The Clinical and Pathological Characteristics That Differentiate Cases With "Low Estrogen Receptor Expression" From Triple-Negative Breast Cancer.

Objective: Estrogen receptor (ER) expression is an immunohistochemical marker that is examined in all invasive breast cancers and has prognostic and predictive value. ER-positive breast cancers refer to those that show positivity for ER at 1% cellular expression or higher. The American Society of Clinical Oncology/College of American Pathologists guidelines suggest using the term "low ER-positive breast cancer" for tumors with ER expression between 1% and 10%. Low ER-positive breast cancers exhibit similarities, in terms of disease-free survival and overall survival rates, to triple-negative breast cancers (TNBCs) rather than ER-positive breast cancers. In this study, our aim was to compare the clinicopathological characteristics of low ER-positive breast cancer cases diagnosed and followed in our clinic with TNBCs. Materials and Methods: A total of 26 cases of low ER-positive breast cancer diagnosed at University of Health Sciences Turkey, Izmir Tepecik Training and Research Hospital between 2010 and 2016 were retrieved from hospital records. The relevant histopathology slides and blocks were retrieved and re-evaluated retrospectively through microscopic examination. Thirteen cases that met the criteria were included in the study. Additionally, a consecutive series of 13 TNBC cases that did not receive neoadjuvant treatment within the same time period were identified. Results: In the low ER-positive group, the presence of tumor necrosis, as well as histological grade, nuclear grade and Ki-67 proliferation index were significantly lower compared to the TNBC group. Ductal carcinoma in situ (DCIS) was significantly more common in the low ER-positive group compared to the TNBC group. There were no significant differences between the two groups in terms of tumor size, histological tumor type, axillary lymph node involvement, tumor margins, peritumoral and intratumoral inflammation, local recurrence, distant metastasis, survival, and other characteristics. Conclusion: Although our study consisted of a small number of cases, some features showed significant differences between low ER-positive breast cancers and TNBCs. Histological and nuclear grades, as well as the presence of a DCIS component, were associated with low ER-positive breast cancer. In contrast, the presence of tumor necrosis, as well as Grade 3 features and a high Ki-67 proliferation index indicated TNBC.

Loss of Nuclear ARID-1A Expressions Is Associated with Hormone Receptor Status in Breast Cancers.

OBJECTIVE: Breast cancer is the most common cancer among women worldwide. Adenine thymine-rich interactive domain 1A (ARIDIA) is a tumor suppressor gene involved in chromatin remodeling and it encodes the ARIDIA protein. Recent studies have shown the loss of ARIDIA protein expression in different carcinomas may have a prognostic significance. In the present study, we aimed to evaluate the interactions between ARIDIA loss and molecular subtypes of breast carcinomas. MATERIALS AND METHODS: ARIDIA expressions were studied in 292 formalin- fixed, paraffin- embedded breast carcinoma specimens and its association with different pathological and clinical parameters was evaluated. RESULTS: Loss of ARIDIA expression was detected in 123 cases. There was no statistically significant association between ARID-1A expression and molecular subtype of breast carcinomas (p=0.110) or HER2 amplification (p=0.909). Contrarily, there was a significant association between ARIDIA expression and presence of estrogen (p=0.047) or progesterone receptors (p=0.023). Besides a statistically significant relationship was found between loss of ARID1A, and the presence of both in situ component (p=0.016) and lymph node metastasis (p=0.001). CONCLUSION: In this study, we have demonstrated that loss of ARID1A expression positively correlates with hormone receptor status as well as tumor aggressiveness.

Randomized Trial Comparing Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at Presentation: Protocol MF07-01.

BACKGROUND: The MF07-01 trial is a multicenter, phase III, randomized, controlled study comparing locoregional treatment (LRT) followed by systemic therapy (ST) with ST alone for treatment-naïve stage IV breast cancer (BC) patients. METHODS: At initial diagnosis, patients were randomized 1:1 to either the LRT or ST group. All the patients were given ST either immediately after randomization or after surgical resection of the intact primary tumor. RESULTS: The trial enrolled 274 patients: 138 in the LRT group and 136 in the ST group. Hazard of death was 34% lower in the LRT group than in the ST group (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.49-0.88; p = 0.005). Unplanned subgroup analyses showed that the risk of death was statistically lower in the LRT group than in the ST group with respect to estrogen receptor (ER)/progesterone receptor (PR)(+) (HR 0.64; 95% CI 0.46-0.91; p = 0.01), human epidermal growth factor 2 (HER2)/neu(-) (HR 0.64; 95% CI 0.45-0.91; p = 0.01), patients younger than 55 years (HR 0.57; 95% CI 0.38-0.86; p = 0.007), and patients with solitary bone-only metastases (HR 0.47; 95% CI 0.23-0.98; p = 0.04). CONCLUSION: In the current trial, improvement in 36-month survival was not observed with upfront surgery for stage IV breast cancer patients. However, a longer follow-up study (median, 40 months) showed statistically significant improvement in median survival. When locoregional treatment in de novo stage IV BC is discussed with the patient as an option, practitioners must consider age, performance status, comorbidities, tumor type, and metastatic disease burden.

Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes.

OBJECTIVE: To evaluate the long-term results of tumorectomy and concomitant bilateral oncoplastic reduction mammoplasty (ORM) for early stage breast cancer patients with macromastia in terms of local disease control and long-term oncological results. PATIENTS AND METHOD: Data of 82 patients with macromastia undergoing ORM for breast cancer between 1996 and 2011 were retrospectively examined and evaluated with regard to oncological results. RESULTS: The median age was 50 years. The median follow-up was 121 months (range 28-212 months). The median breast volume was 1402 cm3 and the median weight of excised breast material was 679 g. The median surgical margin was 16 mm. Ten-year local recurrence rate was 8.7%. The 10-year overall survival rate was 82.2% and the disease-free survival rate was 73.2%. Early and late complication rates were 12.2% and 14.6%, respectively. CONCLUSIONS: From the standpoint of local disease control and long-term observation, ORM can be considered a very safe and acceptable treatment for early stage breast cancer in women with macromastia.

Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: long term aesthetic, functional and satisfaction outcomes.

AIM OF THE STUDY: Despite the increase in studies concerning oncoplastic reduction mammoplasty (ORM), data showing long-term aesthetic and patient satisfaction for ORM in patients with macromastia remain limited. Therefore, this study evaluated the long-term results of tumorectomy and concomitant bilateral ORM for early-stage breast cancer patients with macromastia in terms of cosmesis, patient satisfaction, and functional outcomes. MATERIAL AND METHODS: Retrospective data of patients with macromastia undergoing ORM for breast cancer between 1996 and 2011 were examined and evaluated regarding the aesthetic results, patient satisfaction, and functional outcomes. RESULTS: The median age of the 82 patients was 50 years. The median follow-up was 120 months (range: 28-212 months). The median breast volume was 1402 cm(3), and the median weight of the excised breast material was 679 g. A good or excellent evaluation of the cosmetic outcome was as follows: self-evaluation: 84.1% at the early-stage, 80.3% at the later stage; panel evaluation: 75.4% at the late-stage. Median patient satisfaction rates were 9.1% for early-stage disease and 8.8% for late-stage disease. Reduced mobility and intertrigo improved by three-fold during the post-operative period. CONCLUSIONS: ORM for early-stage breast cancer in women with macromastia results in good cosmesis in both the early-stage and long-term, and is quite acceptable for use in patients. Patients reacted favorably to the prospect of having their breast cancer and macromastia treated in a single session, and positive results continued over the long-term.

The effect of phenol concentration on the treatment of pilonidal sinus disease: Early results of a prospective randomized study.

OBJECTIVE: Our hypothesis was that a low concentration (30%) of phenol would be more effective than a high concentration (80%) in the treatment of pilonidal disease. The purpose of our study was to compare the effects of high and low doses of liquid phenol in the treatment of pilonidal disease. SUMMARY OF BACKGROUND DATA: In the treatment of the pilonidal disease, the phenolization technique and concentration of the phenol solution is not well defined. METHODS: Consecutive patients being treated for pilonidal disease with high and low concentrations of phenol were included in this randomized prospective study. The demographic data, pilonidal disease characteristics, and results of phenol application were examined. RESULTS: Of 101 subjects, 52 were treated with 80% phenol while 49 were treated with 30% phenol. The mean observation period was approximately 1 year. The total recovery rate was higher among the 80% phenol group (P: 0.046). The recovery period, the period of leave from work, and complication rates were similar in both groups (p: 0.414, 0.328, 0.256). Also, in the Likert-type survey administered by validated methods, there was no difference in the degree of satisfaction (P: 0.494). CONCLUSION: The low concentrations of phenol did not achieve faster recovery, faster return to work, or less complications in the treatment of pilonidal disease. An 80% concentration of phenol should be used for a higher rate of recovery.

Metaplastic Breast Carcinoma: Analysis of Clinical and Pathologic Characteristics - A Case Series.

OBJECTIVE: Metaplastic breast cancer (MBC) is a rare type of breast cancer that is considered to be clinically aggressive. The clinical significance and prognostic risk factors of MBC are limited. This study comprises a retrospective analysis of the clinical and pathologic findings of a series of patients treated for MBC. MATERIALS AND METHODS: The files of 657 patients who underwent surgery because of breast cancer at our clinic were examined and the data found on 11 patients who were diagnosed as having MBC were analyzed. RESULTS: With a median age of 56 years, all patients were postmenopausal and presented with a palpable mass on physical examination. Symptoms of ulceration and skin involvement were seen in only one patient. Eight patients were diagnosed as having squamous cell carcinoma (SCC), and 3 had both SCC and osseous differentiation. The median diameter was 3.8 cm (max. 14 cm; min. 1.5 cm). Lymph node metastasis was detected in 5 (45%) patients. Progesterone (PR) and estrogen (ER) were both negative in 11 (100%) patients and 10 (90.9%) patients, respectively, and CerbB2 was negative in 7 (63.6%) patients. Patients were followed up for a median period of 15 months (range, 6-40 months); at the end of which, 10 patients survived and one died of cardiac arrest at 7 months post-operatively. No instances of local recurrence or distant organ metastasis were found in any patients. The overall patient survival rate was 90%. CONCLUSION: There is no consensus on the clinical significance or best treatment approach for metaplastic carcinoma. In our study, patients with MBC were of advanced age, had tumors with large margins, high negativity for hormone receptors, and moderate- to well-differentiated histology.

How do surgeons approach breast cancer surgery in Turkey? A national survey.

BACKGROUND: The aim of this study was to investigate the experience, practice and approaches of general surgeons in relation to the treatment of breast cancer in Turkey. METHODS: A survey was conducted between November 2012 and February 2013 with 453 general surgeons who claimed to perform breast surgery. Initial and most preferred approaches for breast cancer surgery and demographic features of participants were questioned. Initial approaches of surgeons for a suspected breast mass were assessed with a clinical scenario. RESULTS: A total of 12.6 % of practicing general surgeons in Turkey responded to the survey. A multidisciplinary assessment was employed by 57.2 % of participants. The most frequently used diagnostic tool was needle biopsies (64.9 %) and the most frequently performed surgery for early stage cancers was breast-conserving surgery (72.2 %). The initial approach for locally advanced breast cancer was neoadjuvant chemotherapy (59.8 %) and mastectomy for metastatic cancer (22.7 %). Sentinel lymph node biopsies were utilized by 59.2 % of participants by different methods in appropriate cases. Oncoplastic breast surgery was performed by 9.0 % of participants, frequently or constantly. The surgeons' initial approaches for the clinical scenario were imaging (56.7 %) and biopsy (40.6 %). CONCLUSIONS: Although there are efforts to improve up-to-date approaches towards breast cancer surgery by surgeons, currently there are significant inadequacies for evidence-based medicine practices.

Comparison of Clinical and Pathological Differences of Breast Cancer Patients under 35 and above 55 Years of Age.

OBJECTIVE: In this study, we aimed to evaluate the clinical, pathologic and management differences between breast cancer patients under 35 years of age and postmenopausal patients above 55 years of age. MATERIALS AND METHODS: Patients who were operated on for breast cancer between November 2003 and March 2013 in our hospital were retrospectively analyzed. Patients were separated into two Groups according their age; Group 1 (<35 years) and Group 2 (>55 years). RESULTS: 94 patients with breast cancer, 45 patients in Group 1 and 49 patients in Group 2, were included in the study. The mean follow-up was 51 (19-121) months and 50 (19-120) months in Groups 1 and 2, respectively. Stages of breast cancer at the time of diagnosis were similar between the two groups. The groups were similar in terms of rates of re-excision (p=0.42), local recurrence (p=0.34) and solid organ metastases (p=0.182). The number of oncoplastic and reconstructive procedures were higher in Group 1 (p=0.04). Regarding pathological results, the rate of grade 3 tumors, those with Ki-67>12 and triple negative breast cancer were found to be higher in Group 1. In addition, the number of patients receiving chemotherapy was significantly higher in Group 1 (p=0.03). CONCLUSION: Oncologic results were similar between young patients and postmenopausal patients. Nevertheless, tumor biology was found to be worse in young patients. In addition, oncoplastic and reconstructive approaches were significantly higher in young patients.