[Shrinkage mode of the primary breast tumor after neoadjuvant chemotherapy analyzed with part-mount sub-serial sectioning and three-dimensional reconstruction technique].

OBJECTIVE: The aim of this study is to evaluate the shrinkage mode of the primary tumor in women with breast cancer after neoadjuvant chemotherapy (NAC) determined by part-mount sub-serial section (PMSS) and three-dimensional (3D) reconstruction technique. METHODS: Eighty-six women with pathologically proven solitary invasive ductal carcinoma (ⅡA-ⅢC) were recruited. They were divided into two groups. Group A (n=25) received half cycles of NAC and Group B (n=61) received whole cycles of NAC. Breast specimen was prepared with PMSS, and residual tumors were microscopically outlined, scanned and registered by Photoshop software. The 3D model of residual tumors was reconstructed with 3D-Doctor software to evaluate the shrinkage mode. Further, the clinicpathologic shrinkage modes were divided into 2 categories: concentric shrinkage mode (CSM, the longest diameter of the pathological residual tumors was less than 50% and ≤2 cm in comparison with the primary tumor before NAC), and non-concentric shrinkage mode (NCSM, the longest diameter of the pathological residual tumors was more than 50% and/or >2 cm in comparison with the primary tumor before NAC). RESULTS: Pathological shrinkage modes: Group A: modes Ⅰ, Ⅱ, and Ⅴ were observed in 1, 1, and 23 cases, respectively; Group B: modesⅠ, Ⅱ, Ⅲ, Ⅳ, and Ⅴwere observed in 18, 3, 12, 21, and 7 cases, respectively (P<0.001). The multivariate analysis showed that patients with lower primary tumor stage, PR(-) or mammographic malignant calcification before NAC(-) and lymph nodes down-staging after NAC were more likely to present with CSM after NAC (P<0.05 for all). CONCLUSIONS: The pathologic reconstruction of breast residual tumors can fully and three-dimensionally reveal the shrinkage mode of the primary breast tumor in women with breast cancer after NAC. PMSS and 3D reconstruction of pathology provide a new platform in this area. Primary tumor stage, PR expression and mammographic malignant calcification before NAC and lymph node down-staging after NAC are independent predictors of the clinicopathologic shrinkage mode.

Correlation between p53 and epidermal growth factor receptor expression in breast cancer classification.

This study aimed to explore new opportunities for developing targeted therapy for triple-negative breast cancer (TNBC) by analyzing the significance and association between p53 and epidermal growth factor receptor (EGFR) expression in different molecular subtypes of breast cancer. The clinical and pathological data of 264 patients with breast cancer receiving surgery in our hospital from January 2012 to August 2013 were retrospectively analyzed. According to the expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (HER2), Ki-67, CK5/6, p53, and EGFR detected by immunohistochemical methods, breast cancer was divided into four molecular subtypes. Then, the expression of p53 and EGFR as well as their correlation in the different subtypes were determined. Among the four subtypes, luminal B breast cancer was the most common type. TNBC and HER2-enriched breast cancer had larger tumor sizes with higher expression of Ki-67 as compared with the luminal types. TNBC had a lower lymph node metastasis rate but higher CK5/6 and EGFR expression than the other three types. The expression of p53 was higher in luminal B, HER2-enriched, and triple-negative breast cancers, and this was positively correlated with the expression of EGFR in TNBC but not in the other subtypes. p53 and EGFR expression was positively correlated in TNBC, which enables us to explore the molecular biological characteristics of TNBC, so as to provide new ideas for the treatment of TNBC.

Correlation analysis of hormone receptors and the expressions of HER-2 and Ki-67 in breast cancer.

OBJECTIVE: This study aims to investigate the correlation and clinical significance of hormone receptors and the expressions of HER-2 and Ki-67 in breast cancer primary lesions and lymph node metastatic tissues. METHODS: 83 cases were studied, who were performed breast cancer surgeries and confirmed the ipsilateral axillary lymph node metastasis by the postoperative pathological diagnosis. Immunohistochemical method was used to simultaneously detect the expressions of ER, PR, HER-2 and Ki-67 in the primary lesions and lymph node metastases. RESULTS: ER exhibited the expression concordance rate as 85.5% in primary lesions and metastases, with significant difference (P = 0.039); the expression concordance rates of PR and HER-2 in primary lesions and metastases were 90.4% and 89.2%, respectively, without significant difference (P = 0.289, 0.180); between the Ki-67-highly-expressed primary lesions and Ki-67-lowly-expressed metastases, the expressions of ER in primary lesions and metastases exhibited statistical significance, with P as 0.031. CONCLUSIONS: The primary lesions and lymph node metastases had higher consistency, while there was still about 10% patients showed differentiated expression. The simultaneous detection of breast cancer primary lesions and lymph node metastases was still very necessary.

Pathological analysis of extracapsular extension of metastatic lymph node and its potential impact on nodal clinical target volume in the radiotherapy of esophageal squamous cell carcinoma.

There is no consensus regarding the clinical target volume (CTV) margins which surround the gross tumor volume of metastatic lymph nodes (LN) in radiotherapy of esophageal squamous cell carcinoma (ESCC). This study retrospectively assessed the distance of extracapsular extension (ECE) of metastatic LN in thoracic ESCC and defined nodal CTV margins. Histological sections of metastatic LNs from 217 patients with thoracic ESCC were re-examined. The incidence and maximal distance of ECE of metastatic LNs were assessed. The relationships between ECE and clinicopathologic features were also investigated. The ECE was found in 37.3% of patients (81/217) and 23.1% of metastatic LN (159/689), and the incidences had a significant relationship with N stage and LN size. The median distance of ECE was 1.0 mm (range, 0.2-9.7 mm). The distance of ECE showed a positive correlation with LN size (Spearman's correlation coefficient = 0.419; p<0.001). The ECE distances of LN with <10 mm diameter were significantly smaller than LN with 10-30 mm diameter (p<0.001). The 95th percentiles of ECE distances for these two groups were 3 mm and 5 mm, respectively. For pathologic LN <10 mm in diameter, a 3-mm CTV margin appears to be adequate to encompass 95% of the microscopic ECE, and for LN 10-30 mm, a 5-mm CTV margin is recommended.