BCRP was assessed by immunohistochemistry and its relationship with the clinical pathological characteristics and prognosis was evaluated.@*Results@#FoxM1 was expressed in 71.8%(56/78) of IBC-NST, and the expression was related to tumor diameter, TNM staging, ER, PR and HER2. BCRP was expressed in 53.8% (42/78) of IBC-NST, and the expression was related to age, tumor diameter, lymph node metastasis, ER and HER2. Kaplan-Meier survival analysis showed the survival time was related to tumor diameter, TNM staging, lymph node metastasis and the expression of FoxM1, BCRP, ER, PR and HER2. Cox multivariate analysis showed that TNM staging, FoxM1, BCRP, HER2 were determinants of patient survival time.@*Conclusions@#The expression of FoxM1 is associated with tumor diameter, TNM staging, ER, PR and HER2 while BCRP is associated with age, tumor diameter, lymph node metastasis, ER and HER2. Both FoxM1 and BCRP have prognostic significance in IBC-NST patients.

Ultrasonic Characteristics of Complex Fibroadenoma of Breast and Its Differential Diagnosis from Invasive Ductal Carcinoma / 中国医学影像学杂志

Purpose To explore ultrasonic characteristics of complex fibroadenoma (CF) of breast and its differential diagnosis from invasive ductal carcinoma (IDC).Materials and Methods Sixty-one patients with CF and 81 patients with IDC from January 2010 to February 2016 in the Affiliated Union Hospital of Fujian Medical University were enrolled,and the CF and IDC were confirmed by pathology after operation.The preoperative sonographic findings of CF and IDC were retrospectively analyzed and compared.Results Fifty-nine cases with CF were detected by ultrasonography in 61 cases.Ultrasonic findings of 59 cases of CF showed as follows:79.7％ (47/59) of the CF cases with an aspect ratio ＜0.7;79.7％ (47/59) with blood flow signal of 0 to 1 level;72.9％ (43/59) with liquid dark area,including 67.8％ (40/59) with round or oval cystic fluid area showing local sievelike or diffused distribution;72.9％ (43/59) with irregular shape;61.0％ (36/59) with obscure boundary;61.0％ (36/59) with the largest diameter of tumor ＜2 cm;59.3％ (35/59) with calcifications,including 33.9％ (20/59) with coarse calcification,25.4％ (15/59) with microcalcification and 85.7％ (30/35) with distribution of calcified lesions along the linear high echo zone;54.2％ (32/59) with echo heterogenicity showing linear high echo and high echo in the middle and low echo.There were significant differences in the detection rates of internal regular fluid area,internal linear high echo or high echo area,and alcification distribution along the linear high echo between CF and IDC lesions (all P＜0.01).Compared with IDC,there were higher rates in CF for detecting lesions of largest diameter of tumor ＜2 cm,more regular shape,more clear border,poorer blood flow signal (P＜0.05),but there were lower rates in CF for detecting axillary lymph node enlargement,lesions with edge or spiculation and hyperechoic halo (P＜0.01).Conclusion Color Doppler ultrasonography is of great value in the diagnosis of CF and its differential diagnosis from IDC.