bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estrogen receptor-positive, progesterone receptor-negative tumors: Pathology and outcome correlations from a single-center cohort.
Authors: Danciu Oana Cristina , Thakkar Jigisha P. , Mehta Divyesh 
Published: February 2017

160 Background: Estrogen receptor (ER) + progesterone receptor (PR) - tumors are a distinct subset of breast cancers characterized by aggressive behavior and tamoxifen resistance in spite of being ER+. We sought to describe the characteristics of the patients treated for this type of breast cancer at a large, urban, academic center, compare them with ER+PR+ patients and evaluate the outcomes achieved with the current modern treatments and establish the predictors of worse outcomes. Methods: All patients with the diagnosis of breast cancer who underwent a biopsy at our center between January 1st, 2005 and December 31st 2010 were included into a database. We compared ER+/PR- with ER+/PR+ patients. Demographic data, comorbidities, obstetric data, pathology data, type of treatment and outcome data were collected retrospectively through extensive electronic medical records review. The study was approved by the local IRB. Standard statistical methods were used and a p value <0.05 was considered significant. Results: We found 101 ER+/PR- and 150 ER+/PR+ breast cancer patients. Baseline characteristics, pathology data, treatment and outcomes are shown in the table. Within the ER+/PR- group the degree of Ki67 expression was directly associated with recurrence rate (p 0.0039). Conclusions: ER+/PR- breast cancer is an aggressive type with high recurrence rate and mortality, that affects mainly postmenopausal women. This subtype is associated more frequently with p53 and Ki67 overexpression, and the later levels appear useful in predicting recurrence in this subtype of breast cancer. Novel treament paradigms guided by molecular studies are currently being implemented. [Table: see text]
Subpectoral implants in oncoplastic-reconstructive breast surgery: Habit or necessity?
Authors: Paepke Stefan , Dittmer Sissi , Rezai Arian , Klein Evelyn , Kiechle Marion 
Published: February 2017

161 Background: We perform nipple-sparing subcutaneous mastectomies since 2002. Herein we report on 352 cases, in 156 of which acellular dermis (ADM) or meshs (tetanized polypropylene-mesh) as tissue interponates were used. The standard procedure of subpectoral implant positioning with or without caudo-lateral tissue interponates (acellular dermis or mesh) can lead to postoperative problems due to detachment of muscle. Against this background we did not form a submuscular pocket in individual cases, but instead placed the implant in a cranially and caudally covering ADM or mesh pocket. Methods: Between 06/11 and 03/12 17 patients were operated according to the above protocol, and the short-term follow up analyzed. Patients that had to get radiation therapy were not admitted to the study. Furthermore, we only included patients that were planned to get a second, contralateral operation so that corrections of the first operation were possible. Patients were between 34 and 58 years old. One patient had to receive radiotherapy due to a nodal involvement not diagnosed before. Results: Four patients had received prior surgery. Indications for subcutaneous mastectomies comprised invasive carcinomas with large DCIS, R1 resections or secondary prophylaxis. Mastectomy weights ranged between 225 and 1100 g; implant volumes ranged between 225 and 800 cm3. The cosmetic outcome was excellent, the margins of the implants were not visible. In three cases there was a partial necrosis of the nipple and in two cases a partial skin necrosis with the necessity of a wound revision. Conclusions: Using a ADM- or mesh-pocket instead of subpectoral positioning of the implant makes the operation in individual cases easier. Post-operative mobility is immediate and unrestricted. Since the implant size has to be chosen according to the tissue weight removed, a bilaterally identical cosmetic result can be archieved. Complications inculde a mild seroma formation without the necessity to puncture. However, the small number of cases and the short term follow up do not allow to make any statements about consecutive capsular fibrosis.
Clinical and histopathologic tumor characteristics in patients with invasive breast carcinoma receiving metformin.
Authors: Besic Nikola , Gazic Barbara , Satej Nika 
Published: February 2017

165 Background: Although both diabetes mellitus (DM) and breast carcinoma (BC) are common diseases, the data about histopathology characteristics and extent of disease of these patients in the literature are scarce and conflicting. Metformin may exhibit inhibitory effects on cancer cells by inhibiting mTOR signaling pathway. Our hypothesis was that use of metformin has an impact on slower progression of breast carcinoma in comparison to other types of anti-diabetic drugs. The aim of our retrospective study was to examine if the patients with BC and DM receiving metformin have lower tumor stage in comparison to patients not receiving metformin. Methods: A chart review of 252 patients (mean age 66.6; range 38-93 years) with invasive BC and DM was performed. They were surgically treated at our institute from 2005-2011. Data on clinical and histopathology factors were collected. Statistical analysis of these factors (i.e., comparison of metformin group vs. no metformin group) was performed by contingence tables and non-parametric tests. Results: DM type 1 and DM type 2 was present in 14 and 238 cases, respectively. Altogether 126 patients were on metformin, while 126 were not receiving metformin. Larger proportion of patients on metformin in comparison to patients not receiving metformin was younger than 71 years of age (p<0.05). No statistical difference between the study groups (metformin vs. no metformin) were found in TNM stage (T1: 48% vs. 46%; T2: 36% vs. 28%; T3: 7% vs. 5%; T4: 9% vs. 21%, p=0.071; N0: 51% vs. 50%, N1 49% vs. 50%; M0: 97% vs. 97.5%, M1: 3% vs. 4%, p=0.74, respectively). However, patients on metformin had lower proportion of T3 or T4 tumors than patients who were not receiving metformin (16% vs. 26%; p<0.05). Patients on metformin had lower rate of lobular carcinoma than patients who were not receiving metformin (9.5% vs. 19%; p<0.05). Tumor size, tumor grade, mean number of metastatic lymph nodes, hormone receptor status or HER-2 status did not show any statistical difference between both study groups. Conclusions: Patients with BC and DM on metformin have lower proportion of T3 or T4 tumors and lower proportion of lobular carcinoma in comparison to patients not receiving metformin.
Feasibility study of nipple-sparing mastectomy for Japanese breast cancer patients.
Authors: Takahashi Maiko , Jinno Hiromitsu , Hayashida Tetsu , Kitagawa Yuko 
Published: February 2017

166 Background: Nipple-sparing mastectomy (NSM) has been gathering increased recognition as an alternative to more traditional mastectomy approaches. However, the oncological safety of these procedures is still to be elucidated. The purpose of this study is to investigate technical feasibility of NSM without increasing the risk of local recurrence and complications. Methods: Ninety-eight stage 0-III breast cancer patients received NSM between January 2001 and April 2012 at Keio University Hospital. Eligible patients were without skin involvement and not indicated for breast-conserving therapy by preoperative imaging. The pathological analysis of the subareolar tissue was performed and nipple-areolar-complex (NAC) would be removed if positive. Four hundred seventy-four breast cancer patients who had mastectomy during the same period were used as a control group. Results: The median age was 46.0 years (range 29–68). The mean clinical tumor size was 2.8±1.2cm and the mean distance between the nipple and the tumor was 2.5±1.7cm. Ninety-one patients (92.9%) had clinically node-negative status. NAC involvement was observed in 3 patients (3.1%). Three patients (3.1%) presented with epidermal necrosis. After a median follow-up period of 37.3 months (range 1-136), there were 7 recurrences (7.1%), including 4 local recurrences (4.1%) and 3 distant metastases (3.1%). There was no statistically significant difference in local recurrence between the patients with NSM and mastectomy (4.1% vs. 3.2%; p=0.16). Immediate and delayed reconstruction was performed in 2 cases (2.0%) and 41 cases (41.8%), respectively. Conclusions: Our results suggested NSM may provide oncologic safety for strongly motivated and carefully selected patients.
Predictors of residual disease after breast-conserving surgery.
Authors: Aneja Sanjay , Lannin Donald R. , Killelea Brigid K. , Horowitz Nina Ruth , Chagpar Anees B. 
Published: February 2017

168 Background: Locoregional failure after breast conserving surgery (BCS) is often due to undetected residual disease, and the risk of such residual disease frequently guides management. We sought to determine clinical and pathologic factors correlating with the finding of residual invasive cancer and/or DCIS in patients undergoing BCS. Methods: We performed a retrospective cohort study for all invasive and in situ breast cancer treated with BCS at a single institution in 2009. The main outcome variable of interest was residual disease determined by pathologic examinations of cavity shave margins or reexcision. Chart review and statistical analyses were performed to evaluate clinical and pathological factors correlating with residual DCIS or invasive cancer. Results: 256 in situ or invasive breast cancers were treated with BCS in 2009. Of these, 207 (80.9%) underwent additional resection either for close margins or as routine practice. These formed the cohort of interest for this study. 39 patients (18.8%) had residual DCIS and 22 (10.6%) had residual invasive disease. Age, race, histology, ER, PR, her-2-neu and margin distance for invasive disease did not predict the finding of residual DCIS nor invasive cancer. Lymphovascular invasion, while not predicting residual DCIS, was correlated with the finding of residual invasive disease (28.0% vs. 7.9%, p=0.007). Margin distance for DCIS was not predictive of residual invasive cancer but was predictive of residual DCIS. 33.8% of lesions with DCIS margins <1mm were associated with residual DCIS, while 3.4% of those with DCIS margins >5mm were associated with residual in situ disease (p=0.002). Increasing tumor size for invasive and in situ disease were associated with residual DCIS (median 19.5 vs. 13.0 mm, p=0.001 and 22.5 vs. 15.0 mm, p<0.001, respectively); however, neither size component was associated with residual invasive disease. Conclusions: While margin distance and tumor size are associated with residual DCIS in patients undergoing BCS, these are not correlated with residual invasive disease. Conversely, the finding of lymphovascular invasion predicts residual invasive cancer, but not DCIS. These factors may aid in risk stratification of patients and guide postoperative management.
Experience with nipple-sparing mastectomy after prior whole-breast radiation.
Authors: Mackey Aimee Marlena , Taback Bret , Ananthakrishnan Preya , Feldman Sheldon M. 
Published: February 2017

173 Background: Nipple-sparing mastectomy (NSM) is being performed more frequently for risk reduction and breast cancer treatment. Prior whole breast irradiation (WBI) has been considered a contraindication to NSM. This study reviews our NSM experience following prior WBI. Methods: We reviewed our prospective mastectomy database from April 2007 to April 2012 for patients undergoing NSM. Ten patients out of a total 169 NSM were identified that underwent NSM following prior WBI. Data collected included incision type, follow-up, complications, cosmesis, and recurrence. Results: Of the ten NSM patients who received prior WBI, 6 had recurrent ipsilateral breast cancer at the lumpectomy site, 3 developed contralateral breast cancers and opted for bilateral NSM, and 1 patient opted for bilateral NSM after finding a BRCA mutation following BCT. Mean patient age was 53. Two patients had comorbities: 1 hyperlipidemia and 1 former smoker. Three of 10 (30%) developed complications, with 2 partial necrosis of nipple-areola complex (NAC) and 1 complete loss of the NAC (Table). No patient required return to the operating room (local resection in the office was performed for the complete NAC loss) and all patients had good final cosmesis. All patients underwent immediate reconstruction: 5 tissue expanders (TE), 2 DIEP and 3 TRAM flaps. Mean follow up is 23 months with no local recurrences to date. Conclusions: This study demonstrates that NSM with immediate reconstruction can be performed in selected patients with prior WBI with an acceptable rate of nipple preservation and good cosmesis. NAC preservation is the ultimate goal in patients undergoing NSM. Current studies are ongoing to identify risk factors that may be associated with nipple necrosis. [Table: see text]
KLF4 and ER as biomarkers for prognosis of breast cancer patients.
Authors: Nagata Takuya , Matsui Kousi , Shimada Yutaka , Tsukada Kazuhiro 
Published: February 2017

174 Background: Some of the induced pluripotent stem cell (iPS cell)-inducing factors have been reported to be expressed in breast cancer. The aim of the present study was to examine the relationship between the expression of KLF4 that was one of iPS cell-inducing factors and the prognosis of breast cancer patients. Methods: In 162 breast cancer patients, the expression of KLF4 was determined by immunohistochemistry using a tissue microarray analysis. The relationship with the expression of the estrogen receptor (ER) was also examined. Results: Patients with strong expression of KLF4 (KLF4 high: n=76, 46.9%) had significantly better disease-free survival (DFS; p=0.002) and overall survival (OS; P=0.0006) rates than those with weak expression of KLF4 (KLF4 low: n=86, 53.1%). And also, patients with expression of ER (ER+; n=135, 83.3%) had better DFS (p=0.018) and OS (p=0.0018). About the relationship of KLF4 and ER, KLF4low, ER+ group were better DFS (p=0.0024) and OS (p<0.0001) than KLF4low, ER- group. Conclusions: It was suggested that expressions of KLF4 and ER were useful as biomarkers of prognosis for breast cancer patients respectively. It was also suggested that KLF4 was not cooperative with ER to control the metastasis or progression of breast cancer cells.
Nipple-sparing mastectomy and subareolar biopsy: To freeze or not to freeze?
Authors: Alperovich Michael , Blechman Keith M. , Samra Fares , Shapiro Richard , Axelrod Deborah M. , Choi Mihye , Karp Nolan S. , Guth Amber Azniv 
Published: February 2017

185 Background: Advances in breast cancer screening and treatment have fostered the use of surgical procedures that increasingly optimize cosmetic outcome, while ensuring oncologic safety remains the primary concern of the oncologic surgeon. The role of nipple-sparing mastectomy (NSM) for risk-reducing surgery and breast cancer is evolving. It can be difficult to demonstrate involvement of the nipple-areolar complex (NAC) preoperatively, and and in this report we examine the utility of intraoperative subareolar frozen section (FS). Methods: Records of patients undergoing NSM at the NYU Langone Medical Center from 2006-2011 were reviewed retrospectively. Use of subareolar FS was at surgeon’s discretion. Results: 237 NSM were performed (146 prophylacytic, 91 theraputic). FC was not utilized in 58 mastectomies (28 prophylactic), with 2 (+) on paraffin. Among the remaining 180 mastectomies, 11 biopsies were (+)(7.2%); 5 subareolar biopsies were (+) on FS and paraffin histologic slides (PS) (2.8%); 6 were negative on FS and (+) on PS. Among the 3 prophylactic NSM with (+) subareolar biopsies there was 1 (+) FS, 1 (-) FS, and 1 with no FS performed. There were no false (+) FS. Four of the 5 patients with (+)FS underwent simultaneous excision of the NAC. The 5th patient had atypia on FS and DCIS on PS, and returned to the OR during the same hospitalization for removal of NAC. The remaining patients underwent subsequent excision of the NAC either during planned 2nd stage reconstruction or following completion of chemotherapy. 8 NAC were free of disease and 5 were positive for in situ or invasive disease. There has been no local recurrence in these patients to date. Conclusions: The rate of NAC involvement is low, 5.5% in this series, and FS, while utilized in the majority of these cases, detected only 46% of subareolar disease. While FS can direct intraoperative decision making, the predictive power is low, and these considerations must be addressed in preoperative patient discussions. Furthermore, among those patients with (+) subareolar biopsies, only 39% had residual disease on NAC excision. Thus, optimal oncologic management of the NAC must still be considered an unresolved issue.
Indication of sentinel lymph node biopsy with breast-conserving surgery for ductal carcinoma in situ considering lymphatic flow.
Authors: Yamaguchi Ayane , Tsuyuki Shigeru , Okamura Miru , Kawata Yukiko , Kawaguchi Kosuke , Kawaguchi Nobuko , Kohno Yukihiro 
Published: February 2017

192 Background: Ductal carcinoma in situ (DCIS) has been regarded as curable with resection, but axillary lymph node metastases have been reported in 2% of DCIS patients. Even when DCIS has been diagnosed by preoperative core needle biopsy (CNB), 8% to 38% of the patients have been found to have invasive ductal carcinoma (IDC) on the basis of pathological diagnosis after surgical treatment. The indication of sentinel lymph node biopsy (SLNB) and breast-conserving surgery (BCS) for DCIS is still controversial. Methods: SLNB is a standard surgical technique for early breast cancer treatment, and indocyanine green (ICG) fluorescence method is remarkable in terms of the visualization of lymphatic flow. We analyzed the variation in lymphatic drainage routes from the nipple to the SLN (sentinel lymphatic routes) by using the ICG florescence method in early breast cancer patients and investigated the effects on the localization of the tumor to the sentinel lymphatic routes after BCS. Results: From November 2010 to April 2012, we recorded the sentinel lymphatic routes in 118 patients. All the routes passed through the upper outer quadrant (UOQ) area, and there were more than 2 routes in 53 cases. Of these routes, 73% passed through only the UOQ area and 27% passed through the UOQ via the upper inner, lower inner, and/or lower outer quadrant area. Conclusions: We should confirm the sentinel lymphatic routes by using the ICG florescence method before BCS for preoperatively diagnosed DCIS. If the lymphatic routes do not pass over the extent of resection of BCS, we can omit SLNB in the first surgical treatment and await the final pathological result. However, we should perform SLNB in addition to BCS in cases in which the lymphatic routes pass over the tumor in the region except the UOQ area.
Adjuvant docetaxel and cyclophosphamide (DC) with prophylactic growth colony stimulating factor (GCSF) on days 8 and 12 in breast cancer patients: A retrospective analysis.
Authors: Yerushalmi Rinat , Stemmer Salomon M. , Hendler Daniel , Neiman Victoria , Ciuraru Noa Beatrice , Bonilla Luisa , Ben-Aharon Irit , Amit Limor , Granot Tal , Zer Alona , Sulkes Aaron , Rizel Shulamith 
Published: February 2017

202 Background: Four cycles of docetaxel/cyclophosohamide (DC) produced superior survival compared with doxorubicin/cyclophosphamide in the treatment of early breast cancer. The study reported 5% of febrile neutropenia (FN) events using prophylactic antibiotics with no growth factor (GF) support. The worldwide adoption of this protocol yielded several reports on substantially higher rates of FN events (up to 46%), prompting the addition of GCSF by most centers. We explored the use of GF support on days 8 and 12 to the original DC protocol. This report summarizes treatment related morbidity of the DC protocol with GF support given on days 8 and12. Methods: All consecutive patients with stages I-II breast cancer who were treated with the DC protocol in our institute from April 2007 to March 2012 were included. Patient characteristics and toxicity were reported. Results: 131 patients were identified. Median age- 60y (25-81), 65y and older- 25%; 5 patients did not complete the 4 planned cycles (12/524 cycles were missed). Fifteen patients (11.5%) experienced at least one event of FN (4 patients had 2 events), all requiring hospitalization. FN events occurred in 19 out of 512 cycles (3%). Median age of the patients who required hospitalization due to FN was 60y (42-73). Results were comparable in the older group (≥65): 15% developed FN with 6 NF events out of 130 cycles (4.6%), p>0.05. There were additional 14 hospitalizations events due to other causes (diarrhea n=2, chest pain=2, cellulitis n=2, COPD n=1, tonsillitis n=1, fever n=2, bone pain n=1, observation after treatment n=1 and hearing problem n=1, unknown n=1). Six patients had grade 2-3 diarrhea. 2/6 required hospitalization. There was no treatment related mortality. Conclusions: Primary prophylactic growth factor support on days 8 and 12 provides a safe and economic option to deliver the DC protocol. Our results are in line with other retrospective protocols using longer schedules of GF support.
Sentinella: Portable gamma camera versus conventional scintigram for intraoperative sentinel lymph node detection in breast cancer.
Authors: Ghosh Debashis B. , Michalopoulos Nikolaus , Wickham Caspar , Davidson Timothy , Keshtgar Mohammed R. 
Published: February 2017

22 Background: Sentinel lymph node biopsy (SLNB) is a standard practice for staging the axilla in breast cancer. Access to nuclear medicine department and sentinel node imaging remain an issue in number of hospitals in the UK and rest of the world. Preoperative scintigrams are performed to confirm uptake of radioactivity and localisation of nodes in centres where facilities are available. Sentinella is a portable imaging camera used intraoperatively to produce real time visual localisation of SLNs. Sentinella was tested in a controlled laboratory environment at our centre followed by the first use of this device in breast cancer patients from UK. Methods: Sensitivity and spatial resolution of Sentinella was compared with conventional gamma camera (CGC).Intraoperative Sentinella Scans were performed in 130 patients and their yield compared with Lymphoscintigrams from CGC. Further Sentinella scans were performed after the axilla was deemed clear by silent activity of hand held gamma probe. Results: Sentinella resolution is comparable with the CGC for objects close to the camera. Sentinella detects high radioactivity (500 kBq) faster than CGC (1 vs 2.5min). In cases of low radioactivity (10kBq) Sentinella was equally accurate and faster than CGC, when placed nearer to skin.Intra-operative Sentinella scans detected an average of 2 sentinel nodes compared to 1.4 nodes by CGC scans. Sentinella demonstrated a serial decay in activity with removal of every hot node and its LED guidance helped in detecting residual nodes. Sentinella picked up extra nodes in 5/130 cases after the axilla was found silent using hand held gamma probe. In 2/130 cases extra nodes found using Sentinella had presence of cancer that led to a complete axillary clearance. Conclusions: This data confirms the excellent sensitivity and specificity of the machine in localisation of radioactive nodes. This new imaging technique increases our pick up of SLNs intraoperatively that are missed due to inadequate visualisation and provide a superior detection compared to static scintigram imaging. This portable gamma camera can replace the use of conventional lymphoscintigrams saving camera time and cost.