Clinicopathological characteristics and long-term prognosis of screening detected non-palpable breast cancer by ultrasound in hospital-based Chinese population (2001-2014).

PURPOSE: The mainstay modality of breast cancer screening in China is the hospital-based opportunistic screening among asymptomatic self-referred women. There is little data about the ultrasound (US) detected non-palpable breast cancer (NPBC) in Chinese population. METHODS: We analyzed 699 consecutive NPBC from 1.8-2.3 million asymptomatic women from 2001 to 2014, including 572 US-detected NPBC from 3,786 US-positive women and 127 mammography (MG) detected NPBC from 788 MG-positive women. The clinicopathological features, disease-free survival (DFS) and overall survival (OS) were compared between the US- and MG-detected NPBC. Prognostic factors of NPBC were identified. RESULTS: Compared to MG, US could detect more invasive NPBC (83.6% vs 54.3%, p<0.001), lymph node positive NPBC (19.1% vs 10.2%, p=0.018), lower grade (24.8% vs 16.5%, p<0.001), multifocal (19.2% vs 6.3%, p<0.001), PR positive (71.4% vs 66.9%, p=0.041), Her2 negative (74.3% vs 54.3%, p<0.001), Ki67 high (defined as >14%, 46.3% vs 37.0%, p=0.031) cancers and more NPBC who received chemotherapy (40.7% vs 21.3%, p<0.001). There was no significant difference in 10-year DFS and OS between US-detected vs MG-detected NPBC, DCIS and invasive NPBC. For all NPBC and the US-detected NPBC, the common DFS-predictors included pT, pN, p53 and bilateral cancers. CONCLUSION: US could detect more invasive, node-positive, multifocal NPBC in hospital-based asymptomatic Chinese female, who could achieve comparable 10-year DFS and OS as MG-detected NPBC. US would not delay early detection of NPBC with improved cost-effectiveness, thus could serve as the feasible initial imaging modality in hospital-based opportunistic screening among Chinese women.

HER2 amplification level is not a prognostic factor for HER2-positive breast cancer with trastuzumab-based adjuvant treatment: a systematic review and meta-analysis.

BACKGROUND: Trastuzumab-based therapy is a standard, targeted treatment for HER2-positive breast cancer in the adjuvant setting. However, patients do not benefit equally from it and the association between HER2 amplification level and patients' survival remains controversial. A systematic review and meta-analysis was conducted by incorporating all available evidence to evaluate the association between disease free survival (DFS) and HER2 amplification level. RESULTS: Three cohort studies involving 1360 HER2-positive breast cancer patients stratified by HER2 amplification magnitude were eligible for meta-analysis. The combined HRs for DFS were 1.05 (95% CI: 0.80-1.36, p = 0.74) and 0.97 (95% CI: 0.73-1.29, p = 0.83) for HER2 gene copy number (GCN) and HER2/CEP 17 ratio. No evidence of heterogeneity or public bias was found. METHODS: Databases including PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL), were searched for eligible literature. HER2 amplification level was evaluated by fluorescence in situ hybridization (FISH) in terms of gene copy number (GCN) and HER2/CEP17 ratio. Hazard ratios (HRs) for DFS with 95% confidence interval (CI) according to the amplification level of HER2 were extracted. The outcomes were synthesized based on a fixed-effects model. CONCLUSIONS: HER2 amplification level is not a prognostic factor for HER2-positive breast cancer with trastuzumab-based targeted therapy in the clinical adjuvant setting.

Prognosis of subtypes of the mucinous breast carcinoma in Chinese women: a population-based study of 32-year experience (1983-2014).

PURPOSE: The heterogeneous nature of the mucinous breast cancer (MBC), with its pure (PMBC) and mixed subtypes (MMBC), calls for precise prognosis assessment. METHODS: We analyzed 197 consecutive MBC patients, including 117 PMBC and 80 MMBC, who were treated from 1983 to 2014. The clinicopathological features, treatment choice, disease-free survival (DFS) and overall survival (OS) were compared among PMBC, MMBC and MMBC subgroups. Prognostic factors of PMBC and MMBC were identified. RESULTS: Compared to PMBC, MMBC had more lymph node metastasis (p = 0.043), Her2 positivity (p = 0.036), high Ki-67 index (defined as>20%, p = 0.026) and anti-Her2 targeted therapy (p = 0.016). The 5-year DFS of PMBC and MMBC were 90.4% and 86.2%, whereas the 5-year OS were 99.0% and 98.7%. No significant difference was found in DFS or OS among all MBC subtypes. High Ki-67 (p = 0.020) appeared as DFS factor in PMBC, while anti-Her2 targeted therapy (p = 0.047) as the DFS predictors in MMBC. CONCLUSION: MMBC manifested similar 5-year survival to PMBC in Chinese woman, suggesting that intra-tumoral heterogeneity might not interfere with MBC short-term prognosis.

[Analysis of prognostic factors related to triple-negative breast cancer].

OBJECTIVE: To investigate the prognostic factors related to triple-negative breast cancer (TNBC) by analyzing clinicopathologic characteristics, treatment and prognosis. METHODS: Three hundred and five TNBC patients treated between January 2004 and December 2011 were enrolled and retrospectively reviewed with Kaplan-Meier and Cox proportional hazards models. All patients were females and the age onset were 24-82 years old (the median were 50 years old). RESULTS: The follow-up period was 1 to 114 months, with median 38 months. The 5-year disease free survival (DFS) rate was 68% and overall survival (OS) rate 75%. The peak risk of recurrence occurs within the first 2-3 years after initial treatment of the disease, but distant relapse after this time is much less common. Survival analysis showed that surgery type (χ(2) = 4.030, P = 0.045), tumor grade (χ(2) = 8.000, P = 0.046), lymph-vascular invasion (χ(2) = 10.386, P = 0.001) and lymph node stage (χ(2) = 119.36, P = 0.000), TNM stage (χ(2) = 65.961, P = 0.000) and treatment plan (χ(2) = 28.371, 21.874, 32.163, all P = 0.000) were statistically related to DFS; while age (χ(2) = 10.226, P = 0.006), lymph-vascular invasion (χ(2) = 18.881, P = 0.000), lymph node stage (χ(2) = 98.958, P = 0.000), TNM stage (χ(2) = 65.342, P = 0.000) and type of treatment (χ(2) = 17.862, 18.708, 31.921, all P = 0.000) were related to OS. The lymph nodes stage was prognostic factor related to both DFS and OS. CONCLUSIONS: TNBC was characterized by poor prognosis and rapid progression. The lymph nodes metastatic status was the most important prognostic factor of TNBC.

[Comparative analysis of early diagnostic tools for breast cancer].

OBJECTIVE: Mammography is the principle imaging modality used for early diagnosis of breast cancer in Western countries. It has not been well-established whether this Western diagnostic modality is adoptable for Chinese women. The aim of this study was to evaluate the respective accuracy of the common diagnostic tools for breast cancer including history-taking, physical examination, ultrasound and mammography. METHODS: Clinical presentation and investigations for consecutive patients undergoing history-taking, physical examination, ultrasound, mammography and pathological assessment at Peking Union Medical College Hospital were prospectively recorded between April 2010 and September 2011. Breast cancer high-risk factors acquired by history-taking were input into the risk assessment model established previously by Eleventh Five Year Key Programs for Science and Technology Development of China (Grant No. 2006BAI02A09) and classified into low-, medium-, high- and extremely high-risk groups. The low- and medium-risk groups were defined as test negative, while the high- and extremely high-risk groups were defined as test positive. Each mammogram and ultrasound was reported prospectively using a five-point reporting scale of the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS). Clinical data were compared with pathological findings. Sensitivity, specificity, positive predictive value (PRV), negative predictive value (NPV) and accuracy of respective diagnostic methods were calculated and compared. The patients were divided into two groups, above and below 50 years of age for subgroup analysis. RESULTS: A total of 1468 patients (1475 breast lesions) constituted the study population. The median age was 44 (range 13 - 92) years. Five hundred and fifty-one patients were diagnosed as breast cancer. The median age at diagnosis was 51 years and breast cancer peaked in the age group of 40 - 60 years. The sensitivity of risk assessment model, physical examination, ultrasound and mammogram was 47.5%, 86.2%, 89.8% and 79.3%, respectively; specificity was 68.8%, 83.3%, 81.0% and 88.7%, respectively; PRV was 47.6%, 75.5%, 73.8% and 80.8%, respectively; NPV was 68.8%, 91.0%, 93.0% and 87.8%, respectively; and accuracy was 60.9%, 84.4%, 84.3% and 85.2%, respectively. Further subgroup analysis demonstrated that age is an important factor influencing the sensitivity and specificity of physical examination, ultrasound and mammography. CONCLUSIONS: Ultrasound is more sensitive than mammography for early diagnosis of breast cancer in Chinese women and should be routinely used as a first-line diagnostic tool. Only a single diagnostic method is not enough sometimes and combined examination is needed for some high-risk populations.

Diabetic mastopathy mimicking breast cancer: two case reports.

Diabetic mastopathy (DMP) is a benign fibrous disease of the breast. DMP is closely associated with along-standing history of insulin-dependent diabetes mellitus and often demonstrates a palpable, hard, and nontender mass similar to breast cancer. In our study, excisional biopsy was performed for diagnosis in both patients. DMP is an uncommon benign fibrous disease of the breast that is difficult to differentiate from breast cancer by clinical examination. Breast ultrasonography and mammography are recommended. Core biopsy should be performed if the lesions become clinically or radiologically suspicious. Excisional biopsy should be performed if malignancy cannot be excluded. Regarding mastectomy, we think that the patient's preference is very important; physicians can never make decisions for patients no matter how certain we are about nonmalignancy.

[Diagnosis and treatment of occult breast cancer: report of 23 cases].

OBJECTIVE: To explore the presenting clinical features, management approach and treatment outcomes for occult breast cancer. METHODS: Twenty-three patients with occult breast cancer presenting with axillary nodal metastases treated in our department between 1986 and 2007 were included in this study. The clinicopathological, imaging and follow-up data of the 23 cases were retrospectively analyzed. RESULTS: All patients were female. The mean age of diagnosis was 57.7 years with a range of 27 - 73 years. The mean follow-up was 15.70 months (range 1 - 62 months). Eight cases in 17 patients were positive by breast ultrasound, three cases in 9 patients were positive by mammography, one case in 2 patients was positive by breast MRI. 20 patients underwent modified radical mastectomy and three patients did not receive the mastectomy treatment. 16 patients had chemotherapy, four patients had radiotherapy, two patients had both chemotherapy and radiotherapy. Two patients had pulmonary metastasis, one patient had recurrence of axillary nodes, pulmonary metastasis and bone metastasis during follow-up. CONCLUSIONS: A normal check before operation to exclude a cancer of other origin can help to diagnose occult breast cancer. The breast must be treated. Axillary nodal dissection and mastectomy, or breast conservation with radiation therapy alone can be considered as a management option.

Pure mucinous carcinoma of the breast: a clinicopathologic analysis with 56 patients.

OBJECTIVE: To assess recent trends and prognostic features in the treatment of pure mucinous carcinoma (PMC) of the breast. METHODS: Fifty-six patients diagnosed with PMC of the breast in our hospital from December 1982 to June 2008 were included. We evaluated the general information and tumor characteristics of the patients, examined the relationship between these factors and prognosis. Fisher's exact test was applied to analyze tumor characteristics. RESULTS: The mean age of the patients was 53.7 years. The majority of the patients presented with early stage disease. Tumor size was found not a significant prognostic factor in this study. Mean follow-up period was 39 months and no breast cancer-related deaths were identified in the patient cohort. CONCLUSIONS: PMC of the breast has a favorable prognosis. Tumor size does not appear to significantly impact survival.

[Dose dense chemotherapy in the postoperative adjuvant treatment for breast cancer].

OBJECTIVE: To investigate the safety and feasibility of dose dense chemotherapy in the postoperative adjuvant treatment for breast cancer. METHODS: The data of 114 breast cancer patients treated with adjuvant dose dense chemotherapy was retrospectively analyzed. RESULTS: 114 breast cancer patients received postoperative adjuvant dose dense chemotherapy from Jan. 2004 to March 2005. The patients were treated with different regimens according to their recurrence risk: 43 with paclitaxel + epirubicin (PE), 8 with taxotere + epirubicin (TE), 36 with cyclophosphamide + epirubicin + 5-Fu ( CEF) and 27 with epirubicin +5-Fu (EC). Totally, 111 patients except 3 completed the dose dense chemotherapy smoothly. Major toxicities severer than grade III included: neutropenia in 6.3% of the patients, nausea and vomit in 11.7%, peripheral neuropathy in 3.6%. CONCLUSION: Postoperative adjuvant dose dense chemotherapy for breast cancer patient is feasible and safe, but the long-term outcome still needs further observation.

[Application of breast conservative therapy in breast cancer patients with nipple discharge].

OBJECTIVE: To study the feasibility of breast conserving treatment in breast cancer patients with nipple discharge. METHODS: Retrospective analysis were carried out in 7 cases of breast cancer patients with nipple discharge who were treated by central segmental resection with latissimus dorsi myocutaneous transfer. RESULTS: No flap necrosis is happened, and cosmetic outcome was excellent in all 7 patients. Average follow-up was 7 months, there was no local recurrence and distant metastasis. CONCLUSION: Central segmental resection with latissimus dorsi myocutaneous transfer as the local treatment strategy for breast cancer patients with nipple discharge is feasible and safe.