Metastatic profiles and survival differences between infiltrating ductal carcinoma and infiltrating lobular carcinoma in invasive breast cancer.

BACKGROUND: In this study, we conducted a comprehensive evaluation of metastatic profiles and survival outcomes in patients with infiltrating ductal carcinoma (IDC) and infiltrating lobular carcinoma (ILC) treated at our university hospital center. METHODS: We collected and analyzed data from all patients diagnosed with invasive breast cancer at our center between January 1, 2007, and 31 December 2014. We specifically compared three subgroups: patients with IDC, patients with ILC and patients with mixed carcinoma, which is a combination of IDC and ILC. RESULTS: Among the 1963 patients treated for invasive breast cancer in our center during the study period, 1435 had IDC, 466 had ILC, and 59 had mixed carcinoma. The incidence of patients with at least one positive axillary lymph node differed significantly: 40 % for IDC, 36 % for ILC, and 45 % for mixed carcinoma (p = 0.001). However, there was no significant difference in the mean number of positive nodes (p = 0.1633). The occurrence of distant metastases was lower in patients with ILC (p = 0.04), particularly in the case of brain metastases (p = 0.01), although there was no difference in bone or visceral metastatic sites. Patients with ILC exhibited a longer mean time to metastasis from the initial diagnosis of invasive breast carcinoma. Overall survival (p = 0.0525) and survival without locoregional recurrence (p = 0.026) were significantly different. Specifically, the 5-year overall survival rates for IDC, ILC, and mixed carcinoma were approximately 95 %. Distance metastatic-free survival at 5 years was 85 % for IDC, 91 % for ILC, and 87 % for mixed carcinoma (p = 0.00506). CONCLUSION: Our findings indicate variations in the distribution of distant metastatic sites among patients with IDC, ILC, and mixed carcinoma, as well as differences in survival outcomes. This study sheds light on the unique characteristics and clinical implications associated with these two distinct subtypes of invasive breast cancer.

Prognostic value of axillary lymph node metastases in invasive lobular breast carcinoma.

BACKGROUND: Axillary lymph node involvement is a well-established prognostic factor for recurrence in breast cancer, specifically the number of nodes affected and the ratio of the number of affected nodes to the number of harvested nodes for non-specific invasive breast cancer (invasive ductal carcinoma). However, there is limited information on the impact of lymph node involvement in the case of invasive lobular carcinoma. OBJECTIVES: our study aimed to evaluate the prognostic impact of lymph node involvement on overall survival and distant metastatic-free survival according to the number of nodes affected and the ratio of positive nodes (LNR) for patients managed for invasive lobular carcinoma. METHODS: This is a monocentre, comparative, observational study of patients managed for invasive lobular carcinoma at the Gynaecology Department of the University Hospital Center of Tours between January 1, 2007 and December 31, 2018. The LNR cut-off values used were: low risk if LNR ≤ 0.2; intermediate risk if LNR > 0.2 and ≤ 0.65, and high risk for LNR >0.659. RESULTS: Our study demonstrated a significant difference in overall survival and distant metastasis free survival (p < 0.0001). The 5-years Overall survival was 94 % for N0 patients, 92.4 % for low-risk patients, 85.6 % for intermediate-risk patients and 58.5 % for high-risk patients. The 5-year distant metastasis-free survival was 98.2 % for N0 patients, 95.9 % for low-risk patients, 80.1 % for intermediate-risk patients, and 60.3 % for high-risk patients. Multivariate analysis identified age, invasive lobular histologic type, presence of clinical inflammation, and intermediate and high risk classes of LNR ratio as independent factors affecting overall survival. For metastatic-free survival, the presence of clinical inflammation, the presence of LVSI and the low, intermediate, or high-risk classes of LNR ratio were identified as independent factors. However, age and invasive lobular histologic type did not appear to be independent factors affecting metastatic-free survival. CONCLUSION: Our study highlights the significant prognostic impact of lymph node involvement in patients with invasive lobular carcinoma. The LNR ratio can be used as a reliable predictor of overall survival and metastatic-free survival in these patients.

Oncological Safety of Autologous Fat Grafting in Breast Reconstruction after Mastectomy for cancer: A case-control study.

OBJECTIVE: The use of autologous fat grafting in the context of breast reconstruction is still a matter of controversy. The objective of this study was to compare the local relapse rate in women who had a fat grafting session in the context of breast reconstruction after breast cancer management, to those who had breast reconstruction without fat grafting. METHODS: We performed a retrospective, monocentric, case-control study from January 2007 to December 2017 in our hospital. The cases included women who underwent breast reconstruction with autologous fat grafting and controls, undergoing breast reconstruction without fat grafting. We compared survival and local recurrence between the two groups. RESULTS: 412 women were included: 109 (26.5%) in the lipofilling group and 303 women (73.5%) in the "no lipofilling" group. In the overall study population, lipofilling did not appear to be a predictive factor for recurrence, HR = 1.39 [0.63 - 3.06], p = 0.41; or a predictive factor for overall survival, HR = 0.84 [0.23 - 3.02], p = 0.79, or for distant metastases, HR = 1.10 [0.43 - 2.79], p = 0.84. In contrast, in the subgroup of women treated for invasive cancer, the multivariate analysis showed that lipofilling in this context was an independent predictive factor for local recurrence (HR= 5.06 [1.97 - 10.6], p = 0.04). CONCLUSION: we found an increased risk of local recurrence after lipofilling in women who were managed for invasive breast cancer. This suggests that special consideration should be given to women who have had invasive breast cancer before lipofilling.

[Predictive factors of concordance (5mm threshold) between MRI and histological sizes of invasive lobular breast cancer]. / Facteurs prédictifs de concordance (seuil 5mm) entre les tailles mesurées à l'IRM mammaire et les tailles histologiques dans les cancers infiltrants du sein de type lobulaire.

OBJECTIVE: The aim of this study was to search for predictive factors of concordance between MRI and histological sizes for invasive lobular breast cancer. MATERIAL AND METHODS: All women managed for an invasive lobular breast cancer (pure or associated to a component of invasive ductal carcinoma) between 1st january 2007 and 31th december 2016 were included to the study. Univariable and multivariable analysis were performed to determine clinical or histological predictive factors of concordance between MRI and histological sizes for invasive lobular breast cancer (threshold 5mm). RESULTS: During the study period 384 women were managed in our center for an invasive lobular carcinoma. We had access to the breast MRI of 246 of them. For a concordance witha threshold of 5mm, significant factors in univariate analysis were: menopausal status (OR 1.93[1.01-3.71], P=0.04), histological size (OR 0.97 [0.96-0.99], P<0.0001), lthe size of associated in situ component (OR 0.74 [0.32-1.71], P=0.01), multifocality (OR 0.56 [0.33-0.95] P=0.03) and the histological isolated invasive lobular carcinoma versus mixed ((OR 2.64 [1.01-6.91], P=0.03). In multivariate analysis, menopausal status, histological size and the histological isolated invasive lobular carcinoma versus mixed, were considered as independent predictive factors. CONCLUSION: This work identified independent predictive factors of concordance between MRI and histological sizes for invasive lobular breast cancer (threshold 5mm).

Management and prognosis of pure primary squamous cell carcinoma of the breast.

PURPOSE: The aim of the study was to investigate the management and prognosis of Pure primary squamous cell carcinoma (PPSCC) of the breast. MATERIALS AND METHODS: This study is a multicentre retrospective cohort from three French tertiary referral hospitals (Rennes, Orléans and Tours) including all women treated for a PPSCC of the breast defined by squamous cells that could contain a minority of sarcomatoid component. We excluded carcinomas with a ductual component. Clinicopathologic, radiological and therapeutic patterns were described. Demographic, histological and therapeutic characteristics were compared to a population of women with triple negative invasive breast carcinomas. RESULTS: Twelve patients were included, with a mean age of 71.6 years. All lesions were unifocal, with a cystic complex ultrasound mass in 50% of cases. Mean tumor size was 43mm, with axillary lymph node metastasis in 25% of patients. The comparison with a population of women with triple negative breast carcinomas revealed that women with PPSCC were older (71 versus 57 years, p=0.003), tumor size was larger (43mm versus 25mm, p=0.032) and local recurrence occurred earlier (three months versus 38 months, p=0.014). CONCLUSION: PPSCC is a rare entity with a worse prognosis in comparison with triple negative invasive carcinoma.

[Performances of breast magnetic resonance imaging in the context of neoadjuvant chemotherapy for breast cancer to predict pathological complete response]. / Performances de l'imagerie par résonance magnétique au cours des chimiothérapies néoadjuvantes du cancer du sein pour prédire la réponse pathologique complète.

PURPOSE: The objective of this work was to estimate the reliability of MRI after neoadjuvant chemotherapy (NAC) for breast cancer to detect a residual tumour by comparing the tumoral size measured by MRI with the histological size. We also estimated the concordance of diagnosis of complete pathological response between histological examination and MRI. MATERIALS AND METHODS: We included all the patients who received a neoadjuvant chemotherapy for breast cancer in the university hospital of Tours from January, 2008 to December 31st, 2012 and in the comprehensive cancer centre of Rennes from January, 2008 till May 31st 201. We considered that the pathological response was complete (pCR) when there was no residual invasive tumour in the mammary surgical specimen. RESULTS: Two hundred and fifty-one women who received NAC for a non-metastatic breast cancer were included in the study: 103 in Tours and 148 in Rennes. Two women (0.8%) refused breast surgery whatever the type. One hundred and twenty-three (49%) women had a breast conservative surgery. One hundred and fifteen (45.8%) had a mastectomy and 11 (4.4%) had breast conservative surgery followed by mastectomy for positive margins. A complete pathological response was present in 54 cases (21.5%). We did not found any significant difference between characteristics of patients with pCR or not. CONCLUSION: Breast MRI remains the most performing examination to evaluate the initial tumoral size and the residual tumour after NAC, but does not add any value at mid or at the end of treatment for the patients to whom a mastectomy is decided at presentation. The correlation between the breast MRI and the histology size is not perfect, but at the moment, MRI stills of the most performing examination to predict the pCR.

[Role of imaging procedures in the diagnosis of synchronous bilateral breast cancer]. / Place de l'imagerie dans le diagnotic des cancers du sein bilatéraux synchrones.

OBJECTIVE: To investigate the role of imaging procedures in the diagnosis of synchronous bilateral breast cancer (SBBC) PATIENTS AND METHODS: The patient group consisted of consecutive women undergoing managed for SBBC in our institution between January 2006 and July 2012. We defined SBBC as bilateral breast tumors diagnosed simultaneously or up to 3 months after initial diagnosis. Clinical data included comorbidities, BMI (kg/m(2)), preoperative breast imaging modalities used and their findings. RESULTS: Of the 2322 patients with newly diagnosed breast cancer treated on the study period, 46 patients with the diagnosis of SBBC were enrolled to the study. A total of 41.3% patients had family history of breast cancer. A total of 56.52% had clinical symptoms. The most frequent situation of diagnosis (32.6%) was the association of a palpable tumor and a contralateral radiologic abnormality. MRI permitted the diagnosis of 19.6% occult contralateral lesions. DISCUSSION AND CONCLUSION: Clinical examination and conventional imaging procedures (mammography and sonography) detects the majority (76%) of synchronous contralateral breast cancers. A family history of breast cancer, a multifocal breast tumor or the presence of an invasive lobular carcinoma should be arguments for the realization of a breat MRI to eliminate contralateral malignancy.

[Reliability of imaging modalities for preoperative assessment of patients with endometrial carcinoma]. / Pertinence de l'imagerie dans l'évaluation préopératoire des patientes avec cancer endométrial.

OBJECTIVES: To investigate the value of transvaginal sonography, computed tomography and magnetic resonance imaging for the preoperative staging of endometrial cancer. PATIENTS AND METHODS: The patient group consisted of consecutive women undergoing surgery for endometrial cancer in our institution between January 2000, and September 2012. Clinical data included comorbidities, BMI (kg/m(2)), preoperative imaging findings, surgical procedures, surgical International Federation of Gynecology and Obstetrics stage, histological grade, relevant prognostic factors. The pathological data from surgical staging were compared with the preoperative imaging results. RESULTS: Two hundred and forty-four patients with the final diagnosis of endometrial cancer were enrolled. Hundred and ninety-six had preoperative transvaginal ultrasonography, 56 preoperative computed tomography and 158 preoperative MRI assessment. In our analysis, MRI had better sensitivity and specificity for all imaging criteria but lymph node assessment where MRI and CT-scan are equivalent (MRI: Se=45.45 %, Sp=79.52 %; CT: Se=50 %, Sp=80 %). DISCUSSION AND CONCLUSION: In patients with endometrial cancer, preoperative MRI may not accurately diagnose absence of myometrial invasion. This data should be kept in mind before planning the operative treatment modality and particularly before choosing patients for conservative endometrial carcinoma treatment.

An assessment of the performance of elastography for the investigation of BI-RADS 4 and BI-RADS 5 breast lesions: correlations with pathological anatomy findings.

PURPOSE: To study the diagnostic value of static elastography of the breast (score, histogram, quantitative ratio) in masses classed as BI-RADS 4 and BI-RADS 5 on sonography using the findings from pathological anatomy analyses on the masses as a reference. MATERIALS AND METHODS: A prospective study using a representative sample into 68 masses seen on sonography and their elastography results. For each mass, we determined the elastography colourimetry score (UENO et al. classification, scores 1-3=benign and 4-5=malignant). We studied quantitative elastography parameters based on the Z2/Z1 (fat/lesion) ratio and a histogram showing the pattern of mass stiffness distribution. The results were compared with histology findings (68 lesions assessed, 22 benign lesions and 46 malignant lesions). RESULTS: Elastography was consistent with histology (sensitivity: 73.9%, specificity: 86.4%, PPV: 91.9%, NPV: 61.3%). There were twelve false negatives and three false positives. With the Z2/Z1 ratio, we set a cut-off point of 3.05 for 99.0% specificity. CONCLUSION: Elastography is a reliable technique that is able to assist radiologists in their diagnostic approach to breast pathology.