Ki-67 and breast cancer prognosis: does it matter if Ki-67 level is examined using preoperative biopsy or postoperative specimen?

Purpose This study aimed to identify the association between Ki-67 level and the prognosis of patients with breast cancer, regardless of the timing of Ki-67 testing (using preoperative biopsy vs. postoperative specimen). Methods A total of 4177 patients underwent surgery between January 2008 and December 2016. Immunohistochemical Ki-67 levels, using either preoperative (1673) or postoperative (2831) specimens, were divided into four groups using cutoff points of 10%, 15%, and 20%. Results Groups with higher-Ki-67 levels, in both the pre- and postoperative periods, showed significantly larger tumor size, higher grade, more frequent hormone receptor-negativity and human epidermal growth factor receptor 2 overexpression, and active adjuvant treatments than groups with lower-Ki-67 levels. High-Ki-67 levels were also significantly associated with poor survival, irrespective of the timing of specimen examination. Conclusion Despite the problems associated with Ki-67, Ki-67 level is an important independent prognostic factor, regardless of the timing of Ki-67 testing, i.e., preoperative or postoperative testing.

Schwannoma of Left Chest Wall: a Case Report and Literature Review

Background: Schwannoma of chest wall is rare intercostal nerve tumor originated from Schwann cells. Here, we present a rare case about schwannoma was misdiagnosed as solitary fibroma by preoperative biopsy. We intend to improve clinicians' understanding of the disease by discussing the clinical manifestations, diagnostic points and differential diagnosis of patients with thoracic wall schwannoma.Case presentation: A 38-year-old male presented with "left chest pain for more than 1 month". Enhanced Computer Tomography(CT) can of the lung revealed space occupying lesions in the left lower posterior chest wall. Preoperative biopsy was solitary fibroma. After the improvement of preoperative preparation, the patients were given surgical treatment, postoperative pathology showed: schwannoma of chest wall. Chest pain improved after operation. The patients were followed up for 8 months.Discussion and Conclusions: Schwannoma, especially in the chest wall, is rare, with atypical clinical symptoms, single imaging manifestations, high variable rate of puncture pathology, and easy to be misdiagnosed. Complete surgical resection of tumor is the main treatment, and no new adjuvant / adjuvant therapy has been reported yet.

The Effect of Smoking on Progression from Ductal Carcinoma in Situ to Invasive Ductal Carcinoma: A Retrospective Study

Background If ductal carcinoma in situ (DCIS) is diagnosed by histological examination such as core needle biopsy or vacuum-assisted biopsy (VAB), invasion is often found by removing the entire tumor and performing pathological examination. According to a meta-analysis, the rate of invasion found by postoperative pathological examination is about 25%. Smoking is a risk factor for carcinogenesis in various carcinomas, including breast cancer. We examined the correlation between the risk of invasion found by postoperative pathology and smoking history in patients who were diagnosed with DCIS by preoperative biopsy. Methods In this study, we examined 128 patients who were diagnosed with DCIS by preoperative biopsy. Before the biopsy, all patients were asked about the duration of smoking, number of cigarettes smoked per day, and whether they were currently smoking. The data were used to calculate each patient’s tobacco exposure based on pack-years. The statistical analyses included the Pearson’s chi-square test and logistic analysis. Multivariate analysis was performed on the risk factors for invasion diagnosed by postoperative pathological examination in all cases diagnosed with DCIS by preoperative biopsy. Results Of all the patients included in this study, 107 (83.5%) never smoked, which represented the majority, while 8 patients (6.3%) smoked at diagnosis with DCIS, and 13 (10.2%) had quit smoking before diagnosis. Tobacco exposure was 10 or less pack-years for 11 patients (8.6%) and more than 10 pack-years for 10 patients (7.8%). Number of pack-years was not an independent factor (p = 0.349, odds ratio [OR] = 0.329), but current smoker status (p = 0.006, OR = not calculable) was an independent factor with VAB (p = 0.018, OR = 0.327). Conclusions This study suggests that tobacco components may have an influence on the progression from DCIS to invasive ductal carcinoma.

Lobular Carcinoma in Situ During Preoperative Biopsy and the Rate of Upgrade

Background: There is a potential risk that lobular carcinoma in situ (LCIS) on preoperative biopsy might be diagnosed as ductal carcinoma in situ (DCIS) or invasive carcinoma in the final pathology. This study aimed to evaluate the rate of upgrade of LCIS on preoperative biopsy to DCIS or invasive carcinoma.Methods: Data of 55 patients with LCIS on preoperative biopsy were analyzed. All patients underwent surgery between 1991 and 2016 at Severance Hospital in Seoul, Korea. We analyzed the rate of upgrade of preoperative LCIS to DCIS or invasive cancer in the final pathology. The clinicopathologic features related to the upgrade were evaluated.Results: The rate of upgrade of LCIS to DCIS or invasive carcinoma was 16.4% (9/55). In multivariate analysis, microcalcification and progesterone receptor expression were significantly associated with the upgrade of LCIS (P = 0.023 and 0.044, respectively).Conclusions: The current study showed a relatively high rate of upgrade of LCIS on preoperative biopsy to DCIS or invasive cancer. The presence of microcalcification and progesterone receptor expression may be potential predictors of upgradation of LCIS on preoperative biopsy. Surgical excision of the LCIS during preoperative biopsy could be a management option to identify the concealed malignancy.

The value of the tumour-stroma ratio for predicting neoadjuvant chemoradiotherapy response in locally advanced rectal cancer: a case control study

Background The tumour-stroma ratio (TSR) is recognized as a practical prognostic factor in colorectal cancer. However, TSR assessment generally utilizes surgical specimens. This study aims to investigate whether the TSR evaluated from preoperative biopsy specimens by a semi-automatic quantification method can predict the response after neoadjuvant chemoradiotherapy (nCRT) of patients with locally advanced rectal cancer (LARC). Methods A total of 248 consecutive patients diagnosed with LARC and treated with nCRT followed by resection were included. Haematoxylin and eosin (HE)-stained sections of biopsy specimens were collected, and the TSR was evaluated by a semi-automatic quantification method and was divided into three categories, using the cut-offs determined in the whole cohort to balance the proportion of patients in each category. The response to nCRT was evaluated on the primary tumour resection specimen by an expert pathologist using the four-tier tumour regression grade (TRG) system. Results The TSR can discriminate patients that are major-responders (TRG 0–1) from patients that are non-responders (TRG 2–3). Patients were divided into stroma-low (33.5%), stroma-intermediate (33.9%), and stroma-high (32.7%) groups using 56.3 and 72.8% as the cutoffs. In the stroma-low group, 58 (69.9%) patients were major-responders, and only 39 (48.1%) patients were considered major-responders in the stroma-high group (P = 0.018). Multivariate analysis showed that the TSR was the only pre-treatment predictor of response to nCRT (adjusted odds ratio 0.40, 95% confidence interval 0.21–0.76, P = 0.002). Conclusion An elevated TSR in preoperative biopsy specimens is an independent predictor of nCRT response in LARC. This semi-automatic quantified TSR could be easily translated into routine pathologic assessment due to its reproducibility and reliability.