Impact of Molecular Profiling of Breast Cancer on the Rate of Locoregional Recurrence in Young Versus Old Female Patients.

Background Breast cancer (BC) is diverse regarding its natural history and treatment responses. The traditional histopathological classification is unable to confine this diverse clinical heterogeneity. Classically, prognosis and treatment response are influenced by factors including histological grade, lymph node status, and tumour size. Recently, research has diverted from histological classification towards molecular classification. We aim to analyse the locoregional recurrence of breast cancer incidence following surgery across the different molecular subtypes as well as relation to age. Materials and methods Female patients diagnosed with a locoregional recurrence of breast carcinoma in 2012-2014 were identified from our centre histology department. We only included stage I-III patients who were previously treated with surgery achieving negative surgical margins and later developed locoregional recurrence during our study period. These patients were subdivided by age into old (≥40 years old) and young (<40 years old) groups according to their initial diagnosis age. Furthermore, they were categorised according to the molecular subtype of their primary tumour. Results Our study included 184 patients (124 designated to the old age group, 60 to the young age group). In the young group, recurrence occurred after a mean of 4.3 years and the range was one to 23 years, while in the old group, the mean was 3.8 years, and the range was one to 14 years. The most primary cancer subtype recorded was triple-negative (41.85%): 50 old patients and 27 young. Next was the Her-2/neu enriched subtype (27.72%): 35 old patients and 16 young, following this was luminal A subtype (21.19%): 27 old and 12 young. Last was the luminal B subtype (9.24%): 12 old patients and five young. Conclusions To conclude, in our series, the most common molecular subtype found in the recurrent cases was the luminal negative subtypes, with a relatively similar pattern across both age groups. The results of this study can be used as a basis for large prospective studies in our centre to further analyse the effect of molecular subtyping on the recurrence rates of BC.

Significance of Serum Survivin and -31G/C Gene Polymorphism in the Early Diagnosis of Breast Cancer in Egypt.

BACKGROUND: Breast cancer is one of the most relevant malignancies among women. Molecular abnormalities in promotor region of survivin gene may account for overexpression of survivin and increased breast cancer risk. This study aimed to explore the potential association between survivin promotor gene -31G/C single nucleotide polymorphism (rs9904341) and its serum level alteration on one hand, and the risk of breast cancer in Egyptian patients on the other hand. It also aimed to assess the usefulness of survivin as an early noninvasive diagnostic biomarker and in breast cancer staging. PATIENTS AND METHODS: A total of 135 patients with physically and pathologically confirmed breast cancer and 40 unrelated control subjects as well as 40 patients with benign breast mass were recruited from the early detection unit at National Cancer Institute, Cairo University. Genotyping was performed using allelic discrimination probes by real-time quantitative PCR and serum survivin by enzyme-linked immunosorbent assay. RESULTS: The minor allele C of -31G/C survivin single nucleotide polymorphism was more frequent in breast cancer patients (19.3%) compared to the control group (7.5%). Furthermore, subjects with the GC + CC genotype were at increased risk of breast cancer compared to the GG genotype of the control group and also the benign group. Moreover, those patients exhibited higher serum levels of survivin compared to GG genotype. There was also significant elevation of serum survivin in different breast cancer stages. CONCLUSION: Genetic variation in -31G/C of the survivin gene may contribute to the disposition of breast cancer in the Egyptian population. Serum survivin alteration played a pivotal role in the pathogenesis of breast cancer.

Predictive factors of local recurrence and survival following primary surgical treatment of phyllodes tumors of the breast.

BACKGROUND AND PURPOSE: The phyllodes tumor is characterized by its tendency to recur locally and occasionally to metastasize. Local recurrence and death from metastases are occasional, but consistent, theme in reports of patients with phyllodes tumors (PTs). The aim of this study was to determine parameters that influence outcome in this uncommon neoplasm. PATIENTS AND METHODS: Data from 79 patients with phyllodes tumors were reviewed retrospectively, reclassifying the pathological material using the World Health Organization (WHO) criteria. RESULTS: The median age of the patients was 42 years with a range from 16 to 70 years. The tumor size ranged from 2.5 to 24 cm, with a median of 11 cm. Based on the criteria proposed by WHO, 31 cases were benign tumors (39.2%), 27 borderline tumors (34.2%), and 21 malignant tumors (26.6%). The median duration of follow up was 60 months ranging from 3 to 138 months. Following local excision, the local recurrence rates were 14.3%, 50%, and 75% in patients with benign, borderline, and malignant tumors; respectively, while after wide local excision the local recurrence rates were 0%, 36.3% and 40%; respectively. Whereas, 0%, 8.3%, and 8.3% of patients with benign, borderline and malignant tumors; respectively, locally recurred after mastectomy. The 5-year disease free survival was 63.3% after local excision, 70% after wide local excision, and was 87% after mastectomy (p=0.04). Distant metastases (DM) were recorded in 10 patients (12.6%) after a median duration of 14 months (range 3- 36). All cases with DM died after an average of 5 months with a range of 1 to 11 months. Distant metastases developed in 3.2%, 11.1%, and in 28.6% of patients with benign, borderline and malignant tumors; respectively. The 5-year survival with no evidence of disease was 90% for the patients with benign tumors compared to 69% for borderline and 61% for malignant PTs (p= 0.02). CONCLUSIONS: The histotype of phyllodes tumors and resection margins were the principal determinants of local recurrence and distant metastases. Complete surgical excision by either wide local excision or mastectomy if necessary is important in the primary surgical treatment of phyllodes tumors.

Immediate breast reconstruction with expander assisted latissimus dorsi flap after skin sparing mastectomy.

BACKGROUND AND PURPOSE: The latissimus dorsi myocutaneous flap (LDMF) used to be the standard practice for breast reconstruction; however, with the increased use of tissue expanders and the development of the transverse rectus-abdominis myocutaneous flap for autologous tissue breast reconstruction, its use has decreased. To reassess the role of the LDMF in breast reconstruction, a prospective study was performed to evaluate women who had a skin sparing mastectomy followed by immediate reconstruction with a latissimus dorsi flap and tissue expander implant. PATIENTS AND METHODS: Twenty-five women with early breast cancer underwent immediate latissimus dorsi myocutaneous flaps with tissue expander after skin sparing mastectomy. The oncologic safety of skin sparing mastectomy, the postoperative aesthetic results and complications were evaluated. RESULTS: Between May 2003 and April 2005, 25 consecutive women diagnosed with breast cancer underwent skin sparing mastectomy and expander assisted immediate latissimus dorsi breast reconstruction. Their median age was 42 years, ranging from 34 to 48 years. The procedure duration ranged from 2.5 to 6 hours, with a median of 3.9 hours, however, expansion was completed by 4 months (range 1 to 8 months). Patients were discharged 7 days after surgery with a range of 5 to 15 days. The complication rate was low, manifesting with skin flap necrosis in 12%, wound infection in 4%, and port site extrusion in 4%. There was no flap loss. With the exception of seroma formation, the donor site morbidity was low (seroma 40%, hematoma 4%, back pain 8%, and limited arm movement 4%). No local recurrence was recorded. The aesthetic result of surgery was rated as excellent in 20%, good in 60%, fair in 24%, and poor in 4% of cases. The duration of post-operative follow up was 14.7 months, ranging from 6 to 24 months. CONCLUSIONS: Skin sparing mastectomy and immediate breast reconstruction is an oncologically safe technique. The use of latissimus dorsi myocutaneous flap with tissue expansion has proved to be an effective and aesthetic method of immediate breast reconstruction after skin sparing mastectomy.

Feasibility of sentinel lymph node detection in nodular thyroid disease.

BACKGROUND AND PURPOSE: Sentinel lymph node biopsy has been proven to be successful and accurate in predicting the nodal status in melanoma and breast cancer. Occult lymph node metastases are common in well differentiated thyroid cancer (WDTC). Although the prognostic significance of these occult lymph node metastases remains controversial, identifying these patients may help direct therapy. The purpose of the study was to assess the technical feasibility and the safety of the sentinel lymph node biopsy in uni-nodular thyroid disease. METHODS: Patients of previously untreated benign solitary thyroid nodule, diagnosed preoperatively by fine-needle aspiration cytology without any palpable cervical lymph node were prospectively studied. The nodule was injected with isosulfan blue vital dye. Blue stained lymphatics were traced. Then, hemithyroidectomy was performed. RESULTS: A total of 30 patients underwent sentinel lymph node biopsy; lymphatics were observed in 23 patients and sentinel lymph nodes were found in 18. In 5 patients, blue stained lymphatics were traced to the outside of the central compartment but no sentinel lymph node was identified. Sentinel lymph nodes were located in the central compartment in 14 cases, in the lateral compartment in 3 cases and in one patient 2 sentinel lymph nodes were found in both the central and the lateral compartments. Overall detection of sentinel lymph nodes was possible in 60% of cases. There were no intra or postoperative complications. CONCLUSIONS: The role of sentinel lymph node biopsy has yet to be determined in the thyroid setting. Certainly the technique can be performed safely, but its accuracy needs further refinement and investigation on larger series of patients before it can be recommended in the routine management of thyroid neoplasia.