Feasibility of integrated high‐wavenumber Raman imaging and fingerprint Raman spectroscopy for fast margin assessment in breast cancer surgery

Intraoperative assessment of surgical margins remains one of the main challenges in cancer surgery. Raman spectroscopy can detect cancer cells with high accuracy, but it is time‐consuming. In this paper, we investigated a selective‐sampling Raman spectroscopy approach, based on high wavenumber (HW) Raman imaging (spectral range 2,500–3,500 cm−1) and fingerprint Raman spectroscopy (spectral range 600–1,800 cm−1), to reduce the overall tissue analysis time while maintaining high diagnostic accuracy. HW Raman mapping was used as a first step to identify the adipose tissue regions based on the C–H stretching bands at 2,700–2,950 cm−1. As residual tumors are typically found in nonadipose tissue, an algorithm was developed to allocate sampling points for fingerprint Raman spectroscopy at locations corresponding to low intensity in the HW‐Raman maps. Preliminary results show that HW‐Raman imaging based on a 671 nm laser is effective and fast for mapping of adipose tissue in breast resections, with typical imaging times of 2 min for tissue areas as large as 2 × 2 cm2 areas. Albeit the remaining high fluorescence background in the fingerprint region prevents the use of single 671‐nm laser, the HW Raman imaging can be still exploited in combination with 785‐nm excitation Raman spectroscopy for identifying residual tumor. Although this study demonstrates the feasibility of this approach, further improvements, such as using single element detectors for HW Raman imaging, are required to increase the analysis speed further towards intraoperative use in the routine clinical setting

Molecular classification of breast cancer: what the pathologist needs to know

Breast cancer is a heterogeneous disease featuring distinct histological, molecular and clinical phenotypes. Although traditional classification systems utilising clinicopathological and few molecular markers are well established and validated, they remain insufficient to reflect the diverse biological and clinical heterogeneity of breast cancer. Advancements in high-throughput molecular techniques and bioinformatics have contributed to the improved understanding of breast cancer biology, refinement of molecular taxonomies and the development of novel prognostic and predictive molecular assays. Application of such technologies is already underway, and is expected to change the way we manage breast cancer. Despite the enormous amount of work that has been carried out to develop and refine breast cancer molecular prognostic and predictive assays, molecular testing is still in evolution. Pathologists should be aware of the new technology and be ready for the challenge. In this review, we provide an update on the application of molecular techniques with regard to breast cancer diagnosis, prognosis and outcome prediction. The current contribution of emerging technology to our understanding of breast cancer is also highlighted

The Role Of Glutaminase In Cancer

Increased glutamine metabolism (glutaminolysis) is a hallmark of cancer and is recognised as a key metabolic change in cancer cells. As a heterogeneous disease with different morpholog- ical and molecular subtypes and response to therapy, breast cancer cells are known to rewire glutamine metabolism to support survival and proliferation. Glutaminase isoenzymes (GLS and GLS2) are key enzymes for glutamine metabolism. Interestingly, GLS and GLS2 display contrasting functions in tumourigenesis. In this review, we explore the role of glutaminase in cancer, primarily focussing on breast cancer, address the role played by oncogenes and tu- mour suppressor genes in regulating glutaminase, and discuss current therapeutic approaches in targeting glutaminase

Clinicopathological significance of ataxia-telangiectasia-mutated (ATM) kinase and ataxia telangiectasia-mutated and Rad3 related (ATR) kinase in MYC overexpressed breast cancers

Purpose: MYC transcription factor has critical roles in cell growth, proliferation, metabolism, differentiation, transformation and angiogenesis. MYC overexpression is seen in about 15% of breast cancers and linked to aggressive phenotypes. MYC overexpression also induces oxidative stress and replication stress in cells. ATM and ATR- mediated signalling is critical for MYC induced DNA damage response. Whether ATM and ATR expression influence clinical outcomes in MYC overexpressed breast cancers is unknown.Methods: We investigated ATM, ATR and MYC at the transcriptional level [Molecular Taxonomy of Breast Cancer International Consortium cohort (n=1950)] and at the protein level in the Nottingham series comprising 1650 breast tumours. We correlated ATM, ATR and MYC expression to clinicopathological features and survival outcomes.Results: In MYC over expressed tumours, high ATR or low ATM levels were associated with aggressive breast cancer features such as higher tumour grade, de-differentiation, pleomorphism, high mitotic index, high risk Nottingham Prognostic Index, triple negative and basal-like breast cancers (all adjusted p values [less than] 0.05). Tumours with low ATM or high ATR levels in conjunction with MYC overexpression also have worse overall breast cancer-specific survival (BCSS) (p value [less than] 0.05).Conclusions: We conclude that ATR/ATM directed stratification and personalisation of therapy may be feasible in MYC overexpressed breast cancer

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

Panoptic overview of triple-negative breast cancer in Nigeria: current challenges and promising global initiatives

PurposeTriple-negative breast cancer (TNBC) is the most deadly form of breast cancer (BC) today. TNBC treatment is fraught with challenges because of the extensive interpatient heterogeneity in clinical behavior and scarcity of stratifying biomarkers and actionable targets. Women of African ancestry face a disproportionate burden resulting from this disease, which affects them earlier and more aggressively and has a higher propensity to spread and resist conventional treatments. A much higher proportion of Nigerian patients with BC have TNBC compared with patients with BC in the United States and Europe.MethodsThis article spotlights Nigeria as an example of a nation wherein genetic and nongenetic spheres of influence intersect to affect the prevalence of this disease, the scale of its challenge, and its toll.ResultsStudies have illuminated the inherently different tumor biology of Nigerian TNBCs, which show distinct genetic variants and gene expression patterns compared with European or European-American TNBCs. Parallels are apparent between TNBC phenotypes among African Americans and Nigerians, implicating the common thread of shared genetic ancestry between these populations. Reproductive, lifestyle, socioeconomic, and cultural factors also shape TNBC outcomes in Nigeria, as do resource constraints in Nigerian health care and research sectors.ConclusionIncreasing our understanding of how these factors contribute to poorer outcomes among Nigerian women may uncover valuable insights and strategies in alleviating the TNBC burden in many countries of the world and help reduce the racial disparity in BC-related outcomes here in the United States. Importantly, this review also highlights collaborative global and local initiatives that converge expertise and resources to advance research on effective management of TNBC in diverse populations

IL-6 and IL-10 are associated with good prognosis in early stage invasive breast cancer patients

Macrophage-associated cytokines play an important role in cancer metastasis however the functions of Interleukins (IL) 6 and 10 in breast cancer (BC) progression and metastasis are not clear. In this study the roles of IL-6/IL-10 in regulating vascular invasion and their prognostic significance in BC are investigated. MDA-MB-231 and MCF-7 migration (+/- IL-6 or IL-10) was assessed by scratch wound assay. Cancer cell adhesion to IL-6/IL-10 stimulated blood and lymphatic endothelial cells (EC) was investigated. Expression of IL-6 /IL-10 was assessed using immunohistochemistry in an annotated cohort of early stage BC (n=1380) and associations with clinicopathological variables and clinical outcome evaluated. IL-6 did not alter BC cell migration however a dose-dependent inhibition in MDA-MB-231 migration with IL-10 treatment was observed (P=0.03). BC cells were more adhesive to blood vs lymphatic EC however IL-6/IL-10 had no effect on adhesion patterns. High expression of IL-6/IL-10 was associated with clinicopathological criteria (e.g. hormone receptor status, all P<0.05), improved disease free survival (DFS; P<0.05) and improved BC specific survival (BCSS; only IL-6, P=0.017). However neither IL-6 nor IL-10 expression were independent prognostic factors from multivariate analysis. In BC subgroups, IL-6 and IL-10 were good prognosticators in terms of DFS in non-basal, non-triple negative (non-TN), ER-positive, PgR-positive (only IL-10), and Her-2-negative (only IL-6) BC (all P<0.05). IL-6 was associated with improved BCSS in non-basal, ER-positive and non-TN BC (all P<0.05)

Retrospective assessment of cyclin‐dependent kinase 5 mRNA and protein expression and its association with patient survival in breast cancer

Cyclin‐dependent kinase 5 (Cdk5) is an atypical member of the cyclin‐dependent kinase family and functions as a serine/threonine kinase that can be activated by non‐cyclin binding activators p35 or p39. Cdk5 expression and activity has been linked with the development and progression of cancer; however, its expression in breast cancer has not been fully described. Protein expression of Cdk5 was determined in a large cohort of early‐stage invasive breast cancer tumours (n = 1110) with long‐term follow‐up data using immunohistochemistry. Expression of CDK5 mRNA was assessed in the METABRIC cohort (n = 1980). Low nuclear and cytoplasmic expression of Cdk5 expression was significantly associated with shorter breast cancer‐specific survival (P = .004 and P = .001, respectively). Importantly, low nuclear and cytoplasmic expression of Cdk5 remained associated with survival in multivariate analysis, including potentially confounding factors (hazard ratio (HR) = 0.612, 95% confidence interval (CI) = 0.418‐0.896, P = .011 and HR = 0.507, 95% CI = 0.318‐0.809, P = .004, respectively). In addition, low nuclear and cytoplasmic expression of Cdk5 was significantly associated with clinicopathological criteria associated with adverse patient prognosis. Low CDK5 mRNA expression was associated with shorter patient survival (P = .005) in the METABRIC cohort; no associations between copy gain or loss and survival were observed. These data suggest that low Cdk5 expression is associated with poor clinical outcome of breast cancer patients and may be of clinical relevance

The prognostic significance of BMI1 expression in invasive breast cancer is dependent on its molecular subtypes

Purpose: BMI-1, which is a major component of the polycomb groupcomplex 1 is an essential epigenetic repressor of multiple regulatory genes and has been identified as a cancer stem cell (CSC) marker in several cancers. However, its role in breast cancer (BC) remains to be defined. In this study, we have evaluated the prognostic significance of BMI-1 among the different molecular subtypes and assessed its association with other breast CSC markers (BCSC).Material and Method: BMI-1 copy number and mRNA was assessed in large and well-characterised cohorts of early-stage BC patients [METABRIC (n=1980) and the Bc-GenExMiner (n=9616) databases]. BMI-1 protein expression was assessed using tissue microarray and immunohistochemistry in a cohort of 870 invasive BC patients with long- term outcome data and the expression of a panel of BCSC markers was monitored.Result: BMI-1 expression, prognostic significance and its association with BCSC markers were differed between molecular classes. In the luminal oestrogen receptor positive (ER+) BC, BMI-1 showed significantly higher expression compared to ER- tumours. BMI-1 showed positive correlation with favourable prognostic features and it was negatively associated with the expression of key BCSC markers (ALDH1A1, CD24, CD44, CD133, SOX10 and SOX9). High expression of BMI-1 was associated with longer breast cancer specific survival (BCSS) independent of other prognostic variables. In the basal triple negative BC subtype, BMI-1 expression showed positive association with CD133 and SOX10 and it was significantly associated with shorter BCSS.Conclusion: High variables and outcome in BC. However, this association is dependent on the molecular subtypes. Further functional assessment to detect its underlying mechanistic roles in BC subtypes is warranted