Is pathological complete response predictable after neoadjuvant chemotherapy in breast cancer? A single institution's retrospective experience.

BACKGROUND: Pathological complete response (pCR), in breast cancers, after neoadjuvant chemotherapy is linked to improved survival. Determining complete response to chemotherapy prior to surgery has remained elusive even using a combination of pathological factors and imaging modalities, making surgery still a necessity. METHODS: A retrospective analysis was performed from a single institution from 2013 to 2018. Breast cancer patients treated with neoadjuvant chemotherapy with pre- and post-chemotherapy magnetic resonance imaging (MRI) were included. Patients receiving other neoadjuvant modalities were excluded. Imaging characteristics, including response to chemotherapy and pathological factors, were recorded. RESULTS: Analysis showed 134 patients were identified with 40/134 (29.9%) noted to have radiological complete response and 34/134 (25.6%) had pCR. The positive predictive value for MRI to detect pCR was greatest for oestrogen receptor (ER) negative and human epidermal growth factor receptor 2 (HER2) negative tumours at 81.8% and worst for ER+ HER2- tumours at 25%. The negative predictive value was greatest for ER+ HER2- tumours at 93.9% and worst for ER- HER2- tumours at 77.4%. CONCLUSION: MRI after neoadjuvant chemotherapy for breast cancer even combined with tumour factors is not an accurate predictor of pCR.

A review of the Christchurch Hospital Breast Cancer Service in 2012: meeting the new Tumour Standards.

AIMS: To determine whether patients diagnosed with breast cancer in 2012 received timely access to services at Christchurch Hospital when audited against Ministry of Health Tumour Standards of Service Provision (TS) (2013) and the Faster Cancer Treatment (FCT) indicators, and to discover factors which impeded patient pathways, and which would need to be addressed in order to meet the standards. METHODS: Data on referrals, dates and treatment for patients diagnosed with breast cancer at Christchurch Hospital was extracted from the Christchurch Breast Cancer Patient Register and other hospital databases. RESULTS: In 2012, 288 breast cancer patients were treated at Christchurch Hospital, 60% referred by general practitioners, and 40% via the national screening programme. Some 2013 Tumour Standards were achieved. The FCT indicator 1 (TS 2.4) and 3 (TS 2.5) were met, with 87% (greater than or equal to 80%) receiving their first treatment within 62 days of referral, and 89% (greater than or equal to 80%) within 31 days of decision-to-treat. However, FCT indicator 2 (TS 2.1), requiring first specialist assessment within 14 days of referral, was met in 61% (greater than or equal to 90% required). Only 64% of women started adjuvant chemotherapy within 42 days of their surgery (TS 2.6, greater than or equal to 90%). CONCLUSION: The management of breast cancer patients by a multidisciplinary team is crucial to ensure patients receive timely and appropriate care. However, waiting for weekly multidisciplinary meetings and adequate anatomical pathology resource, together with other factors, were identified as delaying the patient pathway and solutions to resolve these are discussed.

Immunohistochemical analysis of cancer stem cell markers in invasive breast carcinoma and associated ductal carcinoma in situ: relationships with markers of tumor hypoxia and microvascularity.

We performed immunohistochemical analysis of 3 cancer stem cell-related markers (CD44(+)/CD24(-/low), aldehyde dehydrogenase [ALDH]-1, CD133) in 94 invasive ductal carcinomas and assessed relationships with markers of hypoxia (carbonic anhydrase IX [CAIX]), tumor microvessel density (CD31), and clinicopathologic variables. Overall, 10% of tumors were CD44(+)/CD24(-/low), 13% were ALDH-1(+), 25% were CD133(+), 35% were immunonegative, and 1 tumor was immunopositive for all 3 markers. Associated ductal carcinoma in situ (DCIS) was present in 48% of tumors. Marker immunopositivity was detected in DCIS in 13% (CD44(+)/CD24(-/low)), 7% (ALDH-1(+)), and 32% (CD133(+)) of these tumors and was more likely present in DCIS when also detected in the invasive compartment (P = .03, P = .001, and P = .009, respectively). CD44(+)/CD24(-/low) cells were more common in progesterone receptor-negative tumors (P < .01), and ALDH-1(+) cells were more common in estrogen receptor-negative tumors (P < .01). CD133(+) cells were more common in patients younger than 50 years (P < .05) and in high grade (P < .01), localized (P < .05), and estrogen receptor-negative (P < .001), progesterone receptor-negative (P = .02), and triple-negative breast cancers (P < .001). CD44(+)/CD24(-/low) (P = .06) and CD133(+) (P = .02) tumor cells were more common in CAIX(+) versus CAIX(-) tumors, whereas ALDH-1(+) tumors had a higher mean microvessel density than did ALDH-1(-) tumors (P = .002). No significant relationships were observed between the markers studied and survival for 5 years. Our study demonstrated the presence of cancer stem cell marker-positive tumor cells in DCIS as well as invasive breast cancer and showed that CD44(+)/CD24(-/low) and CD133(+) cells were more frequently observed in hypoxic regions of tumor, whereas ALDH-1(+) cells more commonly colocalized to tumors with high microvessel density.

The Christchurch Breast Cancer Patient Register: the first year.

AIMS: The aim of this article is to present the first year's findings of the Christchurch Breast Cancer Patient Register (CBCR) to establish the incidence and management of breast cancer in the Canterbury region. METHODS: CBCR commenced recruitment of breast cancer patients in Canterbury from June 2009. Ethical approval was granted by regional ethics committees to collect data. Patient data is recorded onto the database once informed consent is obtained. RESULTS: A total of 337 patients (including one male) consented. At diagnosis, 231 (68.5%) were aged 50 years or over. 48 (14.2%) patients had carcinoma in situ with no invasive component. 289 (85.8%) patients had invasive carcinoma with 47.4% undergoing mastectomy and 44.6% breast conserving surgery whereas 8% had no primary surgery. Nodes were positive in 102 (38.8%), and the predominant tumour type was Ductal NST (no special type) in 68.9% (199) of patients with invasive carcinoma. Additional data incorporating ethnicity, oncology, additional surgical management and pathological variables are also presented in detail. CONCLUSION: Findings on 337 patients recruited and recorded on CBCR database in the first year are discussed. Due to the short follow up, outcome data is not analysed.