Alison Lannigan

The relationship between the systemic inflammatory response, tumour proliferative activity, T-lymphocytic and macrophage infiltration, microvessel density and survival in patients with primary operable breast cancer.

The significance of the inter-relationship between tumour and host local/systemic inflammatory responses in primary operable invasive breast cancer is limited. The inter-relationship between the systemic inflammatory response (pre-operative white cell count, C-reactive protein and albumin concentrations), standard clinicopathological factors, tumour T-lymphocytic (CD4+ and CD8+) and macrophage (CD68+) infiltration, proliferative (Ki-67) index and microvessel density (CD34+) was examined using immunohistochemistry and slide-counting techniques, and their prognostic values were examined in 168 patients with potentially curative resection of early-stage invasive breast cancer. Increased tumour grade and proliferative activity were associated with greater tumour T-lymphocyte (P<0.05) and macrophage (P<0.05) infiltration and microvessel density (P<0.01). The median follow-up of survivors was 72 months. During this period, 31 patients died; 18 died of their cancer. On univariate analysis, increased lymph-node involvement (P<0.01), negative hormonal receptor (P<0.10), lower albumin concentrations (P<0.01), increased tumour proliferation (P<0.05), increased tumour microvessel density (P<0.05), the extent of locoregional control (P<0.0001) and limited systemic treatment (P⩽0.01) were associated with cancer-specific survival. On multivariate analysis of these significant covariates, albumin (HR 4.77, 95% CI 1.35–16.85, P=0.015), locoregional treatment (HR 3.64, 95% CI 1.04–12.72, P=0.043) and systemic treatment (HR 2.29, 95% CI 1.23–4.27, P=0.009) were significant independent predictors of cancer-specific survival. Among tumour-based inflammatory factors, only tumour microvessel density (P<0.05) was independently associated with poorer cancer-specific survival. The host inflammatory responses are closely associated with poor tumour differentiation, proliferation and malignant disease progression in breast cancer.

Evaluation of the relationship between the systemic inflammatory response and cancer-specific survival in patients with primary operable breast cancer.

The relationship between the systemic inflammatory response (as evidenced by elevated C-reactive protein and lowered albumin concentrations), clinico-pathologic status and relapse-free, cancer-specific and overall survival was examined in patients with invasive primary operable breast cancer (n=300). The median follow-up of the survivors was 46 months. During this period, 37 patients relapsed and 25 died of their cancer. On multivariate analysis, only tumour size (P<0.05), albumin (P<0.01) and systemic treatment (P<0.0001) were significant independent predictors of relapse-free, cancer-specific and overall survival. Lower serum albumin concentrations (⩽43 g l−1) were associated with deprivation (P<0.05), hormonal receptor negative tumours (P<0.01) and significantly poorer 3-year relapse-free (85 vs 93%, P=0.001) cancer-specific (87 vs 97%, P<0.0001) and overall survival (84 vs 94%, P=0.001) rates. The results of the present study suggest that lower preoperative albumin concentrations, but not elevated C-reactive protein concentrations, predict relapse-free, cancer-specific and overall survival, independent of clinico-pathologic status and treatment in patients undergoing potentially curative surgery for primary operable breast cancer.

The relationship between deprivation, tumour stage and the systemic inflammatory response in patients with primary operable breast cancer

The extent of deprivation (Carstairs deprivation index) was directly associated with the magnitude of the systemic inflammatory response (reduced albumin and elevated C-reactive protein, P<0.01) in patients with primary operable breast cancer (n=314). Deprivation was not associated with age, tumour size, tumour type, grade, and the proportion of patients with involved lymph nodes and oestrogen receptor status.

Vastagtű-biopsziás hengerből készített imprint citológia növeli a vékonytű-aspirációs citológia szenzitivitását emlőrákos betegekben

BACKGROUND Fine needle aspiration cytology (FNAC) can have high inadequate results. The main objective of this study was to validate the sensitivity of imprint cytology and compare it to that of FNAC across all levels of staff experience. Our other objective was to find out whether handling of a core biopsy to obtain an imprint slide affected its morphology so as to make histopathological reporting from that tissue difficult. This we thought could be of significance while trying to diagnose smaller cancers where just one core could contain tumour. METHODS Patients (n = 56) with a suspicious breast lump had fine needle aspiration (FNA) and core biopsy. The core biopsy used to prepare the two imprint cytology slides was sent separately for histopathology reporting. RESULTS Simultaneous imprint cytology from a core biopsy increased the sensitivity of cytology results by 12% compared to that of FNAC alone. In this series we found imprint cytology to have a sensitivity of 84%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 82.7%. The histopathologists did not report any distortion in tissue morphology so as to affect histological reporting of the core used. CONCLUSION Since most patients will have a core biopsy to confirm invasive cancer and the technique of imprint cytology is easily performed, perhaps it should be more widely used especially in units where the sensitivity of FNA is low.

Population-based study of the sensitivity of axillary ultrasound imaging in the preoperative staging of node-positive invasive lobular carcinoma of the breast: Axillary ultrasound imaging in staging of invasive lobular breast carcinoma

Preoperative staging of the axilla is important to allow decisions regarding neoadjuvant treatment and the management of the axilla. Invasive lobular carcinoma metastases are difficult to detect because of the infiltrative pattern of the nodal spread. In this study the sensitivity of preoperative axillary staging between invasive lobular (ILC) and ductal (IDC) carcinoma was compared.

Abstract P1-07-17: Breast cancer presentation in the over 70s

Aims: Life expectancy of the population in rising, and the risk of breast cancer increases with age. Older patients with breast cancer generally present later with more advanced disease for a variety of factors. We aimed to explore the presentation of the over 70s with breast cancer, along with their attitudes towards screening. Methods: A questionnaire was sent to patients aged over 70 at the time of their breast cancer surgery within the three hospitals across NHS Lanarkshire. This detailed reasons and timing of presentation, in addition to thoughts about screening. Results: Three hundred and fifty-two questionnaires were sent to women with a mean age of 76 years, 230 were returned (65%). Sixty-four percent routinely examined their breasts with more identifying a lump themselves (70%). Knowledge of signs and symptoms beyond a lump was explored, explicitly asking about nipple inversion, nipple discharge and skin changes with all three having similar degrees of awareness (40%, 35%, 25% respectively). Distressingly only 36% of our patients were aware of any of these signs, with only 9% being aware of all three. The majority of women sought medical attention early after identifying a problem, with 39% seeing someone within days and only 6% waiting over 6 months. Personal concern was the greatest prompt for women to see a doctor (68%) followed by family or friend concern (10%). With regard to screening, 83% routinely attended screening when they were invited. Ninety percent also said they would attend if the service was routinely offered to the over 70s. Although the majority (60%) were not aware that they could opt into the screening service once over 70. Conclusions: Despite the belief that most older women are felt to be less breast aware than younger most of our patients routinely examined themselves and identified the pathology, before promptly seeking medical advice (70% within weeks). This is the case despite most women having no knowledge of other signs and symptoms of breast cancer. Our cohort have also shown that they are keen to continue screening over the age of 70 if it was routinely offered. Citation Format: Murray J, Smith L, Lannigan A. Breast cancer presentation in the over 70s. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-07-17.

Abstract P5-15-14: The effect of introducing an enhanced recovery programme on improving compliance with arm exercises post breast cancer surgery and reducing morbidity

Introduction The introduction of an enhanced recovery programme for breast cancer surgery in our institution has provided an opportunity to redesign the service and the way in which patients receive pre-operative information. We have encouraged pre-operative consultations with physiotherapists to demonstrate post-operative arm exercises to see if this can improve compliance with exercises and reduce morbidity. Aim To audit patient reported upper limb symptoms after breast cancer surgery both before and after the introduction of an enhanced recovery programme with more detailed patient information and input from physiotherapy. Methods An enhanced recovery programme was first introduced in our institution in Sep 2012. Between December 2012 and December 2013, 80 patients having breast cancer surgery in Wishaw were sent a detailed questionnaire asking them about all aspects of their treatment. Two patients were excluded from the questionnaire one because of learning difficulties and the other because of acute psychiatric illness. There was an 89% response rate with 71 responses having been received to date. A previous similar questionnaire was sent to patients at 2 and 4 weeks post surgery between November 2011 and April 2012 before the introduction of the enhanced recovery programme. On this occasion there was a 73% response rate with 63 responses having been received from 86 sent. The two groups were compared. 94% of patients reported having received advice about physiotherapy and those who had a session with a physiotherapist increased from 16 to 39% with the introduction of the enhanced recovery programme. 80% of patients received a photographic exercise leaflet in addition to verbal and DVD information on arm exercises. Postoperatively in the enhanced recovery group, 39% of patients reported some numbness in their ipsilateral upper arm (57% in the group who had undergone axillary node clearance compared with 28% in the sentinel node group). 11% of patients reported persistent ongoing pain after surgery and 9% felt that discomfort affected their daily activities. This contrasts with the previous cohort where 43% of patients reported reduced arm function and almost all of these patients (93%) felt that this impacted on their daily activities. As expected performance across a range of arm and shoulder functions was worse in for axillary node clearance than sentinel node biopsy for both groups. ConclusionIntroducing an enhanced recovery programme changed the way in which information was provided to patients about post-operative arm exercises and reduced self reported arm morbidity. Citation Format: Alistair RM Macey, Jayne I McGivern, Juliette Murray, Alison K Lannigan. The effect of introducing an enhanced recovery programme on improving compliance with arm exercises post breast cancer surgery and reducing morbidity [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-15-14.

Abstract P2-13-12: Does the implementation of an enhanced recovery programme impact on post- operative outcomes in populations with significant comorbidity and social deprivation?

Background: Enhanced Recovery Programmes (ERP) are a well established evidence-based model of care which are intended to reduce the impact of surgery and safely reduce the length of inpatient stay for surgical patients. In Lanarkshire, Scotland, the ERP was introduced in Wishaw General Hospital in 2012 but has yet to be extended to neighbouring Monklands Hospital. We audited the impact of the ERP by comparing post-operative outcomes between these district general hospitals in the same health board servicing adjacent catchment areas which are both in areas of significant social deprivation. Materials and Methods: All patients who underwent breast surgery from August 2012 to August 2013 inclusive were identified from a prospectively collected electronic database. Parameters analysed included ASA grades, length of postoperative stay, rate of post-operative complications and re-admissions. The relative social deprivation of patients was calculated by cross referencing their postcodes with the Scottish Index of Multiple Deprivation (SIMD) 2012. Results: 294 and 152 patients underwent 336 and 161 breast operations in Wishaw and Monklands respectively. The mean age of these patients was 57 in Wishaw and 54 in Monklands. 30% of patients in Wishaw and 19% of patients in Monklands had ASA grade 3 (range = 1 to 3, p=0.08). In both hospitals, the most common diagnosis was breast cancer (Wishaw: n=257, 76%; Monklands: n=110, 68%; p=0.17) and the most common procedure performed was wide local excision (Wishaw: n=235, 70%; Monklands: n=114, 71%; p=0.73). The mean postoperative stay was 0.9 days in Wishaw compared to 2.0 days in Monklands (p

The Relationship between Pre-Operative Biomarkers of Inflammation, Clinicopathological Characteristics and Cancer Specific Survival in Early Breast Cancer.

Breast cancer is the second most common malignancy in women. Established prognostic factors include tumour size, grade, nodal involvement, and hormonal receptor status. Recently, the systemic inflammatory response (as evidenced by elevated C-reactive protein and low serum albumin) has been established as an independent predictor of survival in patients with metastatic breast cancer (1). However, the relationship between these systemic inflammatory markers, clinicopathological characteristics and cancer specific survival has not been established in early breast cancer.During the period June 2001 to May 2008, patients with early breast cancer presenting to two hospitals in the West of Scotland were prospectively included into this study (n=959). Preoperative C-reactive protein, albumin and clinico-pathological data were recorded for each patient. The thresholds for normal C-reactive protein and albumin were taken as 43g/l respectively.The median follow-up of the survivors was 4.1yrs. During this period, 93 patients died of their cancer. On multivariate analysis, tumour size (HR 2.03; 95%CI 1.41-2.91, P Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6033.

The relationship between tumour NF-kB expression, hormone status, and clinicopathological factors in primary invasive breast cancer.

Abstract #4038 Breast cancer is one of the most common and lethal malignancies in the UK. Conventionally, prognosis is based on hormone status, tumour size, grade and lymph node involvement. Recently it has been proposed that Nuclear Factor Kappa B (NF-kB) is associated with breast cancer development and progression (1). The aim of the present study was to examine the relationship between NF-kB, hormone status and clinicopathological factors in primary invasive breast cancer.
 Immunohistochemistry was performed on 168 breast tumour sections, with full clinicopathological characteristics. Antibodies were directed against total NF-kB and NF-kB phosphorylated at serine 536 (phospho NF-kB). Two observers independently scored expression using the weighted histoscore technique and grouped tumours as having high or low expression according to the median value.
 Cytoplasmic and nuclear NF-kB expression, either total or phosphorylated did not correlate with grade, size or lymph node involvement. However, nuclear phospho NF-kB expression was inversely associated with Ki67 proliferation index (p Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4038.