Cyclin D1 expression predicts poor response to neoadjuvant chemotherapy and survival in late stage breast cancer patients

We evaluated the prognostic value of cyclin D1, epidermal growth factor receptor [EGFR] and MIB expression in Late Stage breast carcinoma, and their relationship with clinicopathologic response to neoadjuvant chemotherapy. We identified 45 patients who presented with locally advanced breast cancer [T2-T4], diagnosed with core needle biopsies, and treated with neoadjuvant chemotherapy, followed by conservative breast surgery [27/45,60%] with axillary lymph node dissection or modified radical mastectomy [18/45, 40%]. Complete pathologic response was defined as absence of invasive carcinoma at resection, while incomplete pathologic response was defined as having any invasive carcinoma. Cases were immunostained for cyclin D1, EGFR and MIB-1. Cyclin D1 ovcrexpression was found in 47% [21/45] of the cases and correlated with positive estrogen receptor [ER] expression [p < 0.01]. EGFR was positive in 16/45 [36%] of the cases which was expressed in the cytoplasm of the cancer cells, with occasional cell membrane staining. MIB-1 [>20%] was expressed in 15/45 [33%] of the cases. There were significant association between cyclin D1 overexpression and poor pathologic response [r=0.43, P=0.006], Cyclin D1 has significant adverse effect on overall survival and relapse-free survival [Log rank, p=0.05]. Overall, cyclin D1 overexpression was not associated with other clinicopathological features. EGFR was significantly expressed in ER and PR negative tumors [r=0.68 and 0.36, respectively]. Both EGFR and MIB-1 showed no significant correlation with pathologic response. Our findings indicate that cyclin D1 overexpression correlates with poor response to neoadjuvant chemotherapy and a worse survival in locally advanced breast cancer patients [T2-T4]

Serum bone TRAP 5b and ICTP as prognostic markers in bone metastases from primary breast cancer

Bone is one of the earliest and most common sites for breast cancer metastasis. One-third of cancer patients will have metastases of their primary tumor to bone. The incidence ofbone metastases from primary breast cancer is approximately 13%. Bone marker measurements are noninvasive, inexpensive, and can be repeated often. Markers are derived from both cortical and trabecular bone and reflect the metabolic activity of the entire skeleton. The aim of this work was to determine serum level of Tartrate Resistant Acid Phosphatase 5b [TRAP 5b], Carboxy terminal telopeptide of type I collagen [ICTP] and CA15.3 pre-and post-operatively in patients with primary breast, cancer to asses their values as prognostic factors for the subsequent metastatic disease. Serum samples were collected from 41 females [31 patients with primary breast cancer and 10 normal healthy volunteers]. three samples were collected from patients before surgery, after 10 and 20 months from surgery. Serum TRAP 5b, ICTP a"dCA15,3 were detected by using EIA techniques. Preoperative serum ICTP concentrations >4.6ug/l [2+2SD]. were highly predictive for bone as site of metastases and higher risk of death by three times than those with preoperative serum ICTP concentrations <4.6 micro g/l While after 10 months from surgery. Bone TRAP 5b activity >5.4U/Lwas significantly correlated with poor prognosis for breast cancer and shorter 'wall survival. Serum ICTP concentrations in bone metastases sub. group, after 10 months from surgery [before reflect any Metastasis], were significantly increased from control group. Serum ICTP. TRAP'5b and CA15-3 levels were elevated in bone metastatic patients after 20 months from surgery [bone mciastases had been already diagnosed]. ICTP and TRAP 5b could be useful markers in predicting bone meiastases and might identify patients who would need uliiesorptive treatment in addition to chemotherapy.

Evaluation of diagnostic accuracy of fine needle aspiration cytology in different masses

Pre-operative fine needle aspiration is a reliable widely used method for obtaining a rapid diagnosis which can direct further planning of therapy. The procedure enables the clinician to obtain a definitive diagnosis in a high percentage of patients with minimal cost or expenditure of time -and is useful in delineating patients with metastatic disease or primary bone neoplasm such as multiple myeloma or lymphoma to avoid unnecessary surgery. In the present work, a comparative study was carried out on 137 patients with superficially accessible masses to access the accuracy of cytodiagnosis. Fine needle aspiration proved to have a valuable role even in undiagnosed cases as it could differentiate between benign and malignant tumors. Cytologically undiagnosed breast cases were attributed to the presence of dense sclerotic stroma which yielded unsatisfactory smears, the same explanation for one of the cases of thyroid swelling was suspected, while the other case which was suspicious is explained by the similar features of benign and malignant well differentiated follicular tumors. 2 out of 11 cases of salivary glands were misclassified with regard to the type of malignancy. The accuracy rate was 100% in cases with osseous tumors, lymphadenopathy, subcutaneous soft tissue masses as well as liver nodules