Breast Disease - Volume 38, issue 2

Authors: Gunden, Joseph R. | Bendahhou, Karima | Benider, Abdellatif | Ibrahim Khalil, Ahmadaye | Khalis, Mohamed | Wilson, Mark L. | Soliman, Amr S.

Article Type: Research Article

Abstract: BACKGROUND: Inflammatory breast cancer (IBC) is a rare and aggressive type of breast cancer (BC). Physicians have difficulty diagnosing it correctly given its clinical nature. Previous studies have shown that North Africa compared to the United States has a higher proportion of IBC relative to all BC. PURPOSE: The purpose of this study was to calculate a corrected IBC incidence rate using the population-based registry of Casablanca and other, local hospital-based data sources and to characterize the clinical presentation and basis of diagnosis of IBC. METHODS: We retrieved the Casablanca registry data from 2009–2012, and matched …its data with demographic and clinical data from the medical records, logbooks and a local epidemiologic IBC case-control study. A corrected incidence was calculated after accounting for missed cases in the registry. RESULTS: The data showed that the incidence of IBC in the registry was significantly underestimated when the population-based and hospital data were combined. CONCLUSIONS: Population-based registries should focus on specific measures for verifying the diagnosis of IBC since physicians may miss documenting the disease in medical records. This study may have implications for better reporting and documentation of IBC in hospital- and population-based cancer registries in Morocco and other similar countries. Show more

Keywords: Inflammatory breast cancer, North Africa, population-based, registry

DOI: 10.3233/BD-180357

Citation: Breast Disease, vol. 38, no. 2, pp. 39-45, 2019

Authors: Mele, Marco | Sørensen, Anne Schmidt | Bruun, Josephine | Funder, Jonas Amstrup | Tramm, Trine | Bodilsen, Anne | Nielsen, Hanne Melgaard | Christiansen, Peer M.

Article Type: Research Article

Abstract: INTRODUCTION: Inflammatory Breast Cancer (IBC) is a distinct and rare type of breast cancer accounting for up to 6% of all breast cancer cases in Europe. The aim of this study was to investigate diagnostic methods, treatments, and outcome after IBC in patients treated at a single institution in Denmark. METHOD: All patients treated for IBC at Aarhus University Hospital between 2000 and 2014 were identified and included in the cohort. Survival was assessed using Kaplan-Meier curves and log-rank statistics. RESULTS: A total of 89 patients were identified with a median follow up of 3.6 years. …The overall survival at 5 and 10 years were 41% and 18%, respectively. The disease free survival at 5 and 10 years were 47% and 27%, respectively. Thirty-four percent had distant metastasis at time of diagnosis. Patients with ER positive tumors had a significantly better overall survival than patients with ER negative tumors (p = 0.01). CONCLUSION: Despite a more aggressive systemic and loco-regional treatment today, IBC is still a very serious disease with a high mortality. Show more

Keywords: Inflammatory Breast Cancer (IBC), metastases, inflammation

DOI: 10.3233/BD-180365

Citation: Breast Disease, vol. 38, no. 2, pp. 47-55, 2019

Authors: Itoi, Naoko | Umeda, Tomoko | Ishida, Mitsuaki | Murata, Satoshi | Mori, Tsuyoshi | Kawai, Yuki | Tomida, Kaori | Shimizu, Tomoharu | Kushima, Ryoji | Tani, Masaji

Article Type: Research Article

Abstract: BACKGROUND: Trastuzumab (Tz) is assumed to prime antibody-dependent cellular cytotoxicity (ADCC); however, it remains unclear whether Tz therapy can clinically induce adaptive cellular immunity. OBJECTIVE: Adaptive Cellular Immune Effect of Tz Therapy. METHODS: This study included 29 surgical invasive breast carcinomas administered neoadjuvant chemotherapy with Tz (15 cases) or without Tz (14 cases). The numbers of immunoreactive cells (CD4, CD8, CD56, and Fox-P3) in three different compartments (intratumoral, adjacent stromal, and distant stromal) were determined. RESULTS: The average number of adjacent stromal CD4-positive, CD8-positive, and Fox-P3-positive cells in the Tz+ group was significantly …greater than that in the Tz− group (p = 0.036, 0.0049, and 0.043, respectively). However, the number of Fox-P3-positive cells was much less than that of CD4-positive cells. Moreover, distant stromal CD4-positive and CD8-positive cells in the Tz+ group was also significantly greater than that of the Tz− group (p = 0.029 and 0.032, respectively). Only a small number of CD56-positive natural killer cells, playing a main role in ADCC, accumulated at the tumor site after Tz therapy. CONCLUSIONS: The results suggest that Tz therapy induces adaptive cellular immunity, including infiltration of both CD4-positive helper T cells and CD8-positive cytotoxic T cells into the breast carcinoma lesion. Show more

Keywords: Breast carcinoma, HER2, trastuzumab, tumor-infiltrating lymphocyte, immunohistochemistry

DOI: 10.3233/BD-180350

Citation: Breast Disease, vol. 38, no. 2, pp. 57-65, 2019

Authors: Kupsik, M. | Perez, C. | Bargaje, A.

Article Type: Research Article

Abstract: BACKGROUND: The management of papillary lesions is controversial with studies showing different rates of upstaging to malignancy. There is a paucity of research into race as an independent risk factor. The aim of this study is to identify if race is correlated with upstaging to malignancy with a secondary focus of analyzing for other personal and tumor specific risk factors for upstaging. METHODS: We performed a retrospective review of 123 papillary lesions with univariate analysis to identify risk factors for upstaging. RESULTS: The incidence of papillary lesions found on core needle biopsy was 6%. Atypical papillary …lesions were most likely to be upstaged to malignancy at a rate of 27.7%. Papillary lesions and papillary lesions with hyperplasia were also upstaged to cancer at a lower rate of 8.3% and 12.5%, respectively. A univariate analysis of all papillary lesions and a separate analysis of atypical lesions demonstrated a higher likelihood of upstage based on BIRADS classification. Race, age, size of tumor and other radiographic features were not associated with an increased risk for upstaging to malignancy. CONCLUSIONS: Atypia remains the most significant contributor to the risk of upstaging papillary lesions to malignancy. Our research supports the practice of excising all atypical papillary lesions with selected excision of those without atypia. In our cohort, there was no association between race and risk of upstaging to malignacy. Show more

Keywords: Papillary lesion, papillary carcinoma, atypical papillary lesion, breast cancer risk factors

DOI: 10.3233/BD-180379

Citation: Breast Disease, vol. 38, no. 2, pp. 67-72, 2019

Authors: Tomić, Snježana | Mrklić, Ivana | Razumović, Jasminka Jakić | Jonjić, Nives | Šarčević, Božena | Blažičević, Valerija | Jurković, Ilija | Vrbičić, Branka | Lisica Šikic, Nataša | Peteh, Loredana Labinac | Lončarić, Čedna Tomasović | Vučić, Majda | Gašparov, Slavko | Švagelj, Dražen | Radiković, Sandra | Mahovne, Ivana

Article Type: Research Article

Abstract: BACKGROUND: Proliferation rate is a major determinant of the biologic behavior of the tumor and provides information that can be used to guide treatment decisions. METHODS: This ring study included 27 pathologists from 14 Institutions, in order to assess inter-observer concordance between pathologists in Croatia. We analyzed Ki-67 proliferative index on ten randomly selected breast cancer samples comparing consistency between visual assessment using light microscopy compared to digital image analyses results from one central laboratory as a referral value. RESULTS: When we analyzed Ki-67 as numeric value high concordance rate was found between Ki-67 score visually …assessed in all participating Institutions compared to referral value assessed by digital image analysis (ICC 0.76, 95% CI 0.58–0.91), and Krippendorff’s alpha was 0.79 (95% CI 0.58–1.00). Concordance was better in slides with higher Ki-67 values. When we categorized Ki-67 values according to generally accepted 20% cut-off value we noticed the lower concordance rate among participants in our study. CONCLUSION: Proliferation remains one of the most important parameters for tumor characterization helpful in making clinical decisions, but it should be used with great caution. Standardization of the Ki-67 assessment is essential and proliferating index should be expressed as exact numeric value. For patients with proliferative index near the cut-off value, other factors must be considered in making clinical decisions. Show more

Keywords: Breast cancer, immunohistochemistry, Ki-67, proliferation index

DOI: 10.3233/BD-180341

Citation: Breast Disease, vol. 38, no. 2, pp. 73-79, 2019

Authors: Hamdy, Omar | Raafat, Sara | Saleh, Gehad A. | Hamdy, Mohammad

Article Type: Case Report

Abstract: Schwannoma is a usually benign peripheral nerve sheath tumor with rare breast incidence and few reported cases. We report a case which was presented to and managed in the Oncology center, Mansoura University in November 2017.

Keywords: Breast, Schwannoma, benign, rare

DOI: 10.3233/BD-180329

Citation: Breast Disease, vol. 38, no. 2, pp. 81-83, 2019