The PD-L1 Expression Among Triple-Negative Breast Cancer Patients in Universitas Sumatera Utara Teaching Hospital, Indonesia.

Background: The emerging role of precision medicine among in oncologic science is a potentially explorable area to solve long-standing implication of triple-negative breast cancer (TNBC)'s management, especially by identifying programmed cell death ligand-1 (PD-L1) in its population. Objective: To describe the PD-L1's expression among TNBC populations in our Indonesia-based centers. Methods: This descriptive study was conducted in the teaching hospitals of Universitas Sumatera Utara ranging from April 2019 to July 2020. Our investigation encompassed female individuals with histopathologically confirmed TNBC and complete medical record data, especially the status of PD-L1 expression to be reported in this study. We use Daco 22C3 antibodies to confirm the latter protein immunohistochemical positivity after thorough specimen preparation and staining. Results: This study included 60 females with TNBC of which 40 participants were issued in the final report. Our populations were dominated by middle-aged individuals (41-50 years old; 45%), and remarkable presentation of LVSI, angioinvasion, or lymph-node metastatic status. In PD-L1 expression status, our study reported that 45.0% patients were confirmed with confirmed PD-L1 positivity. Conclusion: PD-L1 expression among TNBC patients is concordant with the global report hence anti-PD-1-based treatment trial in Asia or even Indonesia region should be considered.

Role of Hormonal Receptor in Predicting Sentinel Lymph Node Metastasis in Early Breast Cancer.

Background: Sentinel lymph node biopsy is one of the minimally invasive techniques that can confirm the presence of metastasis of regional lymph nodes in cancer. Sentinel lymph node biopsy can be done with a lymph mapping technique using blue-dye, radiotracer, or a combination of both. In developing countries, sentinel lymph node biopsy is often done with a single agent, which is the blue dye. The limitation of conducting SLNB in Indonesia is the availability of patent blue dye and radioisotope tracer. To overcome that, a hormonal receptor is expected to aid in predicting sentinel lymph node metastasis. Objective: The aim of this study was to investigate the hormonal receptor as a prognostic factor of sentinel lymph node metastasis in breast cancer. Methods: This study was conducted in Universitas Sumatera Utara Teaching Hospital with the acknowledgment from the Ethics Committee of the respected hospital by the number of 116/KEP/USU/2020. Total of 51 patients participated in this research. Results: Statistically, the p-value in each immunohistochemistry group is > 0.05 in all ER (+) / PR (+); ER (+) / PR (-); ER (-) / PR (+) groups. This shows that there is no significant relationship between hormonal receptors on sentinel lymph node metastases. Conclusion: The statistical evaluation showed that there is no significant correlation between the hormonal receptor and sentinel lymph node metastasis (p>0.05), but is found clinically significant. Therefore, hormonal receptors should be considered as a predicting factor for sentinel lymph node metastasis.

Accuracy of Methylene Blue Test as Single Technique for Sentinel Lymph Node Biopsy in Early Stages Breast Cancer.

AIM: Sentinel Lymph Node Biopsy (SLNB) establishes as a gold standard for diagnostic lymph node involvement in early breast cancer. Most of the developed country does not have radiotracer and nuclear medicine facilities. Unless in Indonesia there is Methylene Blue as an alternative agent for SLNB. This study measure accuracy of sentinel lymph node biopsy as a single technique using the Methylene Blue test. METHODS: This cross-sectional study enrolled 60 female patients with breast cancer stage I-II. We performed SNB using 2-5 cc of 1% Methylene-blue dye (MBD) injected to periareolar tissue and proceeded with axillary lymph nodes dissection (ALND). The histopathology results of sentinel nodes (SNs) and axillary lymph nodes (ALNs) analyze for diagnostic value assessments. RESULTS: The identification rate of SN was 97.62 %, and the median number of identified SNs was 4 (2-7). Sentinel node metastasis was found in (19/60) % cases and % of them were macrometastases. The sensitivity and specificity of MBD were 91.67% and 96.67% respectively. The negative predictive value (NPV) of SNs to predict axillary metastasis was 96.67% (95% CI, 81-99%). CONCLUSION: Injection of 1% MBD as a single technique in breast cancer SNB has a favorable identification rate and predictive value.