Resources spotlight: breast cancer pathology

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IN the second of our series highlighting key topics to be discussed at the upcoming breast cancer forum, while showcasing the library resources available at the royal society of medicine, we focus on the importance of breast cancer pathology.

See below for list of resources. For forum, info please visit https://tinyurl.com/y8j5vn94,

Intro by Dr Rahul Deb, Consultant Histopathologist/ Breast MDT Lead, Royal Derby Hospital, UK. Dr Deb is also sub-speciality advisor for breast pathology at the Royal College of Pathologists, who will be presenting a special stand-alone pathology session at the forum. Thank you.

CELLULAR pathology plays an important role in all solid tumour cancer diagnosis and treatment but perhaps none more so than in Breast Cancer. Pathology examination is pivotal in providing information on prognostic and predictive markers in breast cancer. A prognostic marker provides information about the inherent biology and behaviour of the tumour whereas a predictive marker is used to predict likelihood of response to a certain intervention or therapeutic agent.    

Hence, information provided by the pathologist has a significant impact on individual patients at every stage of their breast cancer pathway.

At the diagnostic stage, distinguishing Ductal Carcinoma in-situ (pre-cancer) from invasive carcinoma could mean a difference between having no axillary surgery or an axillary staging surgical procedure such as sentinel lymph node biopsy or even an axillary node clearance, in cases where axillary lymph node metastasis has been confirmed. Any surgical intervention has the potential for complications. 

Testing for hormone receptor status [Estrogen Receptor (ER), Progesterone Receptor (PR)] and HER-2 status is also usually carried out on the initial biopsy specimen.  This information is used to select patients for treatment with anti-estrogen and/or anti-Her-2 agents both in adjuvant or neo-adjuvant settings.  Newer therapeutic agents are being developed for use in triple negative tumours (ER, PR, HER-2 negative). Women under 50 years old who have a triple negative tumour are also eligibale for BRCA testing. 

In cases of Ductal carcinoma in situ (DCIS), pathological reporting of grade, size and margins has been shown to be related to probability of recurrence after local excision and could influence type of surgery or use of adjuvant radiotherapy. 

In invasive carcinoma cases, pathological examination of the operative specimen together provides key prognostic information such as tumour size, tumour type, tumour grade, lymphovascular invasion, lymph node status. These have been shown to be related to clinical outcome and hence play a very important role in decision making regarding further interventions such as chemotherapy or chest wall radiotherapy in mastectomy cases. 

In patients undergoing neo-adjuvant chemotherapy, examination of post-neoadjuvant chemotherapy specimen provides information on the degree of response. Presence or absence of a pathological complete response (pathCR) provides the most important prognostic indicator in that setting. 

While the role of the pathologist is somewhat limited in monitoring of patients with advanced and metastatic cancer, biopsies are often taken to assess ER, PR and HER-2 status in the metastatic foci.

In a wider context, pathology data is often used by large organisations such as the cancer registry to monitor changing patterns of disease. 

In recent years, there has been a significant interest in digital pathology, where slides are scanned at a high magnification to produce an image that can be visualised on a computer screen rather than under a microscope. It is anticipated that this will open up opportunities for development of Artificial Intelligence/Machine Learning algorithms which may reveal greater prognostic and predictive marker information.   

In summary,  information provided by the pathologist has a significant impact on individual patients at every stage of their breast cancer pathway but also a wider context in terms of cancer registry data.

Pathology in Breast Cancer

RAKHA, E.A. and GREEN, A.R., 2017. Molecular classification of breast cancer: what the pathologist needs to know. Pathology, 49(2), pp. 111-119.

Abstract from the publisher’s website: https://www.sciencedirect.com/science/article/pii/S003130251640365X 

Full-text available from the RSM Library e-journals collection.

GROEN, E.J., ELSHOF, L.E., VISSER, L.L., RUTGERS, E.J.T., WINTER-WARNARS, H., LIPS, E.H. and WESSELING, J., 2017. Finding the balance between over- and under-treatment of ductal carcinoma in situ (DCIS). Breast, 31, pp. 274-283.

Abstract from the publisher’s website: https://www.thebreastonline.com/article/S0960-9776(16)30162-X/abstract  

Full-text available from the RSM Library e-journals collection.

LI, X., OPREA-ILIES, G. and KRISHNAMURTI, U., 2017. New Developments in Breast Cancer and Their Impact on Daily Practice in Pathology. Archives of Pathology & Laboratory Medicine, 141(4), pp. 490-498.

Abstract and full-text available from the publisher’s website: http://www.archivesofpathology.org/doi/10.5858/arpa.2016-0288-SA

CHARALAMPOUDIS, P., MARKOPOULOS, C. and KOVACS, T., 2018. Controversies and recommendations regarding sentinel lymph node biopsy in primary breast cancer: A comprehensive review of current data. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 44(1), pp. 5-14.

Abstract from the publisher’s website: https://www.ejso.com/article/S0748-7983(17)30955-1/abstract 

Full-text available from the RSM Library e-journals collection.

ROBERTSON, S., AZIZPOUR, H., SMITH, K. and HARTMAN, J., 2018. Digital image analysis in breast pathology-from image processing techniques to artificial intelligence. Translational research : the journal of laboratory and clinical medicine, 194, pp. 19-35.

Abstract from the publisher’s website: https://www.translationalres.com/article/S1931-5244(17)30295-5/abstract   

Full-text available from the RSM Library e-journals collection.

GEYER, F.C., PAREJA, F., WEIGELT, B., RAKHA, E., ELLIS, I.O., SCHNITT, S.J. and REIS-FILHO, J., 2017. The Spectrum of Triple-Negative Breast Disease: High- and Low-Grade Lesions. American Journal of Pathology, 187(10), pp. 2139-2151.

Abstract from the publisher’s website: https://ajp.amjpathol.org/article/S0002-9440(17)30206-7/abstract 

Full-text available from the RSM Library e-journals collection.

MAJIDINIA, M. and YOUSEFI, B., 2017. Breast tumor stroma: A driving force in the development of resistance to therapies. Chemical biology & drug design, 89(3), pp. 309-318.

Abstract from the publisher’s website: https://onlinelibrary.wiley.com/doi/abs/10.1111/cbdd.12893 

Full-text available from the RSM Library e-journals collection.

ESPARZA-LÓPEZ, J., ESCOBAR-ARRIAGA, E., SOTO-GERMES, S. and IBARRA-SÁNCHEZ, M.,DE JES, 2017. Breast Cancer Intra-Tumor Heterogeneity: One Tumor, Different Entities. Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion, 69(2), pp. 66-76.

Abstract and full-text available from the publisher’s website: http://clinicalandtranslationalinvestigation.com/abstract.php?id=123

WANG, M., HE, X., CHANG, Y., SUN, G. and THABANE, L., 2017. A sensitivity and specificity comparison of fine needle aspiration cytology and core needle biopsy in evaluation of suspicious breast lesions: A systematic review and meta-analysis. Breast, 31, pp. 157-166.

Abstract from the publisher’s website: https://www.thebreastonline.com/article/S0960-9776(16)30239-9/abstract 

Full-text available from the RSM Library e-journals collection.

GINTER, P.S., MCINTIRE, P.J. and SHIN, S.J., 2017. Vascular tumours of the breast: a comprehensive review with focus on diagnostic challenges encountered in the core biopsy setting. Pathology, 49(2), pp. 197-214.

Abstract from the publisher’s website: https://www.sciencedirect.com/science/article/pii/S0031302516403533 

Full-text available from the RSM Library e-journals collection.

YEONG, J., THIKE, A.A., TAN, P.H. and IQBAL, J., 2017. Identifying progression predictors of breast ductal carcinoma in situ. Journal of clinical pathology, 70(2), pp. 102-108.

Abstract from the publisher’s website: https://jcp.bmj.com/content/70/2/102  

Full-text available from the RSM Library e-journals collection.

ZHANG, S., ZHANG, D., YI, S., GONG, M., LU, C., CAI, Y., TANG, X. and ZOU, L., 2017. The relationship of lymphatic vessel density, lymphovascular invasion, and lymph node metastasis in breast cancer: a systematic review and meta-analysis. Oncotarget, 8(2), pp. 2863-2873.

Abstract and full-text available from PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356848

KEENEY, M.G., COUCH, F.J., VISSCHER, D.W. and LINDOR, N.M., 2017. Non-BRCA familial breast cancer: review of reported pathology and molecular findings. Pathology, 49(4), pp. 363-370.

Abstract from the publisher’s website: https://www.sciencedirect.com/science/article/pii/S0031302517300806 

Full-text available from the RSM Library e-journals collection.

WANG, Z., WANG, Q., WANG, Q., WANG, Y. and CHEN, J., 2017. Prognostic significance of CD24 and CD44 in breast cancer: a meta-analysis. The International journal of biological markers, 32(1), pp. e75-e82.

Abstract and full-text available from the publisher’s website: http://journals.sagepub.com/doi/abs/10.5301/jbm.5000224

PAN, H., GRAY, R., BRAYBROOKE, J., DAVIES, C., TAYLOR, C., MCGALE, P., PETO, R., PRITCHARD, K.I., BERGH, J., DOWSETT, M. and HAYES, D.F., 2017. 20-year risks of breast-cancer recurrence after stopping endocrine therapy at 5 years. New England Journal of Medicine, 377(19), pp. 1836-1846.

Abstract from the publisher’s website: https://www.nejm.org/doi/10.1056/NEJMoa1701830  

Full-text available from the RSM Library e-journals collection.

ZHA, Q.B., YAO, Y.F., REN, Z.J., LI, X.J. and TANG, J.H., 2017. Extracellular vesicles: An overview of biogenesis, function, and role in breast cancer. Tumor Biology, 39(2).

Abstract from the publisher’s website: http://journals.sagepub.com/doi/10.1177/1010428317691182 

Full-text available from the RSM Library e-journals collection.

IANCU, G., VASILE, D., IANCU, R.C. and DAVIŢOIU, D.V., 2017. “Triple positive” breast cancer – a novel category? Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 58(1), pp. 21-26.

Abstract and full-text available from the publisher’s website: http://www.rjme.ro/RJME/resources/files/580117021026.pdf

PROVENZANO, E. and PINDER, S.E., 2017. Modern therapies and iatrogenic changes in breast pathology. Histopathology, 70(1), pp. 40-55.

Abstract from the publisher’s website: https://onlinelibrary.wiley.com/doi/abs/10.1111/his.13098 

Full-text available from the RSM Library e-journals collection.

TER HOEVE, N.D., MOELANS, C.B., SCHRIJVER, W.A.M.E., DE LENG, W. and VAN DIEST, P.J., 2017. Molecular diagnostics in breast cancer routine practice. European Oncology and Haematology, 13(1), pp. 74-79.

Abstract and full-text available from the publisher’s website: http://www.touchoncology.com/articles/molecular-diagnostics-breast-cancer-routine-practice

TOROUS, V.F., SCHNITT, S.J. and COLLINS, L.C., 2017. Benign breast lesions that mimic malignancy. Pathology, 49(2), pp. 181-196.

Abstract from the publisher’s website: https://www.sciencedirect.com/science/article/pii/S0031302516406215 

Full-text available from the RSM Library e-journals collection.

NILENDU, P., KUMAR, A., KUMAR, A., PAL, J.K. and SHARMA, N.K., 2018. Breast cancer stem cells as last soldiers eluding therapeutic burn: A hard nut to crack. International Journal of Cancer, 142(1), pp. 7-17.

Abstract from the publisher’s website: https://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.30898 

Full-text available from the RSM Library e-journals collection.

RUSTIGHI, A., ZANNINI, A., CAMPANER, E., CIANI, Y., PIAZZA, S. and DEL SAL, G., 2017. PIN1 in breast development and cancer: A clinical perspective. Cell death and differentiation, 24(2), pp. 200-211.

Abstract and full-text available from the publisher’s website: http://www.nature.com/articles/cdd2016122

MELZER, C., VON, D.O. and HASS, R., 2017. Breast Carcinoma: From Initial Tumor Cell Detachment to Settlement at Secondary Sites. BioMed Research International, 2017.

Abstract from the publisher’s website: https://www.hindawi.com/journals/bmri/2017/8534371/abs 

Full-text available from the RSM Library e-journals collection.

COSTA, R., CARNEIRO, B.A., WAINWRIGHT, D.A., SANTA-MARIA, C., KUMTHEKAR, P., CHAE, Y.K., GRADISHAR, W.J., CRISTOFANILLI, M. and GILES, F.J., 2017. Developmental therapeutics for patients with breast cancer and central nervous system metastasis: Current landscape and future perspectives. Annals of Oncology, 28(1), pp. 44-56.

Abstract and full-text available from the publisher’s website: https://academic.oup.com/annonc/article/28/1/44/2676859

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Pink Ribbon is the growing international network of doctors, researchers, charities and other campaigners, interested in bringing forward the date where breast cancer-related deaths are a thing of the past. It focuses on events and information provision, including website bulletins, conferences and awards (being planned for 2018). It is led by publisher Gerard Dugdill.

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