Recurrence and distant free survival: study on breast cancer prognostic factor in Yogyakarta

ABSTRAK Recurrence and Distant free Survival : Study on Breast Cancer Prognostic Factor in Yogyakarta. Background : Relapse and distant metastasis in breast cancer depends on several factor such as clinical, morphological and biological prognostic factors. Objective: The aim of this study was to know prognostic factors of operable breast cancer patients in Yogyakarta, and its relation with recurrence and distant free survival. Methods : Prospective design was applied duct invasive operable breast cancer patients who had been diagnosed and treated since 1993 were followed prospectively for clinical, pathological stage, age, tumor size, lymph node status, histological grade, mitotic index, ER,PR, c-erbB2, p53 and MIB-1, until revealed outcome (recurrence and distant metastasis). Prognostic factor was analyzed univariately for recurrence and distant metastasis with Kaplan Meier method. Difference between two survival group was analyzed with log- rank test. Independent prognostic factor was analyzed multivariately using proportional hazard (Cox) regression. Results: Significant prognostic factor for recurrence was c-erbB2 expression (p=0.0341. Univariate analysis showed that significant prognostic factors for distant metastasis were pathological stage, lymph node status, age and c-erbB2 expression. With multivariate analysis, most significant prognostic factors for distant metastasis were lymph node status (p=0.0151 and age (p=0.042). Conclusion: Independent prognostic factors for recurrence were c-erbB2 expression, while for distant metastasis were lymph node status and age. Key Words : breast cancer, prognostic factor, recurrence free survival, distant free survival-c-erbB

Correlation between preoperative axillary ultrasound and histopathology of resected lymph nodes in patients with carcinoma breast

Background: Axillary Ultrasound is an important tool in assessing regional lymph node status in women who are node negative clinically as many of them will prove to have axillary lymph node involvement on histopathology. The aim of the present study was to establish the role of axillary ultrasound in preoperative assessment of lymph node status in women with carcinoma breast and to correlate the findings of axillary ultrasound with the histopathology of resected axillary nodes.Methods: Forty patients (all women) were included in this study and the preoperative axillary ultrasound was done to know the status of axillary lymph nodes and the findings were correlated with histopathological findings of the resected nodes.Results: The sensitivity of axillary ultrasound was found to be 66.67%, specificity was 87.5%, accuracy 75%, positive predictive value (PPV) of 88.89% and negative predictive value of 63.4%.Conclusions: Axillary ultrasound is very important tool in assessing preoperative axillary lymph node status in patients with carcinoma breast. It is also important in assessment after inadequate axillary dissection and for follow up of non-treated axilla

Histopathology report on colon cancer specimens; measuring surgical quality, an increasing stress for surgeons

Introduction. Improving the quality of surgical resections by evaluating surgical specimens is probably the most important feedback a surgeon can receive. Moreover, prognosis of patients with colon cancer is based on achieving appropriate resection margins and assessment of lymph node status. For these reasons we aim to provide a retrospective analysis on colon cancer specimens operated by a single surgical team. Materials and Methods. 88 patients operated between 2013 and 2016 were included in the study. Data were gathered prospectively and assessed by multivariate analysis for the main variables (age, gender, tumor staging, specimen length, distance to closest resection margin, number of lymph nodes, and number of positive lymph nodes). Results. The mean number of lymph nodes excised was 31,9, with more after right colectomies (39.6) than after left colonic resections (29.1). The average specimen length was 29.2cm after right colectomies, 35.6cm after left hemicolectomies and 18cm after segmental colectomies. There was a significant correlation between the number of lymph nodes, specimen length, and age of patients. Conclusion. Lymph node status is correlated with specimen length and age. The standard of 12 lymph nodes was achieved and surpassed, being comparable to the benchmark literature. Standards on colon resections need to be reevaluated as many surgeons are pressured by quality measurements which do not always reflect sound oncologic principles

Proliferation and differentiation markers of colorectal adenocarcinoma and their correlation with clinicopathological factors

Background/aim: The purpose of this study was to investigate proliferation and differentiation markers in colorectal adenocarcinoma and their correlation with clinicopathological factors. Materials and methods: Samples were collected from 38 patients with colorectal adenocarcinoma and 10 healthy controls. E-cadherin, carcinoembryonic antigen (mCEA), cyclin B1, vascular endothelial growth factor (VEGF), and erythropoietin (EPO) receptor (EPOR) were examined by immunohistochemistry; VEGF and EPO were examined by real-time PCR. Results: The tumor samples were mostly characterized by large dimension (pT3), moderate level of differentiation (G2), negative lymph node status (N0), and no metastasis. Cyclin B1 and VEGF gene and protein expressions were significantly higher in tumor tissues than in control tissues; E-cadherin expression was significantly decreased in tumor samples and in positive correlation with mCEA. EPO was almost undetectable in tumor tissues of colorectal adenocarcinoma. Significant positive correlation was detected between tumor size and cyclin B1, tumor grade, and lymph node status. Conclusion: Decreased expression of EPO, high levels of VEGF and cyclin B1 expression, predominant moderate tumor differentiation, absence of metastasis, and negative lymph node status may suggest low level of aggressiveness, better prognosis, and longer patient survival

DRMS for Patient-Level Lymph Node Status Classification

Generally, automatic diagnosis of the presence of metastases in lymph nodes has therapeutic implications for breast cancer patients. Detection and classification of breast cancer metastases have high clinical relevance, especially in whole-slide images of histological lymph node sections. Fast early detection leads to huge improvement of patient’s survival rate. However, currently pathologists mainly detect the metastases with microscopic assessments. This diagnosis procedure is extremely laborious and prone to inevitable missed diagnoses. Therefore, automated, accurate patient-level classification would hold great promise to reduce the pathologist’s workload while also reduce the subjectivity of diagnosis. In this paper, we provide a novel deep regional metastases segmentation (DRMS) framework for the patient-level lymph node status classification. First, a deep segmentation network (DSNet) is proposed to detect the regional metastases in patch-level. Then, we adopt the density-based spatial clustering of applications with noise (DBSCAN) to predict the whole metastases from individual slides. Finally, we determine patient-level pN-stages by aggregating each individual slide-level prediction. In combination with the above techniques, the framework can make better use of the multi-grained information in histological lymph node section of whole-slice images. Experiments on large-scale clinical datasets (e.g., CAMELYON17) demonstrate that our method delivers advanced performance and provides consistent and accurate metastasis detection in clinical trials

Prognostic Markers of Microinvasive Breast Carcinoma: A Systematic Review and Meta-Analysis

(1) Background: The prognostic factors of microinvasive (≤1 mm) breast carcinoma are not completely clear. The aim of this study was to perform a systematic review and meta-analysis to clarify these factors. (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was followed. Two databases were interrogated, PubMed and Embase, and papers in English were included to address this question. The selected studies were those that reported on female patients affected by microinvasive carcinoma, and on prognostic factors with a hazard ratio (HR) for disease-free survival (DFS) and overall survival (OS). (3) Results: In total, 618 records were identified. After removing duplicates (166), identification, and screening (336 by title and abstract alone, 116 by full text and eventual supplementary material), 5 papers were selected. Seven different meta-analyses were conducted in this study, all referring to DFS, analyzing the following prognostic factors: estrogen receptor, progesterone receptor, HER2 status, multifocality and grade of microinvasion, patient’s age, and lymph node status. Only lymph node status was associated with prognosis and DFS (total number of cases: 1528; Z = 1.94; p = 0.05). The other factors examined did not significantly affect prognosis (p > 0.05). (4) Conclusions: Positive lymph node status significantly worsens prognosis in patients with microinvasive breast carcinoma

Mandatory multidisciplinary approach for the evaluation of the lymph node status in rectal cancer

Colorectal cancer is the third most frequently reported malignancy and also the third leading cancer-related cause of death worldwide. Lymph node evaluation, both preoperatively and postoperatively, represents an important aspect of the diagnosis and therapeutic strategy in colorectal cancer, such that an accurate preoperative staging is required for a correct therapeutic strategy. Treatment of rectal cancer with positive lymph nodes, a very important predictive prognostic parameter, is currently based on neoadjuvant chemoradiotherapy followed by total/ surgical mesorectal excision and adjuvant regimen. Preoperative evaluation of the lymph node status in rectal cancer is based on endoscopic ultrasound and magnetic resonance imaging, but their accuracy, specificity, and sensitivity still require improvement. Postoperative evaluation also presents points of debate, especially related to the role of sentinel lymph node mapping and their final implication, represented by detection of micrometastases and isolated tumor cells. The pathologic interpretation of tumor deposits represents other points in discussion. From a surgical perspective, extended lateral lymph node dissection vs. abstinence and (neo)adjuvant therapeutic approach represent another unresolved issue. This review presents the major controversies existing today in the treatment and pathologic interpretation of the lymph nodes in rectal cancer, the role/ indication and value of the lateral pelvic lymph node dissection, and the postoperative interpretation of the value of the micrometastatic disease and tumor deposits

Separation of excitation and detection coils to locate superparamagnetic iron oxide nanoparticles in vivo

The aim of this study is to develop a novel laparoscopic probe for sentinel node biopsy. The latter is a procedure to analyze the lymph node status of cancer patients [1], enabling personalized patient care