Breast cancer is a heterogeneous disease comprising a variety of entities with various genetic backgrounds. Estrogen receptor-positive, human epidermal growth factor receptor 2-negative tumors typically have a favorable outcome; however, some patients eventually relapse, which suggests some heterogeneity within this category. In the present study, we used proteomics and miRNA profiling techniques to characterize a set of 102 either estrogen receptor-positive (ER+)/progesterone receptor-positive (PR+) or triple-negative formalin-fixed, paraffin-embedded breast tumors. Protein expression-based probabilistic graphical models and flux balance analyses revealed that some ER+/PR+ samples had a protein expression profile similar to that of triple-negative samples and had a clinical outcome similar to those with triple-negative disease. This probabilistic graphical model-based classification had prognostic value in patients with luminal A breast cancer. This prognostic information was independent of that provided by standard genomic tests for breast cancer, such as MammaPrint, OncoType Dx and the 8-gene Score.

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CONTEXT:Various components of follicular fluid are suggested as biochemical predictors of oocyte quality. Previous studies of follicular steroid hormone levels have shown disparate results when related with fertilization outcomes.AIM:The objective of the study was to relate the levels of steroid hormones of each individual follicle with oocyte maturation, fertilization results, embryo quality, and pregnancy rates.SETTINGS AND DESIGN:Prospective cohort study in a university hospital.METHODS:In 31 patients, who underwent intracytoplasmic sperm injection, it was performed an ultrasound guided aspiration of follicular fluid of the first two mature follicles from each ovary. Follicular levels of estradiol, progesterone, testosterone, and dehydroepiandrosterone sulfate were measured by chemiluminescent immunoassay.STATISTICAL ANALYSIS:Generalized estimating equation model.RESULTS:In follicular fluids with mature oocyte presence, in normal as well as in failed fertilization, there was a positive correlation between follicular testosterone and progesterone (r = 0.794, P = 0.0001 and r = 0.829, P = 0.0001). Progesterone levels were higher in cases of normal fertilization compared to failed fertilization (P = 0.003). B quality embryos came from oocytes immersed in follicular fluids with higher estradiol values and higher estradiol/progesterone and estradiol/testosterone ratios than those of C quality (P = 0.01; P = 0.0009; P = 0.001). Estradiol levels were higher in patients who achieved pregnancy (P = 0.02).CONCLUSION:The analysis of follicular hormone composition could be considered as an additional tool in oocyte selection.

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ResumenIntroducciónEl objetivo de este estudio es comprobar la evolución de las especificaciones de la prestación analítica (EPA) utilizadas en programas de garantía externa de la calidad (EQA) y el papel de un programa de categoría 1 en la vigilancia de la estandarización de la prestación de los laboratorios clínicos en España.MétodosSe ha revisado la bibliografía sobre tipos de especificaciones de la calidad usados en programas de otros países y se ha comprobado su evolución; se ha comparado el posible impacto de distintas EPA empleadas en ocho países en la toma de decisiones clínicas con tres ejemplos de magnitudes: sodio, tirotropina (TSH) y tiempo de tromboplastina parcial activado (TTPA).ResultadosSe ha evidenciado la estandarización entre métodos analíticos comprobando si los resultados medios se desvían respecto al valor de referencia certificado del control dentro de las EPA derivadas de la variación biológica (VB). Las EPA usadas en EQA han evolucionado desde el estado del arte hacia la VB. Si se aplican los resultados que se aceptarían con algunas EPA se podrían producir decisiones clínicas erróneas.ConclusiónesEn España, solo 2 de las 18 magnitudes biológicas estudiadas se pueden considerar bien estandarizadas. Sería necesaria una colaboración más estrecha entre los laboratorios y proveedores de sistemas analíticos para resolver las discrepancias.