ABSTRACT
The goal of the present paper is to discuss diagnosis, treatment approaches and histopathologic characteristics of breast cancer developing during pregnancy, based on our results and published literature data. We retrospectively evaluated clinical and pathologic features of tumors, treatment methods, decisions related to pregnancy and final outcome by eight pregnant patients with breast cancer. The patients' age varied from 26 to 36 years. At the last medical examination in October 2013, three among all eight patients were alive, two of them were without local and distant recurrence, and one patient has distant metastases and is carrying out a treatment. The aim of this paper was to discuss the characteristics of breast cancer developing during pregnancy. Retrospectively have been analyzed clinical-pathological characteristics of the tumors in eight pregnant women with breast cancer, the treatment, the management of the pregnancy, and the final outcome. The results are analyzed by comparing with data published in the literature.
Subject(s)
Breast Neoplasms/pathology , Breast Neoplasms/therapy , Breast/pathology , Pregnancy Complications, Neoplastic/pathology , Pregnancy Complications, Neoplastic/therapy , Adult , Breast/drug effects , Breast/radiation effects , Breast/surgery , Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , Chemotherapy, Adjuvant , Female , Humans , Pregnancy , Pregnancy Complications, Neoplastic/diagnosis , Pregnancy Complications, Neoplastic/surgery , Prognosis , Radiotherapy , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: The aim of this retrospective study was to assess the possibilities of whole-body bone scintigraphy (WB BSc) in the monitoring of the effect of biphosphonate treatment in patients with breast cancer and bone metastases. PATIENTS AND METHODS: 51 breast cancer patients with bone metastases, aged from 33 to 73 years, were included.WB BSc was performed on a Siemens DIACAM gamma camera, 2-4 h after i.v. injection of 740 MBq 99mTc-MDP, before the start of the biphosphonate treatment (baseline scintigraphy) with zoledronic acid(Zometa) and at least 6 months thereafter (control scintigraphy) in order to avoid the "flare" effect. RESULTS: At the baseline WB BSc 41 (80.4%) patients presented with multiple (over 3) bone metastatic lesions, 9 (17.6%) patients with single (up to 3) lesions and 1 (1.96%) patient with a solitary bone metastasis. All bone metastases had osteoblastic appearance. At the control scintigraphy 4 (8%) patients showed complete therapeutic response (CR; no bone lesions were visualized); 21 (41%) patients partial response (PR; decrease in the number and the intensity of the lesions); 16 (31%) patients stable bone lesions (SD; no change in the number or the intensity of the bone metastases); and 10(20%) patients showed disease progression (PD). CONCLUSION: WB BSc is a reliable functional imaging modality for assessment of the biphosphonate therapeutic effect and an important method in the multimodal treatment planning of breast cancer patients.
Subject(s)
Bone Neoplasms/diagnostic imaging , Breast Neoplasms/diagnostic imaging , Radiopharmaceuticals , Technetium Tc 99m Medronate/analogs & derivatives , Adult , Aged , Bone Neoplasms/drug therapy , Bone Neoplasms/secondary , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Diphosphonates/therapeutic use , Female , Humans , Middle Aged , Radionuclide Imaging , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Whole Body ImagingABSTRACT
PURPOSE: To evaluate the clinical application of (99m) Tc-methoxyisobutylisonitrile (MIBI) scintigraphy as a functional method for assessment of multidrug resistance (MDR) in breast cancer patients and the correlation of these results with P-glycoprotein (P-gp) overexpression and objective response to chemotherapy. PATIENTS AND METHODS: 22 women, 35-68 years old with breast cancer, suitable for neoadjuvant chemotherapy were included onto this study. Two or three cycles of neoadjuvant chemotherapy were administered (FEC in 15 and CMF in 7 patients). Planar and SPECT (99m) Tc-MIBI scintigraphy was carried out before and after neoadjuvant chemotherapy. Focal (99m) Tc-MIBI uptake in breast cancer lesions was used as a scintigraphic criterion of abnormality. Tumor/background uptake (T/B Index) was calculated. Immunohistochemistry was carried out after surgery for P-gp detection in all cases. The degree of expression was evaluated according to semiquantitative score analysis from 0 to 4. RESULTS: Planar imaging was true positive in 20 patients, false positive in 1 (with breast cancer and mastopathy), and false negative in 1 (with wide tumor necrosis and deep location in the breast). SPECT imaging was true positive in 21 patients and false positive in 1. In 3 patients with multifocal disease additional tumour masses were visualized using SPECT. Sensitivity was 95% (21/22) and 100% (22/22), respectively, for planar and SPECT detection of breast cancer. P-gp expression was positive in 40.8% of the patients and negative in 59.2%. Intense (99m) Tc-MIBI uptake was shown on the planar images in 21 patients independently of the P-gp expression. There was no significant relationship between T/B Index and P-gp detection. Objective response included 2 clinical complete remissions, partial response in 1 patient, minimal response in 12, and no change in 7. Some clinical results corresponded to (99m) Tc-MIBI scintigraphic data: after neoadjuvant chemotherapy T/B Index was reduced > or = 20% in 9 patients with objective response. CONCLUSION: SPECT is an important diagnostic approach for identification of breast cancer with deep location and satellite tumour spots in multifocal disease. T/B Index did not correlate with P-gp overexpression on baseline (99m) Tc-MIBI scan. Objective clinical results after neoadjuvant chemotherapy corresponded to scintigraphic results in 75% of the patients with minimal response.
Subject(s)
Breast Neoplasms/diagnostic imaging , Drug Resistance, Multiple , Drug Resistance, Neoplasm , Radiopharmaceuticals , Technetium Tc 99m Sestamibi , ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Carcinoma, Ductal, Breast/diagnostic imaging , Carcinoma, Ductal, Breast/drug therapy , Carcinoma, Lobular/diagnostic imaging , Carcinoma, Lobular/drug therapy , Chemotherapy, Adjuvant , Cyclophosphamide/therapeutic use , Epirubicin/therapeutic use , Female , Fluorouracil/therapeutic use , Humans , Methotrexate/therapeutic use , Middle Aged , Neoadjuvant Therapy , Neoplasm Invasiveness/diagnostic imaging , Neoplasm Invasiveness/pathology , Phenotype , Radiography , Tomography, Emission-Computed, Single-PhotonSubject(s)
Hematopoietic Stem Cells/radiation effects , Neoplasms, Experimental/radiotherapy , Animals , Cell Division/drug effects , Cell Division/radiation effects , Cell Survival/drug effects , Cell Survival/radiation effects , Clone Cells/drug effects , Clone Cells/radiation effects , Hematopoietic Stem Cells/drug effects , In Vitro Techniques , Mice , Neoplasm Transplantation , Neoplasms, Experimental/drug therapy , Radiation ToleranceABSTRACT
On tumor NKLy/LL the author have studied the efficiency of cloning, the fraction of proliferating and resting cells and the rate of DNA synthesis in peripheral and central tumor sites. It was shown that the more far from the periphery the less fraction of labelled cells and the rate of DNA synthesis but the greater are differences in the content of proliferating cells in some sites. The efficiency of cloning in peripheral and central tumor sites does not differ, the fraction of clonogenic cells being larger than that of proliferating ones. Following persistent administration of 3H-thymidine in animals, it was found that the number of colonies produced by proliferating cells is considerably less than the general efficiency of cloning. It is concluded that resting cells can divide infinitely and are clonogenic ones.
