Cilj: Princip oslikavanja na kontrastnoj digitalnoj mamografiji (CEDM) temelji se na istom principu kao kod magnetske rezonancije (MR), tj. u prikazu neovaskularizacije. Cilj našega rada je usporedba ...osjetljivosti CEDM-a u detekciji malignih lezija u dojci s MR-om te određivanje osjetljivosti i specifičnosti navedenih metoda. Ispitanici i metode: Uključeno je 56 ispitanika (55 žena i jedan muškarac; medijan dobi 63,51 godina; raspon 40 – 88 godina) kod kojih je temeljem nalaza na digitalnoj mamografiji postavljena sumnja na maligni proces u dojci. Kod svih ispitanika učinjen je ultrazvuk dojki, MR i CEDM te biopsija suspektne lezije. Indikacija za CEDM je nejasna ili suspektna sjena, distorzija, asimetrija ili nakupina patoloških mikrokalcifikata na digitalnoj mamografiji. Rezultati: Kod 13 (23,21 %) ispitanika došlo je do kontrastne imbibicije lezija na CEDM-u i MR-u. Od ukupnog broja ispitanika, kod njih 15 (26,78 %) dijagnosticirana je maligna lezija, a u 17,85 % došlo je do kontrastne imbibicije samo na CEDM procedure, od kojih je 7 lezija bilo maligno (invazivni karcinom te duktalni karcinom in situ s invazivnom komponentom). Specifičnost i osjetljivost MR-a iznosi 97,1 %, i 85,7 % (ROC-AUC = 0,914, PPV 92,3 %, NPV 94,3 %). Specifičnost i osjetljivost CEDM-a iznosi 94,1 %, odnosno 100 % (ROC-AUC = 0,971, PPV 91,3 %, NPV 100 %). Zaključak: CEDM je procedura jednakovrijedna MR-u u detekciji suspektnih lezija u dojci te može zamijeniti MR u procjeni proširenosti bolesti kada MR nije dostupan ili je kontraindiciran. CEDM je komplementarna dijagnostička metoda MR-u kada se MR ne može napraviti te pokazuje dobru korelaciju u detekciji malignih lezija u dojci.
Objective: The imaging principle of contrast-enhanced digital mammography (CEDM) is based on the same principle as magnetic resonance imaging (MR), i.e., the representation of neovascularization. The aim of this work is to compare the sensitivity of CEDM in the detection of malignant lesions in the breast with MR and to determine the sensitivity and specificity of the mentioned methods. Patients and methods: Fifty-six subjects were included (55 women and 1 man; median age 63.51 years; range 40-88 years) in whom, based on findings on digital mammography, the suspicion of a malignant process on the breast was raised. All subjects underwent breast ultrasound, MR, CEDM, and a biopsy of the suspicious lesion was performed. An indication for CEDM is a vague or suspicious shadow, distortion, asymmetry, or a cluster of pathological microcalcifications on digital mammography. Results: In 13 (23.21%) subjects there was contrast enhancement of lesions on both CEDM and MR. Of the total number of subjects, 15 (26.78%) were diagnosed with a malignant lesion, and in 17,85% contrast enhancement occurred only during the CEDM procedure, of which 7 lesions were malignant (invasive carcinoma and ductal carcinoma in situ with an invasive component). The specificity and sensitivity of MR is 97.1% and 85.7%, respectively (ROC-AUC = 0.914, PPV 92.3%,
Contrast-enhanced mammography (CEM) is a relatively new imaging technique that allows morphologic, anatomic and functional imaging of the breast. The aim of our study was to validate ...contrast-enhanced mammography (CEM) compared to mammography (MMG) and digital breast tomosynthesis (DBT) in daily clinical practice. This retrospective study included 316 consecutive patients who underwent MMG, DBT and CEM at the Centre for Prevention and Diagnosis of Chronic Diseases of Primorsko-goranska County. Two breast radiologists independently analyzed the image data, without available anamnestic information and without the possibility of comparison with previous images, to determine the presence of suspicious lesions and their morphological features according to the established criteria of the Breast Imaging Reporting and Data System (BI-RADS) lexicon. The diagnostic value of MMG, DBT and CEM was assessed by ROC analysis. The interobserver agreement was excellent. CEM showed higher diagnostic accuracy in terms of sensitivity and specificity compared to MMG and DBT, the reporting time for CEM was significantly shorter, and CEM findings resulted in a significantly lower proportion of equivocal findings (BI-RADS 0), suggesting fewer additional procedures. In conclusion, CEM achieves high diagnostic accuracy while maintaining simplicity, reproducibility and applicability in complex clinical settings.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Globally, breast cancer is the main cause of death among female cancer patients. The tumor-infiltrating lymphocytes (TILs) in breast cancer are associated with a more favorable outcome of a disease. ...Natural killer (NK) cells are important cytotoxic cells involved in tumor immunosurveillance, causing the direct killing of tumor cells. In solid tumors, peripheral NK cells and tumor-infiltrating NK cells display an altered phenotype characterized by reduced cytotoxicity or anergy. The goal of this study was to investigate the NK cells' phenotype and activation status in order to get into the pathological process of breast cancer subtypes. In our study, the normal tissues and tumoral breast tissue were fixed in formalin, embedded in paraffin, and the phenotypic marker CD56 and proinflammatory cytokine IL-15 were identified by immunohistology. The distribution and expression of receptors repertoire (NKG2A, NKG2C, NKp46, CD94, CD69, and CD107a) were investigated in peripheral NK cells of mononuclear cells by flow cytometry. mRNA of cytolytic mediators was determined by real-time PCR. The frequency of CD56+ and IL-15+ cells were significantly higher in triple-negative breast cancer tissue. The frequency of NK cell activating receptors was decreased in investigated breast cancer subtypes while the inhibitory NKG2A receptor was increased. Decreased percentage of CD69+/CD107a+ in NK cells could indicate lower cellular activation and cytotoxicity. In luminal B breast cancer, the mRNA of cytolytic mediators was upregulated. In conclusion, modulation of activation status in tumor-infiltration NK cells could be involved in the pathogenesis of molecular breast cancer subtypes. This highlights the importance of NK cells as an appropriate target for potent anti-tumor response in the immunosuppressive tumor microenvironment of breast cancer.
Cilj. Cilj istraživanja je procijeniti podudarnost veličine rezidualnog tumora, izmjerene magnetskom rezonancijom (MR) i patohistološkom dijagnostikom (PHD) u pacijentica s karcinomom dojke nakon ...provedene neoadjuvantne kemoterapije (NAK) te procijeniti mogući utjecaj ypT stadija tumora na nepodudarnost veličina izmjerenih navedenim metodama. Ispitanici i metode: U retrospektivno istraživanje uključeno je 50 pacijentica. Uključni kriterij su pacijentice kod kojih je učinjen operativni zahvat uz prethodno proveden NAK karcinoma dojke, na što je odgovor praćen s najmanje dva MR pregleda. Veličina tumora na MR-u uspoređena je s veličinom na PHD-u (zlatni standard) pomoću regresijske analize Passing-Bablok te je izračunat njihov koeficijent korelacije. Analizirana su sva odstupanja i podudarnosti veličine, kao i eventualni utjecaj ypT stadija tumora na razliku između dviju metoda. Razlika od ± 0,5 cm u veličini tumora procijenjenih slikovnom metodom i u PHD nalazu smatrale su se podudarnima veličinama. Rezultati: Srednja vrijednost veličine rezidualnog tumora na MR-u iznosila je 19,1 ± 17,71 mm, dok je na PHD-u iznosila 16,87 ± 18,19 mm. Izračunati r koeficijent korelacije iznosi 0.64 (p < 0.001). Provedenom analizom potvrđeno je da nema značajne razlike izmjerenih veličina tumora na MR-u i PHD-u (p = 0.552) te se metode mogu smatrati podudarnima. Nije uočena statistički značajna razlika u ovisnosti o ypT stadiju tumora koja bi utjecala na nepodudarnost veličina. Zaključci: Među dvjema metodama nema konstantnog niti proporcionalnog odstupanja u mjerenjima te se metode mogu smatrati podudarnim. MR dojke je dobra metoda za procjenu veličine rezidualnog tumora dojke kod pacijentica koje su podvrgnute neoadjuvantnoj kemoterapiji usporedno s PHD-om (zlatni standard).
Aim: The goal of this study is to evaluate the concordance between residual tumour size measured on magnetic resonance imaging (MRI) and pathohistological findings in patients who underwent neoadjuvant chemotherapy and operative procedure, and if any pathohistological features may affect that agreement. Respondents and methods: Fifty patients with breast cancer were retrospectively evaluated. Patients who underwent neoadjuvant chemotherapy before the operative procedure, and were assessed with at least two MRI examinations, where included in this study. The primary tumour size measured by MRI was compared with pathohistological findings, which was considered as the gold standard. All differences and size correspondence were analyzed as well as the possible influence of ypT stage of tumour between the two methods. Results: The mean value of residual tumour size on MRI was 19,2 ± 17,71 mm, while on pathohistological findings it was 16,87 ± 18,29 mm. A calculated correlation coefficient between the two methods was 0.64 (p < 0.001). There was no statistically significant difference between two methods for measuring residual tumour size (p = 0.552), as well as a statistically significant influence of ypT stage on measuring, so these methods may be considered to be concordant. Conclusions: There is neither a constant nor a proportional deviation in the measurements between the two methods, so these methods can be considered concordant. Breast MRI is a reliable method for estimating residual tumour size in patients undergoing neoadjuvant chemotherapy in comparison to pathology.
Breast carcinoma is the most common malignant disease in the female and one of the leading causes of death among women worldwide. Chronic inflammation and immunosuppressive environment achieved by ...the interaction of tumour and infiltrating immune cells are the hallmarks of cancers, including breast cancer. Natural killer cells are one of innate immune cells in tumour bed that possess great antitumour potential due to their ability to kill tumour cells without prior sensitization. They also play an important role in priming of type I immune responses and are considered to be main source of Interferon-γ. Unfortunately, antitumour activity of natural killer cells is often suppressed by pro-inflammatory cytokines secreted in tumour microenvironment and suppression of NK cells activity often correlates with therapy response and general outcome of patient with breast carcinoma. Different types of breast cancer are associated with different subsets of natural killer cells that possess different immunoregulatory function. Identification of specific tumour associated natural killer cell subset endowed with different functional capabilities might help practitioners in therapy decisions, therapy response monitoring, as well as in predicting overall prognosis of breast cancer patients. The purpose of this review is to give an overview of natural killer cells and their subsets, their role in pathogenesis of breast cancer and to discuss NK cells as potential useful therapy and prognostic tool for breast carcinomas.
Karcinom dojke je maligna bolest u žena i jedan je od vodećih uzroka smrti žena širom svijeta. Kronična upala i imunosupresivni okoliš koji nastaje kao posljedica interakcije tumorskih stanica i infiltrirajućih imunoloških stanica obilježja su karcinoma, uključujući karcinom dojke. Prirodnoubilačke stanice (NK stanice) jedna su od subpopulacija urođenih imunoloških stanica u tumorskom sijelu, koje posjeduju antitumorski potencijal zbog svoje sposobnosti direktnog ubijanja tumorskih stanica bez prethodne senzibilizacije. Također, igraju važnu ulogu u pripremi imunološkog odgovora tipa 1 i smatraju se glavnim izvorom interferona-γ. Nažalost, antitumorska aktivnost NK stanica često je potisnuta proupalnim citokinima koji se izlučuju u tumorskom mikrookolišu, a supresija aktivnosti NK stanica obično korelira s terapijskim odgovorom i općim lošijim ishodom kod bolesnica s karcinomom dojke. Surogati molekularnih podtipova karcinoma dojke povezani su s različitim subpopulacijama NK stanica, koje posjeduju različite imunoregulacijske funkcije. Identifikacija specifične subpopulacije NK stanica pridruženih s tumorom, koje posjeduju različite imunološke funkcije, može pomoći liječnicima u donošenju odluka o terapiji, praćenju terapijskog odgovora, kao i u predviđanju ukupne prognoze pacijenata s karcinomom dojke. Svrha je ovog preglednog članka istaknuti važnost NK stanica i njihovih subpopulacija u patogenezi karcinoma dojke te diskutirati terapijske i prognostičke mogućnosti korištenja NK stanica u osoba oboljelih od karcinoma dojke.
Cilj: Osnovni cilj našeg istraživanja je usporedba doznih parametara i debljine komprimirane dojke kod mamografskog pregleda koji je izvršen digitalnom tomosintezom (engl. digital breast ...thomosynthesis; DBT) i standardne, 2D mamografije. Ispitanici i metode: U istraživanje je uključeno 200 ispitanica životne dobi od 40 do 81 godine (median 60,5 ± 10,6). Ispitanice su podijeljene u dvije skupine, ovisno o vrsti mamografskog pregleda. Ova retrospektivna analiza obuhvatila je pretrage koje su vršene na mamografskom uređaju Hologic Selenia Dimensions (Hologic, Bedford, Mass) u razdoblju od 1. veljače 2018. do 30. ožujka 2018. Rezultati: Hi-kvadrat testom isključila se statistički značajna razlika u gustoći parenhima dojki između dviju grupa ispitanica. T-test nije pokazao statistički značajnu razliku u dobi ispitanica, kao niti razlike u debljini komprimiranih dojki između dviju ispitanih skupina. Vrijednost srednje glandularne doze (engl. average glandular dose; AGD) kod DBT-a u odnosu na 2D mamografiju bila je viša 0,53 mGy za lijevu dojku, a 0,37 mGy za desnu dojku (3,83 / -1 mGy, p = 0.001; 3.82 / -0.9 mGy, p = 0.023). Zaključak: Usprkos statistički značajnoj razlici u AGD-u kod DBT-a u odnosu na 2D mamografiju između dviju skupina ispitanica, ona je unutar granica prihvatljivosti propisanih Pravilnikom o uvjetima za primjenu izvora ionizirajućeg zračenja u svrhu medicinskog i nemedicinskog ozračenja (NN 42/2018, 9. 5. 2018.), stoga smatramo da je opravdano uvođenje DBT-a kao standardne radiološke metode pregleda dojki.
Background: In modern breast cancer management, SLNB is a standard of care. For the patients with limited sentinel lymph node involvement in the upfront surgery setting, ALND can be safely omitted. ...However, for any sentinel node metastasis detected following neoadjuvant systemic treatment (NST), ALND is still considered a mandatory procedure. Patients and methods: Present retrospective analysis has included all breast cancer patients submitted to surgery following NST in Clinical Hospital Centre (CHC) Rijeka in the period from 2017 till 2020. Results: SLNB was performed in 151 of 222 consecutive patients, and sentinel node metastasis was detected in 49 cases. The risk of non-sentinel lymph node involvement in sentinel node-positive patients was 34.7%, but exclusively for cases with macro-metastatic disease detected in the sentinel node. In addition, for the patients diagnosed with clinically uninvolved axilla, the risk of ypN2-3 status was only 2.8%. Conclusions: ALND following NST is overtreatment in 65.3% of sentinel node-positive patients. Axillary irradiation with the omission of ALND should be considered for the sentinel-positive patients with only micro-metastatic disease detected in the sentinel node following neoadjuvant chemotherapy, as well as for those with low volume macro metastatic disease, diagnosed with the uninvolved axilla.
Introduction: After the consensus conference in St. Gallen and updated NCCN guidelines, we started doing sentinel lymph node biopsy (SLNB) in May 2017, for breast cancer patients who achieve clinical ...axillary remission following neoadjuvant treatment. This study’s primary goal was to evaluate the clinical impact of SLNB after neoadjuvant therapy in the group mentioned above. Methods: We retrospectively analyzed all neoadjuvant breast cancer patients from May 2016 until May 2018 at Clinical Hospital Center Rijeka. Our preliminary results recorded the appearance of locoregional and distant recurrence. Results: From 65 patients involved in this analysis, 48 patients were node-positive at the time of diagnosis, and 45.83% among those achieved complete pathological axillary remission. After the first postoperative year, there were no locoregional relapses nor statistically significant differences in the prevalence of distant recurrences, regardless of the extent of surgical procedure. However, results showed higher rates of locoregional and distant relapse for the group of patients that did not attain complete axillary remission. Conclusion: SLNB is a reliable alternative to ALND for locoregional and overall disease control for breast cancer patients who achieve complete clinical axillary remission after preoperative systemic treatment. The clinical axillary lymph node status, after neoadjuvant therapy, is a more relevant prognostic factor than the clinical axillary lymph node status at the beginning of the treatment.
Background: Following breast cancer treatment recommendations, the conservative approach is accepted and highly respected in the Clinical Hospital Center (CHC) Rijeka. However, we have found that ...institutional follow-up data are lacking. This retrospective analysis aims to update institutional data on survival and disease control rates. Methods: From 2011 till 2014, 915 breast cancer patients underwent surgery at CHC Rijeka, and 615 were included in this analysis. The Institutional Ethics Committee approved the analysis. Results: All patients were female, and the average age was 59 years. In the 5-year postoperative period, local, regional, and distant recurrence-free survival rates and overall survival and disease-free survival were calculated. All rates negatively correlate with a higher T and N status and a higher stage of the disease. The analysis has also demonstrated that in the pT1-3 pN0-1 subgroup, sentinel lymph node biopsy (SLNB) was not inferior to axillary lymph node dissection (ALND) in terms of locoregional control of disease and overall survival. Conclusion: Besides updating institutional data, the analysis confirmed that overall survival and locoregional control of the disease in the upfront-surgery patients are similar between pN0 and pN1 subpopulations and between pN2 and pN3, but statistically significantly different between pN0-1 and pN2-3. Currently ongoing, prospective observational multicenter clinical trial aims to translate the significance of these results into the neoadjuvant era.
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