Breast Cancer : Basic and Clinical Research最新文献

{"title":"Biomechanical and Biophysical Properties of Breast Cancer Cells Under Varying Glycemic Regimens.","authors":"Diganta Dutta, Xavier-Lewis Palmer, Jose Ortega-Rodas, Vasundhara Balraj, Indrani Ghosh Dastider, Surabhi Chandra","doi":"10.1177/1178223420972362","DOIUrl":"10.1177/1178223420972362","url":null,"abstract":"<p><p>Diabetes accelerates cancer cell proliferation and metastasis, particularly for cancers of the pancreas, liver, breast, colon, and skin. While pathways linking the 2 disease conditions have been explored extensively, there is a lack of information on whether there could be cytoarchitectural changes induced by glucose which predispose cancer cells to aggressive phenotypes. It was thus hypothesized that exposure to diabetes/high glucose alters the biomechanical and biophysical properties of cancer cells more than the normal cells, which aids in advancing the cancer. For this study, atomic force microscopy indentation was used through microscale probing of multiple human breast cancer cells (MCF-7, MDA-MB-231), and human normal mammary epithelial cells (MCF-10A), under different levels of glycemic stress. These were used to study both benign and malignant breast tissue behaviors. Benign cells (MCF-10A) recorded higher Young's modulus values than malignant cells (MCF-7 and MDA-231) under normoglycemic conditions, which agrees with the current literature. Moreover, exposure to high glucose (for 48 hours) decreased Young's modulus in both benign and malignant cells, to the effect that the cancer cells showed a complete loss in elasticity with high glucose. This provides a possible insight into a link between glycemic stress and cytoskeletal strength. This work suggests that reducing glycemic stress in cancer patients and those at risk can prove beneficial in restoring normal cytoskeletal structure.</p>","PeriodicalId":9163,"journal":{"name":"Breast Cancer : Basic and Clinical Research","volume":"14 ","pages":"1178223420972362"},"PeriodicalIF":2.9,"publicationDate":"2020-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1178223420972362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38643976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Cancer Cryoablation: Assessment of the Impact of Fundamental Procedural Variables in an In Vitro Human Breast Cancer Model.","authors":"Kristi K Snyder, Robert G Van Buskirk, John G Baust, John M Baust","doi":"10.1177/1178223420972363","DOIUrl":"10.1177/1178223420972363","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Breast cancer is the most prominent form of cancer and the second leading cause of death in women behind lung cancer. The primary modes of treatment today include surgical excision (lumpectomy, mastectomy), radiation, chemoablation, anti-HER2/neu therapy, and/or hormone therapy. The severe side effects associated with these therapies suggest a minimally invasive therapy with fewer quality of life issues would be advantageous for treatment of this pervasive disease. Cryoablation has been used in the treatment of other cancers, including prostate, skin, and cervical, for decades and has been shown to be a successful minimally invasive therapeutic option. To this end, the use of cryotherapy for the treatment of breast cancer has increased over the last several years. Although successful, one of the challenges in cryoablation is management of cancer destruction in the periphery of the ice ball as the tissue within this outer margin may not experience ablative temperatures. In breast cancer, this is of concern due to the lobular nature of the tumors. As such, in this study, we investigated the level of cell death at various temperatures associated with the margin of a cryogenic lesion as well as the impact of repetitive freezing and thawing methods on overall efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Human breast cancer cells, MCF-7, were exposed to temperatures of -5°C, -10°C, -15°C, -20°C, or -25°C for 5-minute freeze intervals in a single or repeat freeze-thaw cycle. Samples were thawed with either passive or active warming for 5 or 10 minutes. Samples were assessed at 1, 2, and 3 days post-freeze to assess cell survival and recovery. In addition, the modes of cell death associated with freezing were assessed over the initial 24-hour post-thaw recovery period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Exposure of MCF-7 cells to -5°C and -10°C resulted in minimal cell death regardless of the freeze/thaw conditions. Freezing to a temperature of -25°C resulted in complete cell death 1 day post-thaw with no cell recovery in all freeze/thaw scenarios evaluated. Exposure to a single freeze event resulted in a gradual increase in cell death at -15°C and -20°C. Application of a repeat freeze-thaw cycle (dual 5-minute freeze) resulted in an increase in cell death with complete destruction at -20°C and near complete death at -15°C (day 1 survival: single -15°C freeze/thaw = 20%; repeated -15°C freeze/thaw = 4%). Analysis of thaw interval time (5 vs 10 minute) demonstrated that the shorter 5-minute thaw interval between freezes resulted in increased cell destruction. Furthermore, investigation of thaw rate (active vs passive thawing) demonstrated that active thawing resulted in increased cell survival thereby less effective ablation compared with passive thawing (eg, -15°C 5/10/5 procedure survival, passive thaw: 4% vs active thaw: 29%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In summary, these in vitro findings suggest that freezing to te","PeriodicalId":9163,"journal":{"name":"Breast Cancer : Basic and Clinical Research","volume":"14 ","pages":"1178223420972363"},"PeriodicalIF":2.9,"publicationDate":"2020-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/66/81/10.1177_1178223420972363.PMC7672727.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38643977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Recovery With Paravertebral and Transversus Abdominis Plane Blocks in Microvascular Breast Reconstruction.","authors":"Ryan Guffey,&nbsp;Grace Keane,&nbsp;Austin Y Ha,&nbsp;Rajiv Parikh,&nbsp;Elizabeth Odom,&nbsp;Li Zhang,&nbsp;Terence M Myckatyn","doi":"10.1177/1178223420967365","DOIUrl":"https://doi.org/10.1177/1178223420967365","url":null,"abstract":"<p><strong>Purpose: </strong>We have shown previously that a preoperative paravertebral nerve block is associated with improved postoperative recovery in microvascular breast reconstruction. The purpose of this study was to compare the outcomes of a complete enhanced recovery after surgery (ERAS) protocol with complete regional anesthesia coverage to our traditional care with paravertebral block.</p><p><strong>Patients and methods: </strong>This was a retrospective cohort study of 83 patients who underwent autologous breast reconstruction by T.M.M. between May 2014 and February 2018 at a tertiary academic center. Patients in the ERAS group were additionally administered acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), gabapentin, a transversus abdominis plane block (liposomal or plain bupivacaine), and primarily oral opioids postoperatively. The patients were mobilized earlier with more rapid diet progression. All patients received a preoperative paravertebral block.</p><p><strong>Results: </strong>Forty-four patients in the ERAS cohort were compared with 39 retrospective controls. The 2 groups were similar with respect to demographics and comorbidities. The ERAS cohort required significantly less opioids (291 vs 707 mg oral morphine equivalent, <i>P</i> < .0001) with unchanged postoperative pain scores and a shorter time to oral only opioid use (16.0 vs 78.2 hours, <i>P</i> < .0001). Median length of stay (3.20 vs 4.62, <i>P</i> < .0001) and time to independent ambulation (1.86 vs 2.88, <i>P</i> < .0001) were also significantly decreased in the ERAS cohort. Liposomal bupivacaine use did not significantly affect the results (<i>P</i> ⩾ .2).</p><p><strong>Conclusions: </strong>Implementation of a robust enhanced recovery protocol with complete regional anesthesia coverage was associated with significantly decreased opioid use despite unchanged pain scores, with improved markers of recovery including length of stay, time to oral only narcotics, and time to independent ambulation.</p>","PeriodicalId":9163,"journal":{"name":"Breast Cancer : Basic and Clinical Research","volume":"14 ","pages":"1178223420967365"},"PeriodicalIF":2.9,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1178223420967365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25377499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Microinvasive Carcinoma With Different Morphologies: Analysis of Clinicopathologic Features of 121 Cases.","authors":"ChangYin Feng,&nbsp;QiaoLing Zheng,&nbsp;YingHong Yang","doi":"10.1177/1178223420948482","DOIUrl":"https://doi.org/10.1177/1178223420948482","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the clinicopathological features of patients with breast microinvasive carcinoma (MI).</p><p><strong>Methods: </strong>The clinical data of 121 cases with breast MI were retrospectively collected. The whole tumor in each case was stained with hematoxylin and eosin (H&E) for pathological evaluation. The relationships among size of tumor, histological grade, tumor-infiltrating lymphocytes (TILs), the number of MIs, type of MI, and lymph node metastasis were analyzed.</p><p><strong>Results: </strong>It was revealed that 86% of the cases had high-grade ductal carcinoma in situ (DCIS) and 63.6% had multiple MIs. The larger size of the tumors, the higher the grade of DCIS, the more the number of MIs; 3.3% of cases had rich TILs (lymphocyte/stroma > 30%) in the DCIS, and 26.5% had rich TILs in MIs. The type A of MIs is characterized by single cells and small clusters of solid cells. Tumor cells in type B of MIs can form glandular ducts. Formal grading of microinvasive is challenging/impossible due to its limited size precluding a representative mitotic count. But nuclear grade and tubule (differentiation) grades can be reported. In addition, 72.7% of cases had type A of MIs and 27.3% of cases had type B of MIs. Type B was found to be highly accompanied by moderate-grade DCIS. Only 6.6% of patients with MI had lymph node metastasis, which was mainly related to MIs with less TILs.</p><p><strong>Conclusion: </strong>Breast MI is easy to occur in high-grade DCIS, and multiple infiltration foci may be observed in case with tumor size of higher than 3.5 cm. Microinvasive carcinoma with poor TILs maybe a risk factor for lymph node metastasis in patient with DCIS-Mi.</p>","PeriodicalId":9163,"journal":{"name":"Breast Cancer : Basic and Clinical Research","volume":"14 ","pages":"1178223420948482"},"PeriodicalIF":2.9,"publicationDate":"2020-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1178223420948482","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38515415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic, Clinical, and Pathological Factors Influencing Outcomes in Locally Advanced Triple Negative Breast Cancer: A Brazilian Cohort.","authors":"Jesse Lopes da Silva,&nbsp;Bruno Henrique Rala de Paula,&nbsp;Isabele Avila Small,&nbsp;Luiz Claudio Santos Thuler,&nbsp;Andréia Cristina de Melo","doi":"10.1177/1178223420962488","DOIUrl":"https://doi.org/10.1177/1178223420962488","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association of sociodemographic, clinical, and pathological factors with response and survival in triple negative breast cancer (TNBC) undergoing neoadjuvant chemotherapy (NACT).</p><p><strong>Methods: </strong>Clinical-pathological and sociodemographic data were obtained from medical records of 235 eligible women with TNBC diagnosed between 2010 and 2014 undergoing NACT and surgery at the Brazilian National Cancer Institute. They have been assessed for pathological complete response (pCR), event-free survival (EFS), and overall survival (OS). Both univariate and multivariate Cox regression analyses were performed.</p><p><strong>Results: </strong>The median follow-up was 64.3 months. Most patients had advanced clinical stage (III: 85.1%; cT3/T4: 86.4%; cN1-3: 74.4%) and high-grade tumors (72.1%). Clinical staging (III vs II, adjusted hazard ratio [HR] = 2.95, <i>P</i> = .012) significantly influenced the pCR rate. Alcohol intake negatively influenced EFS (adjusted HR = 1.67, <i>P</i> = .006) and OS (adjusted HR = 1.89, <i>P</i> = .005). Women with pCR showed better EFS (crude HR = 0.15, <i>P</i> < .001) and OS (crude HR = 0.12, <i>P</i> < .001) compared with non-pCR. The ypT (<0.001) and ypN (<0.001) gradually influenced survival outcomes.</p><p><strong>Conclusion: </strong>Clinical stage III were associated with lower response rate and worse survival. Alcohol intake, pCR, and burden of post-NACT residual disease have shown considerable influence on survival outcomes.</p>","PeriodicalId":9163,"journal":{"name":"Breast Cancer : Basic and Clinical Research","volume":"14 ","pages":"1178223420962488"},"PeriodicalIF":2.9,"publicationDate":"2020-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1178223420962488","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38464946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burning Questions in the Oncofertility Counseling of Young Breast Cancer Patients.","authors":"Luca Arecco, Marta Perachino, Alessandra Damassi, Maria Maddalena Latocca, Davide Soldato, Giacomo Vallome, Francesca Parisi, Maria Grazia Razeti, Cinzia Solinas, Marco Tagliamento, Stefano Spinaci, Claudia Massarotti, Matteo Lambertini","doi":"10.1177/1178223420954179","DOIUrl":"10.1177/1178223420954179","url":null,"abstract":"<p><p>The improved prognosis of breast cancer patients makes survivorship issues an area of crucial importance. In this regard, an increased attention is needed toward the development of potential anticancer treatment-related long-term side-effects, including gonadal failure and infertility in young women. Therefore, fertility preservation and family planning are crucial issues to be addressed in all young women of reproductive age with newly diagnosed cancer. Despite a growing availability of data on the efficacy and safety of fertility preservation options and the fact that conceiving after prior history of breast cancer has become more accepted over time, there are still several gray zones in this field so that many physicians remain uncomfortable to deal with these topics. The purpose of this review is to answer some of the most controversial questions frequently asked by patients during their oncofertility counseling, in order to provide a detailed and up-to-date overview on the evidence available in this field to physicians involved in the care of young women with breast cancer.</p>","PeriodicalId":9163,"journal":{"name":"Breast Cancer : Basic and Clinical Research","volume":"14 ","pages":"1178223420954179"},"PeriodicalIF":1.8,"publicationDate":"2020-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3d/f7/10.1177_1178223420954179.PMC7476336.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38398120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Cancer Fear Among Mexican American Women in the United States.","authors":"Silvia Flores-Luevano, Navkiran K Shokar, Alok Kumar Dwivedi, Gurjeet S Shokar, Sandrine N Defeu","doi":"10.1177/1178223420952745","DOIUrl":"10.1177/1178223420952745","url":null,"abstract":"<p><strong>Introduction: </strong>Fear has been described as potentially important in affecting breast cancer screening completion. Limited information is available on the prevalence and determinants of fear among Mexican American women. This study describes perceived breast cancer fear and its association with personal characteristics and screening behavior among Mexican American women.</p><p><strong>Methods: </strong>This is a secondary analysis of data collected during the implementation of the Breast Cancer Education, Screening and NavigaTion program among eligible uninsured women in two Texas border counties. Participants completed a 26-item survey to assess eligibility, risk status, prior screening, and breast cancer fear. Descriptive statistics and multivariable analyses were used to determine associations between the fear score, personal characteristics, and mammography screening.</p><p><strong>Results: </strong>In all, 1916 of 2012 eligible women completed the study. The mean age was 57.3 years, 99.2% were Hispanic, and 88% were born in Mexico; 15% had a family history of breast cancer and 14% had never had a mammogram. The mean breast cancer fear score was 25.5 (standard deviation: 10.52; range: 8-40); 54.0 % (95% confidence interval: 52.1%-56.7%) had a high fear level. In multivariable analyses, better health status (<i>P</i> < .001), older age (<i>P</i> = .039), birth in the United States (<i>P</i> = .020), and having a regular doctor (<i>P</i> = .056) were associated with lower fear scores. There was no association between breast cancer fear and mammography screening.</p><p><strong>Conclusion: </strong>Breast cancer fear is high and varies by personal characteristics and health status among uninsured Mexican American border-residing women due for screening, but is not associated with screening behavior. Further research is needed to clarify the effect of interventions designed to help reduce breast cancer fear among these women, including educational interventions to reduce breast cancer fear.</p>","PeriodicalId":9163,"journal":{"name":"Breast Cancer : Basic and Clinical Research","volume":"14 ","pages":"1178223420952745"},"PeriodicalIF":1.8,"publicationDate":"2020-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/72/09/10.1177_1178223420952745.PMC7453449.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38373268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antitumour Property of <i>Pterocarpus santalinus</i> Seeds Against DMBA-Induced Breast Cancer in Rats.","authors":"Vivek Akhouri, Arun Kumar, Manorma Kumari","doi":"10.1177/1178223420951193","DOIUrl":"10.1177/1178223420951193","url":null,"abstract":"<p><p>Breast cancer has been one of the most common form of malignancy globally among women, for more than a decade. Despite various preventive and treatment measures, it remains associated with high incidence and mortality rate. <i>Pterocarpus santalinus</i> Linn. f. has been extensively used in Indian medicine system <i>Ayurveda</i>, due to its various medicinal properties. However, despite various research works on the anticancer activity of <i>P santalinus</i>, no studies have been reported on animal model. Therefore, this study was aimed to decipher the antitumour activity of ethanolic seeds extract of <i>P santalinus</i> on DMBA (7,12-dimethylbenz(a)-anthracene)-induced breast cancer in rats. Fifty-five-days-old weighed (150 ± 10 g) female Charles Foster rats (12 females) were used for the study. The rats were divided into 3 groups of 4 rats each. 7,12-Dimethylbenz(a)-anthracene (single dose of 20 mg/mL dissolved in olive oil) was induced orally, to develop breast tumour. After the development of breast tumours (about 0.5 cm), the rats were treated with <i>P santalinus</i> ethanolic seeds extract (300 mg/kg body weight/day) orally for 5 weeks and then volume of tumour was measured. Oral administration of <i>P santalinus</i> extract resulted in about 49.5% tumour growth inhibition in the final week of treatment in DMBA + <i>P santalinus</i> group as compared with the DMBA group. <i>Pterocarpus santalinus</i> administration also significantly reduced (<i>P</i> < .0001) the serum malondialdehyde level from 58.81 ± 4.09 nmol/mL in DMBA group to 10.87 ± 1.20 nmol/mL in the DMBA + <i>P santalinus</i> group. Serum tumour necrosis factor-α level reduced significantly (<i>P</i> < .0001) from 80.43 ± 2.45 pg/mL in DMBA group to 28.30 ± 3.24 pg/mL in the DMBA + <i>P santalinus</i> group. The blood serum glucose level also reduced significantly (<i>P</i> < .0001) from 205.9 ± 22.22 mg/dL in DMBA group to 86.44 ± 8.36 in DMBA + <i>P santalinus</i> group. There was significant (<i>P</i> <i><</i> .0001) improvement in the both the liver and kidney serum biomarkers level after <i>P santalinus</i> administration. The histological study of mammary tissues of rats shows that, in the DMBA group immature fibrocytes are completely replacing the normal adipocytes suggestive of fibroma molle, whereas in the DMBA + <i>P santalinus</i> group mature fibrocytes with multilayer glandular cells were seen denoting fibroadenoma. Thus, the <i>P santalinus</i> ethanolic seed extract possesses antitumorigenic, antioxidant and hypoglycaemic properties as well as hepato-renal protective effect. Hence, it may be concluded that <i>P santalinus</i> has therapeutic role against DMBA-induced breast cancer in rats and has a greater potential to develop as a chemotherapeutic agent in breast cancer treatment.</p>","PeriodicalId":9163,"journal":{"name":"Breast Cancer : Basic and Clinical Research","volume":"14 ","pages":"1178223420951193"},"PeriodicalIF":1.8,"publicationDate":"2020-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9b/7d/10.1177_1178223420951193.PMC7444153.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38368133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Preoperative Breast Magnetic Resonance Imaging on Surgical Management in Symptomatic Patients With Invasive Lobular Carcinoma.","authors":"Brian M Moloney,&nbsp;Peter F McAnena,&nbsp;Éanna J Ryan,&nbsp;Ellen O Beirn,&nbsp;Ronan M Waldron,&nbsp;AnnaMarie O Connell,&nbsp;Sinead Walsh,&nbsp;Rachel Ennis,&nbsp;Catherine Glynn,&nbsp;Aoife J Lowery,&nbsp;Peter A McCarthy,&nbsp;Michael J Kerin","doi":"10.1177/1178223420948477","DOIUrl":"https://doi.org/10.1177/1178223420948477","url":null,"abstract":"<p><strong>Objective: </strong>Due to an insidious proliferative pattern, invasive lobular breast cancer (ILC) often fails to form a defined radiological or palpable lesion and accurate diagnosis remains challenging. This study aimed to determine the value of preoperative magnetic resonance imaging (MRI) for ILC and its impact on surgical outcomes.</p><p><strong>Methods: </strong>Consecutive symptomatic patients diagnosed with ILC in a tertiary centre over a 9-year period were reviewed. The time from diagnosis until surgery, initial type of surgery/index operation (breast-conserving surgery [BCS]/mastectomy) and the rates of reoperation (re-excision/completion mastectomy) were recorded. Patients were grouped into those who received conventional imaging and preoperative MRI (MR+) and those who received conventional imaging alone (MR-).</p><p><strong>Results: </strong>There were 218 cases of ILC, and 32.1% (n = 70) had preoperative MRI. Time from diagnosis to surgery was longer in the MR+ than the MR- group (32.5 vs 21.1 days, <i>P</i> < .001) even when adjusting for age and breast density. Initial BCS was performed on 71.4% (n = 50) of MR+ patients and 72.3% (n = 107) of the MR- group. While the rate of completion mastectomy following initial BCS was higher in the MR+ group (30.0%, n = 15 vs 14.0%, n = 15; χ² = 5.63; <i>P</i> = .018), this association was not maintained in multivariable analysis. No difference was recorded in overall (initial and completion) mastectomy rate between the MR+ and MR- group (50.0%, n = 35 vs 37.8%, n = 56; χ² = 2.89; <i>P</i> = .089). Margin re-excision following BCS was comparable between groups (8.0%, n =4, vs 9.3%, n = 10; χ² = 0.076, <i>P</i> = .783) despite the selection bias for borderline conservable cases in the MR+ group. The rate of usage of MRI for ILC cases declined over the study period.</p><p><strong>Conclusion: </strong>While MRI was associated with minor delays in treatment and did not reduce overall rates of margin re-excision or completion mastectomy, it altered the choice of surgical procedure in almost a quarter of MR+ cases. The benefit of preoperative breast MRI appears to be confined to select (younger, dense breast, borderline conservable) cases in symptomatic ILC.</p>","PeriodicalId":9163,"journal":{"name":"Breast Cancer : Basic and Clinical Research","volume":"14 ","pages":"1178223420948477"},"PeriodicalIF":2.9,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1178223420948477","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38325544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocrine Therapy Plus Anti-HER2 Therapy as Adjuvant Systemic Therapy for Luminal HER2-Positive Breast Cancer: An Analysis of the National Cancer Database.","authors":"Zeina A Nahleh,&nbsp;Elizabeth B Elimimian,&nbsp;Leah C Elson,&nbsp;Brian Hobbs,&nbsp;Wei Wei,&nbsp;Cassann N Blake","doi":"10.1177/1178223420945694","DOIUrl":"https://doi.org/10.1177/1178223420945694","url":null,"abstract":"<p><strong>Background: </strong>Guidelines regarding the usage of adjuvant systemic therapy in patients with small human epidermal growth factor receptor 2 (HER2)-positive and estrogen receptor/progesterone receptor-positive (luminal HER2 positive) tumors are nonspecific. Outcomes of chemotherapy followed by endocrine therapy (ET), with or without anti-HER2 therapy, vs ET alone (no chemotherapy) have not been widely studied in this disease subtype. We sought to examine the usage and outcomes of adjuvant systemic therapy (ET vs chemotherapy with or without trastuzumab) in stage I luminal HER2-positive breast cancer (BC), based on the large National Cancer Database.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients with luminal HER2-positive stage I BC, diagnosed between 2010 and 2015, in the United States, using univariable and multivariable logistic regression analyses. The Kaplan-Meier method estimated overall survival (OS).</p><p><strong>Results: </strong>A total of 37 777 patients were included in the analysis; of these, n = 32 594 (86%) received adjuvant ET and n = 5183 (14%) received chemotherapy. Around 40% of all patients received anti-HER2 therapy (trastuzumab). Patients who received trastuzumab had a better 5-year OS (93.4% vs 92.0%, <i>P</i> = .0002) compared with those who did not. Patients who received anti-HER2 therapy plus ET had the best OS rate at 5 years (93.5%, confidence interval [CI]: 89.2%-98%, <i>P</i> < .0001) compared with those receiving anti-HER2 therapy plus chemotherapy (92.7%, CI: 89.4%-96.1%, <i>P</i> < .0001).</p><p><strong>Conclusions: </strong>Most patients in the United States, with stage I luminal HER2 positive BC, received ET, not chemotherapy but most of them do not receive anti-HER2 therapy resulting in inferior outcome. Future trials exploring the de-escalation of systemic adjuvant therapy for early-stage luminal HER2-positive BC to ET plus anti-HER2 therapy would be desirable.</p>","PeriodicalId":9163,"journal":{"name":"Breast Cancer : Basic and Clinical Research","volume":"14 ","pages":"1178223420945694"},"PeriodicalIF":2.9,"publicationDate":"2020-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1178223420945694","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38284144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}