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1.
Medicine (Baltimore) ; 99(33): e21736, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872060

RESUMO

RATIONALE: Pilot studies have reported that patients with systemic lupus erythematosus (SLE) appear more likely to develop into neoplasia, especially lymphatic hyperplasia diseases. To our knowledge, this is the first case report of the concomitant onset of SLE and primary breast diffuse large B-cell lymphoma (PB-DLBCL). PATIENT CONCERNS: We reported an unusual case of the occurrence of primary breast diffuse large B-cell lymphoma in a 25-year-old female patient who had been diagnosed with SLE and treated with immunosuppressive drugs for about 4 years. She presented a 7-week history of a painless mass above the left breast and no history suggestive of any nipple discharge, fever, and weight loss. DIAGNOSIS: Ultrasonography of the breast showed that there was 1 mass in the left breast. After breast mass surgical resection, histopathological examinations were performed and revealed that it was primary breast diffuse large B-cell lymphoma. INTERVENTIONS: Treatment strategy with vincristine and dexamethasone was used to improve symptoms. However, the patient's renal function deteriorated and the blood potassium rose continuously and she and their family members refused the follow-up treatments. OUTCOMES: The patient died 8 months after she was discharged from the hospital. LESSONS: PB-DLBCL is a rare occurrence in SLE patients. Therefore, a careful examination is very important in SLE cohort, as activity of the disease and malignancy may mimic each other. Meanwhile, when symptoms cannot be explained or insensitive to treatment, the occurrence of malignant tumors must be highly considered.


Assuntos
Neoplasias da Mama/complicações , Mama/patologia , Falência Renal Crônica/etiologia , Lúpus Eritematoso Sistêmico/complicações , Linfoma Difuso de Grandes Células B/complicações , Adulto , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Evolução Fatal , Feminino , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/terapia , Radiografia , Ultrassonografia
2.
Anticancer Res ; 40(10): 5883-5893, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988919

RESUMO

BACKGROUND/AIM: Somatic mutations were investigated in 21 patients with postmenopausal estrogen receptor (ER)-positive and human epidermal growth factor receptor-2 (HER-2)-positive (ER+HER2+) breast cancer (BC) treated with neoadjuvant letrozole and lapatinib, to identify their distinct molecular landscape. PATIENTS AND METHODS: We used tissue samples of 21 patients from phase II Neo ALL-IN cohort, and somatic alterations were examined using targeted exome sequencing performed in Foundation Medicine, Inc. (FMI). RESULTS: TP53 (61.9%) and PIK3CA (57.1%) were the two most frequently mutated genes that were inter-correlated (p=0.026). They were associated with unfavorable clinical outcomes, particularly when accompanying PIK3CA mutations at exon 9 in helical domains. Meanwhile, MLL2 alteration was negatively associated with mutations of TP53 or PIK3CA, and it tended to be present in patients with low KI-67 levels and no initial nodal involvement. Moreover, patients with MLL2 mutations numerically showed more favorable overall response rates (ORR) (80% vs. 56.2%) and better 5-year event-free survival (EFS) rates (100% vs. 87.5%) compared to the wild-type. CONCLUSION: Mutations in TP53 and PIK3CA hotspot at exon 9 may be potential negative predictors of ER+HER2+ BC treated with neoadjuvant letrozole and lapatinib, while MLL2 inactivating mutation might confer therapeutic benefit in these patients.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Classe I de Fosfatidilinositol 3-Quinases/genética , Proteínas de Ligação a DNA/genética , Proteínas de Neoplasias/genética , Proteína Supressora de Tumor p53/genética , Idoso , Biomarcadores Tumorais/genética , Mama/efeitos dos fármacos , Mama/patologia , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Receptor alfa de Estrogênio/genética , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Lapatinib/administração & dosagem , Letrozol/administração & dosagem , Pessoa de Meia-Idade , Mutação/genética , Intervalo Livre de Progressão , Receptor ErbB-2/genética
3.
Am Surg ; 86(9): 1088-1090, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32816560

RESUMO

BACKGROUND: The management of flat epithelial atypia (FEA) on core needle biopsy remains controversial. The upstaging rates after surgical excision are variable. In this study, we seek to determine the upstaging rate of FEA at our institution. METHODS: Patients with a diagnosis of FEA were identified from the institution's pathology database from 2009 to 2018. Patients were included in the study if FEA alone, without atypia or cancer, was identified on core needle biopsy. Patient demographics, imaging, management, and pathology characteristics were obtained. Statistical analysis performed using IBM SPSS 26.0 (Armonk, NY, USA). RESULTS: FEA was diagnosed on core needle biopsy in 235 patients from 2009 to December 2018. Forty-eight patients met the inclusion criteria. The majority of patients presented with calcifications on mammogram (n = 21, 64%) with the remainder as masses (n = 6, 18%) or architectural distortion (n = 6, 18%). Of those, 15 (31%) patients declined surgical excision, of which none developed cancer over a mean follow-up of 4.4 years. Of the 33 (69%) patients undergoing excisional biopsy, 17 (52%) confirmed FEA, 11 (33%) had benign findings, and 3 (9%) demonstrated atypical ductal hyperplasia on final pathology. One (3%) case revealed ductal carcinoma in situ (DCIS) and 1 (3%) was upgraded to invasive cancer for an overall upstaging rate of 4% (2/48). After a mean follow-up of 3.4 years, none of the excisional biopsy patients developed invasive breast cancer. Adjuvant therapy was used in the cases of DCIS and invasive cancer; however, chemoprevention with raloxifene or tamoxifen was not chosen by any of the remaining patients. CONCLUSION: In our cohort, expectant management of FEA alone appears to be a safe option as our upstaging rate to DCIS or invasive cancer for FEA diagnosed on core biopsy was only 4%. Our study suggests that close follow-up is a safe and feasible option for pure FEA without a radiographic discordance found on core biopsy.


Assuntos
Biópsia/métodos , Neoplasias da Mama/patologia , Mama/patologia , Estadiamento de Neoplasias/métodos , Lesões Pré-Cancerosas/patologia , Biópsia com Agulha de Grande Calibre , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 99(30): e20797, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791669

RESUMO

To evaluate the value of a breast computed tomography (CT) (B-CT) in assessing breast density, pathologies and implant integrity in women with breast implants.This retrospective study was approved by the local ethics committee. B-CT images of 21 women with implants (silicone/saline; 20 bilateral, 1 unilateral) who underwent opportunistic screening or diagnostic bilateral B-CT were included. Breast density, implant integrity, extensive capsular fibrosis, soft tissue lesions and micro-/macrocalcifications were rated. In 18 of the 21 women, an additional ultrasound and in two patients breast magnetic resonance imaging was available for comparison. The average dose was calculated for each breast using verified Monte Carlo simulations on 3D image data sets.Breast density was nearly completely fatty (ACR a) in two patients, scattered fibroglandular (ACR b) in five, heterogeneously dense (ACR c) in ten and very dense (ACR d) in four women. In three women showed a unilateral positive Linguine sign indicative of an inner capsule rupture. Extensive capsular fibrosis was found in three women. In three women, soft tissue lesions were depicted, which revealed to be cysts (n = 2) and lymph nodes (n = 1) on subsequent sonography. Diffuse, non-clustered microcalcifications were found in nine women. Eleven women showed cutaneous or intramammary macrocalcifications. Average dose was 6.45 mGy (range 5.81-7.28 mGy).In women with implants, B-CT presents a promising modality for evaluating breast density, implant integrity, extensive capsular fibrosis, soft tissue lesions and micro-/macrocalcifications without the need of breast compression utilizing a lower dose compared to doses reported for conventional four-view mammography.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Implantes de Mama , Mama/diagnóstico por imagem , Tomografia Computadorizada Espiral , Adulto , Idoso , Mama/patologia , Feminino , Fibrose , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Plast Reconstr Surg ; 146(2): 117e-126e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740565

RESUMO

BACKGROUND: Occult breast carcinoma is occasionally found in breast reduction specimens. Although its incidence varies widely, there is a trend toward an increased incidence for women with a history of breast cancer. The authors performed a systematic review and meta-analysis of occult carcinoma incidence in breast reduction specimens. METHODS: The MEDLINE and Embase databases were searched for peer-reviewed studies with no language restrictions for studies that recorded the incidence of occult carcinoma in breast reduction specimens. Cancer incidence per specimen was pooled for women with and without a history of breast cancer. RESULTS: Forty-two studies were eligible for inclusion, of which 29 were quantitatively analyzed. The pooled incidence of carcinoma was higher within specimens from women with breast cancer (3.4 percent; 95 percent CI, 2.2 to 5.3 percent) than without (0.6 percent; 95 percent CI, 0.4 to 0.8 percent), and this increased likelihood was significant when populations were compared directly (OR, 6.02; 95 percent CI, 3.06 to 11.86; p < 0.0001). CONCLUSIONS: Women with a history of breast cancer have an increased incidence of occult breast carcinoma within their breast reduction specimens compared with women with no breast cancer history. There is a need for preoperative radiology screening, counseling, and histopathology guidelines to ensure adequate diagnosis and management of these women.


Assuntos
Neoplasias da Mama/cirurgia , Mama/cirurgia , Mamoplastia/efeitos adversos , Programas de Rastreamento/métodos , Mastectomia Segmentar/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Mama/patologia , Neoplasias da Mama/diagnóstico , Feminino , Saúde Global , Humanos , Incidência , Achados Incidentais , Recidiva Local de Neoplasia/etiologia
6.
Adv Exp Med Biol ; 1252: 9-16, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816257

RESUMO

Physical exam of the breast is a very important part of breast assessment both for breast cancer screening, and when approaching breast lesions. Examination during pregnancy and breastfeeding follows exactly the same method as non-pregnancy periods. However, physical changes that occur in the breast during these times due to hormonal effects cause alterations that can on one hand conceal some pathologic disorders, and may on the other hand appear as pathologic findings while being purely physiologic. This chapter focuses first on some key points for an accurate breast examination, and then reviews some challenging controversial findings that may be noticed during breast exam in a pregnant or lactating woman.


Assuntos
Doenças Mamárias/diagnóstico , Mama/anatomia & histologia , Mama/patologia , Lactação/fisiologia , Exame Físico , Mama/fisiologia , Doenças Mamárias/patologia , Aleitamento Materno , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Feminino , Humanos , Gravidez
7.
Adv Exp Med Biol ; 1252: 27-32, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816259

RESUMO

Breast tissue reveals some physiologic changes during pregnancy and lactation due to hormonal alterations. Whole range of breast diseases including inflammatory, benign and malignant neoplasms can be seen in pregnancy but due to concurrent physiologic changes, may lead to diagnostic challenges. This chapter reviews sampling methods and histologic features of common benign breast lesions in pregnancy and lactation periods.


Assuntos
Doenças Mamárias/patologia , Mama/citologia , Mama/patologia , Lactação/fisiologia , Complicações na Gravidez , Gravidez/fisiologia , Neoplasias da Mama/patologia , Feminino , Humanos
8.
Gene ; 761: 145024, 2020 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-32755659

RESUMO

Understanding how various pathologies of breast cancer respond to their environment may be imperative in the creation of novel therapeutic targets. Central to the organisation and behaviour of cells within the tumour microenvironment is the extracellular matrix (ECM), a meshwork of fibrous proteins and glycoproteins that directly influences cell behaviour and the bioavailability of signalling molecules. Our appreciation on how the composition of the ECM can influence cancer behaviour has evolved significantly and although we are highly cognisant of the dramatic impact the ECM can have on cancer cell behaviour, we continue to neglect this during diagnosis and treatment. In the following study, we aimed to identify how three breast cancer cell lines respond functionally and genetically to common components of the ECM. Using real time and end point assays we have identified similar patterns of behaviour among the three breast cancer cell lines in response to commonly found ECM components of the breast. Using a selected gene panel, we have been able to identify cell line specific changes in gene differentiation when breast cancer cells are in contact with these elements. Although the response of our cells to these elements differ at the genetic level, their functional responses are consistent. This work adds to the growing arguments that highlight a need for histologically assessing ECM composition of breast tumours. In particular monitoring of fibrous protein deposition at the site of malignancy could provide critical information during clinical assessment influencing disease prognosis and treatment decisions for breast cancer patients.


Assuntos
Neoplasias da Mama/genética , Colágeno/genética , Fibronectinas/genética , Mama/patologia , Linhagem Celular Tumoral , Colágeno/metabolismo , Colágeno Tipo I/genética , Matriz Extracelular/metabolismo , Proteínas da Matriz Extracelular/genética , Feminino , Fibronectinas/metabolismo , Perfilação da Expressão Gênica/métodos , Regulação Neoplásica da Expressão Gênica/genética , Genótipo , Glicoproteínas/genética , Humanos , Fenótipo , Prognóstico , Transdução de Sinais , Microambiente Tumoral
9.
Lancet Oncol ; 21(9): 1165-1172, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32800099

RESUMO

BACKGROUND: The appropriate age range for breast cancer screening remains a matter of debate. We aimed to estimate the effect of mammographic screening at ages 40-48 years on breast cancer mortality. METHODS: We did a randomised, controlled trial involving 23 breast screening units across Great Britain. We randomly assigned women aged 39-41 years, using individual randomisation, stratified by general practice, in a 1:2 ratio, to yearly mammographic screening from the year of inclusion in the trial up to and including the calendar year that they reached age 48 years (intervention group), or to standard care of no screening until the invitation to their first National Health Service Breast Screening Programme (NHSBSP) screen at approximately age 50 years (control group). Women in the intervention group were recruited by postal invitation. Women in the control group were unaware of the study. The primary endpoint was mortality from breast cancers (with breast cancer coded as the underlying cause of death) diagnosed during the intervention period, before the participant's first NHSBSP screen. To study the timing of the mortality effect, we analysed the results in different follow-up periods. Women were included in the primary comparison regardless of compliance with randomisation status (intention-to-treat analysis). This Article reports on long-term follow-up analysis. The trial is registered with the ISRCTN registry, ISRCTN24647151. FINDINGS: 160 921 women were recruited between Oct 14, 1990, and Sept 24, 1997. 53 883 women (33·5%) were randomly assigned to the intervention group and 106 953 (66·5%) to the control group. Between randomisation and Feb 28, 2017, women were followed up for a median of 22·8 years (IQR 21·8-24·0). We observed a significant reduction in breast cancer mortality at 10 years of follow-up, with 83 breast cancer deaths in the intervention group versus 219 in the control group (relative rate [RR] 0·75 [95% CI 0·58-0·97]; p=0·029). No significant reduction was observed thereafter, with 126 deaths versus 255 deaths occurring after more than 10 years of follow-up (RR 0·98 [0·79-1·22]; p=0·86). INTERPRETATION: Yearly mammography before age 50 years, commencing at age 40 or 41 years, was associated with a relative reduction in breast cancer mortality, which was attenuated after 10 years, although the absolute reduction remained constant. Reducing the lower age limit for screening from 50 to 40 years could potentially reduce breast cancer mortality. FUNDING: National Institute for Health Research Health Technology Assessment programme.


Assuntos
Fatores Etários , Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/normas , Mamografia/normas , Adulto , Idoso , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Feminino , Humanos , Mamoplastia , Pessoa de Meia-Idade , Sistema de Registros , Reino Unido
11.
Anticancer Res ; 40(8): 4557-4565, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32727786

RESUMO

BACKGROUND/AIM: Holocarboxylase synthetase (HLCS) catalyzes the specific attachment of biotin onto biotin-dependent carboxylases (BDCs) which play important roles in intermediary metabolism. Previous studies show that BDCs are overexpressed in many cancer types. However, expression of HLCS in cancerous tissues has not been reported. MATERIALS AND METHODS: Immunohistochemistry was used to investigate HLCS expression in breast tissue obtained from 65 Thai patients, and the correlation between its expression and key clinical-pathological parameters was assessed. The role of HLCS in supporting invasion was investigated in HLCS-knockdown MCF-7 cells. RESULTS: Overexpression of HLCS was significantly associated with metastasis of breast cancer cells to other lymph nodes but not the sentinel and axillary lymph nodes - a finding supported in cellular invasion assays using HLCS knockdown cells. Furthermore, overexpression of HLCS reduced survival time of patients with breast cancer. CONCLUSION: HLCS appears to be a prognostic marker for patients with breast cancer.


Assuntos
Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Carbono-Nitrogênio Ligases/genética , Metástase Linfática/genética , Mama/patologia , Linhagem Celular Tumoral , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática/patologia , Células MCF-7 , Prognóstico
12.
PLoS One ; 15(7): e0235790, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697770

RESUMO

Pleomorphic lobular carcinoma (PLC) is a histological variant of invasive lobular carcinoma (ILC) and is associated with worse prognosis than classical ILC. It exhibits a greater degree of cellular atypia and pleomorphism and is occasionally accompanied with apocrine morphology. We investigated the immunohistochemical characteristics of samples from 31 Japanese patients with PLC to elucidate the clinicopathological characteristics of PLC including androgen receptor (AR) immunoreactivity. The surrogate molecular subtypes were luminal A-like, luminal B-like, luminal B-like/HER2, HER2-type, and triple-negative in 5, 4, 3, 5, and 14 cases, respectively. AR was positive in 92.8% (13/14) of the triple-negative PLC cases and 100% (10/10) of the non-triple-negative PLC cases. Disease-specific survival was worse in patients with histological grade 3 PLCs than in those with histological grade 2 PLCs (p = 0.007). However, there was no significant difference in the progression-free survival between the two groups (p = 0.152). No other clinicopathological characteristics were associated with prognosis. These results reveal that PLC exhibits various surrogate molecular subtypes and that the triple-negative subtype frequently expresses AR. The observed molecular apocrine differentiation implicates that triple-negative PLC can be categorized into the luminal AR subtype. Furthermore, AR-targeted therapy might be useful for patients with triple-negative PLC.


Assuntos
Neoplasias da Mama/patologia , Mama/patologia , Carcinoma Lobular/patologia , Receptores Androgênicos/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Carcinoma Lobular/diagnóstico , Carcinoma Lobular/epidemiologia , Feminino , Humanos , Japão/epidemiologia , Pessoa de Meia-Idade , Prognóstico , Análise de Sobrevida
13.
Anticancer Res ; 40(7): 3633-3643, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620602

RESUMO

BACKGROUND/AIM: With the increase in detection of non-palpable breast lesions through screening, wire-guided localisation (WGL) has long been the favoured method for preoperative localisation. However, this technique comes with several limitations. New methods have been developed, including several non-radioactive, wireless options. We aimed to assess the effectiveness of Savi Scout® localisation (SSL) through this pooled analysis and systematic review. MATERIALS AND METHODS: A number of databases were searched for records reporting data on localisation and retrieval of SSL reflectors, as well as re-excision rate. We included our own data from 20 patients (22 reflectors) at our institution. RESULTS: A total of 842 reflectors were inserted across eleven studies and our own data. Pooled analysis revealed an overall successful deployment rate of 99.64% and a successful retrieval rate of 99.64% using SSL. A statistically significant difference in re-excision rate was found in a smaller pooled analysis conducted across four studies comparing SSL and WGL (12.9% and 21.1% respectively, p<0.01). CONCLUSION: The Savi Scout® localisation system is a safe and effective alternative to WGL. It facilitates flexible scheduling by decoupling radiology and surgery interventions and may reduce the need for re-excision procedures for positive surgical margins.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Mama/diagnóstico por imagem , Mama/patologia , Radiografia/métodos , Feminino , Humanos , Margens de Excisão , Radar
14.
Am Surg ; 86(8): 1029-1031, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32721172

RESUMO

BACKGROUND: Breast cancer is the most commonly diagnosed noncutaneous malignancy and remains the second leading cause of cancer deaths in women. The Savi Scout (Cianna Medical, Merit Medical Systems, Inc. South Jordan, UT) is a wireless, nonradioactive, wave reflection implant system that enables surgeons to remove targeted breast lesions. Our study aims to be the largest comparison of wire and Savi Scout localization techniques for positive margin, complication, and reoperation rates. METHODS: Single-institution retrospective review of 512 patients that had Savi Scout Surgical Guidance System breast lesion biopsy or wire localized breast biopsy from May 2017 to December 2018. A RedCaps database was created and reviewed for outcomes. RESULTS: For 320 Savi scout patients, margins were positive or less than 1 mm in 18 cases (5.6%). 17 (5.3%) patients required reoperation. Surgical site occurrence was found in 7 (2.1%) patients, and 2 patients required intervention (0.6%). For 175 wire localization patients, margins were positive or less than 1 mm in 24 patients, and all required reoperation (13.7%). A surgical site occurrence was found in 13 (7.4%) patients and 5 patients required intervention (2.8%). DISCUSSION: In our series, the Savi Scout localization system resulted in a lower rate of positive margins, reoperation, and surgical site occurrence. These data suggest that Savi Scout localization is a reasonable replacement to wire localization for breast lesions and might produce superior results.


Assuntos
Neoplasias da Mama/cirurgia , Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Marcadores Fiduciais , Mastectomia Segmentar/métodos , Radar , Cirurgia Assistida por Computador/instrumentação , Adulto , Idoso , Biópsia , Mama/diagnóstico por imagem , Mama/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/patologia , Feminino , Humanos , Margens de Excisão , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Cirurgia Assistida por Computador/métodos
15.
Clin Imaging ; 67: 130-135, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32619774

RESUMO

PURPOSE: To assess the performance of preoperative breast MRI biopsy recommendations based on breast cancer molecular subtype. METHODS: All preoperative breast MRIs at a single academic medical center from May 2010 to March 2014 were identified. Reports were reviewed for biopsy recommendations. All pathology reports were reviewed to determine biopsy recommendation outcomes. Molecular subtypes were defined as Luminal A (ER/PR+ and HER2-), Luminal B (ER/PR+ and HER2+), HER2 (ER-, PR- and HER2+), and Basal (ER-, PR-, and HER2-). Logistic regression assessed the probability of true positive versus false positive biopsy and mastectomy versus lumpectomy. RESULTS: There were 383 patients included with a molecular subtype distribution of 253 Luminal A, 44 Luminal B, 20 HER2, and 66 Basal. Two hundred and thirteen (56%) patients and 319 sites were recommended for biopsy. Molecular subtype did not influence the recommendation for biopsy (p = 0.69) or the number of biopsy site recommendations (p = 0.30). The positive predictive value for a biopsy recommendation was 42% overall and 46% for Luminal A, 43% for Luminal B, 36% for HER2, and 29% for Basal subtype cancers. The multivariate logistic regression model showed no difference in true positive biopsy rate based on molecular subtype (p = 0.78). Fifty-one percent of patients underwent mastectomy and the multivariate model demonstrated that only a true positive biopsy (odds ratio: 5.3) was associated with higher mastectomy rates. CONCLUSION: Breast cancer molecular subtype did not influence biopsy recommendations, positive predictive values, or surgical approaches. Only true positive biopsies increased the mastectomy rate.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Imagem por Ressonância Magnética , Adulto , Idoso , Biópsia , Mama/patologia , Neoplasias da Mama/patologia , Feminino , Humanos , Mastectomia , Mastectomia Segmentar , Pessoa de Meia-Idade , Receptor ErbB-2 , Receptores Estrogênicos , Receptores de Progesterona
16.
Nat Commun ; 11(1): 3616, 2020 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-32680987

RESUMO

Genomic and precision medicine research has afforded notable advances in human cancer treatment, yet applicability to other species remains uncertain. Through whole-exome and transcriptome analyses of 191 spontaneous canine mammary tumors (CMTs) that exhibit the archetypal features of human breast cancers, we found a striking resemblance of genomic characteristics including frequent PIK3CA mutations (43.1%), aberrations of the PI3K-Akt pathway (61.7%), and key genes involved in cancer initiation and progression. We also identified three gene expression-based CMT subtypes, one of which segregated with basal-like human breast cancer subtypes with activated epithelial-to-mesenchymal transition, low claudin expression, and unfavorable disease prognosis. A relative lack of ERBB2 amplification and Her2-enrichment subtype in CMT denoted species-specific molecular mechanisms. Taken together, our results elucidate cross-species oncogenic signatures for a better understanding of universal and context-dependent mechanisms in breast cancer development and provide a basis for precision diagnostics and therapeutics for domestic dogs.


Assuntos
Biomarcadores Tumorais/genética , Neoplasias da Mama/genética , Carcinogênese/genética , Regulação Neoplásica da Expressão Gênica , Neoplasias Mamárias Animais/genética , Animais , Mama/patologia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Classe I de Fosfatidilinositol 3-Quinases/genética , Estudos de Coortes , Variações do Número de Cópias de DNA , Análise Mutacional de DNA , Conjuntos de Dados como Assunto , Cães , Transição Epitelial-Mesenquimal , Feminino , Humanos , Glândulas Mamárias Animais/patologia , Glândulas Mamárias Animais/cirurgia , Neoplasias Mamárias Animais/mortalidade , Neoplasias Mamárias Animais/patologia , Neoplasias Mamárias Animais/cirurgia , Mutação , Prognóstico , RNA-Seq , Especificidade da Espécie , Sequenciamento Completo do Exoma
17.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(2): 69-71, abr.-jun. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193713

RESUMO

La mastopatía diabética es una entidad infrecuente. La presentación más común suele ser en forma de nódulo único o múltiple. Sus características clínicas y radiológicas pueden simular un cáncer de mama, por lo que debe tenerse en cuenta este diagnóstico diferencial en las pacientes jóvenes y con antecedentes de diabetes mellitus. Un correcto diagnóstico puede evitar tratamientos quirúrgicos innecesarios. Presentamos 2 casos que hemos diagnosticado en nuestra área sanitaria así como la revisión de la bibliografía al respecto


Diabetic mastopathy is an uncommon disorder, in which the most frequent presentation is as a single or multiple nodules. It can imitate breast cancer both clinically and radiologically. A differential diagnosis should be done in young patients with a personal history of diabetes, in order to avoid unnecessary surgical interventions. Two cases are presented that were diagnosed in our health area, as well as a review of the literature on this pathology


Assuntos
Humanos , Feminino , Adulto , Doença da Mama Fibrocística/diagnóstico por imagem , Doença da Mama Fibrocística/cirurgia , Doença da Mama Fibrocística/complicações , Diagnóstico Diferencial , Fibroadenoma/complicações , Mama/diagnóstico por imagem , Mama/patologia , Biópsia por Agulha Fina/métodos , Diabetes Mellitus/diagnóstico
18.
PLoS One ; 15(6): e0234991, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584853

RESUMO

The breast cancer (BC) biomarker HER2 (Human Epidermal Receptor 2) is overexpressed in 25% of BC. Only patients with HER2-positive tumors receive HER2-targeting therapies, like trastuzumab (Herceptin). However, some women with a HER2-negative BC could benefit from trastuzumab. This could be explained by the activation/phosphorylation of HER2 that can be recognized by trastuzumab. The aim of this study is to examine trastuzumab effects on HER2 phosphorylation at tyrosine Y877 (pHER2Y877). HER2 and pHER2Y877 status were evaluated in a cohort of BC patients representative of molecular subtypes distribution (n = 497) and in a series of BC cell lines (n = 7). Immunohistochemistry against pHER2Y877 was performed on tissue micro arrays. Cellular proliferation assays were performed on BC cell lines presenting different combinations of HER2 and pHER2Y877 status and treated with increasing doses of trastuzumab (0-150 µg/ml). The prevalence of pHER2Y877 in this cohort was 6%. Nearly 5% of patients with HER2-negative tumors (n = 406, 82%) overexpressed pHER2Y877. Among triple negative BC patients (n = 39, 8%), 7.7% expressed pHER2Y877. Trastuzumab treatment decreased cell proliferation in HER2-/pHER2Y877+ BC cell lines, to an extent comparable to what occurs in HER2+ cell lines, but did not affect HER2-/pHER2Y877- cell lines. Trastuzumab sensitivity in HER2-/pHER2Y877+ cell line is specific to HER2 tyrosine 877 phosphorylation. Hence, with further confirmation in a bigger cohort, trastuzumab treatment could be envisaged as a treatment option to women presenting with HER2-/pHER2+ tumors, representing more than 1000 BC women in Canada in 2019.


Assuntos
Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/tratamento farmacológico , Inibidores de Proteínas Quinases/farmacologia , Receptor ErbB-2/metabolismo , Trastuzumab/farmacologia , Biomarcadores Tumorais/antagonistas & inibidores , Mama/patologia , Neoplasias da Mama/patologia , Canadá , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Estudos de Coortes , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Fosforilação , Inibidores de Proteínas Quinases/uso terapêutico , Receptor ErbB-2/antagonistas & inibidores , Análise Serial de Tecidos , Trastuzumab/uso terapêutico , Tirosina/metabolismo
19.
Br J Radiol ; 93(1112): 20200154, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32525693

RESUMO

OBJECTIVES: To assess the associations between automated volumetric estimates of mammographic asymmetry and breast cancers detected at the same ("contemporaneous") screen, at subsequent screens, or in between (interval cancers). METHODS: Automated measurements from mammographic images (N = 79,731) were used to estimate absolute asymmetry in breast volume (BV) and dense volume (DV) in a large ethnically diverse population of attendees of a UK breast screening programme. Logistic regression models were fitted to assess asymmetry associations with the odds of a breast cancer detected at contemporaneous screen (767 cases), adjusted for relevant confounders.Nested case-control investigations were designed to examine associations between asymmetry and the odds of: (a) interval cancer (numbers of cases/age-matched controls: 153/646) and (b) subsequent screen-detected cancer (345/1438), via conditional logistic regression. RESULTS: DV, but not BV, asymmetry was positively associated with the odds of contemporaneous breast cancer (P-for-linear-trend (Pt) = 0.018). This association was stronger for first (prevalent) screens (Pt = 0.012). Both DV and BV asymmetry were positively associated with the odds of an interval cancer diagnosis (Pt = 0.060 and 0.030, respectively). Neither BV nor DV asymmetry were associated with the odds of having a subsequent screen-detected cancer. CONCLUSIONS: Increased DV asymmetry was associated with the risk of a breast cancer diagnosis at a contemporaneous screen or as an interval cancer. BV asymmetry was positively associated with the risk of an interval cancer diagnosis. ADVANCES IN KNOWLEDGE: The findings suggest that DV and BV asymmetry may provide additional signals for detecting contemporaneous cancers and assessing the likelihood of interval cancers in population-based screening programmes.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mama/diagnóstico por imagem , Detecção Precoce de Câncer , Mamografia , Interpretação de Imagem Radiográfica Assistida por Computador , Idoso , Mama/patologia , Densidade da Mama , Neoplasias da Mama/patologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Mamografia/efeitos adversos , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Fatores de Risco , Fatores de Tempo , Reino Unido
20.
Br J Radiol ; 93(1112): 20200301, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32574075

RESUMO

OBJECTIVES: Neoadjuvant chemotherapy (NAC) is an important method for breast cancer treatment. By monitoring its pathological response, the selection of clinical treatment strategies can be guided. In this study, the meta-analysis was used to compare the accuracy of contrast-enhanced MRI (CE-MRI) and contrast-enhanced spectral mammography (CESM) in detecting the pathological response of NAC. METHODS: Literatures associated to CE-MRI and CESM in the evaluation of pathological response of NAC were searched from PubMed, Cochrane Library, web of science, and EMBASE databases. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the quality of studies. Pooled sensitivity, specificity, and the area under the SROC curve were calculated to evaluate the diagnostic accuracy of CE-MRI and CESM in monitoring the pathological response of NAC. RESULTS: There were 24 studies involved, 18 of which only underwent CE-MRI examination, three of which only underwent CESM examination, and three of which underwent both CE-MRI and CESM examination. The pooled sensitivity and specificity of CE-MRI were 0.77 (95%CI, 0.67-0.84) and 0.82 (95%CI, 0.73-0.89), respectively. The pooled sensitivity and specificity of CESM were 0.83 (95%CI, 0.66-0.93) and 0.82 (95%CI, 0.68-0.91), respectively. The AUCs of SROC curve for CE-MRI and CESM were 0.86 and 0.89, respectively. CONCLUSIONS: Compared to CE-MRI, CESM has equal specificity, greater sensitivity and excellent performance, which may have a brighter prospect in evaluating the pathological response of breast cancer to NAC. ADVANCES IN KNOWLEDGE: CESM showed equal specificity, greater sensitivity, and excellent performance than CE-MRI.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Meios de Contraste , Imagem por Ressonância Magnética/métodos , Mamografia/métodos , Terapia Neoadjuvante , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Feminino , Humanos , Terapia Neoadjuvante/métodos , Resultado do Tratamento
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