International Journal of Breast Cancer最新文献

Aims: This study aimed to compare the performance of immunohistochemistry (IHC)-based luminal subtyping of breast cancer against gene expression panels at our institute and to evaluate a CE-certified artificial intelligence (AI) Ki67 image analysis program for improving subtyping accuracy.

Methods and results: We retrospectively analysed IHC-based luminal subtyping in breast cancer biopsies diagnosed at our institute from 2019 to 2022 (n = 1736), and identified n = 104 (Oncotype DX) and n = 64 (EndoPredict) cases with gene expression tests requested by clinicians. Of the eligible ER-positive HER2-negative cases, 11.9% (n = 168) underwent multigene testing. After excluding incomplete data (n = 22), gene tests revealed 48 patients (32.9%) would benefit from chemotherapy, 86 (58.9%) could avoid it and 12 (8.2%) had inconclusive results. A moderate correlation was observed between Ki67 and EndoPredict EPClin scores (r = 0.47-0.58) and a weak correlation between Ki67 and Oncotype DX recurrence scores (r = 0.31-0.38). Ki67 scores were significantly higher in luminal B compared with luminal A tumours (difference of 9.1-15.2, p < 0.01). No significant difference was found between mean Ki67 scores reported by pathologists and AI (pathologists' mean Ki67 17.36 vs. AI mean Ki67 18.36, n = 146, p = 0.456) and the accuracy of luminal subtyping was similar between pathologists and AI (accuracy pathologists 66.4% vs. AI 62.7%, p = 0.538).

Conclusions: Our data provides a snapshot of the real-world allocation of multigene testing in early breast cancer, and supports other studies in highlighting the discrepancy between IHC-based and gene-based luminal subtyping. Ki67 evaluation remained consistent over time, and the use of AI for Ki67 scoring did not enhance the accuracy of IHC-based luminal subtyping.

Purpose: We set out to assess whether the extensive intraductal component (EIC) status in invasive breast cancers serves as an independent predictor of residual disease (RD) in re-excisions performed at our institution. This laboratory-based study provides insights into the thresholds for additional surgical intervention in cases with close ductal carcinoma in situ (DCIS) margins following initial breast-conserving surgery (BCS). We also examined the unique characteristics specific to EIC-positive cases.

Methods: BCS cases with invasive breast cancer and DCIS with close margins that had re-excisions following initial surgery (Dec 2019-Dec 2024) were selected and classified into EIC positive or EIC negative. Data collected on the initial excision included the EIC status and other clinicopathological information such as margin status, DCIS extent, cancer type and focality, TNM stage, biomarker status, and OncotypeDX Recurrence Score (RS). The RD status was collected on re-excision specimens.

Results: Ninety-one cases were included (57 EIC positive and 34 EIC negative), with most being invasive ductal carcinoma. The rate of RD on re-excision was 70.2% and 32.4% in EIC-positive and EIC-negative cases, respectively (p < 0.001). EIC-positive cases showed a higher tendency to involve multiple margins, had a lower T stage and greater DCIS extent, and they were more commonly associated with multifocal cancer. Finally, when assessing predictors of RD, EIC status emerged as the most significant factor among other variables (adjusted odds ratio = 3.39). Secondary findings included a relatively increased proportion of EIC-positive cases (19%) exhibiting mucinous morphology (p = 0.0063) and HER2-positive tumor status (p = 0.035).

Conclusion: Findings show that EIC status is the most significant predictor of RD following BCSs with close DCIS margins. This emphasizes the importance of identifying EIC-positive cases in pathology reports and prioritizing them for additional re-excision when DCIS margins are close.

Background: Breast cancer is among the leading causes of mortality in women globally, with a rising incidence in developing countries, including Saudi Arabia. Early detection through screening is essential for reducing the mortality rate among women. However, factors such as awareness, attitudes, and barriers significantly influence women's participation in screening programs, especially in resource-limited settings.

The aim of the study: The aim of this study is to assess the awareness, attitudes, and barriers to breast cancer screening among breast cancer screening health education week attendees at King Saud Medical City, Riyadh.

Materials and methods: The study was conducted during breast cancer screening health education week at King Saud Medical City in Riyadh, from October 13 to 17, 2024. A convenience sample of 277 women, aged 18-60, completed a structured, self-administered questionnaire. Data on awareness, attitudes, and barriers related to breast cancer screening were analyzed using descriptive and inferential statistics in SPSS Version 23.0.

Results: Among the women surveyed, 63.5% showed a good level of awareness about breast cancer screening, with an average awareness score of 12.6 ± 5.5 out of 23. Positive attitudes toward screening were common, with 97.8% expressing supportive views (p = 0.045). Higher awareness levels were significantly associated with age (p = 0.003) and occupation (p = 0.001), while attitudes toward screening were significantly linked to education. The main barriers reported were lack of time (30.3%), difficulty accessing services (15.2%), and fear of the procedure (15.2%). In the multiple logistic regression analysis, any significant predictors of awareness and attitude toward breast cancer screening were not identified.

Conclusion: The study indicates a relatively high level of awareness and a positive attitude toward breast cancer screening among participants. However, significant barriers, including time constraints, accessibility challenges, and fear of the procedure, limit regular participation. To increase screening rates and reduce breast cancer mortality in Saudi Arabia, it is recommended to implement targeted awareness campaigns, enhance service accessibility, and provide continuous education through healthcare providers.

Background: Virtual teleconsultation plays a pivotal role in managing diseases requiring long-term communication between patients and treatment teams, such as breast diseases. The Ruban Virtual Breast Clinic in Iran offers teleconsultation services focusing on nonurgent chronic complaints through offline messaging. This study aimed to evaluate patient satisfaction with these teleconsultation services.

Methods: A comprehensive questionnaire was designed with three sections: identifying the individual interacting with the clinic and prior teleconsultation use; collecting demographic data and reasons for consultation; and assessing satisfaction using 16 items rated on a Likert scale from 1 (poor) to 10 (excellent). The study included patients who received at least one consultation by a breast surgeon through the Ruban platform.

Results: Of 583 eligible cases, 367 (62.9%) consented to participate. The average satisfaction score was 91.6 out of 100, indicating a high level of patient satisfaction.

Conclusions: The high satisfaction rates suggest that telehealth services, particularly virtual consultations, are feasible and highly acceptable in meeting patients' healthcare needs. These findings underscore telehealth's potential to improve access to care, though further research is required to establish its clinical effectiveness.

Background: Breast cancer is a leading cause of cancer-related morbidity and mortality in women worldwide. Among its subtypes, triple-negative breast cancer (TNBC) poses the greatest therapeutic challenge due to its aggressive nature and lack of targeted treatments. Holocytochrome c synthase (HCCS), a mitochondrial enzyme essential for cytochrome c maturation, may play a pivotal role in cancer pathogenesis.

Objective: This study aimed to investigate the expression profile, epigenetic regulation, immune interactions, prognostic significance, and molecular networks of HCCS across cancers, with a particular focus on breast cancer and its subtypes.

Methods: Publicly available datasets and bioinformatics tools were employed to analyze HCCS expression, methylation, survival outcomes, immune infiltration, and interaction networks. Expression and clinical outcomes were examined using TCGA, while methylation and expression patterns were assessed via UALCAN and TNMplot. Survival analyses were performed using Kaplan-Meier Plotter, and immune infiltration was evaluated with TIMER2.0. Protein-protein interaction networks were generated with STRING, and functional enrichment was conducted through g:Profiler. Key findings were validated in independent breast cancer cohorts from GEO and the GOBO platform.

Results: HCCS was significantly overexpressed in multiple cancers, with the highest upregulation observed in breast cancer, particularly TNBC. Hypomethylation of the HCCS promoter was associated with increased expression. High HCCS expression correlated with poorer relapse-free survival and greater immune infiltration, including CD4⁺ T cells, CD8⁺ T cells, macrophages (M1/M2), mast cells, and regulatory T cells. Protein-protein interaction analysis revealed HCCS-associated genes enriched in mitochondrial and apoptotic pathways. Validation across independent datasets consistently supported the association of elevated HCCS expression with poor prognosis in breast cancer.

Conclusion: This integrated bioinformatics analysis highlights HCCS as a potential prognostic biomarker and therapeutic target in breast cancer, particularly in TNBC, although further experimental validation is required before clinical application.

Purpose: HER2-low status is a predictive factor for novel anti-HER2 therapies in metastatic hormone receptor-positive breast cancer (HR+ MBC). However, its impact on endocrine therapy outcomes remains uncertain. We aimed to explore the effect of HER2-low and HER2-zero status in HR+ MBC patients treated with first-line aromatase inhibitors (AIs) with or without CDK4/6 inhibitors (CDK4/6i).

Methods: We retrospectively reviewed postmenopausal women with HR+ MBC treated with first-line AI ± CDK4/6i between January 1, 2017, and December 31, 2022, from six tertiary hospitals in Thailand. HER2-low was defined as HER2 IHC 1+ or IHC 2+ with ISH-negative. Progression-free survival (PFS) and overall survival (OS) were compared in unadjusted and adjusted cohorts using stabilized inverse probability of treatment weighting (sIPTW), adjusting for age, ECOG performance status, de novo metastasis, endocrine sensitivity, visceral metastasis, number of metastatic sites, and treatment year. Interaction analyses were performed to assess effect modification by HER2 status and other clinical subgroups.

Results: Among 504 patients, 219 (43.5%) were HER2-low, and 285 (56.5%) were HER2-zero. Median follow-up was 31 months (IQR 19-47). CDK4/6i + AI was administered to 52.5% of HER2-low and 43.9% of HER2-zero patients. After sIPTW adjustment, CDK4/6i + AI prolonged median PFS to 22.1 months compared with 21.5 months for AI alone in the HER2-low cohort (HR = 0.80, 95% CI 0.54-1.18; p = 0.26) and to 20.1 months compared with 13.5 months in the HER2-zero cohort (HR = 0.65, 95% CI 0.45-0.93; p = 0.02). Median OS was 49.3 months with CDK4/6i + AI versus 48.4 months with AI alone in HER2-low (HR = 0.81, 95% CI 0.48-1.36; p = 0.43) and 45.8 versus 42.3 months in HER2-zero (HR = 0.85, 95% CI 0.43-1.05; p = 0.52). Subgroup analyses showed consistent benefit of CDK4/6i + AI across most clinical categories. The interaction test for treatment × HER2 status was not significant (HR = 1.21, 95% CI 0.74-1.98; p = 0.44), indicating no effect modification by HER2-low status.

Conclusions: HER2-low status was not associated with prognosis or predictive value for CDK4/6i efficacy, supporting CDK4/6i + AI as the standard first-line therapy irrespective of HER2 expression level.

Patients with advanced HR+/HER2- breast cancer often experience prolonged disease courses, with bone being a dominant site of metastasis. Bone-targeted agents (BTAs) are recommended to reduce the risk of skeletal-related events (SREs), yet most clinical trials report follow-up durations of less than 2 years. Here, we present two cases of patients with breast cancer and bone metastases who received continuous BTA therapy for 8 and 10 years, respectively, in the context of ongoing antitumor treatment. Neither patient developed SREs during follow-up. The two cases demonstrated good tolerabilit during long-term treatment, though broader conclusions regarding safety require further investigation.

Breast cancer is one of the most common malignancies and the leading cause of cancer-related mortality among women worldwide, with hormone receptor-positive (HR+) breast cancer being the most common subtype. Current guidelines recommend endocrine therapy as the first-line treatment for HR+, human epidermal growth factor Receptor 2-negative breast cancer. In this case report, we describe a patient with HR+ breast cancer who developed bone and liver metastases after breast cancer surgery. We document the disease progression from initial treatment to managing local recurrence and treating distant metastasis using salvage chemotherapy combined with endocrine therapy. Importantly, following denosumab treatment, the patient experienced a bone flare; this presented as increased radionuclide uptake on bone scans, but was later confirmed as pseudoprogression. Furthermore, we note changes in the patient's pathology as the disease progresses.

Background: Breast cancer screening and effective neoadjuvant treatments have increased surgeries for nonpalpable tumors, often requiring preoperative localization. The wire-guided method, performed on the same day as surgery, has limitations, prompting interest in wire-free alternatives like magnetic seed devices. Methods: A retrospective single-center study (November 2020-March 2024) compared magnetic seed and wire-guided localization in 558 patients. The primary aim was to assess localization and retrieval success, resection margins, and reoperation rates. Secondary endpoints included the interval between localization and surgery, operative time, incision site selection, and volume excised. Results: Among 558 patients, 188 underwent magnetic seed and 370 wire-guided localizations. Both groups were similar in BMI, breast size, and lesion characteristics. Complications in the wire-guided group included device migration (0.5%) and hematoma (1.3%). Success rates were comparable (98.9% vs. 99.7%), as were positive margins (5.3% vs. 6.7%) and reoperation rates (6.9% vs. 7.8%). Excised volume was significantly lower in the magnetic seed group (24.2 [range 6.5-48.0 cm³] vs. 41.5 cm³ [range 16.0-68.0 cm³], p < 0.001). The magnetic seed group had an average localization-to-surgery interval of 1 day (range 0-160 days). Conclusions: Magnetic seed localization is as safe and effective as wire-guided localization, with comparable success rates and resection margins adequacy. Its primary advantage is scheduling flexibility, offering a longer interval between localization and surgery.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating complication of cancer treatment, particularly with agents like paclitaxel. Effective preventive measures for CIPN are limited. Metformin, an antihyperglycemic agent with neuroprotective properties, has shown promise in preclinical studies; however, its clinical utility in preventing CIPN remains underexplored. Objective: This study evaluates the preventive effects of metformin on paclitaxel-induced peripheral neuropathy in breast cancer patients. Methods: A randomized, controlled study was conducted involving 60 breast cancer patients receiving paclitaxel chemotherapy. Patients were assigned to an intervention group receiving metformin (500 mg twice daily) or a control group without metformin. Peripheral nerve function was assessed using nerve conduction studies (NCSs), measuring sensory nerve action potential (SNAP) amplitude, compound muscle action potential (CMAP) amplitude, and distal latency (DL). Clinical neurological symptoms and adverse effects of metformin were monitored throughout the study. Results: Of the 60 enrolled patients, 47 completed the study (26 control and 21 intervention). The incidence of CIPN was lower in the metformin group compared to the control group, although this difference did not reach statistical significance. Metformin was well-tolerated, with mild gastrointestinal side effects being the most common adverse events. No significant differences between the groups were observed in SNAP amplitude, CMAP amplitude, or DL. Conclusion: Metformin may modestly reduce the incidence of CIPN in patients receiving paclitaxel chemotherapy, although the observed effect was not statistically significant. Given its safety profile and potential neuroprotective benefits, metformin warrants further investigation in larger, multicenter trials to confirm its role in CIPN prevention.