Is Oncotype DX Testing Necessary For Patients With Node Negative, Low-Grade Invasive Ductal Breast Carcinoma?

Introduction/Objective Oncotype DX (Genomic Health/Exact Sciences, Redwood City, CA) is a 21-gene expression test that is used to predict the risk of recurrence following hormonal therapy and adjuvant chemotherapy (CT) benefit for patients with early-stage, ER-positive and HER2-negative invasive breast carcinoma (IBC). Testing is performed on formalin-fixed, paraffin-embedded tumor tissue from patients that are either lymph node (LN) negative, have micro- metastases, or 1-3 positive LNs. For years pathologists have studied traditional prognostic features of IBC (tumor grade, size, and LN status), as well as biomarker testing results (ER, PR, HER2, and Ki-67), in an effort to identify surrogate equations that could help identify patients that would benefit from CT. The “TAILORx” clinical trial, performed to study CT benefit in patients with midrange recurrence scores (11-25), has shown that the majority of these patients do not derive benefit from CT. Post-TAILORx, we have observed that only a small subset of our node- negative patients who were tested showed a benefit for CT. Following the examination of Oncotype DX results from testing performed on our patients, we hypothesized that overall tumor grade (Nottingham) might predict which patients with invasive ductal breast carcinoma (IDBC) do not require Oncotype DX testing; therefore, eliminating the need for Oncotype DX testing. Methods/Case Report We reviewed the surgical pathology reports and Oncotype DX reports for 251 patients with node-negative disease who underwent surgery at our institution from September 2019 through June 2021. All excisional tumors sent for Oncotype DX testing were ER-positive (Allred score ≥6/8) and HER2-negative by IHC and/or FISH. Results (if a Case Study enter NA) Oncotype DX recurrence scores ranged from 0-65. A benefit for CT was seen in 10.4% (26/251) of the patients with node-negative IDBC. A benefit for CT was seen in 6.1% (7/114) of patients with an overall tumor grade of II and 44.2% (19/43) of patients with an overall grade of III. No patients (0/94) with IDBC and an overall tumor grade of I showed a benefit for CT. Conclusion In the post-TAILORx era, patients with ER-positive (Allred ≥6/8), HER2-negative IDBC, who are node- negative and show an overall tumor grade of I, apparently do not require Oncotype DX testing. Additional studies from other institutions are needed to confirm our observation.

LAPAROSCOPIC METASTASECTOMY OF ADRENAL MASS: A THERAPEUTIC OPTION. CASE REPORT AND LITERATURE REVIEW.

Invasive ductal breast carcinoma (IDC) metastasizes to several organs, but it does not usually affect the adrenal glands. In our knowledge, the cases described in the literature are few. A 60-year-old woman diagnosed with ductal breast carcinoma, was found to have adrenal metachronous metastasis during follow-up. While treatment is unclear, laparoscopic adrenalectomy could be a treatment option with curative intention. In our patient, we decided transperitoneal laparoscopic adrenalectomy, with favourable evolution after surgery.

Infiltrating Ductal Breast Carcinoma Metastasized to the Rectum: A Case Report and a Review of the Literature

BACKGROUND:Gastrointestinal (GI) metastasis in breast cancer (BC) is uncommon, although in the rare cases when it occurs, infiltrating lobular carcinoma is the most commonly reported pathological subtype. Nonetheless, gastrointestinal metastasis from infiltrating ductal breast carcinoma is extremely rare and usually occurs several years after the appearance of the primary tumor. The present study was, to the best of our knowledge, the first one to present a case of distal rectum metastasis originating from infiltrating ductal breast carcinoma. CASE PRESENTATION:The present report discusses the case of a Chinese female patient aged 37 years. The patient presented with diarrhea along with bloody stools and anal bearing-down pain. Earlier in 2015, she had undergone axillary lymph node dissection (LND) and right modified radical mastectomy in another hospital to treat the infiltrating ductal breast carcinoma pT1N1M0. The presented symptoms were investigated by performing colonoscopy, which indicated lower rectal swelling at 3 cm on the top of the anal verge. Further investigation with positron emission tomography-computed tomography (PET-CT) revealed an uptake of fluorodeoxyglucose (FDG) within the distal rectum as well as in the left acetabulum. The samples from laparoscopic exploration were biopsied, which revealed metastases of breast cancer. Therefore, the patient was intraoperatively diagnosed with the rectal metastasis of BC and was treated with laparoscopic radical abdominoperineal resection. Furthermore, the immunohistochemical analysis of the tumor confirmed that the patient had the rectal metastasis of infiltrating ductal BC. CONCLUSION:Rectal metastasis should be considered when breast cancer patients present with a complaint of changed bowel habits, even for those with a history of ductal breast cancer.