RÉSUMÉ
OBJECTIVE: Tumor budding is a phenomenon in which the tumor cells detach from the main mass and are present at the invasive front. The present study was conducted to study tumor budding in invasive breast carcinoma and to correlate it with clinicopathological parameters and molecular subtypes. METHODS: The study was conducted over a period of 1 year, and tumor budding was studied as a single or group of cells at the invasive front of breast carcinoma counted in a high-power field (40×). The grading was statistically correlated with tumor size, grade, lymph node status, lymphovascular invasion, pathological TNM staging, molecular subtype, and survival of patients. RESULTS: A total of 50 cases of invasive breast carcinoma were included, out of which 66% (n=33) showed high-grade tumor budding, which was statistically significantly higher in grade 2 invasive ductal carcinoma (p<0.05). High tumor budding was associated with lymphovascular invasion, lymph node metastasis, and a high Ki-67 proliferative index. All cases showing low-grade budding were alive until 6 months of diagnosis, but there was no statistically significant association between stage and budding. CONCLUSION: Tumor buds are significantly higher in grade 2 invasive ductal carcinoma with lymphovascular invasion, lymph node metastasis, and a high Ki-67 proliferative index. Immunohistochemistry may prove helpful in distinguishing tumor buds from their mimickers. Further studies with extended follow-up are recommended to predict tumor budding as a prognostic marker in breast carcinoma, which may play an important role in cancer therapy.
Sujet(s)
Tumeurs du sein , Carcinome canalaire du sein , Antigène KI-67 , Métastase lymphatique , Grading des tumeurs , Invasion tumorale , Stadification tumorale , Humains , Femelle , Tumeurs du sein/anatomopathologie , Adulte d'âge moyen , Carcinome canalaire du sein/anatomopathologie , Métastase lymphatique/anatomopathologie , Adulte , Antigène KI-67/analyse , Sujet âgé , Immunohistochimie , PronosticRÉSUMÉ
The objective of this study was to evaluate the intramammary distribution of MRI-detected mass and focus lesions that were difficult to identify with conventional B-mode ultrasound (US) alone. Consecutive patients with lesions detected with MRI but not second-look conventional B-mode US were enrolled between May 2015 and June 2023. Following an additional supine MRI examination, we performed third-look US using real-time virtual sonography (RVS), an MRI/US image fusion technique. We divided the distribution of MRI-detected mammary gland lesions as follows: center of the mammary gland versus other (superficial fascia, deep fascia, and atrophic mammary gland). We were able to detect 27 (84%) of 32 MRI-detected lesions using third-look US with RVS. Of these 27 lesions, 5 (19%) were in the center of the mammary gland and 22 (81%) were located in other areas. We were able to biopsy all 27 lesions; 8 (30%) were malignant and 19 (70%) were benign. Histopathologically, three malignant lesions were invasive ductal carcinoma (IDC; luminal A), one was IDC (luminal B), and four were ductal carcinoma in situ (low-grade). Malignant lesions were found in all areas. During this study period, 132 MRI-detected lesions were identified and 43 (33%) were located in the center of the mammary gland and 87 (64%) were in other areas. Also, we were able to detect 105 of 137 MRI-detected lesions by second-look conventional-B mode US and 38 (36%) were located in the center of the mammary gland and 67 (64%) were in other areas. In this study, 81% of the lesions identified using third-look US with RVS and 64% lesions detected by second-look conventional-B mode US were located outside the center of the mammary gland. We consider that adequate attention should be paid to the whole mammary gland when we perform third-look US using MRI/US fusion technique.
Sujet(s)
Tumeurs du sein , Imagerie par résonance magnétique , Échographie mammaire , Humains , Femelle , Imagerie par résonance magnétique/méthodes , Tumeurs du sein/imagerie diagnostique , Tumeurs du sein/anatomopathologie , Adulte d'âge moyen , Adulte , Échographie mammaire/méthodes , Sujet âgé , Imagerie multimodale/méthodes , Région mammaire/imagerie diagnostique , Carcinome canalaire du sein/imagerie diagnostique , Carcinome canalaire du sein/anatomopathologieRÉSUMÉ
INTRODUCTION: The risk of breast cancer increases with increasing age. The aim of our retrospective study was to determine the extent of breast and axillary surgery, including subsequent adjuvant therapy, in 80-year and older patients. METHODS: Between 2017 and 2021, 834 breast cancer patients were operated in the Surgical Department of the EUC Clinic. Ninety-eight women (2× with bilateral cancer) and 2 men were included in this retrospective study. A total of 102 breast cancer cases in patients older than 80 years were analyzed. The surgical procedure corresponded to the stage of the disease and the general condition of the patient. Adjuvant systemic therapy was indicated according to the same principles. RESULTS: At the time of surgery, the patients were more than 80 years old (80-96 years). The predominant type of invasive ductal carcinoma was diagnosed 83×, lobular carcinoma 6×, mucinous 6×, papillary carcinoma 4×, other 3×, with luminal A, B predominating (89×). The breast-conserving procedures were performed 63×. Sentinel node biopsy was performed 65×, supplemented by axillary lymph node dissection 13×. Primary axillary lymph node dissection was performed 15×. No axillary procedure was performed 23×. Radiotherapy was given 49×, chemotherapy 9× and hormonal therapy 82×. Local and regional recurrences were each observed 2×. A total of 37 patients died, 10 of them from breast cancer. CONCLUSION: The most common cause of death in patients aged 80+ years is a cardiovascular disease, not breast cancer itself. This fact should be taken into account when determining the treatment plan.
Sujet(s)
Tumeurs du sein , Humains , Sujet âgé de 80 ans ou plus , Tumeurs du sein/anatomopathologie , Tumeurs du sein/chirurgie , Femelle , Études rétrospectives , Mâle , Aisselle , Tumeur du sein de l'homme/anatomopathologie , Tumeur du sein de l'homme/chirurgie , Lymphadénectomie , Carcinome canalaire du sein/chirurgie , Carcinome canalaire du sein/anatomopathologie , Carcinome canalaire du sein/mortalité , Biopsie de noeud lymphatique sentinelle , Traitement médicamenteux adjuvant , Radiothérapie adjuvante , Mastectomie partielleRÉSUMÉ
BACKGROUND: Invasive micropapillary carcinoma (IMPC) was first proposed as an entity by Fisher et al. In the 2003 World Health Organization (WHO) guidelines for histologic classification of the breast tumors. IMPC was recognized as a distinct, rare histological subtype of breast cancer. IMPC is emerging as a surgical and oncological challenge due to its tendency to manifest as a palpable mass, larger in size and higher in grade than IDC with more rate of lymphovascular invasion (LVI) and lymph node (LN) involvement, which changes the surgical and adjuvant management plans to more aggressive, with comparative prognosis still being a point of ongoing debate. AIM OF THE STUDY: In this study, we compared the clinicopathological characteristics, survival and surgical management of breast cancer patients having invasive micropapillary carcinoma pathological subtype in comparison to those having invasive duct carcinoma. METHOD: This is a comparative study on female patients presented to Baheya center for early detection and treatment of breast cancer, in the period from 2015 to 2022 diagnosed with breast cancer of IMPC subtype in one group compared with another group of invasive duct carcinoma. we analyzed 138 cases of IMPC and 500 cases of IDC. RESULTS: The incidence of LVI in the IMPC group was 88.3% in comparison to 47.0% in the IDC group (p < 0.001). IMPC had a higher incidence of lymph node involvement than the IDC group (68.8% and 56% respectively). IMPC had a lower rate of breast conserving surgery (26% vs.37.8%) compared with IDC. The survival analysis indicated that IMPC patients had no significant difference in overall survival compared with IDC patients and no differences were noted in locoregional recurrence rate and distant metastasis rate comparing IMPCs with IDCs. CONCLUSION: The results from our PSM analysis suggested that there was no statistically significant difference in prognosis between IMPC and IDC patients after matching them with similar clinical characteristics. However, IMPC was found to be more aggressive, had larger tumor size, greater lymph node metastasis rate and an advanced tumor stage.
Sujet(s)
Tumeurs du sein , Carcinome canalaire du sein , Carcinome papillaire , Humains , Femelle , Tumeurs du sein/anatomopathologie , Tumeurs du sein/mortalité , Tumeurs du sein/chirurgie , Adulte d'âge moyen , Pronostic , Carcinome canalaire du sein/anatomopathologie , Carcinome canalaire du sein/mortalité , Carcinome canalaire du sein/chirurgie , Carcinome canalaire du sein/thérapie , Sujet âgé , Carcinome papillaire/anatomopathologie , Carcinome papillaire/mortalité , Carcinome papillaire/chirurgie , Adulte , Métastase lymphatique , Invasion tumoraleRÉSUMÉ
BACKGROUND: A better understanding of ductal carcinoma in situ (DCIS) is urgently needed to identify these preinvasive lesions as distinct clinical entities. Semaphorin 3F (SEMA3F) is a soluble axonal guidance molecule, and its coreceptors Neuropilin 1 (NRP1) and NRP2 are strongly expressed in invasive epithelial BC cells. METHODS: We utilized two cell line models to represent the progression from a healthy state to the mild-aggressive or ductal carcinoma in situ (DCIS) stage and, ultimately, to invasive cell lines. Additionally, we employed in vivo models and conducted analyses on patient databases to ensure the translational relevance of our results. RESULTS: We revealed SEMA3F as a promoter of invasion during the DCIS-to-invasive ductal carcinoma transition in breast cancer (BC) through the action of NRP1 and NRP2. In epithelial cells, SEMA3F activates epithelialmesenchymal transition, whereas it promotes extracellular matrix degradation and basal membrane and myoepithelial cell layer breakdown. CONCLUSIONS: Together with our patient database data, these proof-of-concept results reveal new SEMA3F-mediated mechanisms occurring in the most common preinvasive BC lesion, DCIS, and represent potent and direct activation of its transition to invasion. Moreover, and of clinical and therapeutic relevance, the effects of SEMA3F can be blocked directly through its coreceptors, thus preventing invasion and keeping DCIS lesions in the preinvasive state.
Sujet(s)
Tumeurs du sein , Carcinome intracanalaire non infiltrant , Invasion tumorale , Protéines de tissu nerveux , Neuropiline 1 , Neuropiline 2 , Humains , Neuropiline 1/métabolisme , Neuropiline 1/génétique , Femelle , Tumeurs du sein/anatomopathologie , Tumeurs du sein/métabolisme , Tumeurs du sein/génétique , Neuropiline 2/métabolisme , Neuropiline 2/génétique , Carcinome intracanalaire non infiltrant/métabolisme , Carcinome intracanalaire non infiltrant/anatomopathologie , Carcinome intracanalaire non infiltrant/génétique , Lignée cellulaire tumorale , Protéines de tissu nerveux/métabolisme , Protéines de tissu nerveux/génétique , Transition épithélio-mésenchymateuse/génétique , Animaux , Protéines membranaires/métabolisme , Protéines membranaires/génétique , Souris , Carcinome canalaire du sein/anatomopathologie , Carcinome canalaire du sein/métabolisme , Carcinome canalaire du sein/génétique , Régulation de l'expression des gènes tumoraux , Transduction du signalRÉSUMÉ
OBJECTIVE: The ultrasonographic characteristics of lymph node metastasis in breast cancer patients were retrospectively analyzed, and a predictive nomogram model was constructed to provide an imaging basis for better clinical evaluation. METHODS: B-mode ultrasound was used to retrospectively analyze the imaging characteristics of regional lymph nodes and tumors. Pathological examination confirmed the presence of lymph node metastasis in breast cancer patients. Univariable and multivariable logistic regression analyses were performed to analyze the risk factors for lymph node metastasis. LASSO regression analysis was performed to screen noninvasive indicators, and a nomogram prediction model was constructed for breast cancer patients with lymph node metastasis. RESULTS: A total of 187 breast cancer patients were enrolled, including 74 patients with lymph node metastasis in the positive group and 113 patients without lymph node metastasis in the negative group. Multivariate analysis revealed that pathological type (OR = 4.58, 95% CI: 1.44-14.6, p = 0.01), tumor diameter (OR = 1.37, 95% CI: 1.07-1.74, p = 0.012), spiculated margins (OR = 7.92, 95% CI: 3.03-20.67, p < 0.001), mixed echo of the breast tumor (OR = 37.09, 95% CI: 3.49-394.1, p = 0.003), and unclear lymphatic hilum structure (OR = 16.07, 95% CI: 2.41-107.02, p = 0.004) were independent risk factors for lymph node metastasis. A nomogram model was constructed for predicting breast cancer with lymph node metastasis, incorporating three significantly correlated indicators identified through LASSO regression analysis, namely, tumor spiculated margins, cortical thickness of lymph nodes, and unclear lymphatic hilum structure. The receiver operating characteristic (ROC) curve revealed that the area under the curve (AUC) was 0.717 (95% CI, 0.614-0.820) for the training set and 0.817 (95% CI, 0.738-0.890) for the validation set. The Hosmer-Lemeshow test results for the training set and the validation set were p = 0.9148 and p = 0.1648, respectively. The prediction nomogram has good diagnostic performance. CONCLUSIONS: B-mode ultrasound is helpful in the preoperative assessment of breast cancer patients with lymph node metastasis. The predictive nomogram model, which is based on logistic regression and LASSO regression analysis, is clinically safe, reliable, and highly practical.
Sujet(s)
Tumeurs du sein , Noeuds lymphatiques , Métastase lymphatique , Nomogrammes , Humains , Tumeurs du sein/anatomopathologie , Tumeurs du sein/imagerie diagnostique , Tumeurs du sein/chirurgie , Femelle , Métastase lymphatique/imagerie diagnostique , Études rétrospectives , Adulte d'âge moyen , Noeuds lymphatiques/anatomopathologie , Noeuds lymphatiques/imagerie diagnostique , Noeuds lymphatiques/chirurgie , Adulte , Pronostic , Sujet âgé , Facteurs de risque , Études de suivi , Échographie mammaire/méthodes , Échographie/méthodes , Carcinome canalaire du sein/imagerie diagnostique , Carcinome canalaire du sein/anatomopathologie , Carcinome canalaire du sein/chirurgie , Carcinome canalaire du sein/secondaireRÉSUMÉ
BACKGROUND Breast cancer (BC) is the most common malignant disease in females and one of the leading causes of death worldwide. Its treatment plan includes a long-term follow-up and close surveillance, as recurrence is a well-acknowledged concern. BC can recur either locally or as a metastasis, and skin metastasis is a common complication in advanced breast cancer patients. It can present as a skin nodule, plaque, or erythematous lesion, and can be difficult to distinguish from benign skin conditions. The risk of skin metastasis is higher in patients with inflammatory BC. Treatment of such a complex condition is even more challenging, with poor prognosis. Here, we report a case of a 42-year-old woman with stage 4 luminal A BC who had soft tissue recurrence. CASE REPORT A 42-year-old woman with a history of left-sided BC diagnosed and treated 10 years ago presented with multiple soft tissue masses mimicking abscesses at the right lower middle of the back, bilateral thighs, and back of the neck, in the last 6 months, the largest measuring 8×10 cm. The masses were found to be metastatic BC that had spread to the skin and lungs. Because it was invasive ductal carcinoma with positive ER and PR receptors, she was started on hormonal treatment and chemotherapy. CONCLUSIONS This case report highlights the importance of follow-up in patients with a history of BC, as the cancer can recur and spread many years after treatment.
Sujet(s)
Tumeurs du sein , Tumeurs cutanées , Humains , Femelle , Tumeurs du sein/anatomopathologie , Adulte , Tumeurs cutanées/secondaire , Tumeurs cutanées/anatomopathologie , Carcinome canalaire du sein/secondaire , Tumeurs du poumon/secondaire , Tumeurs du poumon/anatomopathologieRÉSUMÉ
Mixed invasive ductal and lobular carcinoma (MDLC) is a rare histologic subtype of breast cancer displaying both E-cadherin positive ductal and E-cadherin negative lobular morphologies within the same tumor, posing challenges with regard to anticipated clinical management. It remains unclear whether these distinct morphologies also have distinct biology and risk of recurrence. Our spatially resolved transcriptomic, genomic, and single-cell profiling revealed clinically significant differences between ductal and lobular tumor regions including distinct intrinsic subtype heterogeneity - e.g., MDLC with triple-negative breast cancer (TNBC) or basal ductal and estrogen receptor positive (ER+) luminal lobular regions, distinct enrichment of cell cycle arrest/senescence and oncogenic (ER and MYC) signatures, genetic and epigenetic CDH1 inactivation in lobular but not ductal regions, and single-cell ductal and lobular subpopulations with unique oncogenic signatures further highlighting intraregional heterogeneity. Altogether, we demonstrated that the intratumoral morphological/histological heterogeneity within MDLC is underpinned by intrinsic subtype and oncogenic heterogeneity which may result in prognostic uncertainty and therapeutic dilemma.
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Tumeurs du sein , Carcinome canalaire du sein , Carcinome lobulaire , Mutation , Humains , Femelle , Carcinome lobulaire/génétique , Carcinome lobulaire/anatomopathologie , Carcinome lobulaire/métabolisme , Carcinome canalaire du sein/génétique , Carcinome canalaire du sein/anatomopathologie , Carcinome canalaire du sein/métabolisme , Tumeurs du sein/génétique , Tumeurs du sein/anatomopathologie , Tumeurs du sein/métabolisme , Tumeurs du sein/classification , Cadhérines/génétique , Cadhérines/métabolisme , Régulation de l'expression des gènes tumoraux , Marqueurs biologiques tumoraux/génétique , Marqueurs biologiques tumoraux/métabolisme , Tumeurs du sein triple-négatives/génétique , Tumeurs du sein triple-négatives/anatomopathologie , Tumeurs du sein triple-négatives/métabolisme , Transcriptome , Analyse de profil d'expression de gènes/méthodesRÉSUMÉ
BACKGROUND: Despite advances in breast carcinoma therapies, drug resistance mechanisms as anti-apoptosis and anti-pyroptosis limit the application of these therapies. This work assesses the immunohistochemical (IHC) expression of Caspase1 and EGFR in breast carcinoma and analyzes their clinicopathological associations as prognostic markers and potential therapeutic targets. Caspase1/EGFR expression patterns are utilized to specify breast carcinoma patients who may benefit from these therapies. METHODS: After reviewing the hematoxylin and eosin-stained slides and the routine breast carcinoma IHC stains (estrogen receptors, progesterone receptors, HER2/NEU, Ki-67) by two pathologists and preparation of tissue microarray blocks, anti-Caspase-1 and EGFR IHC staining was performed using Horseradish Peroxidase (HRP) technique. Intensity and percentage-based scoring was applied dividing the 153 included breast carcinomas into Caspase1-negative and positive expression groups; and EGFR low and overexpression groups. Groups were statistically analyzed in relation to age, tumor size, histological and molecular subtype, grade, nodal status, metastasis/recurrence, TNM stage and Ki-67 proliferation index. Kaplan-Meier's analysis was used to compare disease-free survival (DFS) and overall survival (OS). Combined patterns based on Caspase1 and EGFR expression status were created to stratify patients into prognostic groups. RESULTS: Caspase1 was positive in 54.2% of breast carcinomas and its positivity was significantly associated with smaller tumor size, absence of metastasis/recurrence, luminal A and B molecular subtypes and longer OS (p<0.05). EGFR overexpression was detected in 32.7% of carcinomas and was significantly associated with larger tumor size, TNBLBC and a shorter OS (p<0.05). Caspase1-negative/EGFR-overexpression pattern comprised 14.4% of carcinomas and had the worst prognostic associations including larger tumor size, metastasis/recurrence, TNBLBC subtype and shortest OS (p=0.002, 0.002, 0.004 and ≤0.001 respectively). Conclusions: Combined Caspase1/EGFR IHC expression may provide a tool for selection of patients who benefit from combined EGFR-inhibitors with miR-155-5p down-regulators or photodynamic therapy via induction of apoptosis/pyroptosis in EGFR-overexpression carcinomas through enhanced Caspase1 signaling.
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Marqueurs biologiques tumoraux , Tumeurs du sein , Caspase-1 , Récepteurs ErbB , Humains , Femelle , Tumeurs du sein/anatomopathologie , Tumeurs du sein/métabolisme , Tumeurs du sein/mortalité , Récepteurs ErbB/métabolisme , Pronostic , Adulte d'âge moyen , Marqueurs biologiques tumoraux/métabolisme , Caspase-1/métabolisme , Taux de survie , Adulte , Études de suivi , Carcinome canalaire du sein/métabolisme , Carcinome canalaire du sein/anatomopathologie , Sujet âgé , Récepteur ErbB-2/métabolisme , Invasion tumorale , Immunohistochimie , Récidive tumorale locale/anatomopathologie , Récidive tumorale locale/métabolismeRÉSUMÉ
BACKGROUND/AIM: Invasive ductal carcinoma (IDC) is classified into distinct subtypes with varying prognoses and treatment sensitivities. For instance, triple-negative breast cancer (TNBC) is associated with poorer outcomes than other subtypes. We have previously reported the role of interstitial CD73 in tumor invasion and its correlation with prognosis in other cancers. This study aimed to investigate the expression of stromal CD73 (sCD73) in IDC and its potential prognostic significance. PATIENTS AND METHODS: We analyzed 61 cases of human epidermal growth factor receptor 2-negative IDC, including TNBC and hormone receptor-positive (luminal-type) cases, treated surgically at our institution from 2005 to 2010. Cases that received preoperative drug therapy were excluded. CD73 expression was evaluated by immunostaining of the tumor stroma. RESULTS: sCD73 expression was observed in 70% of all cases, with a significantly higher rate in TNBC (93%) compared with luminal breast cancer (48%). High sCD73 expression was associated with poor prognosis in terms of overall survival (OS) and disease-free survival (DFS) across all cases. In patients with luminal breast cancer, high sCD73 expression was also indicative of poor prognosis with respect to both OS and DFS. CONCLUSION: High expression of sCD73 is associated with poor prognosis in IDC, particularly in luminal breast cancer. Further research is needed to establish sCD73 as an independent prognostic factor.
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5'-Nucleotidase , Protéines liées au GPI , Humains , 5'-Nucleotidase/métabolisme , Femelle , Adulte d'âge moyen , Pronostic , Protéines liées au GPI/métabolisme , Sujet âgé , Adulte , Tumeurs du sein triple-négatives/anatomopathologie , Tumeurs du sein triple-négatives/métabolisme , Tumeurs du sein triple-négatives/mortalité , Marqueurs biologiques tumoraux/métabolisme , Tumeurs du sein/anatomopathologie , Tumeurs du sein/métabolisme , Tumeurs du sein/mortalité , Carcinome canalaire du sein/anatomopathologie , Carcinome canalaire du sein/métabolisme , Carcinome canalaire du sein/mortalité , Survie sans rechute , Cellules stromales/métabolisme , Cellules stromales/anatomopathologie , Sujet âgé de 80 ans ou plusRÉSUMÉ
Invasive ductal carcinoma (IDC) in breast specimens has been detected in the quadrant breast area: (I) upper outer, (II) upper inner, (III) lower inner, and (IV) lower outer areas by electrical impedance tomography implemented with Gaussian relaxation-time distribution (EIT-GRTD). The EIT-GRTD consists of two steps which are (1) the optimum frequencyfoptselection and (2) the time constant enhancement of breast imaging reconstruction.foptis characterized by a peak in the majority measurement pair of the relaxation-time distribution functionγ,which indicates the presence of IDC.γrepresents the inverse of conductivity and indicates the response of breast tissues to electrical currents across varying frequencies based on the Voigt circuit model. The EIT-GRTD is quantitatively evaluated by multi-physics simulations using a hemisphere container of mimic breast, consisting of IDC and adipose tissues as normal breast tissue under one condition with known IDC in quadrant breast area II. The simulation results show that EIT-GRTD is able to detect the IDC in four layers atfopt= 30, 170 Hz. EIT-GRTD is applied in the real breast by employed six mastectomy specimens from IDC patients. The placement of the mastectomy specimens in a hemisphere container is an important factor in the success of quadrant breast area reconstruction. In order to perform the evaluation, EIT-GRTD reconstruction images are compared to the CT scan images. The experimental results demonstrate that EIS-GRTD exhibits proficiency in the detection of the IDC in quadrant breast areas while compared qualitatively to CT scan images.
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Tumeurs du sein , Carcinome canalaire du sein , Impédance électrique , Tomographie , Humains , Femelle , Tumeurs du sein/imagerie diagnostique , Tomographie/méthodes , Carcinome canalaire du sein/imagerie diagnostique , Loi normale , Région mammaire/imagerie diagnostique , Simulation numérique , Algorithmes , Traitement d'image par ordinateur/méthodesRÉSUMÉ
Various histopathological, clinical and imaging parameters have been evaluated to identify a subset of women diagnosed with lesions with uncertain malignant potential (B3 or BIRADS 3/4A lesions) who could safely be observed rather than being treated with surgical excision, with little impact on clinical practice. The primary reason for surgery is to rule out an upgrade to either ductal carcinoma in situ or invasive breast cancer, which occurs in up to 30% of patients. We hypothesised that the stromal immune microenvironment could indicate the presence of carcinoma associated with a ductal B3 lesion and that this could be detected in biopsies by counting lymphocytes as a predictive biomarker for upgrade. A higher number of lymphocytes in the surrounding specialised stroma was observed in upgraded ductal and papillary B3 lesions than non-upgraded (p < 0.01, negative binomial model, n = 307). We developed a model using lymphocytes combined with age and the type of lesion, which was predictive of upgrade with an area under the curve of 0.82 [95% confidence interval 0.77-0.87]. The model can identify some patients at risk of upgrade with high sensitivity, but with limited specificity. Assessing the tumour microenvironment including stromal lymphocytes may contribute to reducing unnecessary surgeries in the clinic, but additional predictive features are needed.
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Tumeurs du sein , Lymphocytes , Cellules stromales , Microenvironnement tumoral , Humains , Femelle , Tumeurs du sein/anatomopathologie , Tumeurs du sein/immunologie , Microenvironnement tumoral/immunologie , Adulte d'âge moyen , Sujet âgé , Lymphocytes/immunologie , Lymphocytes/anatomopathologie , Cellules stromales/anatomopathologie , Adulte , Grading des tumeurs , Lymphocytes TIL/immunologie , Lymphocytes TIL/métabolisme , Carcinome intracanalaire non infiltrant/anatomopathologie , Carcinome intracanalaire non infiltrant/immunologie , Carcinome canalaire du sein/anatomopathologie , Carcinome canalaire du sein/immunologie , Marqueurs biologiques tumorauxRÉSUMÉ
Purpose To determine whether time-dependent deep learning models can outperform single time point models in predicting preoperative upgrade of ductal carcinoma in situ (DCIS) to invasive malignancy at dynamic contrast-enhanced (DCE) breast MRI without a lesion segmentation prerequisite. Materials and Methods In this exploratory study, 154 cases of biopsy-proven DCIS (25 upgraded at surgery and 129 not upgraded) were selected consecutively from a retrospective cohort of preoperative DCE MRI in women with a mean age of 59 years at time of diagnosis from 2012 to 2022. Binary classification was implemented with convolutional neural network (CNN)-long short-term memory (LSTM) architectures benchmarked against traditional CNNs without manual segmentation of the lesions. Combinatorial performance analysis of ResNet50 versus VGG16-based models was performed with each contrast phase. Binary classification area under the receiver operating characteristic curve (AUC) was reported. Results VGG16-based models consistently provided better holdout test AUCs than did ResNet50 in CNN and CNN-LSTM studies (multiphase test AUC, 0.67 vs 0.59, respectively, for CNN models [P = .04] and 0.73 vs 0.62 for CNN-LSTM models [P = .008]). The time-dependent model (CNN-LSTM) provided a better multiphase test AUC over single time point (CNN) models (0.73 vs 0.67; P = .04). Conclusion Compared with single time point architectures, sequential deep learning algorithms using preoperative DCE MRI improved prediction of DCIS lesions upgraded to invasive malignancy without the need for lesion segmentation. Keywords: MRI, Dynamic Contrast-enhanced, Breast, Convolutional Neural Network (CNN) Supplemental material is available for this article. © RSNA, 2024.
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Tumeurs du sein , Carcinome canalaire du sein , Carcinome intracanalaire non infiltrant , Produits de contraste , Apprentissage profond , Imagerie par résonance magnétique , Humains , Femelle , Tumeurs du sein/imagerie diagnostique , Tumeurs du sein/anatomopathologie , Tumeurs du sein/chirurgie , Adulte d'âge moyen , Imagerie par résonance magnétique/méthodes , Études rétrospectives , Carcinome intracanalaire non infiltrant/imagerie diagnostique , Carcinome intracanalaire non infiltrant/anatomopathologie , Carcinome intracanalaire non infiltrant/chirurgie , Carcinome canalaire du sein/imagerie diagnostique , Carcinome canalaire du sein/anatomopathologie , Carcinome canalaire du sein/chirurgie , Sujet âgé , Adulte , Valeur prédictive des tests , Interprétation d'images assistée par ordinateur/méthodes , Région mammaire/imagerie diagnostique , Région mammaire/anatomopathologie , Région mammaire/chirurgieSujet(s)
Tumeurs du sein , Carcinome basocellulaire , Tumeurs cutanées , Humains , Carcinome basocellulaire/anatomopathologie , Femelle , Tumeurs du sein/anatomopathologie , Tumeurs cutanées/anatomopathologie , Mamelons/anatomopathologie , Carcinome canalaire du sein/anatomopathologie , Sujet âgé , Immunohistochimie , Adulte d'âge moyenRÉSUMÉ
Purpose To determine whether metrics from mean apparent propagator (MAP) MRI perform better than apparent diffusion coefficient (ADC) value in assessing the tumor-stroma ratio (TSR) status in breast carcinoma. Materials and Methods From August 2021 to October 2022, 271 participants were prospectively enrolled (ClinicalTrials.gov identifier: NCT05159323) and underwent breast diffusion spectral imaging and diffusion-weighted imaging. MAP MRI metrics and ADC were derived from the diffusion MRI data. All participants were divided into high-TSR (stromal component < 50%) and low-TSR (stromal component ≥ 50%) groups based on pathologic examination. Clinicopathologic characteristics were collected, and MRI findings were assessed. Logistic regression was used to determine the independent variables for distinguishing TSR status. The area under the receiver operating characteristic curve (AUC) and sensitivity, specificity, and accuracy were compared between the MAP MRI metrics, either alone or combined with clinicopathologic characteristics, and ADC, using the DeLong and McNemar test. Results A total of 181 female participants (mean age, 49 years ± 10 [SD]) were included. All diffusion MRI metrics differed between the high-TSR and low-TSR groups (P < .001 to P = .01). Radial non-Gaussianity from MAP MRI and lymphovascular invasion were significant independent variables for discriminating the two groups, with a higher AUC (0.81 [95% CI: 0.74, 0.87] vs 0.61 [95% CI: 0.53, 0.68], P < .001) and accuracy (138 of 181 [76%] vs 106 of 181 [59%], P < .001) than that of the ADC. Conclusion MAP MRI may serve as a better approach than conventional diffusion-weighted imaging in evaluating the TSR of breast carcinoma. Keywords: MR Diffusion-weighted Imaging, MR Imaging, Breast, Oncology ClinicalTrials.gov Identifier: NCT05159323 Supplemental material is available for this article. © RSNA, 2024.
Sujet(s)
Tumeurs du sein , Carcinome canalaire du sein , Imagerie par résonance magnétique de diffusion , Humains , Femelle , Tumeurs du sein/imagerie diagnostique , Tumeurs du sein/anatomopathologie , Adulte d'âge moyen , Études prospectives , Carcinome canalaire du sein/imagerie diagnostique , Carcinome canalaire du sein/anatomopathologie , Imagerie par résonance magnétique de diffusion/méthodes , Sensibilité et spécificité , Adulte , Région mammaire/imagerie diagnostique , Région mammaire/anatomopathologie , Sujet âgé , Imagerie par résonance magnétique/méthodesSujet(s)
Aisselle , Tumeurs du sein , Traitement néoadjuvant , Noeud lymphatique sentinelle , Femelle , Humains , Protocoles de polychimiothérapie antinéoplasique/usage thérapeutique , Tumeurs du sein/traitement médicamenteux , Tumeurs du sein/anatomopathologie , Tumeurs du sein/imagerie diagnostique , Carcinome canalaire du sein/traitement médicamenteux , Carcinome canalaire du sein/imagerie diagnostique , Carcinome canalaire du sein/anatomopathologie , Carcinome canalaire du sein/chirurgie , Métastase lymphatique/imagerie diagnostique , Lymphoscintigraphie , Radiopharmaceutiques , Noeud lymphatique sentinelle/imagerie diagnostique , Noeud lymphatique sentinelle/anatomopathologie , Biopsie de noeud lymphatique sentinelleRÉSUMÉ
ABSTRACT: We aimed to develop and validate a nomogram based on conventional ultrasound (CUS) radiomics model to differentiate radial scar (RS) from invasive ductal carcinoma (IDC) of the breast. In total, 208 patients with histopathologically diagnosed RS or IDC of the breast were enrolled. They were randomly divided in a 7:3 ratio into a training cohort (n = 145) and a validation cohort (n = 63). Overall, 1316 radiomics features were extracted from CUS images. Then a radiomics score was constructed by filtering unstable features and using the maximum relevance minimum redundancy algorithm and the least absolute shrinkage and selection operator logistic regression algorithm. Two models were developed using data from the training cohort: one using clinical and CUS characteristics (Clin + CUS model) and one using clinical information, CUS characteristics, and the radiomics score (radiomics model). The usefulness of nomogram was assessed based on their differentiating ability and clinical utility. Nine features from CUS images were used to build the radiomics score. The radiomics nomogram showed a favorable predictive value for differentiating RS from IDC, with areas under the curve of 0.953 and 0.922 for the training and validation cohorts, respectively. Decision curve analysis indicated that this model outperformed the Clin + CUS model and the radiomics score in terms of clinical usefulness. The results of this study may provide a novel method for noninvasively distinguish RS from IDC.
Sujet(s)
Tumeurs du sein , Région mammaire , Carcinome canalaire du sein , Nomogrammes , Échographie mammaire , Humains , Femelle , Tumeurs du sein/imagerie diagnostique , Adulte d'âge moyen , Diagnostic différentiel , Échographie mammaire/méthodes , Carcinome canalaire du sein/imagerie diagnostique , Adulte , Région mammaire/imagerie diagnostique , Cicatrice/imagerie diagnostique , Sujet âgé , Reproductibilité des résultats , Études rétrospectives ,RÉSUMÉ
INTRODUCTION: Quality of surgical care is understudied for lobular inflammatory breast cancer (IBC), which is less common, more chemotherapy-resistant, and more mammographically occult than ductal IBC. We compared guideline-concordant surgery (modified radical mastectomy [MRM] without immediate reconstruction following chemotherapy) for lobular versus ductal IBC. METHODS: Female individuals with cT4dM0 lobular and ductal IBC were identified in the National Cancer Database (NCDB) from 2010-2019. Modified radical mastectomy receipt was identified via codes for "modified radical mastectomy" or "mastectomy" and "≥10 lymph nodes removed" (proxy for axillary lymph node dissection). Descriptive statistics, chi-square tests, and t-tests were used. RESULTS: A total of 1456 lobular and 10,445 ductal IBC patients were identified; 599 (41.1%) with lobular and 4859 (46.5%) with ductal IBC underwent MRMs (p = 0.001). Patients with lobular IBC included a higher proportion of individuals with cN0 disease (20.5% lobular vs. 13.7% ductal) and no lymph nodes examined at surgery (31.2% vs. 24.5%) but were less likely to be node-negative at surgery (12.7% vs. 17.1%, all p < 0.001). Among those who had lymph nodes removed at surgery, patients with lobular IBC also had fewer lymph nodes excised versus patients with ductal IBC (median [interquartile range], 7 (0-15) vs. 9 (0-17), p = 0.001). CONCLUSIONS: Lobular IBC patients were more likely to present with node-negative disease and less likely to be node-negative at surgery, despite having fewer, and more frequently no, lymph nodes examined versus ductal IBC patients. Future studies should investigate whether these treatment disparities are because of surgical approach, pathologic assessment, and/or data quality as captured in the NCDB.
Sujet(s)
Carcinome canalaire du sein , Carcinome lobulaire , Cancers du sein inflammatoires , Guides de bonnes pratiques cliniques comme sujet , Humains , Femelle , Carcinome lobulaire/chirurgie , Carcinome lobulaire/anatomopathologie , Adulte d'âge moyen , Cancers du sein inflammatoires/chirurgie , Cancers du sein inflammatoires/anatomopathologie , Carcinome canalaire du sein/chirurgie , Carcinome canalaire du sein/anatomopathologie , Sujet âgé , Guides de bonnes pratiques cliniques comme sujet/normes , Études de suivi , Pronostic , Adhésion aux directives/statistiques et données numériques , Lymphadénectomie , Mastectomie radicale modifiée , Tumeurs du sein/chirurgie , Tumeurs du sein/anatomopathologie , AdulteRÉSUMÉ
A checkpoint protein called the V-domain Ig suppressor of T cell activation (VISTA) is important for controlling immune responses. Immune cells that interact with VISTA have molecules, or receptors, known as VISTA receptors. Immune system activity can be modified by the interaction between VISTA and its receptors. Since targeting VISTA or its receptors may be beneficial in certain conditions, VISTA has been studied in relation to immunotherapy for cancer and autoimmune illnesses. The purpose of this study was to examine the expression levels and interactions between VISTA and its receptors, VSIG3 and PSGL-1, in breast cancer tissues. IHC analysis revealed higher levels of proteins within the VISTA/VSIG3/PSGL-1 axis in cancer tissues than in the reference samples (mastopathies). VISTA was found in breast cancer cells and intratumoral immune cells, with membranous and cytoplasmic staining patterns. VISTA was also linked with pathological grade and VSIG3 and PSGL-1 levels. Furthermore, we discovered that the knockdown of one axis member boosted the expression of the other partners. This highlights the significance of VISTA/VSIG3/PSGL-1 in tumor stroma and microenvironment remodeling. Our findings indicate the importance of the VISTA/VSIG3/PSGL-1 axis in the molecular biology of cancer cells and the immune microenvironment.