Multicentricity and bilaterality in invasive breast carcinoma

Multicentricity and bilaterality are well-established characteristics of breast carcinoma, but little is known about the relationship of these variables with each other. This question was explored by analyzing the data pertaining to 880 women with invasive breast carcinoma. Patients with multicentric carcinoma had bilateral disease more often than those whose carcinoma was apparently limited to a single quadrant. Among women who had lobular carcinoma in situ coexisting with infiltrating duct carcinoma or infiltrating lobular carcinoma, bilaterality and multicentricity were significantly more common than they were among patients whose only lesion was infiltrating duct or medullary cancer. Other variables associated with bilaterality and multicentricity were degree of ductal differentiation, tumor size, nodal status, type of tumor margin, intensity of lymphoid infiltrate, and menstrual status. Age at diagnosis and estrogen receptors were related to bilaterality but not to multicentricity. The following variables proved to be unrelated to bilaterality and multicentricity: family history of breast carcinoma, height, weight, and parity. The data obtained in this study tend to support a conclusion that multicentricity and bilaterality are manifestations of similar factors involved in the neoplastic transformation of mammary gland epithelium leading to the development of breast cancer. [1]

Expression of fatty acid synthase (FAS) as a predictor of recurrence in stage I breast carcinoma patients

BACKGROUND

Fatty acid synthase (FAS) is a molecule found in tumor cells from breast carcinomas of patients whose prognosis is very poor. Recently, this molecule has been identified as the key enzyme in fatty acid biosynthesis. This study was done to test the strength of FAS as a prognostic indicator for disease free survival (DFS) and overall survival (OS).

METHODS

Clinical records, histologic features, immunohistochemical expression of cathepsin D and c‐erb B‐2, and estrogen and progesterone receptor status of 110 Stage I breast carcinoma patients were all associated with FAS by a chi‐square test. The patterns of DFS and OS were estimated over a ten‐year follow‐up period using the Kaplan‐Meier method. Univariate and multivariate analysis were evaluated using a log logistic regression model. Multivariate regression analysis was based on the Cox proportional hazard model. To detect FAS, cathepsin D and c‐erb B‐2 expression as well as estrogen and progesterone receptor status, we used the unlabeled immunoperoxidase technique on formalin fixed, paraffin embedded tissue.

RESULTS

FAS was significantly associated with a higher risk of recurrence because it predicted both DFS (P = 0.0001) and OS (P = 0.003) when evaluated as a continuous variable and DFS (P = 0.0001) when evaluated with other prognostic markers. Peritumoral lymphatic vessel invasion was the other most significant independent predictor for DFS (P = 0.001) and OS (P = 0.003).

CONCLUSIONS

FAS is a reliable prognostic marker to predict DFS and OS in patients with early breast cancer. [2]

Intraoperative Examination of the Sentinel Lymph Node for Breast Carcinoma Staging

Intraoperative pathologic examination of the sentinel lymph node (SLN) draining a primary breast carcinoma allows an SLN-positive patient to undergo complete axillary lymphadenectomy as part of the same surgical procedure. However, the optimal technique for rapid SLN assessment has not been determined. We reviewed our results with imprint cytology (IC) and frozen section (FS) examination of SLNs from 278 patients. Compared with H&E-stained paraffin sections, IC and FS had an overall accuracy of 93.2%. The false-reassurance rate (false-negative results/all negative results) was 8.4%. It correctly identified 98% of macrometastases but only 28% of micrometastases. There were no false-positive results. Compared with paraffin-section cytokeratin immunohistochemistry results, the IC-FS false-reassurance rate increased to 25.8%. The false-reassurance rate decreased with smaller primary tumor size (Tl vs T2/3) and ductal type, smaller diameter of the SLN (≤2.0 cm), and greater pathologist experience. IC combined with 2- level FS reliably identifies SLN macrometastases but commonly fails to detect SLN micrometastases. If SLN micrometastasis is used to determine the need for further lymphadenectomy, more sensitive intraoperative methods will be needed to avoid a second operation. [3]

Antiproliferative Activity by Ethanolic Extract of Red Alpinia galanga (L) Willd in Inoculated Breast Carcinoma Cells of C3H Mice

Background: The objective of this study is to investigate the anticancer activity of ethanolic extract of Alpinia galanga Willd (galangal) on breast adenocarcinoma cells transplanted in C3H mice. In some previous studies ethanolic extract of galangal containing active substance i.e 1’-acetoxychavicol acetate (ACA), is used as anticancer by various mechanisms such as induction of apoptosis, inhibiting cell proliferation, antiinflammation and antioxidant.

Methods: This experimental study was designed by post test only controlled design group, using 32 C3H mice. The C3H mice  were inoculated with tumor cells and then divided into 4 groups: control group (K) and three treatment groups (T1, T2 and T3) given graded doses of ethanolic extract of galangal (225 mg/kobo/day, 450 mg/kobo/day and 675 mg/kobo/day) for 2 weeks. After all mice were terminated, we count the tumor volume of each mice. Ki-67 immunostaining was performed to analyse cell proliferative activity. All the data were analyzed with Pearson Chi Square and OneWay Anova.

Results: This study found that there is marked differences of tumor volume between groups, with control group has the highest tumor volume and treatment group 3 is the lowest. The immunoexpression of Ki-67 has highest mean score at control group  and the lowest at T3 group. There were statistically significant correlation between tumor volume and dose of galangal extract, and significant differences among groups of Ki-67 immunoexpression.

Conclusion: Oral administration of ethanolic extract of Alpinia galanga Willd at the graded doses  has anticancer activity on C3H breast adenocarcinoma by inhibition of cell proliferative activity and growth of tumor volume. The best result of anticancer activity is found in group with the highest dose of galangal extract (675 mg/kgBW). [4]

Sentinel Lymph Node Biopsy in Breast Carcinoma: A Tertiary Center Experience

Objectives: To evaluate feasibility, accuracy and technique of sentinel lymph node biopsy in the management of early breast cancer.

Methods: A retrospective study of sentinel lymph node biopsy was done at King Abdulaziz University Hospital from June 2007– to –June 2013. Total of 110 patients were studied, these patients underwent lumpectomy + Sentinel lymph node biopsy. Patients records were studied by looking file, electronic records, OPD records and data was collected regarding previous surgery, location of mass in breast, size of mass, site of breast, pre or postmenopausal, previous axillary surgery, radiological evaluation, radiotherapy, type of surgery done, adjuvant or neo-adjuvant chemotherapy, gross margins, frozen section margins, new frozen section margins, permanent margins, reoperation, intra-operative radiotherapy[IOR], tumor type, lympho-vascular invasion, estrogen receptor[ER], progesterone receptor[PR], HER2, metastasis, stage of disease, tumor size, no. of lymph nodes, sentinel lymphnode dissection [SLD] done, number of sentinel lymph node, sentinel lymph node [SLN] frozen section, SLN permanent, completion axillary lymph node dissection [ALND], skin necrosis, numbness, wound infection.

Results: Majority of patients were Saudis (64.5%). 9.1% had previous surgery. Pre menopausal were 43.6% and post menopausal 56.4%. Left breast was involved in 60% and right breast in 40% of cases. Upper outer quadrant was involved in 51.9%9%. Size of mass was less than 1 cm in 14.8% cases, 1-2.9 cm in 43.5%, 3-4 cm in 13%, more than 4 cm in 10.2%. Previous axillary surgery was done in 3.7% cases. Radiological evaluation of axilla was done in 68.2%. Lumpectomy plus sentinel lymph node biopsy was done in 96.4% and lumpectomy and axillary lymph node dissection was done in 1.8% cases, and unspecified BCS in 1.8%. Neo-adjuvant chemotherapy was given in 3.6% and adjuvant chemotherapy in 80% of cases Intra-operative radiotherapy was done in 29.1%. Invasive ductal carcinoma was found in 77.3%, DCIS in 10%, invasive lobular carcinoma in 7.3%, mucinus on 2.7%, medullary in 0.9%, LCIS in 0.9% cases. Lympho-vascular margins were positive in 20.9%. ER were positive in 69.1%, PR were positive in 60%. HER-2 was positive in 26.4% cases. Tumor size was T1 42.7%, T2-42.7%, T3-5.5%, T4-0.9% and carcinoma in situ in 6.4% cases. Lymph nodes were N1-33.6%, N2-4.5%, N0-60.9%. MI-0.9% and MO -98.2%. Sentinel Lymph node biopsy was done in 98.2% of cases. Number of Sentinel lymph nodes retrieved was assessed, two LN in 21.8%, three in 18.2%, one in 17.3%, four in 16.4%, five in 13.6%, six in 6.4%, seven in 1.8%. SLN on frozen section had positive for malignancy in 25.5%, while on permanent section they were positive in 38.2%. Completion axillary dissection was done in 34.5%. Skin necrosis was found in 2.2%, numbness was found in 4.4%, wound infection was in 2.2%.

Conclusion: Methylene blue is effective and safe in the detection of sentinel lymph node in patients with breast cancer and it has low cost and readily available. [5]

Reference

[1] Lesser, M.L., Rosen, P.P. and Kinne, D.W., 1982. Multicentricity and bilaterality in invasive breast carcinoma. Surgery, 91(2), pp.234-240.

[2] Alo, P.L., Visca, P., Marci, A., Mangoni, A., Botti, C. and Di Tondo, U., 1996. Expression of fatty acid synthase (FAS) as a predictor of recurrence in stage I breast carcinoma patients. Cancer: Interdisciplinary International Journal of the American Cancer Society, 77(3), pp.474-482.

[3] Turner, R.R., Hansen, N.M., Stern, S.L. and Giulino, A.E., 1999. Intraoperative examination of the sentinel lymph node for breast carcinoma staging. American journal of clinical pathology, 112(5), pp.627-634.

[4] Asri, A. and Winarko, S. (2015) “Antiproliferative Activity by Ethanolic Extract of Red Alpinia galanga (L) Willd in Inoculated Breast Carcinoma Cells of C3H Mice”, Journal of Advances in Medical and Pharmaceutical Sciences, 5(4), pp. 1-9. doi: 10.9734/JAMPS/2016/22301.

[5] Zaidi, N., Merdad, A., Althoubaity, F., Akeel, N. and Sultan, A. (2017) “Sentinel Lymph Node Biopsy in Breast Carcinoma: A Tertiary Center Experience”, Journal of Advances in Medicine and Medical Research, 19(10), pp. 1-8. doi: 10.9734/BJMMR/2017/30919.