The association between conventional ultrasound and contrast-enhanced ultrasound appearances and pathological features in small breast cancer

OBJECTIVE: To investigate the association between ultrasound appearances and pathological features in small breast cancer. MATERIALS AND METHODS: A total of 186 small breast cancers in 186 patients were analyzed in this retrospective study from January 2015 to December 2019 according to pathological results. Forty-seven cases of axillary lymph node metastasis were found. All patients underwent radical axillary surgery following conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) examinations. The association between ultrasound appearances and pathological features was analyzed using univariate distributions and multivariate analysis. Then, a logistic regression model was established using the pathological diagnosis of lymph node metastasis and biochemical indicators as the dependent variable and the ultrasound appearances as independent variables. RESULTS: In small breast cancer, risk factors of axillary lymph node metastasis were crab claw-like enhancement on CEUS and abnormal axillary lymph nodes on US. The logistic regression model was established as follows: (axillary lymph node metastasis) = 1.100×(crab claw-like enhancement of CEUS) + 2.749×(abnormal axillary lymph nodes of US) –5.790. In addition, irregular shape on CEUS and posterior echo attenuation on US were risk factors for both positive estrogen receptor and progesterone receptor expression, whereas calcification on US was a risk factor for positive Her-2 expression. A specific relationship could be found using the following logistic models: (positive ER expression) = 1.367×(irregular shape of CEUS) + 1.441×(posterior echo attenuation of US) –5.668; (positive PR expression) = 1.265×(irregular shape of CEUS) + 1.136×(posterior echo attenuation of US) –4.320; (positive Her-2 expression) = 1.658×(calcification of US) –0.896. CONCLUSION: Logistic models were established to provide significant value for the prediction of pre-operative lymph node metastasis and positive biochemical indicators, which may guide clinical treatment.

The Role of Trastuzumab in Patients with HER2 Positive Small (pT1mi/a) Breast Cancers, a Multicenter Retrospective Study

The treatment with adjuvant Trastuzumab in patients diagnosed with HER2+ small breast cancers is controversial: limited prospective data from randomized trials is available. This study aims to measure the effect of Trastuzumab in the early stages of breast cancer (pT1mic/a pN0/1mi) in terms of disease recurrence and to identify which are the factors that most affect the prognosis of small HER2+ tumors. One hundred HER2+ pT1mic-pT1a breast cancer patients who were treated in three Turin Breast Units between January 1998 and December 2018 were retrospectively selected and reviewed. Trastuzumab was administered to 23 patients. Clinicopathological features and disease-free survival (DFS) were compared between different subgroups. The primary outcome was the disease recurrence rate. Median follow-up time was 86 months. Compared to pT1a tumors, pT1mic lesions had a higher tumor grade (84% of pT1mic vs. 55% of pT1a; p = 0.003), a higher Ki-67 index (81% vs. 46%; p = 0.007) and were more frequently hormone receptor (HR) negative (69% vs. 36%, p = 0.001). Disease recurrence rate was significantly lower among patients who received adjuvant Trastuzumab (p = 0.02), with this therapy conferring an 85% reduction in the risk of relapse (HR 0.15; p = 0.02). Among the patients who did not receive adjuvant Trastuzumab, the only factor significantly associated with an increased risk of developing a recurrence was the immunohistochemical (IHC) subtype: in fact, HR− HER2+ tumors showed a risk seven times higher of relapsing (HR 7.29; p = 0.003). Adjuvant Trastuzumab appears to reduce the risk of disease recurrence even in small HER2+ tumors. The adjuvant targeted therapy should be considered in patients with HR− HER2+ tumors since they have the highest risk of recurrence, independently from size and grade.

In vivo Estimation of Breast Cancer Tissue Volume in Subcutaneous Xenotransplantation Mouse Models by Using a High-Sensitivity Fiber-Based Terahertz Scanning Imaging System

Absorption contrast between the terahertz (THz) frequency range of fatty and cancer tissues allows cancer diagnosis by THz imaging. We successfully demonstrated the ability of THz imaging to measure small breast cancer volume in the subcutaneous xenotransplantation mouse models even without external comparison. We estimated the volume detection limitation of the fiber-based THz scanning imaging system using a highly sensitive cryogenic-temperature-operated Schottky diode detector to be smaller than 1 mm3, thus showing the potential application of this technique in preliminary early cancer diagnosis.

The Lavender Way – Lavender Procedure, A Way to Defeat Breast Cancer Without Surgery: Chemotherapy or Radiation

Background: Despite advances in metabolic pathways, exosomes, ct-DNA, biomarkers, and imaging technology, breast cancer is still with us. It is a global curse, with incidence set to double in the U.S. by 2030. Increasingly, researchers blame this debacle on our persistent use of unreliable preclinical testing with mouse models. Further, while basic science understanding has exploded, we know each daughter cell is genetically different, with likely increased resistance to therapy – and increased aggressiveness. Nonetheless, our current approach requires killing every one of these daughters to the last. The authors have devised a new game plan; the new goal is to kill the very first cells, not the last ones. This can be implemented globally – with dramatic cost reduction, and more lives saved while leaving the breast intact. Methods: The authors have created The Lavender Way, which employs multiple non-radiation diagnostic modalities. This allows us to predict within ten years in a person's lifetime when breast cancer will likely manifest. Then imaging is accelerated with modified military Infrared, ultrasound, and others to locate ultra-small breast cancers (5-8mm). Tumor analysis can determine each tumor’s aggressiveness. Via a 20-minute office procedure under local anaesthesia (i.e., Cryoablation, aka The Lavender Procedure), the tumor can be killed with the patients resuming normal activity immediately. It is both a dramatic change in treatment and, just as significant, a dramatic change in lifting the psychological burden of this dreaded disease. Results: Group I: Ideal Patients, Group II: Less than Ideal, Group III: Strictly Palliative. All in Group I are alive after seven years except one. That one died of a fall, cancer-free, and one is alive with a local recurrence successfully treated with repeat cryoablation. Group II had one local recurrence, and one had a second primary tumor in a different location in the breast. Group III refused any other treatment and had metastatic disease. They were treated to prevent tumors from eroding through the skin. Most have died. The Lavender Way paves the way for The Lavender Procedure. Conclusion: Ultra-small breast cancers with optimal bio-markers are ideal candidates for The Lavender Procedure (i.e., Cryoablation). All patients resumed normal activity immediately – without sutures. All patients in Group I and II patients have avoided surgery, chemotherapy, and radiation.

Assessment of Tumor Cell Death After Percutaneous Ultrasound– Guided Radiofrequency Ablation of Breast Carcinoma: A Prospective Study

Background: Current trends in breast cancer treatment include the use of less aggressive surgeries to reduce morbidity, shorten hospital stays and improve cosmetic results. The aim of the study is to assess tumor cell viability after percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) for small breast cancer by a combination of staining techniques. Methods: A prospective study was conducted at a single institution from 2013 to 2017. Twenty women with invasive ductal carcinoma of the breast measuring ≤ 20 mm were treated with US-guided RFA followed immediately by surgical resection. Tumor viability pre- and post-RFA was assessed with Hematoxylin and Eosin (H&E), Nicotinamide adenine dinucleotide (NADH), Succinate dehydrogenase (SDH), Cytochrome c oxidase (COX), Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and Cytokeratin 18 and 19 (CK18/CK19) staining techniques. Outcomes and correlation with the different techniques were evaluated with principal component analysis Cronbach’s alpha. Results: Oxidative enzymes in frozen sections showed loss of SDH and NADH in 13 of the 16 tumors (81%) and COX in 11 of the 13 tumors (84%). In paraffin-embedded tissues, CK18 was negative or markedly reduced in 98% and CK19 in 100% of the cases. Lack of evidence of cell death was seen in 3 cases where the maximum temperature achieved at the center of the tumor was ≤ 70ºC. The reliability and internal consistency between the different staining techniques was high (Cronbach’s alpha, 0.8), with concordance between the staining results of the oxidative enzymes and of CK18/CK19. Conclusion: Loss of tumor viability in small breast tumors after US-guided percutaneous RFA could be assessed in our series with different staining methods. CK18 and CK19 could be used in paraffin-embedded tissues as surrogate markers of tumor cell viability after immediate RFA.

Difficulties of radiological diagnosis оf small breast cancers

Introduction. Breast cancer in the structure of malignancies in women takes the 1st place. There has been an annual increase in morbidity, including due to improvements in diagnostic interventions and screening. Mammography and ultrasound of the breasts is mandatory when diagnosing breast cancer. The difficulties of diagnosis are revealed in small tumors.Methods. Breast ultrasounds were performed on the ultrasound machines of the expert class TOSHIBA APLIO 500, PHILIPS EPIQ 5 and PHILIPS EPIQ 7. Mammography and tomosynthesis were performed on mammogram MAMMOMAT INSPITATION PRIME. Core-biopsia under ultrasound control was carried out on the Logiq9 ultrasound scanner. Eighty women were selected with suspected cancer after breast core-biopsy with the category BI-RADS 3, 4 and 5. The size of the node according to ultrasound data was 6-10 mm.Results. According to core-biopsia has been identified cancer, histologically and immunohystochemically confirmed in 50 cases. In 30 women benign tumors were identified. The most informative mammograms of breast cancer were high tumor density, ray of radiibility and local deformity of soft tissues. Among the characteristic ultrasonic signs of the cancer more often noted vertical orientation, reduced echogenicity, uneven contour, other signs were not so character for the cancer.Conclusion. You can't focus on a separate sign of education! Only a combination of traits, different diagnostic methods contribute to the correct diagnosis.

Surgery for Good Prognosis Breast Cancers

Purpose of Review The introduction of mammographic screening programmes has resulted increasing numbers of women with small breast cancers with biologically favourable characteristics. Many of these cancers may represent overdiagnosis, with a resulting treatment burden for women and healthcare costs for providers. Here, current surgical approaches to the treatment of such tumours are reviewed, together with alternative approaches to their management. Recent Findings The surgical treatment of small, screen-detected breast cancers with biologically favourable characteristics has been extrapolated from the management of symptomatic breast cancers. There is no prospective randomised evidence for conventional open surgery compared with other approaches in this setting. A number of minimally invasive techniques, most notable vacuum-assisted excision, have been described for the management of these tumours, but at present, there is a lack of high-quality evidence to support their routine use. There are currently ongoing randomised trials evaluating risk-adapted surgical and minimally invasive approaches to the management of good prognosis disease. Summary It is possible that the surgical treatment of good prognosis screen-detected breast cancers may be de-escalated. However, high-quality evidence from ongoing prospective randomised trials will be required in order to change clinical practice.