Radiofrequency Ablation of Invasive Breast Carcinomas: A Phase II Trial

Background Local ablative therapy of breast cancer represents the next frontier in the minimally invasive breast-conservation treatment. We conducted a phase II trial to evaluate radiofrequency ablation (RFA) of invasive breast carcinomas. Methods Consecutive patients from two Mexican Institutions with invasive breast cancers < 4 cm, with no multicentric tumors and no previous chemotherapy were included in this trial. Under ultrasound guidance, the tumor and a 5 mm margin of surrounding breast tissue were ablated with saline-cooled RFA electrode followed by surgical resection. Routine pathologic analysis and viability evaluation with NADPH-diaphorase stain were performed to assess tumor ablation. Procedure-associated morbidity was recorded. Results Twenty-five patients were included. Mean patient age was 55.3 years (range 42–89 years). Mean tumor size was 2.08 cm (range 0.9–3.8 cm). Fourteen tumors (56%) were <2 cm. The mean ablation time was 11 minutes using a mean power of 35 W. During ablation, the tumors become progressively echogenic that corresponded with the region of severe RFA injury at pathologic examination. Of the 25 patients treated, NADPH stain showed no evidence of viable malignant cells in 19 patients (76%), with significant difference between tumors <2 cm (complete necrosis in 13 of 14 cases, 92.8%) vs. those >2 cm (complete necrosis 6 of 11 cases, 54.5%) (P < .05). No significant morbidity was recorded. Conclusions RFA is a promising minimally invasive treatment of small breast carcinomas, as it can achieve effective cell killing with a low complication rate. Further studies are necessary to optimize the technique and evaluate its future role as local therapy for breast cancer.     

Radiofrequency ablation of breast cancer: first report of an emerging technology.

HYPOTHESIS: Radiofrequency (RF) energy applied to breast cancers will result in cancer cell death. DESIGN: Prospective nonrandomized interventional trial. SETTING: A university hospital tertiary care center. PATIENTS: Five women with locally advanced invasive breast cancer, aged 38 to 66 years, who were undergoing surgical resection of their tumor. One patient underwent preoperative chemotherapy and radiation therapy, 3 patients received preoperative chemotherapy, and 1 had no preoperative therapy. All patients completed the study. INTERVENTIONS: While patients were under general anesthesia and just before surgical resection, a 15-gauge insulated multiple-needle electrode was inserted into the tumor under sonographic guidance. Radiofrequency energy was applied at a low power by a preset protocol for a period of up to 30 minutes. Only a portion of the tumor was treated to evaluate the zone of RF ablation and the margin between ablated and nonablated tissue. Immediately after RF ablation, the tumor was surgically resected (4 mastectomies, 1 lumpectomy). Pathologic analysis included hematoxylin-eosin staining and enzyme histochemical analysis of cell viability with nicotinamide adenine dinucleotide-diaphorase (NADH-diaphorase) staining of snap-frozen tissue to assess immediate cell death. MAIN OUTCOME MEASURE: Cancer cell death as visualized on hematoxylin-eosin-stained paraffin section and NADH-diaphorase cell viability stains. RESULTS: There was evidence of cell death in all patients. Hematoxylin-eosin staining showed complete cell death in 2 patients. In 3 patients there was a heterogeneous pattern of necrotic and normal-appearing cells within the ablated tissue. The ablated zone extended around the RF electrode for a diameter of 0.8 to 1.8 cm. NADH-diaphorase cell viability stains of the ablated tissue showed complete cell death in 4 patients. The fifth patient had a single focus of viable cells (<1 mm) partially lining a cyst. There were no perioperative complications related to RF ablation. CONCLUSIONS: Intraoperative RF ablation results in invasive breast cancer cell death. Based on this initial report of the use of RF ablation in breast cancer, this technique merits further investigation as a percutaneous minimally invasive modality for the local treatment of breast cancer.     

Radiofrequency Thermal Ablation of Breast Cancer Local Recurrence: A Phase II Clinical Trial

Background  The role of radiofrequency (RF) ablation to treat local recurrence of breast cancer is unknown. Methods  We conducted a two-stage phase II clinical trial. Eligible patients had a histologically confirmed noninflammatory and ≤3 cm ipsilateral breast tumor recurrence. The tumor site was identified by intraoperative sonography. A LeVeen needle electrode (RadioTherapeutics Corp, Mountain View, Calif) was inserted into a single site within the tumor and radiofrequency ablation was performed using a RF-2000 generator (RadioTherapeutics Corp). After completion of radiofrequency, a mastectomy was performed. Conventional staining and nicotinamide adenine dinucleotide-diaphorase (NADH-diaphorase) cell viability staining were performed. Results  During the first stage, procedures were uneventful. Conventional, cytokeratin, and NADH-diaphorase staining identified persistent viable tumor cells in the RF-ablated region in three patients. This phase II trial was stopped after completion of the first stage because of insufficient efficacy. Conclusion  We demonstrate in this study that RF ablation is a potential technique to destroy local recurrence of breast tumors but the technique we tested in this phase II clinical trial had insufficient efficacy to recommend its use in routine.     

乳腺癌中bcl-2蛋白表达的意义

为探讨抑凋亡基因ｂｃｌ－２蛋白表达在乳腺癌中的意义,应用免疫组织化学的方法,对１２５例浸润性乳腺癌患者的石蜡包埋组织切片中ｂｃｌ－２,雌激素受体,孕激素受体及ｐ＾５３基因的表达产物进行检测。结果：ｂｃｌ－２蛋白在浸润性导管癌中的表达为６３．３％,而在浸润性小叶癌中为８８．９％,二者间菜显著性间谍;在浸润性导管癌中,ｂｃｌ－２蛋白的表达与原发癌大小及肿瘤分级呈负相关,与ＥＲ,ＰＲ的表达呈正相关,与ｐ     

乳腺癌病理生物学特性与多肿瘤基因表达的关系

目的 观察多肿瘤基因在乳腺癌组织中的表达,探讨其与乳腺癌病理生物学特性的关系.方法 采用免疫组织化学SP染色法对120例乳腺癌组织中多肿瘤基因的表达进行检测[雌激素受体(ER)、孕激素受体(PR)、表皮生长因子受体(C-erB-2)、p53、转移抑制基因(mn23)、bcl-2、增殖细胞核抗原(PCNA)、多药耐药蛋白(MRP)],分析其与乳腺癌病理生物学特性的关系.结果 p53、bcl-2的表达在不同乳腺癌激素受体状态中差异有统计学意义,且与ER、PR的表达有显著相关性:p53在ER(-)、PR(-)的乳腺癌中呈现高表达,在ER(+)、PR(+)的乳腺癌中呈现低表达(P<0.01);而bcl-2则相反(P<0.01).bcl-2的表达与月经状态有关,在绝经前乳腺癌组织中的表达明显高于绝经后乳腺癌(P<0.01).PCNA的表达与肿瘤的大小相关,在直径较大的肿瘤(>3 cm)中的表达显著高于直径较小的肿瘤(≤3 cm,P<0.01).结论 p53、bcl-2的表达与ER、PR的状态相关,可作为判断乳腺癌生物学特性和预后的重要指标.     

Metaplastic breast cancer: clinical significance

BACKGROUND: Metaplastic breast carcinoma (MBC) is a rare poorly differentiated breast cancer characterized by coexistence of ductal carcinoma with areas of matrix producing, spindle-cell, sarcomatous, or squamous differentiation; ER/PR/HER2 negativity; and a reputation for poor outcome. METHODS: The Swedish Cancer Institute prospective breast cancer database (> 6500 patients; 1990-2005) has 24 MBC cases that were compared with typical breast cancer cases matched for age, date of diagnosis, stage, and ER/PR/HER2 status. RESULTS: The mean metaplastic primary tumor diameter was 2.5 cm. The histological/nuclear grade was high in 21 of 24 cases. No patient had distant metastasis. ER and/or PR receptor status was negative in all cases. HER2 was negative in 10 of 11 cases tested. EGFR (HER1) was positive in 7 of 7 cases tested. All patients had sentinel and/or axillary lymph node dissection and surgical resection; 18 received chemotherapy and 22 had radiation therapy. Four patients had distant recurrences 5 to 88 months from diagnosis. Five-year survival was 83% (95% confidence interval, 66-100%). Comparison with matched typical breast cancer cases revealed no major significant difference in multidisciplinary treatment patterns, recurrence, or survival. CONCLUSION: MBC is associated with poor prognostic indicators, but outcomes comparable with matched typical breast cancer cases can be achieved with routine aggressive multidisciplinary care. Increased, expression of EGFR (HER1) provides an opportunity for targeted tumor therapy.     

Prognostic Value of Breast Cancer Subtypes,Ki‐67 Proliferation Index,Age, and Pathologic Tumor Characteristics on Breast Cancer Survival in Caucasian Women

Estrogen receptor (ER), progesterone receptor (PR), and epidermal growth factor receptor 2 (HER2) status are well‐established prognostic markers in breast cancer management. The triple negative breast carcinoma subtype (ER‐/PR‐/HER2‐) has been associated with worse overall prognosis in comparison with other subtypes in study populations consisting of ethnic minorities and young women. We evaluated the prognostic value of breast cancer subtypes, Ki‐67 proliferation index (Ki‐67PI), and pathologic tumor characteristics on breast cancer survival in Caucasian women in our institution, where greater than 90% of the total patient population is white. From 628 new invasive breast cancer cases in our data base (2000‐late 2004), 593 (94%) were identified in Caucasian women. ER/PR/HER2 breast cancer subtypes were classified based on St. Gallen International Expert Consensus recommendations from 2011. ER/PR/HER2 status and its effect on survival were analyzed using a Kaplan–Meier curve. ER/PR/HER2 status, grade, tumor‐node‐metastasis status (TNM)/anatomic stage, and age were analyzed in terms of survival in a multivariate fashion using a Cox regression. Ki‐67PI was analyzed between ER/PR/HER2 groups using the Kruskal–Wallis, Mann–Whitney U‐tests, and 2 × 5 ANOVA. Our results showed that patients with stage IIB through stage IV breast carcinomas were 2.1–16 times more likely to die than patients with stages IA‐B and IIA disease, respectively (95% CI 1.17–3.81 through 9.68–28.03, respectively), irrespective of ER/PR/HER2 subtype. Similar effect was seen with T2, N2/N3, or M1 tumors in comparison with T1, N0/N1, and M0 tumors. Chances of dying increase approximately 5% for every year increase in age. There was a significant main effect of Ki‐67PI between ER/PR/HER2 subtypes, p < .001, but Ki‐67PI could not predict survival. In summary, TNM status/anatomic stage of breast carcinomas and age are predictive of survival in our patient population of Caucasian women, but breast carcinoma subtypes and Ki‐67 proliferation index are not.     

ERCC1和β-tubulinⅢ和TS及TOPOⅡα在浸润性乳腺癌组织中的表达及临床意义

目的:探讨核苷酸切除修复交叉互补基因1(ERCC1)、β-微管蛋白-Ⅲ(β-tubulinⅢ)、胸苷酸合成酶(TS)、拓扑异构酶Ⅱα(TOPOⅡα)在浸润性乳腺癌组织中的表达水平及临床意义。方法:用免疫组织化学法对53例乳腺癌患者肿瘤组织中的ERCC1、β-tubulinⅢ、TS、TOPOⅡα蛋白表达水平进行检测,并分析其与肿瘤大小、TNM分期、淋巴结转移、ER、PR表达水平的关系。结果:53例浸润性乳腺癌患者中ERCC1低表达率为75.47%(40/53),其表达与淋巴结阴性、ER阳性及PR阳性表达相关(P0.05);β-tubulinⅢ低表达率为54.72%(29/53),其表达与年龄、肿瘤大小、肿瘤分期、淋巴结是否转移、ER及PR表达状态均无关(P0.05);TS低表达率为83.02(44/53),其表达水平与肿瘤分期及ER阳性表达状态相关(P0.05);TOPOⅡα高表达率为45.28%(24/53),其表达与肿瘤直径2 cm、淋巴结阳性、ER阳性表达状态相关(P0.05)。ERCC1、β-tubulinⅢ、TS、TOPOⅡα表达之间无相关性(P0.05)。结论:ERCC1、β-tubulinⅢ、TS、TOPOⅡα在乳腺癌组织中的表达水平有助于判断浸润性乳腺癌患者对于化疗药物的敏感性,结合浸润性乳腺癌临床病理特征,为制定个体化化疗方案提供了重要理论依据。     

Steroid Hormone Receptor Profile of Normal, Benign, and Malignant Female Breast Epithelium: An Immunohistochemical Analysis of 325 Biopsies

Abstract: The steroid hormone receptor (SR) profile was determined for both the estrogen receptor (ER) and progesterone receptor (PR) in 55 fibroadenomas, 69 fibrocystic changes, 38 ordinary, and 14 atypical intraductal hyperplasias as well as 149 breast carcinomas obtained from 325 female patients by diagnostic surgical biopsy. Normal breast tissue adjacent to the lesions under study was simultaneously evaluated in 234 cases. SR were proven immunohistochemically in cryostat sections using an immunohistochemical assay with rat monoclonal antibodies against human ER or PR. The findings were scored and summarized into the phenotypes ER+PR+,ER?PR+, ER+PR? and ER?PR?. The ER+PR+ status was most often found in fibroadenomas (67%) and normal breast tissue (64%) as well as in fibrocystic changes (63%) and breast carcinomas (58%). ER?PR? was inversely rare in fibroadenomas (4%), normal breast tissue (15%), fibrocystic changes (23%), and breast carcinomas (29%). The simultaneous SR analysis in breast disease and its surrounding normal tissue showed in fibroadenomas in 90% and in fibrocystic changes in 80%, a ER/PR phenotype expression similar to adjacent normal tissue; whereas in breast carcinomas the SR status corresponded with the preexisting normal tissue only in 36%. The comparative SR analysis of normal and pathological breast tissue showed a gradually inverse biological correlation between the decrease of ER+PR+ and the increase of ER?PR? frequency from benign breast changes to noninvasive and invasive breast carcinomas. In benign breast epithelium, ER?PR+ might be regarded as low-risk phenotype, whereas ER+PR? could be estimated as high-risk phenotype in view of a later dedifferentiation and possible malignization. The more frequent discordance of SR expression between breast carcinomas and their adjacent normal breast tissue suggests that the neoplastic growth may become more and more independent from normal endocrine influences.     

B型超声引导经皮经肝穿刺射频治疗肝癌的近期疗效

目的 评估集束电极射频（radiofrequency,RF)治疗肝癌的临床疗效及适应证。方法 回顾分析我院245例肝癌患者经集束电极射频治疗的临床资料,比较治疗前后癌体内血液供应状况,癌灶体积,胎甲球蛋白（AFP）的变化,及患者自觉症状的改善情况。结果 AFP术后1周内下降者占50％,患者自觉症状明显改善。癌灶直径小于5cm的肝癌,术后1至6个月内70％－90％癌灶血液供应消失,癌灶缩小,甚至消失。个别癌灶复发经再次射频治疗得到控制。直径大于5cm的肝癌,配合介入栓塞治疗,60％癌灶缩小。继发性肝癌,就癌灶而言,射频治疗术后癌灶缩小,症状得到控制。结论 B型超声引导下集束电极射频治疗肝癌近期疗效确切。直径小于5cm的癌灶疗效理想,直径大于5cm的肝癌,采用多点射频治疗,再配合介入栓塞治疗,也取得了比较理想的疗效。     

芳香化酶在乳腺癌中表达的临床病理学观察

目的研究芳香化酶对乳腺癌增殖和侵袭性的影响,探求乳腺癌局部产生的雌激素与乳腺癌生物学特性的关系。方法应用免疫组织化学方法检测腋淋巴结无转移的原发性乳腺癌组织内芳香化酶的表达,分析其与金属蛋白酶2（matrix metalloproteinases 2,MMP2）、金属蛋白酶9（matrix metalloproteinases 9,MMP9）及肿瘤的大小、分级和雌激素及孕激素受体等的相关性。结果在原发性乳腺癌细胞中芳香化酶的表达弱阳性（＋）者占25．0％、阳性（＋＋）者占29．9％;芳香化酶状态与MMP2、MMP9以及二者的共表达成正相关（P〈0．05）,但与肿瘤的大小、ER与PR表达、月经状态、组织学类型及病理分级无相关性（P〉0．05）;在绝经后患者中芳香化酶的表达与肿瘤的大小成正相关（P〈0．05）,而在绝经前的患者中二者无相关性（P〉0．05）;在ER和（或）PR阳性的肿瘤中芳香化酶的表达与MMP2／MMP9的共表达成正相关（P〈0．05）,而在ER和PR均阴性的肿瘤中二者无相关性（P〉0．05）。结论乳腺癌组织内表达的芳香化酶所产生的局部雌激素环境在部分乳腺癌中可能通过ER通路刺激肿瘤的增殖及增强肿瘤的侵袭性,这一现象在绝经后的患者体内表现更为明显。     

Glycogen Rich Clear Cell Carcinoma (GRCC) of the breast may not have a poor prognosis

IntroductionGlycogen Rich Clear Cell Carcinoma (GRCC) is a rare variant of breast carcinomas and believed to be linked with a poor prognosis.Case summaryWe are presenting a 60-year-old Saudi lady with a 2 cm GRCC carcinoma associated with clear cell ductal carcinoma in situ (DCIS) and no axillary lymph node involvement. The tumor was Estrogen and Progesterone receptors (ER & PR) positive and HER 2-neu negative. She underwent mastectomy with sentinel lymph node biopsy followed by hormonal therapy. She is alive and free of disease for 35 months.ConclusionThe prognosis of GRCC may not be different from other types of invasive breast cancer.     

Ultrasound-Guided Laser-Induced Thermal Therapy for Small Palpable Invasive Breast Carcinomas: A Feasibility Study

Background  The next step in breast-conserving surgery for small breast carcinomas could be local ablation. In this study, the feasibility of ultrasound-guided laser-induced thermal therapy (LITT) is evaluated. Methods  Patients with large-core needle biopsy-proven invasive, palpable breast carcinoma (clinically ≤2 cm) underwent ultrasound-guided LITT, followed by surgical excision. Completeness of ablation was determined by both hematoxylin and eosin staining and nicotinamide adenosine diaphorase staining. Results  Fourteen patients completed the treatment. The mean histological tumor size was 17 mm (range, 8–37 mm); 6 of 14 tumors were histologically larger than the clinical entry threshold of 2 cm. The power applied in all patients was 7 W, and the mean treatment time was 21.4 min (range, 15–30 min). In one patient, a skin burn occurred, and one patient had a localized pneumothorax that could be treated conservatively. In 7 (50%) of 14 patients, the tumor was completely ablated, as confirmed by nicotinamide adenosine diaphorase staining. In 11 cases, extensive in-situ carcinoma was present. In one case, the in-situ carcinoma was also completely ablated. A total of seven (88%) of eight tumors <2 cm in size were completely ablated versus one (17%) of six tumors that were ≥2 cm in size (P = .026). Conclusions  Successful LITT of invasive breast cancer seems to be feasible when confined to small (<2 cm) nonlobular carcinomas without surrounding extensive in-situ component and angioinvasion. However, to implement LITT in a curative setting, improvements in imaging to more reliably preoperatively assess tumor size and monitoring of fiber tip placement and treatment affect are essential.     

乳腺癌c-erbB-2与雌孕激素受体及淋巴结转移的相关性分析

目的：分析乳腺癌c-erbB-2的表达与ER、PR，以及腋窝淋巴结、肿瘤大小、病理类型的相关性。方法：收集术前未行新辅助化疗而行手术切除加腋窝清扫的乳腺癌病人346例，采用免疫组化法检测c-erbB-2、ER及PR；比较c-erbB-2表达与ER、PR、腋窝淋巴结、肿瘤大小以及病理类型之间的关系。结果：c-erbB-2阳性表达者占48．2％，腋窝淋巴结有转移者的c-erbB-2阳性表达为69．6％，而淋巴结阴性者则为34．6％（P〈0．001）。ER、PR均阳性且c-erbB-2表达也阳性者为38．1％；而ER、PR均阴性、c-erbB-2阳性者达64．6％（P〈0．001）。仅ER阳性和阴性者的c-erbB-2阳性表达分别是40．7％和69.2％（P（0．001）。仅PR阳性和阴性者的c-erbB-2阳性分别为46．4％和49．7％（P〉0．05）。〈2cm和2～5cm肿瘤的c-erbB-2阳性率分别是47．1％和48．8％（P〉0．05）。导管内癌和黏液癌的c-erbB-2表达阳性率分别达73．8％和60．0％。结论：c-erbB-2阳性表达与腋窝淋巴结的转移呈正相关，与ER呈负相关，与PR和肿瘤大小不相关。c-erbB-2是判断乳腺癌预后的良好指标。     

Cryoablation of Early-Stage Breast Cancer: Work-in-Progress Report of a Multi-Institutional Trial

Background With recent improvements in breast imaging, our ability to identify small breast tumors has markedly improved, prompting significant interest in the use of ablation without surgical excision to treat early-stage breast cancer. We conducted a multi-institutional pilot safety study of cryoablation in the treatment of primary breast carcinomas.Methods Twenty-nine patients with ultrasound-visible primary invasive breast cancer 2.0 cm were enrolled. Twenty-seven (93%) successfully underwent ultrasound-guided cryoablation with a tabletop argon gas-based cryoablation system with a double freeze/thaw cycle. Standard surgical resection was performed 1 to 4 weeks after cryoablation. Patients were monitored for complications, and pathology data were used to assess efficacy.Results Cryoablation was successfully performed in an office-based setting with only local anesthesia. There were no complications to the procedure or postprocedural pain requiring narcotic pain medications. Cryoablation successfully destroyed 100% of cancers <1.0 cm. For tumors between 1.0 and 1.5 cm, this success rate was achieved only in patients with invasive ductal carcinoma without a significant ductal carcinoma-in-situ (DCIS) component. For unselected tumors >1.5 cm, cryoablation was not reliable with this technique. Patients with noncalcified DCIS were the cause of most cryoablation failures.Conclusions Cryoablation is a safe and well-tolerated office-based procedure for the ablation of early-stage breast cancer. At this time, cryoablation should be limited to patients with invasive ductal carcinoma 1.5 cm and with <25% DCIS in the core biopsy. A multicenter phase II clinical trial is planned.     

Clinicopathologic Characteristics and Prognosis of Glycogen‐Rich Clear Cell Carcinoma of the Breast

Glycogen‐rich clear cell carcinoma (GRCC) of the breast is a rare type of breast carcinoma. Knowledge about the characteristics of this type is fragmentary, and the prognosis is on debate. In this study, we aimed to summarize the clinical, pathologic, and biologic characteristics of GRCC of the breast and analyze the survival. We reviewed the cases of breast cancer in our hospital between January 1999 and December 2009 and identified 28 patients as GRCC of the breast. The routine hematoxylin–eosin staining, periodic acid‐Schiff (PAS) staining, and diastase PAS staining were performed on the tumor tissues. The expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER‐2), Ki67 and P53 were evaluated by immunohistochemistry. Tumors with a HER‐2 score of 2+ were confirmed by fluorescent in situ hybridization test. Each GRCC case, who had complete follow‐up data, was compared with four cases of usual invasive ductal carcinomas as controls in the same database and matched with age, year of diagnosis, tumor size, nodal status, and immunophenotype. The chi‐squared test and the Fisher's exact test were used to compare the characteristics of GRCC cases and controls. The univariate analysis was used to study the prognosis, and Kaplan–Meier method was used to compare the survival of two groups. The clinicopathologic and imaging features were analyzed in the GRCC cases. Tumor sizes ranged from 0.8 to 7.5 cm (mean, 3.2 cm). Thirteen cases (46.4%) had positive lymph nodes. The positivity of ER and PR was 61.5% (16 of 26). HER‐2 was positive for three cases (12%). The positivity of Ki67 and P53 were 87.5% and 45.8%, respectively. Twenty‐four cases were followed up from 19 to 158 months. The prognosis of GRCC of the breast was significantly related with the number of positive lymph nodes (p < 0.001), and patients with more than 10 positive lymph nodes were at high risk of recurrence or metastasis. There was no significant difference in overall survival (p = 0.547), and disease‐free survival (p = 0.900) between GRCC of the breast and the usual invasive ductal carcinomas. GRCC of the breast may not have a worse survival.     

乳腺浸润性导管癌组织中PTTG及COX2的表达及临床意义

目的:检测乳腺浸润性导管癌组织中垂体肿瘤转化基因(pituitary tumor-transforming gene,PTTG)和环氧化酶2(cyclooxygenase-2,COX2)的蛋白表达水平并分析与其他临床病理特征的关系。方法:用免疫组织化学Evinson法检测104例乳腺浸润性导管癌组织中PTTG和COX2的蛋白表达水平。结果:104例乳腺浸润性导管癌组织中,有95例检测到PTTG阳性表达,阳性率为91%,其中41例呈低表达(39%),54例呈高表达(52%)。104例乳腺浸润性导管癌组织中,有70例检测到COX2阳性表达,阳性率为67%,其中53例呈低表达(51%),17例呈高表达(16%);PTTG表达与肿瘤大小、组织学分级密切相关,组织学分级越高,PTTG表达越强,PTTG表达与年龄、淋巴结转移、ER、PR和HER2状态无关;COX2表达与ER表达、肿瘤大小、组织学分级和淋巴结转移相关,ER( )组的COX2表达高于ER(-)组,COX2表达与PTTG表达、年龄、PR和HER2状态无关。结论:PTTG和COX2在乳腺浸润性导管癌组织中的表达可能促进乳腺浸润性导管癌的发生发展,并且与低分化、预后不良有关。COX2可能通过刺激雌激素合成来促进乳腺癌细胞增殖。COX2可能促进乳腺癌侵袭转移。     

Treatment of invasive breast carcinoma with ultrasound-guided radiofrequency ablation

BACKGROUND: Radiofrequency ablation (RFA) is a minimally invasive thermal ablation technique. This study reports the safety and efficacy of RFA as a minimally invasive strategy for breast cancers <3 cm diameter in postmenopausal women. METHODS: Twenty-two postmenopausal women (aged 60 years or older) with clinical T-1N0 core biopsy proven breast cancers were studied. Thermocoagulation was undertaken using a sonographically guided RF probe under local anesthesia and sedation. The ablated tumor was resected between 1 and 2 weeks later. Endpoints were technical success, completeness of tumor kill, marginal clearance, skin damage, and patient reports of pain and procedural acceptability. RESULTS: The procedure was well tolerated and cosmesis was excellent. Pathology revealed a central ablation zone surrounded by hyperemia. Coagulative necrosis was complete in 19 of 22 patients. Disease at the ablation zone margin was found in 3 patients and 5 patients had disease distant to the ablation zone consisting of multifocal tumors (2), in-transit metastasis (1), and extensive ductal carcinoma in situ with microinvasive carcinoma (2). Ninety-five percent of patients would be willing to have RFA again. CONCLUSIONS: Radiofrequency ablation can be safely applied in an outpatient setting with acceptable patient tolerance. By itself, RFA cannot be considered effective local therapy. Trials to evaluate RFA complemented with breast irradiation are justified.     

Hormone Receptors and Her2 Expression in Breast Cancer in Sub‐Saharan Africa. A Comparative Study of Biopsies from Ghana and Norway

Hormonal treatment of breast cancer is effective only in patients whose tumors express estrogen and/or progesterone receptors (ER, PR). Receptor assessment is often not available in low‐resource areas, and the choice may be to apply endocrine therapy to all or none of breast cancer patients, depending on the proportion of patients that can be expected to respond. Fifty‐one invasive breast cancers from Ghana and 100 from Norway diagnosed in the same laboratory during the same time period were reexamined in a blinded slide review. Of Ghanaian tumors, 76% were ER+ (≥1% ER+ tumor cells). Of Norwegian tumors, 85% were ER+. Triple‐negative tumors were seen in 22% of Ghanaian patients and in 7% of Norwegian patients. A review of previous similar studies in sub‐Saharan patients shows very discrepant results. Standardization and quality control of receptor assessment and well‐designed clinical trials in sub‐Saharan African breast cancer patients are needed to give a sound basis for endocrine treatment in this area.     

Breast Cancer Subtypes as Defined by the Estrogen Receptor (ER), Progesterone Receptor (PR), and the Human Epidermal Growth Factor Receptor 2 (HER2) among Women with Invasive Breast Cancer in California, 1999–2004

Abstract: Breast cancer research examining either molecular profiles or biomarker subtypes has focused on the estrogen receptor negative/progesterone receptor negative/human epidermal growth factor receptor 2 negative (ER−/PR−/HER2−) and ER−/PR−/HER2+ subtypes. Less is known about the epidemiology or clinical outcome of the other subtypes. This study examines the eight combinations of ER/PR/HER2 in patients with invasive breast cancer. The 5‐year relative survival and the distribution among demographic, socioeconomic, and tumor characteristics of each of the subtypes are examined. Using the California Cancer Registry, 61,309 women with primary invasive breast cancer were classified according to ER/PR/HER2 status. Five‐year relative survival was computed for the eight subtypes. Bivariate analyses were used to assess the distribution of cases across all subtypes. Multivariate logistic regression was used to compute the adjusted odds of having one of the five subtypes with the best and worst survival. Survival varied from 96% (ER+/PR+/HER2−) to 76% (ER−/PR−/HER2+ and ER−/PR−/HER2−). The four subtypes with the poorest survival were all ER negative. Women who were younger than age 50, non‐Hispanic black or Hispanic, of the lowest SES groups, and had stage IV tumors that were undifferentiated were overrepresented in ER−/PR−/HER2+ and triple negative (ER−/PR−/HER2−) subtypes. Asian Pacific Islanders had increased odds (OR = 1.41; 95% confidence interval [CI] = 1.26–1.57) of having the ER−/PR−/HER2+ subtype. Stage III tumors (OR = 1.25; 95% CI = 1.08–1.44) and stage IV tumors (OR = 1.58; 95% CI = 1.27–1.98) had higher odds than stage I tumors of being ER−/PR−/HER2+. Stage IV tumors (OR = 0.54; 95% CI = 0.44–0.67) strongly decreased the odds of the ER−/PR−/HER2− subtype. Poorly differentiated and undifferentiated tumors were over 20 times as likely as well‐differentiated tumors of being ER−/PR−/HER2− or ER−/PR−/HER2+. There are considerable differences in survival, demographics, and tumor characteristics among the eight subtypes. We recommend reporting breast cancer as an ER/PR/HER2 subtype and precisely documenting demographic and tumor characteristics.