RESUMEN
The APIS Breast Cancer Subtyping Kit is an mRNA-based assessment of the seven parameters including three biomarkers routinely assessed in all the newly diagnosed breast cancers (BC), oestrogen receptor (ER), progesterone receptor (PR) and HER-2 and an additional four genes that create a novel proliferation signature, MKI67, PCNA, CCNA2 and KIF23. Taken together, the data are used to produce a molecular subtype for every sample. The kit was evaluated against the current standard protocol of immunohistochemistry (IHC) and/or in situ hybridisation (ISH) in breast cancer patients. The data were presented at the weekly breast multidisciplinary team (MDT) meeting. A total of 98 consecutive cases of pre-operative breast cancer core biopsies and two core biopsies of nodal metastases yielding 100 cases were assessed. IHC and APIS results were available for 100 and 99 cases. ER was concordant in 97% cases, PR was concordant in 89% and HER-2 results were concordant with IHC/ISH in 100% of the cases. Ki-67 IHC was discordant in 3% of cases when compared with MK167 alone but discordant in 24% when compared with the four-gene proliferation signature. In conclusion, our study indicates that the APIS Breast Cancer Subtyping Kit is highly concordant when compared to the results produced for ER/PR/HER-2 by IHC and/or ISH. The assay could play a role in the routine assessment of newly diagnosed breast cancer (BC) specimens.
Asunto(s)
Neoplasias de la Mama , Humanos , Abejas , Animales , Femenino , Neoplasias de la Mama/patología , Receptor ErbB-2/genética , Mama/patología , Receptores de Estrógenos/genética , Inmunohistoquímica , Biopsia , Biomarcadores de Tumor/genética , Receptores de Progesterona/genéticaRESUMEN
INTRODUCTION: Surgical resection remains the only potentially curative treatment for colorectal liver metastases (CLM). However, involvement of both the hepatic lobes or extrahepatic disease (EHD) can be a contra-indication for resection. The aim of the present study was to examine the addition of combined positron emission and computed tomography (PET/CT) to CLM staging to assess the effects upon staging and management. METHODS: All CLM patients referred to a single centre between January 2005 and January 2009 were prospectively included. All underwent routine staging (clinical examination and computed tomography), followed by a whole body (18) fluoro-deoxy-glucose ((18)FDG)-PET/CT scan and Fong clinical risk score calculation. RESULTS: Sixty-four patients were included [63% male with a median age of 63 years (age range 32-79 years)]. The addition of PET/CT led to disease upstaging in 20 patients (31%) and downstaging in two patients (3%). EHD was found in 24% of low-risk patients (Fong score 0-2) as compared with 44% of high-risk patients (Fong score 3-5) (P= 0.133). There was a trend towards a greater influence upon management in patients with a low score (44% vs. 17%; P= 0.080). CONCLUSION: The addition of PET/CT led to management changes in over one-third of patients but there was no correlation between alterations in staging or management and the Fong clinical risk score; suggesting that PET/CT should be utilized, where available, in the pre-operative staging of CLM patients.
Asunto(s)
Neoplasias Colorrectales/patología , Fluorodesoxiglucosa F18 , Neoplasias Hepáticas/diagnóstico , Imagen Multimodal/métodos , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Adulto , Anciano , Neoplasias Colorrectales/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Hepatectomía , Humanos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Estadificación de Neoplasias/métodos , Estudios Prospectivos , Radiofármacos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
The role of positron emission tomography (PET) and PET/computed tomography (CT) in the assessment of a patient presenting with cancer of the pancreas is discussed in the overall context of the management of this condition. The clinical limitations persist, with many patients presenting late with unresectable disease and poor prospects for novel drug therapies. PET and PET/CT are best at diagnosing and staging but are relatively inefficient in the detection of nodal disease. The detection of late disease manifestations such as metastatic spread is often of little clinical consequence. PET/CT may be considered as a first-line imaging investigation but evidence for this approach needs to accrue. Overall detection sensitivity at diagnosis varies between 90% and 95% and specificity from 82% to 100%, whereas for staging, sensitivity data vary from 61% to 100% and specificity data from 67% to 100%.