Swarup Kumar1, Bhawana Ashok Badhe2, K M Krishnan1, Haritha Sagili3. 1. Intern MBBS, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry, India . 2. Professor, Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry, India . 3. Associate Professor, Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry, India .
Abstract
BACKGROUND: Breast cancer is the most common invasive malignancy which occurs in women worldwide. The advent of neoadjuvant chemotherapy has radically changed the management of locally advanced breast cancer and a complete response is reported to significantly improve disease free survival. Traditionally, clinical response is assessed on basis of tumour size. In this study, an attempt was made to check whether tumour cellularity could be a better prognostic factor and also to check as to what impact the correlation of tumour size with cellularity had on the response assessment in locally advanced breast cancer patients. MATERIALS AND METHODS: Thirty seven patients with locally advanced breast cancer, who were treated by neoadjuvant chemotherapy during the period of December 2008 to May 2009, were selected for the study and from their case records, tumour size, clinical response and demographic details were gathered. Tumour cellularity was assessed prior to chemotherapy in core needle biopsy sections and it was matched with that seen in subsequent mastectomy specimens. Tumour size and cellularity were then correlated with the different treatment response groups and they were statistically analyzed by using the SPSS, version 13.0 software. RESULTS: After neoadjuvant chemotherapy, the tumour size and cellularity were found to be significantly reduced in breast carcinomas (p<0.05, paired t-test). The relative changes in cellularity which were seen were highly variable between individual patients and different clinical response groups, particularly in the partial response and no response categories. The product of cellularity and size dramatically changed the distribution of residual tumour pathology, thus causing a shift towards a complete response. CONCLUSION: The current study showed that the product of tumour size and cellularity may be a better prognostic indicator of clinical response in patients with neoadjuvant chemotherapy treated locally advanced breast cancer and that it would enable a new definition for clinical response in the future.
BACKGROUND:Breast cancer is the most common invasive malignancy which occurs in women worldwide. The advent of neoadjuvant chemotherapy has radically changed the management of locally advanced breast cancer and a complete response is reported to significantly improve disease free survival. Traditionally, clinical response is assessed on basis of tumour size. In this study, an attempt was made to check whether tumour cellularity could be a better prognostic factor and also to check as to what impact the correlation of tumour size with cellularity had on the response assessment in locally advanced breast cancerpatients. MATERIALS AND METHODS: Thirty seven patients with locally advanced breast cancer, who were treated by neoadjuvant chemotherapy during the period of December 2008 to May 2009, were selected for the study and from their case records, tumour size, clinical response and demographic details were gathered. Tumour cellularity was assessed prior to chemotherapy in core needle biopsy sections and it was matched with that seen in subsequent mastectomy specimens. Tumour size and cellularity were then correlated with the different treatment response groups and they were statistically analyzed by using the SPSS, version 13.0 software. RESULTS: After neoadjuvant chemotherapy, the tumour size and cellularity were found to be significantly reduced in breast carcinomas (p<0.05, paired t-test). The relative changes in cellularity which were seen were highly variable between individual patients and different clinical response groups, particularly in the partial response and no response categories. The product of cellularity and size dramatically changed the distribution of residual tumour pathology, thus causing a shift towards a complete response. CONCLUSION: The current study showed that the product of tumour size and cellularity may be a better prognostic indicator of clinical response in patients with neoadjuvant chemotherapy treated locally advanced breast cancer and that it would enable a new definition for clinical response in the future.
Entities:
Keywords:
Locally advanced breast cancer; Neoadjuvant chemotherapy; Tumour cellularity
Authors: Vicente Valero; Aman U Buzdar; Marsha McNeese; Eva Singletary; Gabriel N Hortobagyi Journal: Clin Breast Cancer Date: 2002-10 Impact factor: 3.225
Authors: G Bonadonna; P Valagussa; C Brambilla; L Ferrari; A Moliterni; M Terenziani; M Zambetti Journal: J Clin Oncol Date: 1998-01 Impact factor: 44.544
Authors: J P Ferrière; I Assier; H Curé; S Charrier; F Kwiatkowski; J L Achard; J Dauplat; P Chollet Journal: Am J Clin Oncol Date: 1998-04 Impact factor: 2.339
Authors: Edwin R Fisher; Jiping Wang; John Bryant; Bernard Fisher; Eletherios Mamounas; Norman Wolmark Journal: Cancer Date: 2002-08-15 Impact factor: 6.860
Authors: B Fisher; J Bryant; N Wolmark; E Mamounas; A Brown; E R Fisher; D L Wickerham; M Begovic; A DeCillis; A Robidoux; R G Margolese; A B Cruz; J L Hoehn; A W Lees; N V Dimitrov; H D Bear Journal: J Clin Oncol Date: 1998-08 Impact factor: 44.544
Authors: Keith N Ogston; Iain D Miller; Simon Payne; Andrew W Hutcheon; Tarun K Sarkar; Ian Smith; A Schofield; Steven D Heys Journal: Breast Date: 2003-10 Impact factor: 4.380
Authors: Radhika Rajan; Anna Poniecka; Terry L Smith; Ying Yang; Deborah Frye; Lajos Pusztai; Derek J Fiterman; Eva Gal-Gombos; Gary Whitman; Roman Rouzier; Marjorie Green; Henry Kuerer; Aman U Buzdar; Gabriel N Hortobagyi; W Fraser Symmans Journal: Cancer Date: 2004-04-01 Impact factor: 6.860
Authors: P Chollet; S Amat; H Cure; M de Latour; G Le Bouedec; M-A Mouret-Reynier; J-P Ferriere; J-L Achard; J Dauplat; F Penault-Llorca Journal: Br J Cancer Date: 2002-04-08 Impact factor: 7.640
Authors: Nara P Pereira; Carla Curi; Cynthia A B T Osório; Elvira F Marques; Fabiana B Makdissi; Katja Pinker; Almir G V Bitencourt Journal: Sci Rep Date: 2019-11-08 Impact factor: 4.379
Authors: Nicholas Petrick; Shazia Akbar; Kenny H Cha; Sharon Nofech-Mozes; Berkman Sahiner; Marios A Gavrielides; Jayashree Kalpathy-Cramer; Karen Drukker; Anne L Martel Journal: J Med Imaging (Bellingham) Date: 2021-05-08