Comparative study of Hormonal Receptor Status Discrepancy - Brain Breast Cancer Metastasectomy vs Other Localities.

Purpose: Hormonal receptor (HR) status is one of the key factors when determining the treatment of breast cancer. Even though HR conversion is one of the most researched topics recently, most of the previous studies include only the results of biopsies instead of samples obtained by metastasectomy. Aim: The aim of this study is to compare the occurrence of HR status conversion in brain breast cancer metastatic tissue to other localities. Methods: A total of 50 patients after breast cancer metastasectomy of brain, lung or liver were included in the study. The clinical characteristics were recorded. Results: HR conversion was observed in a total of 30 cases (60.0%), while HER2 (human epidermal growth factor receptor 2) discrepancy occurred only in one case (2.0%). Endocrine therapy significantly contributed to the decrease progesterone and estrogen receptor expression in metastatic tissue compared to the primary tumor (p = 0.009, p = 0.023; respectively). Triple negativity was more common in the brain metastases (p = 0.039). Liver metastases occurred in significantly younger patients (p = 0.034), however brain metastases had the poorest OS (p = 0.007). Conclusion: HR conversion occurs in more than 50% of cases of breast cancer metastatic disease, while HER2 discrepancy is rare. Hormonal therapy significantly contributes to the decrease of HR positivity in metastases. Triple negativity is more common in the brain metastases than in other localities. Brain metastases of breast cancer are associated with the poorest prognosis.

Association of Oral Contraceptives use with Breast Cancer and Hormone Receptor Status in Iraqi Women

BACKGROUND: Worldwide, there is a significant concern regarding the association of breast cancer risk and oral contraceptives use. Differences in demographical and pathological breast cancer characteristics in Iraqi patients have been reported compared to other western countries; however, studies addressing the risk of breast cancer among oral contraceptive users in Iraq and subsequent correlation with hormonal receptor status are lacking. AIM: The aim of the study was to evaluate association of breast cancer risk and oral contraceptives use in patients visiting tertiary oncology center and to correlate hormone receptor status with history of oral contraception use in breast cancer patients. PATIENTS AND METHODS: Two hundred women with breast cancer were compared regarding patterns of oral contraceptives use with 300 age-matched healthy female controls by personal interview and questionnaire. Patient’s records were reviewed for hormone receptor status. RESULTS: A significantly higher proportion (49%) of women with breast cancer reported a positive history of combined oral contraceptives use as compared with (35.7%) healthy controls. Ever oral contraceptives users had a significantly increased risk of breast cancer (odds ratio [OR] = 1.73; 95%, confidence interval = 1.2–2.5, p = 0.003), with the highest risk was seen in early use before the age of 20 (OR = 6.62, p = 0.02); whereas increased duration of use did not significantly increase the risk of breast cancer. There was no significant association between estrogen and progesterone receptors expression profile in breast cancer patients and combined oral contraceptive use. CONCLUSION: In Iraqi women, the risk of breast cancer increases with oral contraceptives intake particularly when starts early before the age of 20 years. The hormonal receptor status of breast cancer patients is not significantly affected by combined oral contraceptives use.

Prediction of Late Recurrence and Distant Metastasis in Early-stage Breast Cancer: Overview of Current and Emerging Biomarkers

Recently, a significant number of breast cancer (BC) patients have been diagnosed at an early stage. It is therefore critical to accurately predict the risk of recurrence and distant metastasis for better management of BC in this setting. Clinicopathologic patterns, particularly lymph node status, tumor size, and hormonal receptor status are routinely used to identify women at increased risk of recurrence. However, these factors have limitations regarding their predictive ability for late metastasis risk in patients with early BC. Emerging molecular signatures using gene expression-based approaches have improved the prognostic and predictive accuracy for this indication. However, the use of their based-scores for risk assessment has provided contradictory findings. Therefore, developing and using newly emerged alternative predictive and prognostic biomarkers for identifying patients at high- and low-risk is of great importance. The present review discusses some serum biomarkers and multigene profiling scores for predicting late recurrence and distant metastasis in early-stage BC based on recently published studies and clinical trials.

Quantitative Analysis of Enhancement Intensity and Patterns on Contrast-enhanced Spectral Mammography

CESM is an emerging digital mammography technology with a high breast cancer detection and a limited diagnostic specificity. In order to improve specificity, we quantitatively assessed enhancement intensity of breast lesions with different pathological types and hormonal receptor status and evaluated the consistency of enhancement patterns between CESM and DCE-MRI. A total of 145 lesions were enrolled, consisting of 43 malignant (17 non-infiltrating cancers and 26 infiltrating cancers) and 99 benign lesions. The diagnostic performance of enhancement intensity in the former positions was significantly higher than that in the latter positions (AUC: 0.834 vs. 0.755, p = 0.0008). Infiltrating cancers showed the highest enhancement intensity, while benign lesions the lowest (mean CNR1: 7.6% vs. 2.7%; median CNR1: 6.8% vs. 2.7%). Enhancement intensity of ER or PR positive group was weaker than negative group, while HER-2 positive group was stronger than negative group. 28 patients with 28 lesions performed both CESM and DCE-MRI examinations, showing a coincidence rate of 64.2% and moderate agreement (k = 0.515) between CESM and DCE-MRI. In conclusion, quantitative analysis of enhancement characteristics is feasible to the diagnosis practice on CESM.

The Association of HER-2 Over-expression in Relation to Hormonal Receptor Status and Common Clinico-pathological Parameters in Breast Carcinoma

Objective: To determine the association of Human Epidermal growth factor Receptor2 (HER-2) with hormonal receptor status and common clinico-pathological parameters of breast carcinoma. Study Design: Cross-sectional, observational study. Place and Duration of Study: Department of Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh during the period from January 2009 to December 2009. Methodology: A total of 100 patients of female breast carcinoma with HER-2 status, hormonal receptor profile and clinico-pathological parameters were included in this study. Patient's age, menopausal status, tumour size, lymph node status, Estrogen Receptor (ER) and Progesterone Receptor (PR) status were evaluated and their association was determined with H.ER-2 over expression using the chi-square test for analysis. Results: Of these 100 cases, mean age of diagnosis was 48 years and mean tumour size 4.4 cm. Lymph node metastases were present in 50% cases. HER-2 over-expression was seen in 29% cases, while ER and PR expression was seen in 61 % and 43% respectively. ER and PR showed inverse association (p <0.05) with HER-2 while positive association was seen with tumour size and lymph node metastases (p <0.05). No association was seen with menopausal status. Further, among 61 ER positive cases, 4 cases also HER-2 over expressed. Conclusion: The study had indicated that Her-2 may be a powerful predictor of poor prognosis as its over-expression was strongly directly associated with tumor size and lymph node involvement and inversely associated with hormonal receptor status of breast carcinoma. ER positive cases can also be HER-2 over expressed (4%), so ER status cannot be used to select tumours for evaluation of HER-2 status. As treatment modalities of ER positive and HER-2 over expressed is different, so all the patients should be studied with both receptor and treat accordingly. Journal of Surgical Sciences (2012) Vol. 16 (2) : 59-67

Female Sex Hormone Receptor Profiling in Uterine Adenosarcomas

ObjectiveThis study aimed to identify the hormonal receptor status in uterine adenosarcoma (AS) and uterine AS with sarcomatous overgrowth (AS + SO), including those with high-grade histologic features (nuclear pleomorphism, atypical mitoses, necrosis), with or without heterologous elements. Estrogen receptor (ER) status, including estrogen receptor α (ERα), estrogen receptor β (ERβ), and G protein–coupled estrogen receptor (GPER), and progesterone receptor (PgR) status were examined.MethodsFrom August 2001 to November 2013, 11 patients with histologic diagnosis of uterine AS were identified. Tumor tissue sections were stained for ERα, ERβ, GPER, and PgR and examined both for percentage of overall cells stained and for intensity of staining. Descriptive statistics were calculated using clinicopathologic data abstracted from the medical record.ResultsEight cases of AS and 3 cases of AS with high-grade features were identified. Seven of 8 tumor samples of AS showed strong or moderate intensity immunostaining for ERα; all AS + SO tumor samples showed minimal to no immunoreactivity for ERα. There was a significant decrease in ERαHscores in high-grade tumors when compared with AS (P= 0.01). Lower PgRHscores were observed in high-grade tumors compared with those in AS (P= 0.04). Estrogen receptor β immunostaining was variable, and GPER immunostaining was absent in the majority of tumor samples.ConclusionsHigher expression of ERα and PgR was observed in AS when compared with those with AS + SO and high-grade features. Both tumor subtypes showed similar levels of ERβ and GPER expression, although significant differences in ERβ and GPER expression were not detected. In contrast to our previous findings in uterine carcinosarcoma, ERs ERβ and GPER do not seem to play a significant role in AS in this study.