Sentinel lymph node biopsy in patients affected by breast ductal carcinoma in situ with and without microinvasion

Bertozzi, Serena; Cedolini, Carla; Londero, Ambrogio P.; Baita, Barbara; Giacomuzzi, Francesco; Capobianco, Decio; Tortelli, Marta; Uzzau, Alessandro; Mariuzzi, Laura; Risaliti, Andrea

doi:10.1097/md.0000000000013831

Cited by 19 publications

(24 citation statements)

References 38 publications

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“…The incidence of lymph node metastasis in microinvasive breast cancer was 5.5%-12%. 10 , 18 , 19 The proportion of lymph node metastasis was 6.6% (8/121) in the present study, which was similar to that reported in the literature. At the same time, the size of CIS reported in the literature is similar to the tumor size range in this study.…”

Section: Discussionsupporting

confidence: 91%

Breast Microinvasive Carcinoma With Different Morphologies: Analysis of Clinicopathologic Features of 121 Cases

Feng

Zheng

Yang

2020

Breast Cancer�(Auckl)

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Purpose: To investigate the clinicopathological features of patients with breast microinvasive carcinoma (MI). Methods: The clinical data of 121 cases with breast MI were retrospectively collected. The whole tumor in each case was stained with hematoxylin and eosin (H&E) for pathological evaluation. The relationships among size of tumor, histological grade, tumor-infiltrating lymphocytes (TILs), the number of MIs, type of MI, and lymph node metastasis were analyzed. Results: It was revealed that 86% of the cases had high-grade ductal carcinoma in situ (DCIS) and 63.6% had multiple MIs. The larger size of the tumors, the higher the grade of DCIS, the more the number of MIs; 3.3% of cases had rich TILs (lymphocyte/stroma > 30%) in the DCIS, and 26.5% had rich TILs in MIs. The type A of MIs is characterized by single cells and small clusters of solid cells. Tumor cells in type B of MIs can form glandular ducts. Formal grading of microinvasive is challenging/impossible due to its limited size precluding a representative mitotic count. But nuclear grade and tubule (differentiation) grades can be reported. In addition, 72.7% of cases had type A of MIs and 27.3% of cases had type B of MIs. Type B was found to be highly accompanied by moderate-grade DCIS. Only 6.6% of patients with MI had lymph node metastasis, which was mainly related to MIs with less TILs. Conclusion: Breast MI is easy to occur in high-grade DCIS, and multiple infiltration foci may be observed in case with tumor size of higher than 3.5 cm. Microinvasive carcinoma with poor TILs maybe a risk factor for lymph node metastasis in patient with DCIS-Mi.

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Section: Discussionsupporting

confidence: 91%

Breast Microinvasive Carcinoma With Different Morphologies: Analysis of Clinicopathologic Features of 121 Cases

Feng

Zheng

Yang

2020

Breast Cancer�(Auckl)

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“…Table 1 shows a description of the included samples. The median age at breast cancer surgery was 55 years (48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65), and the median BMI was 25 kg/m2 (IQR [22][23][24][25][26][27][28][29]. In 99.26 and 8.82% of cases, respectively, adjuvant and neoadjuvant chemotherapy was administered.…”

Section: Population Descriptionmentioning

confidence: 99%

TFEB, SIRT1, CARM1, Beclin-1 expression and PITX2 methylation in breast cancer chemoresistance: a retrospective study

et al. 2021

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Background Breast cancer chemoresistance is attributed to a wide variety of mechanisms, including autophagy. Transcription factor EB (TFEB) has been recently identified and characterized as one major regulator of autophagy and lysosomal genesis. Objective This study aims to evaluate the prognostic impact of TFEB and its pathway in breast cancer chemoresistance. Methods This retrospective study analyzes the expression of TFEB, CARM1, SIRT1, and Beclin-1 and the methylation of PITX2 in breast carcinoma. A group of breast cancer patients treated with chemotherapy, who relapsed within 12 months from treatment initiation, were compared to a sub-cohort of chemo-treated patients who did not recur within 12 months of follow-up. The expression of TFEB, CARM1, SIRT1, and Belcin-1 was analyzed using immunohistochemistry or RT-PCR on formalin-fixed paraffin-embedded samples. PITX2 methylation was tested with the diagnostic CE-marked kit Therascreen PITX2 RGQ PCR. In the final model, 136 cases of chemo-treated breast cancer were included. Results A higher TFEB and Beclin-1 expression correlate with shorter survival in patients with chemo-treated invasive breast cancer (respectively HR 3.46, CI.95 1.27–9.47, p < 0.05 and 7.11, CI.95 2.54–19.9). TFEB, CARM1, and SIRT1 are positively correlated with Beclin-1. The protein expression of SIRT1 is significantly associated with TFEB and CARM1 so that a very low SIRT1 expression (lower than the first quartile of the H-score distribution) correlates with a low expression of TFEB and CARM1 and with longer survival. SIRT1 seems to have a lower H-score in the basal-like and HER2-enriched tumors than the luminal subtypes. Beclin-1 and TFEB seem to have a higher H-score in the basal-like and HER2-enriched tumors than the luminal subtypes. PITX2 methylation analysis was feasible only in 65% of the selected samples, but no significant differences between cases and controls were found, and there was also no correlation with the expression of the TFEB pathway. Conclusions TFEB, SIRT1, and Beclin-1 seem to have a potential prognostic significance in patients with chemo-treated breast cancer, likely because of their role in the regulation of autophagy. In addition, no correlation between TFEB and PITX2 methylation was found, likely because they perform two different roles within the autophagy process.

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“…Changes in the analysis of LN using serial sections coupled with cytokeratin immunodetection by IHC has increased ITC and micrometastases identification. Depending on the studies, SLN removal associated with exhaustive LN analysis has increased the incidence of LN involvement varying from 0.9% to 8% (49)(50)(51)(52)(53). In these studies, most of ALN involvements were limited to isolated or small clusters of epithelial cells (49).…”

Section: Slnb Indications and Contraindications In Case Of Ductal Carcinoma In Situ (Dcis)mentioning

confidence: 99%

Narrative review of sentinel lymph node biopsy in breast cancer: a technique in constant evolution with still numerous unresolved questions

Mathelin¹,

Lodi²

2021

Chin Clin Oncol

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The aim of this narrative review was to provide an update on the use of sentinel lymph node biopsy (SLNB) for breast carcinoma (BC). Relevant studies published between 01/01/1994 and 15/08/2020 assessing the accuracy and the usefulness of SLNB were reviewed. SLNB was first used in 1977 for penile cancers. However, it took 17 years to enter in clinical practice for BC. The first procedures were based on two methods of non-specific marking of LN vmacrophages using a radioisotope ( 99m Tc) and a blue dye (BD, Isosulfan, Patent or Methylene). To overcome side effects of radioisotopes (radiation exposure) and BD (allergic reactions), innovative tracers such as indocyanine green (ICG), superparamagnetic iron oxide (SPIO), and microbubbles have been explored. The SLN intraoperative examination is no longer performed, due to its low impact on the rate of reoperation and high time and cost of surgery. Likewise, immunohistochemistry, which can lead to an unnecessary ALND in some cases of occult metastases, is no more recommended.Except cases with metastasized LN, all contraindications aim to avoid situations where the risk of false negative would be too high (notably T3-T4 or multicentric tumors). The current indications for invasive BC are T0-T1-T2 N0 or N1 (after an accurate LN evaluation with ultrasound and/or cytology or core biopsy) and for DCIS treated by mastectomy or presenting as a palpable mass. After SLNB, axillary recurrence rates are generally below 2% after a follow up of 8-10 years, comparable to those observed after ALN. Likewise, when the SLN contains less than 2 metastases, axillary recurrence rates remain low even when ALN is omitted. In case of more than 2 metastatic SLN or capsular effraction, ALND is still indicated. For most teams, SLNB can be performed in clinically node-negative patients receiving neoadjuvant systemic therapy.The results of the literature consistently show that SLNB is extremely reliable in selected BC, as long as it is performed with a rigorous technique by teams having undergone multidisciplinary training and having gained the necessary experience.

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Sentinel lymph node biopsy in patients affected by breast ductal carcinoma in situ with and without microinvasion

Abstract: Supplemental Digital Content is available in the text

Cited by 19 publications

References 38 publications

Breast Microinvasive Carcinoma With Different Morphologies: Analysis of Clinicopathologic Features of 121 Cases

Breast Microinvasive Carcinoma With Different Morphologies: Analysis of Clinicopathologic Features of 121 Cases

TFEB, SIRT1, CARM1, Beclin-1 expression and PITX2 methylation in breast cancer chemoresistance: a retrospective study

Narrative review of sentinel lymph node biopsy in breast cancer: a technique in constant evolution with still numerous unresolved questions

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