Discordence of HER-2/neu overexpression and estrogen receptor between the primary breast cancer and axillary lymph node with metastasis

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 20106-20106
Author(s):  
R. K. Shahid ◽  
I. Ahmad ◽  
S. Yadav ◽  
A. Sami ◽  
K. Haider ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Axillary Lymph Node ◽  
Primary Breast Cancer ◽  
Fish Analysis ◽  
Axillary Lymph ◽  
Her 2

20106 Background: Adjuvant hormonal therapy and trastuzumab are known to be associated with a significant reduction in cancer-related mortality in a subset of women with breast cancer. The treatment decision is usually based on immunohistochemistry (IHC) staining of the primary tumor. We reported here a case of discordance of HER-2/neu overexpression and estrogen receptor status between the primary breast cancer and axillary lymph node with metastasis. Methods: IHC and fluorescence in situ hybridization (FISH) analysis was perfromed for the assessment of HER-2/neu. E-cadherin staining was done on the primary tumor and lymph node with metastasis. Results: A 52 year old woman presented with right breast lump. The imaging studies showed a 5 × 5 cm speculated mass. No other abnormalities were noted. An excision biopsy revealed 3 cm moderately differentiated invasive lobular carcinoma. Subsequently a wider excision and axillary lymph node dissection was done. 2/20 lymph nodes were involved by the cancer. IHC was done in the primary tumor and the lymph node with metastasis. IHC of the primary tumor revealed less than 1% nuclei positive for estrogen receptor (ER), 0% nuclei positive for progesterone receptor (PR), and no HER-2/neu overexpression. IHC of the lymph nodes with metastasis revealed 80% nuclei positive for ER, less than 1% nuclei positive for PR, and equivocal HER-2/neu overexpression. FISH analysis for HER-2/neu gene was done on the primary tumor which revealed no amplification in the tumor nuclei (Her2/CEP17 ratio was 3.6/2.7 = 1.3) whereas FISH analysis on the lymph node section revealed amplification in tumor nuclei (Her2/CEP 17 ratio of 7.3/1.9 = 3.9). E-cadherin staining of the primary breast tumor as well as the lymph node with metastasis revealed no membrane staining of the malignant cells in either section. Conclusions: The unusual occurrence of a divergent IHC profile and FISH analysis results between the primary carcinoma and metastatic carcinoma may be due to a subselection of a malignant clone which were not represented in the section of primary tumor chosen for IHC. Future studies are required to determine the utility of IHC staining of metastatic cells involving the lymph nodes if primary tumor is negative for HER-2/neu & ER. No significant financial relationships to disclose.

scholarly journals Immunohistochemical and Clinicopathological Factors Associated with Axillary Lymph Node Metastasis in Breast Cancer Patients of Northern Pakistan

2017 ◽  
Vol 2 (4) ◽  
pp. 53
Author(s):  
Muhammad Zubair ◽  
Muhammad Tahir Khadim ◽  
Hassan Tariq ◽  
Salman Ali ◽  
Omer Ali Khan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Lymph Node ◽  
Progesterone Receptor ◽  
Tumor Size ◽  
Axillary Lymph Node ◽  
Axillary Lymph ◽  
Northern Pakistan ◽  
Her 2 ◽  
Pakistani Women

Background: Breast cancer is the most common type of tumors in Pakistani women, with axillary lymph node (ALN) positivity reported to be one of the most important prognostic factors.This study shows the distribution of various clinical and pathological variables including age, tumor size, grade, histologic subtype, and hormone receptor status among Pakistani women with and without ALN metastasis.Materials and Methods: A total of 245 cases of primary breast cancer from Northern Pakistan were analyzed in this study. Their clinical, pathological and immunohistochemical parameters, including estrogen receptor (ER), progesterone receptor (PR) and Her-2/Neu status, were extracted from previous histopathological reports and stratified based on the occurrence of ALN metastasis. Results: Occurrence of ALN metastasis was significantly different between older age patients above 50 years and younger age patients age <50 years [χ² (1, N=245) =14.6, p<0.001]. There was an increased number of metastases in large sized tumors >5cm in size (80%, n=60), [χ² (2, N=245) =23.1, p<0.001] and tumors with higher nuclear grade III (78.4%, n=40), [χ² (1, N=245) =5.1, p=0.02]. ALN metastasis was inversely associated with expression of estrogen receptor [χ² (1, N=245) =12.5, p<0.001], and progesterone receptor [χ² (1, N=245) = <0.001, p=0.99], while it was directly associated with Her-2/Neu expression [χ² (1, N=245) =5.63, p=0.01]. Conclusion: In Pakistani women, ALN metastasis was significantly associated with older age, tumor size, and high-grade tumors showing Her2/Neu expression and was inversely associated with ER, PR expression in breast tumors.

scholarly journals Estrogen Receptor, Progesterone Receptor, and Her-2/neu Oncogene Expression in Breast Cancers Among Bangladeshi Women

1970 ◽  
Vol 28 (3) ◽  
pp. 157-162 ◽  
Author(s):  
MG Mostafa ◽  
MT Larsen ◽  
RR Love
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Lymph Node ◽  
Progesterone Receptor ◽  
Axillary Lymph Node ◽  
Histological Grade ◽  
Axillary Lymph ◽  
Breast Cancers ◽  
Her 2 ◽  
Neu Oncogene

Two-thirds of all women who develop breast cancer each year live in Asia. In many countries, including Bangladesh, there are few data on the pathological characteristics of breast tumours. The objectives of this study were a) to describe the estrogen receptor (ER), progesterone receptor (PR), and the expression of Her-2/neu oncogene expression status in a large series of breast cancers occurring in Bangladeshi women and b) to correlate these findings with the patients' age at diagnosis, tumour histological grade, and presence of axillary lymph node metastatic disease.Method: One thousand forty two cases were evaluated in a referral practice. Tumour sections were stained immunohistochemically using Dako 1D5 (ER) and Dako 636 (PR) and semiquantitatively scored for ER and PR expression. Three hundred thirty five of these cases were also stained using Dako c-erb2 oncoprotein and scored for Her-2/neu over-expression.Results: Estrogen Receptor expression was positive in 69.0%, PR expression was positive in 72.3%, and Her-2/ neu was over-expressed (IHC score 3+) in 28.4% of the cases. Her-2/neu over-expression did not consistently correlate with ER and PR expression. ER and PR expression were inversely associated with tumour histological grade. Cases with axillary lymph node metastases had higher rates of ER and PR expression. No significant association was observed with patient’s age.Conclusion: Estrogen Receptor, PR, and Her-2/neu expression frequencies and prognostic factor associations in Bangladeshi women with breast cancer referred for tumour marker testing are very similar to those reported in Western countries. These findings have important implications for ensuring optimal testing capacity for all patients with these tumours, to allow for appropriate choices of treatment. DOI: 10.3329/jbcps.v28i3.6509J Bangladesh Coll Phys Surg 2010; 28: 157-162

scholarly journals Dedicated Axillary MRI-Based Radiomics Analysis for the Prediction of Axillary Lymph Node Metastasis in Breast Cancer

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 757
Author(s):  
Sanaz Samiei ◽  
Renée W. Y. Granzier ◽  
Abdalla Ibrahim ◽  
Sergey Primakov ◽  
Marc B. I. Lobbes ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Axillary Lymph Node Metastasis ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Mr Images ◽  
Node Metastasis

Radiomics features may contribute to increased diagnostic performance of MRI in the prediction of axillary lymph node metastasis. The objective of the study was to predict preoperative axillary lymph node metastasis in breast cancer using clinical models and radiomics models based on T2-weighted (T2W) dedicated axillary MRI features with node-by-node analysis. From August 2012 until October 2014, all women who had undergone dedicated axillary 3.0T T2W MRI, followed by axillary surgery, were retrospectively identified, and available clinical data were collected. All axillary lymph nodes were manually delineated on the T2W MR images, and quantitative radiomics features were extracted from the delineated regions. Data were partitioned patient-wise to train 100 models using different splits for the training and validation cohorts to account for multiple lymph nodes per patient and class imbalance. Features were selected in the training cohorts using recursive feature elimination with repeated 5-fold cross-validation, followed by the development of random forest models. The performance of the models was assessed using the area under the curve (AUC). A total of 75 women (median age, 61 years; interquartile range, 51–68 years) with 511 axillary lymph nodes were included. On final pathology, 36 (7%) of the lymph nodes had metastasis. A total of 105 original radiomics features were extracted from the T2W MR images. Each cohort split resulted in a different number of lymph nodes in the training cohorts and a different set of selected features. Performance of the 100 clinical and radiomics models showed a wide range of AUC values between 0.41–0.74 and 0.48–0.89 in the training cohorts, respectively, and between 0.30–0.98 and 0.37–0.99 in the validation cohorts, respectively. With these results, it was not possible to obtain a final prediction model. Clinical characteristics and dedicated axillary MRI-based radiomics with node-by-node analysis did not contribute to the prediction of axillary lymph node metastasis in breast cancer based on data where variations in acquisition and reconstruction parameters were not addressed.

scholarly journals Relationship between Upper Extremity Lymphatic Drainage and Sentinel Lymph Nodes in Patients with Breast Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Xiaokai Ma ◽  
Shishuai Wen ◽  
Baofeng Liu ◽  
Dumin Li ◽  
Xiaolong Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Upper Extremity ◽  
Axillary Lymph Node ◽  
Lymphatic Drainage ◽  
Sentinel Lymph Nodes ◽  
Blue Dye ◽  
Axillary Lymph ◽  
Axillary Reverse Mapping

Purpose. The purpose of this study was to identify the relationship between upper extremity lymphatics and sentinel lymph nodes (SLNs) in breast cancer patients.Methods. Forty-four patients who underwent axillary reverse mapping (ARM) during axillary lymph node dissection (ALND) with SNL biopsy (SLNB) between February 2017 and October 2017 were investigated. ARM was performed using indocyanine green (ICG) to locate the upper extremity lymphatics; methylene blue dye was injected intradermally for SLN mapping.Results. ARM nodes were found in the ALND fields of all examined patients. The rate of identification of upper extremity lymphatics within the SLNB field was 65.9% (29 of 44). The ARM nodes were involved in metastases arising from primary breast tumors in 7 of the patients (15.9%), while no metastases were detected in pathologic axillary lymph node-negative patients. Lymphatics from the upper extremity drained into the SLNs in 5 of the 44 patients (11.4%); their ARM-detected nodes were found to be in close proximity to the SLNs.Conclusions. The ARM nodes and SLNs are closely related and share lymphatic drainage routes. The ARM procedure using fluorescence imaging is both feasible and, in patients who are SLN negative, oncologically safe. ARM using ICG is therefore effective for identifying and preserving upper extremity lymphatics, and SLNB combined with ARM appears to be a promising surgical refinement for preventing upper extremity lymphoedema.Clinical Trial Registration. This trial is registered with ClinicalTrial.gov:NCT02651142.

Preoperative Staging of Large Primary Breast Cancer With [18F]Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Compared With Conventional Imaging Procedures

2008 ◽  
Vol 26 (29) ◽  
pp. 4746-4751 ◽  
Author(s):  
David Fuster ◽  
Joan Duch ◽  
Pilar Paredes ◽  
Martín Velasco ◽  
Montserrat Muñoz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Sensitivity And Specificity ◽  
Primary Breast Cancer ◽  
Distant Metastases ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Pet Ct ◽  
Large Primary

Purpose To evaluate the utility of positron emission tomography (PET) and [18F]fluorodeoxyglucose in the initial staging of large primary breast tumors. Patients and Methods This prospective study was approved by the ethics committee, and all patients gave their informed consent before enrollment. Sixty consecutive patients with large (> 3 cm) primary breast cancer diagnosed by clinical examination and breast magnetic resonance imaging (MRI) were entered onto the study. The mean age was 57 ± 13 years. Chest computed tomography (CT), liver ultrasonography, bone scan, and PET/CT were performed in all patients. All findings were histologically confirmed, and/or at least 1 year of follow-up was required. Correlation between parameters was calculated using Pearson's correlation coefficient. P < .05 was considered statistically significant. Results Primary tumor was identified by both PET/CT and MRI in all patients. Multifocal and/or multicentric tumors were found in 19 patients by MRI. Axillary lymph node metastases were found in 20 of 52 patients. Extra-axillary metastatic lymph nodes were also found in three patients. One patient showed an infiltrated lymph node in the contralateral axilla. The sensitivity and specificity for PET/CT to detect axillary lymph nodes metastases were 70% and 100%, respectively. PET/CT diagnosed all extra-axillary lymph nodes. The overall sensitivity and specificity of PET/CT in detecting distant metastases were 100% and 98%, respectively; whereas the sensitivity and specificity of conventional imaging were 60% and 83%, respectively. PET led to a change in the initial staging in 42% of patients. Conclusion PET/CT underestimates locoregional lymph node staging in large primary breast cancer patients. PET/CT is a valuable tool to discard unsuspected extra-axillary lymph nodes and distant metastases.

The prognostic value of nodal ratios in node-positive breast cancer: AUBMC experience

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 21072-21072
Author(s):  
A. Shamseddine ◽  
H. Hatoum ◽  
Z. Salem ◽  
Z. Abdel Khalek ◽  
N. El Saghir ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Disease Free Survival ◽  
Axillary Lymph ◽  
Node Positive ◽  
The Impact ◽  
Positive Breast Cancer

21072 Background: Axillary lymph node metastasis has proven to be the most important factor affecting overall survival (OS) and disease free survival (DFS) in patients with breast cancer. Recent evidence suggests that axillary lymph node ratio (LNR) may be at least as important as absolute number of involved lymph nodes in predicting OS and DFS. The aim of this retrospective study is to evaluate the impact of axillary nodal ratios in node-positive breast cancer as a prognostic factor for survival. Methods: Data from 1181 patients with stage I, II and III breast cancer diagnosed at AUBMC between 1990 and 2001 were studied. The median age at diagnosis was 50 years (23 - 88); the median number of lymph nodes dissected was 17 (0 - 49). Survival was compared in 737 patients with node-positive disease according to a LNR below or more than 0.25 (defined as number of involved lymph nodes divided by total dissected axillary lymph nodes). Results: Patients with LNR = 0.25 had a median follow-up of 30 months (1.2–156) and a median DFS of 26 months (1–156). The 5-year survival was 26.2% (94/358) and the 5-year DFS was 22.9% (82/358). Patients with LNR <0.25 had a median follow-up of 36 months (1.2–157) and a median DFS of 36 months (1–157). The 5-year survival of 33.2% (245/737) and the 5-year DFS was 29.8 % (220/737). LNR showed significance as a continuous variable and a categorical variable (0, < 0.25, and = 0.25) with a p < 0.001 Conclusions: LNR significantly predicts OS and DFS in node-positive primary breast cancer. No significant financial relationships to disclose.

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