Relationship of the breast ductal carcinoma in situ (DCIS) immune microenvironment with clinicopathological features: An institutional experience.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12565-e12565
Author(s):  
Lauren Eisenbud ◽  
Tsering G. Lama Tamang ◽  
Caleb Cheng ◽  
Ibe Ifegwu ◽  
Tianyi Tang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Clinical Outcomes ◽  
Invasive Ductal Carcinoma ◽  
Invasive Breast Cancer ◽  
Ductal Carcinoma ◽  
Recurrent Disease ◽  
Response To Therapy ◽  
Data Set ◽  
Risk Of Recurrence

e12565 Background: DCIS is usually treated with resection followed by 5 years of adjuvant endocrine therapy for hormone receptor (HR) + DCIS. Endocrine therapy is not used in HR- DCIS. Although DCIS is considered a precursor lesion to invasive breast cancer, the different molecular subtypes confer variable clinical outcomes. The host immune response plays a key role in breast cancer progression and response to therapy. However, relative to invasive breast cancer, the immune milieu of DCIS is less understood. This retrospective study compares the clinical outcomes and tumor microenvironment of HR+ and HR- DCIS in order to identify clinical and immunological features in HR- DCIS that may predict an increased risk of recurrence or progression to invasive breast cancer. Methods: A single institution retrospective chart review was performed to identify patients diagnosed with DCIS between 2012 and 2017. A clinico-pathologic data set, as well as the PD-L1 expression of the DCIS and TILs were collected and correlated with various outcomes. Results: Our cohort consisted of 20 cases of HR- DCIS and 50 cases of HR+ DCIS. Overall, 56% were Caucasian, 20% Asian, 18% Hispanic, and 6% African American. Of the HR- patients, 70% were Caucasian, 15% Hispanic, and 15% Asian. Of the 17 HR- patients with available HER2 data, 76% had HER2+, and 24% triple negative (TN) DCIS. 18% of the HR+ patients and 38% of the HR- patients were PD-L1+. 25% of the HR-/HER2+ patients, and 75% of the TN patients were PD-L1+. 6% of the HR+ patients developed recurrent disease, 2 with DCIS and 1 with invasive ductal carcinoma. 20% of the HR- patients had recurrent disease, all of whom were HER2+. Of the HR- patients that recurred, 2 recurred with metastatic disease, 1 with ipsilateral invasive ductal carcinoma, and 1 with DCIS. All 7 patients that recurred had original DCIS pathology showing a high nuclear grade. Our future results at the time of the meeting will expand on this cohort. Conclusions: This retrospective analysis showed that HR- DCIS conferred higher rates of local and distant recurrence. Therefore, there is a need for treatments to reduce the recurrence rates of HR- DCIS. There are ongoing clinical trials for the high risk, HR-/HER2+ DCIS subtype. TN DCIS is also an aggressive phenotype. Given the high rate of PD-L1 positivity we detected in TN DCIS, immune-based therapy may be useful in the adjuvant setting to reduce the risk of recurrence in this cohort of patients.

Likelihood of late relapse assessed by the Breast Cancer Index (BCI) in LN-invasive lobular compared to invasive ductal carcinoma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12025-e12025
Author(s):  
Raquel Nunes ◽  
Max Salganik ◽  
Junmei Liu ◽  
Catherine A. Schnabel ◽  
Andrea Lynn Richardson
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Endocrine Therapy ◽  
Invasive Ductal Carcinoma ◽  
Ductal Carcinoma ◽  
Prognostic Score ◽  
Response To Therapy ◽  
Individual Risk ◽  
Histologic Subtype ◽  
Extended Endocrine Therapy

e12025 Background: Women with HR+ breast cancer remain at risk for late distant recurrences (DR) despite optimal adjuvant therapy. Invasive lobular carcinoma (ILC) is the 2nd most common subtype of invasive breast cancer. When compared to invasive ductal carcinoma (IDC), ILC has distinguishing clinical and pathologic characteristics that may result in different response to therapy and long term prognosis. BCI is a validated gene expression-based assay for pts with early stage HR+ breast cancer that provides risk of late (5-10 y) DR and predicts likelihood of benefit of extended endocrine therapy (EET). Here, we compared BCI assay results in pts with HR+, LN- ILC vs IDC. Methods: The BCI Clinical Database for Correlative Studies is an IRB-approved de-identified database that contains >50 clinicopathologic and molecular variables from cases submitted for BCI in clinical practice (N=14,463). Molecular variables include BCI Prognostic score, HoxB13/IL17BR ratio (H/I), and molecular grade index (MGI). Clinicopathologic variables were abstracted from pathology reports (available for a subset of cases). LN- pts with available pathologic data were analyzed. Chi-squared tests were used to compare BCI results between IDC and ILC subgroups. Results: Analyses included 2554 LN- pts with available histologic subtype data (80.7% IDC; 13.7% ILC; 2.6% mixed; 2.9% other). Median age was 59.3y (range 27-89y; 74% ≥ 50y). BCI Prognostic had a broad distribution of individual risk assessment in both IDC and ILC. However, BCI Prognostic had a lower median BCI scores (P<0.0001) in ILC, and classified a smaller proportion of pts with ILC as high risk for late DR compared to IDC (36.5% vs 53.1%; P<0.0001). IDC had a higher median molecular proliferative status (MGI) compared to ILC (P<0.0001). BCI Predictive (H/I) identified a slightly decreased proportion of pts with ILC benefiting from extended endocrine therapy compared to IDC (38.2% vs 41.1%). There was no difference in quantitative ER or PR (by PCR) between groups. Conclusions: BCI identified a smaller proportion of pts with ILC at high risk of late DR compared to IDC. Further studies evaluating outcomes are warranted to further validate BCI in pts with ILC.

StackBC: Deep learning and transfer learning techniques based stacking approach for accurate Invasive Ductal Carcinoma classification using histology images

2022 ◽  
pp. 1-12
Author(s):  
Amin Ul Haq ◽  
Jian Ping Li ◽  
Samad Wali ◽  
Sultan Ahmad ◽  
Zafar Ali ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Deep Learning ◽  
Transfer Learning ◽  
Invasive Ductal Carcinoma ◽  
Ductal Carcinoma ◽  
Early Recognition ◽  
Predictive Performance ◽  
Operating Characteristics ◽  
Data Set ◽  
Learning Techniques

Artificial intelligence (AI) based computer-aided diagnostic (CAD) systems can effectively diagnose critical disease. AI-based detection of breast cancer (BC) through images data is more efficient and accurate than professional radiologists. However, the existing AI-based BC diagnosis methods have complexity in low prediction accuracy and high computation time. Due to these reasons, medical professionals are not employing the current proposed techniques in E-Healthcare to effectively diagnose the BC. To diagnose the breast cancer effectively need to incorporate advanced AI techniques based methods in diagnosis process. In this work, we proposed a deep learning based diagnosis method (StackBC) to detect breast cancer in the early stage for effective treatment and recovery. In particular, we have incorporated deep learning models including Convolutional neural network (CNN), Long short term memory (LSTM), and Gated recurrent unit (GRU) for the classification of Invasive Ductal Carcinoma (IDC). Additionally, data augmentation and transfer learning techniques have been incorporated for data set balancing and for effective training the model. To further improve the predictive performance of model we used stacking technique. Among the three base classifiers (CNN, LSTM, GRU) the predictive performance of GRU are better as compared to individual model. The GRU is selected as a meta classifier to distinguish between Non-IDC and IDC breast images. The method Hold-Out has been incorporated and the data set is split into 90% and 10% for training and testing of the model, respectively. Model evaluation metrics have been computed for model performance evaluation. To analyze the efficacy of the model, we have used breast histology images data set. Our experimental results demonstrated that the proposed StackBC method achieved improved performance by gaining 99.02% accuracy and 100% area under the receiver operating characteristics curve (AUC-ROC) compared to state-of-the-art methods. Due to the high performance of the proposed method, we recommend it for early recognition of breast cancer in E-Healthcare.

How accurately can clinicians predict the Oncotype DX DCIS score?

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 90-90
Author(s):  
Sarah Patricia Cate ◽  
Alyssa Gillego ◽  
Manjeet Chadha ◽  
John Rescigno ◽  
Paul R. Gliedman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Invasive Breast Cancer ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Partial Mastectomy ◽  
Risk Of Recurrence ◽  
Radiation Oncologists ◽  
Medical Oncologists

90 Background: The Oncoype DX DCIS Score was developed to assess the risk of recurrence for ductal carcinoma in situ, as well as an invasive breast cancer. It is a 12 gene assay performed on an individual patient’s tumor and is used to predict the ten year local recurrence risk of an ipsilateral breast event, which can be either an invasive breast cancer or ductal carcinoma in situ. It is also used to predict the 10 year risk of an invasive cancer. The DCIS Score was clinically validated using patients from ECOG 5194. The purpose of this study was to investigate how often clinicians, (medical oncologists, breast surgical oncologists, and radiation oncologists) can predict the DCIS Score. Methods: In this IRB approved study, we retrospectively reviewed the charts of 27 patients at our institution who underwent unilateral or bilateral partial mastectomy for DCIS from April 2012 to February 2013 and who had their pathology specimens submitted for DCIS Scores. Patient age range was 40-79 years old, with a mean of 56.8. All patients underwent consultation with radiation oncology. A chart was compiled to include the patient’s age and tumor histology. This included grade of DCIS, extent of DCIS, presence of necrosis, margin width, and hormone receptors. We then removed all identifying factors from the patients’ data, and surveyed our radiation oncologists, medical oncologists, and breast surgical oncologists on whether patients had a low, intermediate, or high DCIS Score. Results: Breast surgical oncologists accurately predicted the DCIS score 49% of the time. Medical oncologists predicted the DCIS score 35% of the time, while radiation oncologists were accurate 51% of the time. Conclusions: This study demonstrates the difficulty in predicting the DCIS Score. The information obtained from the DCIS Score is specific to the genetic behavior of each individual tumor, whereas traditional methods of predicting risk of recurrence and benefit of radiation are based on standard pathologic and clinical criteria. Further studies on larger patient populations need to be performed prior to wide scale acceptance of this genomic test. [Table: see text]

scholarly journals Neuroglobin: A New Possible Marker of Estrogen-Responsive Breast Cancer

Cells ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 1986
Author(s):  
Virginia Solar Fernandez ◽  
Marco Fiocchetti ◽  
Manuela Cipolletti ◽  
Marco Segatto ◽  
Paolo Cercola ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
De Novo ◽  
Ductal Carcinoma ◽  
Strong Association ◽  
Therapeutic Interventions ◽  
Breast Cancer Cell Lines ◽  
Breast Cancers ◽  
Data Set

The expression of the α-subtype of Estrogen Receptor (ERα) characterizes most breast cancers (more than 75%), for which endocrine therapy is the mainstay for their treatment. However, a high percentage of ERα+ breast cancers are de novo or acquired resistance to endocrine therapy, and the definition of new targets for improving therapeutic interventions and the prediction of treatment response is demanding. Our previous data identified the ERα/AKT/neuroglobin (NGB) pathway as a common pro-survival process activated in different ERα breast cancer cell lines. However, no in vivo association between the globin and the malignity of breast cancer has yet been done. Here, we evaluated the levels and localization of NGB in ERα+ breast ductal carcinoma tissue of different grades derived from pre-and post-menopausal patients. The results indicate a strong association between NGB accumulation, ERα, AKT activation, and the G3 grade, while no association with the menopausal state has been evidenced. Analyses of the data set (e.g., GOBO) strengthen the idea that NGB accumulation could be linked to tumor cell aggressiveness (high grade) and resistance to treatment. These data support the view that NGB accumulation, mainly related to ER expression and tumor grade, represents a compensatory process, which allows cancer cells to survive in an unfavorable environment.

scholarly journals Chronic Lymphocytic Leukemia Involving the Breast Parenchyma, Mimicker of Invasive Breast Cancer: Differentiation on Breast MRI

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Vandana Dialani ◽  
Kalpana Mani ◽  
Nicole B. Johnson
Keyword(s):  
Breast Cancer ◽  
Chronic Lymphocytic Leukemia ◽  
Invasive Ductal Carcinoma ◽  
Invasive Breast Cancer ◽  
Ductal Carcinoma ◽  
Breast Mri ◽  
Collision Tumor ◽  
Lymphocytic Leukemia ◽  
Imaging Features ◽  
Breast Parenchyma

Leukemic involvement of the breast is rare, particularly involvement by chronic lymphocytic leukemia (CLL). While concurrent invasive ductal carcinoma and CLL manifesting as a collision tumor in the breast is extremely rare, this association (CLL and carcinoma) has been described in other organs. We report here a case of a 58-year-old woman with concurrent invasive ductal carcinoma and CLL and describe the imaging features of CLL, particularly the differentiation on MRI.

scholarly journals The COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial: a phase III randomised controlled clinical trial for low-risk ductal carcinoma in situ (DCIS)

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e026797 ◽  
Author(s):  
E Shelley Hwang ◽  
Terry Hyslop ◽  
Thomas Lynch ◽  
Elizabeth Frank ◽  
Donna Pinto ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Invasive Breast Cancer ◽  
Ductal Carcinoma ◽  
Low Risk ◽  
Phase Iii ◽  
Controlled Clinical Trial ◽  
Institutional Review ◽  
Randomised Controlled

IntroductionDuctal carcinoma in situ (DCIS) is a non-invasive non-obligate precursor of invasive breast cancer. With guideline concordant care (GCC), DCIS outcomes are at least as favourable as some other early stage cancer types such as prostate cancer, for which active surveillance (AS) is a standard of care option. However, AS has not yet been tested in relation to DCIS. The goal of the COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial for low-risk DCIS is to gather evidence to help future patients consider the range of treatment choices for low-risk DCIS, from standard therapies to AS. The trial will determine whether there may be some women who do not substantially benefit from current GCC and who could thus be safely managed with AS. This protocol is version 5 (11 July 2018). Any future protocol amendments will be submitted to Quorum Centralised Institutional Review Board/local institutional review boards for approval via the sponsor of the study (Alliance Foundation Trials).Methods and analysisCOMET is a phase III, randomised controlled clinical trial for patients with low-risk DCIS. The primary outcome is ipsilateral invasive breast cancer rate in women undergoing GCC compared with AS. Secondary objectives will be to compare surgical, oncological and patient-reported outcomes. Patients randomised to the GCC group will undergo surgery as well as radiotherapy when appropriate; those in the AS group will be monitored closely with surgery only on identification of invasive breast cancer. Patients in both the GCC and AS groups will have the option of endocrine therapy. The total planned accrual goal is 1200 patients.Ethics and disseminationThe COMET trial will be subject to biannual formal review at the Alliance Foundation Data Safety Monitoring Board meetings. Interim analyses for futility/safety will be completed annually, with reporting following Consolidated Standards of Reporting Trials (CONSORT) guidelines for non-inferiority trials.Trial registration numberNCT02926911; Pre-results.

Do We Need to Irradiate All Small Invasive Breast Cancers and DCIS?

2013 ◽  
pp. 40-44
Author(s):  
Julia White
Keyword(s):  
Breast Cancer ◽  
Invasive Breast Cancer ◽  
Lower Risk ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Cancer Control ◽  
Breast Cancers ◽  
Breast Radiotherapy ◽  
Risk Of Recurrence

Breast radiotherapy after lumpectomy is considered standard for nearly all patients with invasive breast cancer and is recommended for many patients after lumpectomy for ductal carcinoma in situ (DCIS). However, there is recognition that lumpectomy alone can achieve optimal cancer control for some patients with invasive breast cancer and DCIS. Patients with breast cancers with lower risk of recurrence are less likely to derive benefit from breast radiotherapy. This review will focus on defining populations of patients with invasive breast cancer and DCIS with a low risk of recurrence post-lumpectomy and the evidence supporting omission of breast radiotherapy post-lumpectomy.

Expression of Let-7c in invasive ductal carcinoma of breast cancer and its clinical significance

2009 ◽  
Vol 29 (4) ◽  
pp. 400-403
Author(s):  
Shu-rong SHEN ◽  
Jun-yi SHI ◽  
Xian SHEN ◽  
Guan-li HUANG ◽  
Xiang-yang XUE
Keyword(s):  
Breast Cancer ◽  
Clinical Significance ◽  
Invasive Ductal Carcinoma ◽  
Ductal Carcinoma

Patients With Invasive Breast Cancer Who Refuse Treatment: An Analysis of Associated Factors and Impact on Survival

2021 ◽  
pp. 000313482110241
Author(s):  
Jackelyn J. Moya ◽  
Ashkan Moazzez ◽  
Junko J. Ozao-Choy ◽  
Christine Dauphine
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Invasive Breast Cancer ◽  
Risk Groups ◽  
Breast Cancer Treatment ◽  
Study Cohort ◽  
National Cancer Database ◽  
Optimal Outcomes ◽  
Impact On Survival ◽  
The Impact

Background Completion of surgical resection and adjuvant/neoadjuvant treatments (chemotherapy, radiation, and endocrine therapy) is necessary to achieve optimal outcomes in invasive breast cancer. The objective of this study was to determine the characteristics of patients refusing treatment and to analyze the impact of refusal on survival. Study Design A retrospective cohort study of invasive breast cancer cases diagnosed 2004-2016 was performed utilizing the National Cancer Database. Results Of 2 058 568 cases comprising the study cohort, .6% refused recommended surgery, 14.1% refused chemotherapy, 5.5% refused radiation, and 6.3% refused endocrine therapy. Patients refusing therapy were older and more likely uninsured; they did not live farther from the treating hospital. Racial disparities were also associated with refusal. Surgery refusal had the highest hazard ratio for mortality (2.7; 95% CI: 2.5-3.0, P < .001) compared to chemotherapy (1.3; 95% CI: 1.3-1.4, P < .001), radiation (1.8; 95% CI: 1.7-1.9, P < .001), and endocrine therapy (1.5; 95% CI: 1.4-1.6, P < .001) independent of race, insurance, receptor status, and stage. Conclusion This study demonstrates significant associations with refusal of breast cancer treatment and quantifies the impact on mortality, which may help to identify at-risk groups for whom interventions could prevent increases in mortality associated with declining treatment.

Uncommon Breast Malignancies: Presentation Pattern, Prognostic Issue and Treatment Outcome in an Italian Single Institution Experience

2013 ◽  
Vol 99 (1) ◽  
pp. 39-44
Author(s):  
Claudia Maria Regina Bareggi ◽  
Dario Consonni ◽  
Barbara Galassi ◽  
Donatella Gambini ◽  
Elisa Locatelli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Outcome ◽  
Invasive Ductal Carcinoma ◽  
Ductal Carcinoma ◽  
Early Stage ◽  
Medullary Carcinoma ◽  
Mucinous Carcinoma ◽  
Lymph Node Involvement ◽  
Tubular Carcinoma ◽  
Breast Malignancies

Aims and background Often neglected by large clinical trials, patients with uncommon breast malignancies have been rarely analyzed in large series. Patients and methods Of 2,052 patients diagnosed with breast cancer and followed in our Institution from January 1985 to December 2009, we retrospectively collected data on those with uncommon histotypes, with the aim of investigating their presentation characteristics and treatment outcome. Results Rare histotypes were identified in 146 patients (7.1% of our total breast cancer population), being classified as follows: tubular carcinoma in 75 (51.4%), mucinous carcinoma in 36 (24.7%), medullary carcinoma in 25 (17.1%) and papillary carcinoma in 10 patients (6.8%). Whereas age at diagnosis was not significantly different among the diverse diagnostic groups, patients with medullary and papillary subtypes had a higher rate of lymph node involvement, similar to that of invasive ductal carcinoma. Early stage diagnosis was frequent, except for medullary carcinoma. Overall, in comparison with our invasive ductal carcinoma patients, those with rare histotypes showed a significantly lower risk of recurrence, with a hazard ratio of 0.28 (95% CI, 0.12–0.62; P = 0.002). Conclusions According to our analysis, patients with uncommon breast malignancies are often diagnosed at an early stage, resulting in a good prognosis with standard treatment.

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