Genomic testing in early stage invasive male breast cancer: An NCDB analysis from 2008 to 2014.

PURPOSE: Genomic assays, or tissue gene profiling tests, are widely used to predict recurrence of early stage invasive breast cancer and guide systemic therapy. The purpose of our study was to examine the current national trends of genomic testing in male breast cancer (MBC) and its association with systemic therapy. MATERIALS AND METHODS: The National Cancer Database (NCDB) includes 6227 cases of pathologic T1/T2 and N0/N1 MBC from 2008 to 2014 with known genomic testing status. Results of the tests were grouped as low, intermediate, and high risk of recurrence scores (RRS). Statistical analysis included multivariate logistic regression and Chi-square tests. A supplemental analysis in female breast cancer was provided as reference. RESULTS: Of the 6227 cases of MBC age 18-90, 1478 (23.74%) underwent genomic testing. Testing was significantly associated with age, race, tumor grade, year of diagnosis, receptor status, and nodal status. Distribution of RRS in MBC was 59.3% low, 27.4% intermediate, and 13.3% high. RRS in men were significantly associated with tumor grade and size, but not nodal status. Those with a low RRS were 7-times more likely to be treated with hormone therapy alone (AOR 7.18, CI 5.78-8.91, P < 0.001). Those with a high RRS were five times more likely to receive a combination of hormone and chemotherapy (AOR 5.16, CI 3.60-7.40, P < 0.001). CONCLUSION: Rates of testing and distribution of RRS in men and women with early stage invasive breast cancer are similar. Treatment patterns in MBC varied significantly based on genomic testing results, even when adjusted for other clinicopathologic features. Further investigation is required to determine the prognostic and predictive nature of genomic testing in male breast cancer.

Ductal carcinoma in situ on core needle biopsy only with no residual disease at surgery.

BACKGROUND: The treatment of ductal carcinoma in situ (DCIS) remains controversial and may be particularly difficult for patients with minimal disease. There is a dearth of information regarding patients who have been diagnosed with DCIS on core needle biopsy (CNB), who have no residual disease in the lumpectomy specimen. The purpose of this study was to explore the frequency of this presentation and short-term outcomes in these patients. METHODS: Our institutional Breast Cancer Database was queried for all women who were diagnosed with pure DCIS from 2010 to 2016 and treated with lumpectomy. Variables included patient and tumor characteristics, adjuvant treatment, and ipsilateral breast tumor recurrence (IBTR). Statistical analyses included Pearson's chi-square, Fisher's exact tests, and Kaplan-Meier analysis. RESULTS: Of 547 patients with pure DCIS, 50 (14%) had DCIS on CNB only. Of the patients with DCIS on CNB only, 15 were treated with lumpectomy and radiation therapy (RT), while 35 underwent lumpectomy without RT. At a median follow-up of 4 years, there were 3 (6%) IBTR all within the same quadrant as the original lumpectomy site. None of the patients who recurred received adjuvant RT or hormonal therapy. CONCLUSIONS: Despite the minimal extent of disease exhibited in these cases, 6% of patients with DCIS on CNB only had IBTR at a median follow-up of 4 years. These data suggest that even minimal DCIS represents a significant risk of recurrence to the patient. Size and margins are not sufficient criteria to stratify risk and guide decisions for adjuvant therapies.

Solitary Fibrous Tumor of Breast with Anaplastic Areas (Malignant Solitary Fibrous Tumor): A Case Report with Review of Literature.

Solitary fibrous tumor (SFT) is a rare, soft tissue neoplasm that rarely presents in breast tissue, with only 27 previously reported cases. To our knowledge, only one case of malignant SFT has been reported in the English literature. A 75-year-old Caucasian woman presented to our institution with a 3-month history of a palpable left breast mass. No other symptoms, including nipple discharge or skin changes, were noted. She underwent 3 previous biopsies for right breast masses, all of which were benign, with no evidence of spindle cell neoplasm, atypical hyperplasia, or malignancy. Microscopic examination of the mass demonstrated a classic area of SFT with areas of high-grade anaplastic component. In these areas, the tumor showed atypical epithelioid cells arranged in hypercellular sheets with diminished branching vasculature, nuclear pleomorphism, and increased mitotic count (up to 9/10 high-power fields). This case represents the second case of malignant SFT in the breast.

In vivo RNAi screening identifies regulators of actin dynamics as key determinants of lymphoma progression.

Mouse models have markedly improved our understanding of cancer development and tumor biology. However, these models have shown limited efficacy as tractable systems for unbiased genetic experimentation. Here, we report the adaptation of loss-of-function screening to mouse models of cancer. Specifically, we have been able to introduce a library of shRNAs into individual mice using transplantable Emu-myc lymphoma cells. This approach has allowed us to screen nearly 1,000 genetic alterations in the context of a single tumor-bearing mouse. These experiments have identified a central role for regulators of actin dynamics and cell motility in lymphoma cell homeostasis in vivo. Validation experiments confirmed that these proteins represent bona fide lymphoma drug targets. Additionally, suppression of two of these targets, Rac2 and twinfilin, potentiated the action of the front-line chemotherapeutic vincristine, suggesting a critical relationship between cell motility and tumor relapse in hematopoietic malignancies.