Evaluating TIMP-1, Ki67, and HER2 as markers for non-sentinel node metastases in breast cancer patients with micrometastases to the sentinel node.

The aim was to investigate whether the biochemical prognostic markers TIMP-1, Ki67, and HER2 could predict metastatic spread to non-sentinel nodes (NSN) in breast cancer patients with micrometastases to sentinel node (SN). We included all breast cancer patients with micrometastases to SN operated between 2001 and 2007 at the Department of Breast Surgery, Herlev Hospital. The study was designed as a matched case-control study with 25 cases with micrometastases to SN and, in addition, metastatic spread to NSN and 50 matched controls with micrometastases to SN, but without NSN metastases. Patient and tumor characteristics were retrieved from the Danish Breast Cancer Cooperative Group database. Immunohistochemical analyses of TIMP-1 and Ki67 and measurements of HER2 on formalin-fixed paraffin-embedded tumor tissue were performed. No significant differences in the immunoreactivity of TIMP-1 and Ki67 were found between patients with and without NSN metastases. Six of seven HER2 positive patients did not have NSN metastases, but the results did not reach statistical significance. Despite being prognostic markers in breast cancer, TIMP-1 and Ki67 could not predict NSN metastases in women with micrometastatic disease to SN. Larger studies are needed to further validate HER2 as a marker for NSN metastases in these patients.

Psychosocial group intervention for patients with primary breast cancer: a randomised trial.

PURPOSE: To test the effectiveness of a psycho-educational group intervention to improve psychological distress measured by POMS TMD, Quality of Life measured by European Organisation for Research and Treatment of Cancer (EORTC), the core and breast cancer module, Mental Adjustment measured by MAC and marital relationship measured by BLRI in women with primary breast cancer conducted 10 weeks after surgery. A secondary outcome was 4-year survival. PATIENTS AND METHODS: We randomly assigned 210 patients with primary breast cancer to a control or an intervention group. Patients in the intervention group were offered two weekly 6-h sessions of psycho-education and eight weekly 2-h sessions of group psychotherapy. All participants were followed up for Quality of Life, coping ability and social relations 1, 6 and 12 months after the intervention and on survival 4 years after surgical treatment. RESULTS: No statistically significant effects of the intervention were found on any of the psychosocial questionnaire outcomes. There were not enough cases of death to analyse overall survival. The only statistically significant result was for patients who used anti depressive medication, for whom almost all measures improved over time, in both the control and intervention groups. CONCLUSION: Psycho-education and group psychotherapy did not decrease psychological distress or increase Quality of Life, Mental Adjustment or improve marital relationship among patients with primary breast cancer.

Intraoperative immunohistochemistry staining of sentinel nodes in breast cancer: clinical and economical implications.

The study aimed to evaluate intraoperative immunohistochemistry (IHC) staining of sentinel nodes in primary breast cancer surgery. We analysed retrospectively 1209 consecutive sentinel node procedures and compared the rate of late positive metastases in sentinel node biopsy (SNB) and the duration of the surgical procedures before (n=706) and after (n=503) introducing intraoperative IHC on frozen section. We also did a cost analysis. Intraoperative IHC staining led to a lowering of the late positive SNB rate. Introducing IHC gave a decrease in the late positive rate from 93 to 52% (p<0.0001) for isolated tumour cell metastasis, from 56 to 36.4% (p<0.02) for micrometastasis, and from 16 to 5% (p<0.01) for macrometastasis. The surgical procedures were slightly prolonged for lumpectomies but not for mastectomies after introducing intraoperative IHC staining. The cost analysis showed an overall cost saving of approximately 40%. In conclusion, intraoperative IHC staining of the SNB lowered the late positive rate and gave an overall cost saving.

[Treatment of elderly patients with breast cancer]. / Behandling af brystkraeft hos aeldre.

The latest investigations have been searched in order to present new guidelines for the treatment of elderly patients with primary breast cancer. It is concluded that breast-conserving surgery should be offered as well as the sentinel node technique. Axillary lymph node dissection is not necessary in the case of micrometastases. Adjuvant radiotherapy can be omitted in low risk cases. Endocrine treatment can be used in adjuvant and neo-adjuvant settings, but surgery should be offered as well. In high risk cases with receptor-negative tumour chemotherapy should be considered as an option. Generalized follow-up is recommended.