José Ignacio Sánchez-Méndez

Primary Hormonal Therapy for Elderly Breast Cancer Patients: Single Institution Experience

Aims: Breast cancer is the most frequently diagnosed cancer among women. Up to 50% of breast cancer cases occur in patients over the age of 65 years. Hormonal therapy as a single alternative treatment has been used in this population. The aim of this study was to analyze the oncological outcomes in breast cancer patients who received hormonal therapy alone as a primary treatment. Methods: We retrospectively reviewed our database to find all patients with breast cancer from 2006 to 2011 who were treated with hormonal therapy only at our center. The collected data included patients and tumor characteristics, type of drug administered, follow-up details and type of response obtained using RECIST criteria. Results: We included 44 breast cancer patients. The mean age was 83.5 ± 6.0 years. The majority of patients had tumors with less aggressive immunohistochemical characteristics and 100% of them presented positive estrogen receptors. The pharmacological treatment included exemestane, anastrozole, tamoxifen, letrozole and fulvestrant. The effectiveness rate was 60%, evaluated according to tumor reduction or no progression. Conclusion: The efficacy of hormonal therapy in older patients is reasonably high to justify its use in selected patients. Therefore, it is a sensible alternative for patients who refuse or are unfit for surgery.

Comparison of risk classification between EndoPredict and MammaPrint in ER-positive/HER2-negative primary invasive breast cancer

Purpose To compare the concordance in risk classification between the EndoPredict and the MammaPrint scores obtained for the same cancer samples on 40 estrogen-receptor positive/HER2-negative breast carcinomas. Methods Formalin-fixed, paraffin-embedded invasive breast carcinoma tissues that were previously analyzed with MammaPrint as part of routine care of the patients, and were classified as high-risk (20 patients) and low-risk (20 patients), were selected to be analyzed by the EndoPredict assay, a second generation gene expression test that combines expression of 8 genes (EP score) with two clinicopathological variables (tumor size and nodal status, EPclin score). Results The EP score classified 15 patients as low-risk and 25 patients as high-risk. EPclin re-classified 5 of the 25 EP high-risk patients into low-risk, resulting in a total of 20 high-risk and 20 low-risk tumors. EP score and MammaPrint score were significantly correlated (p = 0.008). Twelve of 20 samples classified as low-risk by MammaPrint were also low-risk by EP score (60%). 17 of 20 MammaPrint high-risk tumors were also high-risk by EP score. The overall concordance between EP score and MammaPrint was 72.5% (κ = 0.45, (95% CI, 0.182 to 0.718)). EPclin score also correlated with MammaPrint results (p = 0.004). Discrepancies between both tests occurred in 10 cases: 5 MammaPrint low-risk patients were classified as EPclin high-risk and 5 high-risk MammaPrint were classified as low-risk by EPclin and overall concordance of 75% (κ = 0.5, (95% CI, 0.232 to 0.768)). Conclusions This pilot study demonstrates a limited concordance between MammaPrint and EndoPredict. Differences in results could be explained by the inclusion of different gene sets in each platform, the use of different methodology, and the inclusion of clinicopathological parameters, such as tumor size and nodal status, in the EndoPredict test.

Abstract P3-01-15: Molecular subtypes and axillary metastases in breast cancer

Objective To assess differences in axillary infiltration (global, sentinel, and non-sentinel lymph nodes) according to breast cancer molecular subtype. Material and methods Patients with infiltrating breast carcinoma diagnosed in the years 2011 to 2014 in our institution were included. Sentinel lymph node biopsy (SLNB) was performed in all patients staged N0 by clinical examination and axillary ultrasound. One-step nucleic acid amplification (OSNA) was performed in cases positive for cytokeratin-19. Complete lymphadenectomy was done in patients with axillary macrometastasis and, until February 2012, also in those with micrometastasis in the SLNB. Immunohistochemistry-based St. Gallen 2013 criteria were used to assign the molecular subtype (hormonal receptors, ki67 and HER2). Results Overall 720 patients were included, 53.9% of whom had axillary infiltration (75.8% macrometastases). Axillary infiltration was most common in the HER2 subtype -82.1% (91.3% macrometastases) and least common in the basal subtype -42.7%. On the contrary, the HER2 subtype had the lowest risk of axillary infiltration in patients subjected to SLNB (14.3%). No differences were seen in the other subtypes subjected to SLNB. 90 patients underwent complete lymphadenectomy. Positive non-sentinel lymph nodes were most commonly seen in luminal A tumors (30%). Conclusions 1. Significant differences in axillary infiltration were seen according to molecular subtypes. 2. Most HER2+ tumors had N+ disease detected by ultrasound. However, in those HER2+ with negative ultrasound, the SLNB was usually negative. If positive, non-sentinel lymph nodes were most commonly negative. 3. Half of luminal A tumors had N+ disease detected by ultrasound. In the other half, there was an increased risk of positive SLNB and non-sentinel lymph nodes with regard to other subtypes. Citation Format: Sanchez-Mendez JI, Alonso P, Marti C, Pinto A, Escabias C, Espinosa E, De Santiago J, Zamora P. Molecular subtypes and axillary metastases in breast cancer. [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 P3-01-15.

P341 Use of fibrin glue in the prevention of seroma formation after axillary lymphadenectomy

Goals: The ACOSOG Z0011 trial showed that an axillary lymph node dissection (ALND) may be safely omitted in selected patients with a positive sentinel lymph node biopsy (SNB). One of these eligible criteria has non palpable lymphadenopathy. However, the eligibility for patients with a suspicious Ultrasonography (US) is controversial. The purpose of this study was to evaluate the validity of the SNB for patients with suspicious lymph node (sN+) compared to clinical node negative patients (cN0). Methods: Patients with suspicious axillary lymph node positive breast cancer by preoperative assessed US or CT were performed fine needle aspiration (FNA) cytology between 2004 and 2014. Patients with a negative axillary US (cN0 group) or negative FNAC (sN+ group) result underwent SNB. All SNB positive patients underwent completion ALND. The number of positive nodes after ALND was compared cN0 group with sLN group. Results: 530/2683 patients (19.7%) had positive SNB. Ultrasoundaxilla was 49% sensitive and 84% specific in predicting SNB metastases. The positive (PPV) and negative predictive value (NPV) was 53% and 81% respectively. For suspicious group, this was 68.4% sensitive and 99.7% specific in detecting SNB metastases. PPV and NPV were 99.6% and 74.2% respectively. The number of metastasis lymph nodes is 1 (48%), 2 (19%), 3 (9%), more than 4 (54%) and N1mic (17%) in the cN0 group, and 1 (37%), 2 (14%), 3 (7%), more than 4 (10%) and N1mic (28%) in the cN1 suspicious group. Conclusion: These results suggest that patients with suspicious axillary metastases on ultrasound-guided biopsy have less involved nodes than SNB-positive patients with clinical negative node. Therefore, we conclude that SNB can be safely performed in patients with clinically suspicious lymph node on ultrasonography. Disclosure of Interest: No significant relationships.

Abstract P2-01-29: Axillary involvement in lobular breast cancer

Purpose: Since the beginning of the use of the technique of selective sentinel node biopsy (SLNB), multiple models have been proposed to predict both the probability of involvement of the sentinel lymoh node (SLN), and, in case it is positive, the likelihood of non-sentinel lymph node (NSLN) involvement. Some of the factors that increase the likelihood of SN involvement (multifocallity, hormonal receptors, larger size…)are frequently found in invasive lobular carcinoma. Invasive lobular carcinoma (ILC) is the second most common histologic type of invasive mammary carcinoma, comprising 5%– 15% of all invasive breast carcinomas. However, in recent decades an increase in the relative incidence of this variant has been reported in the literature. This has been linked to the employment of hormone replacement therapy, the use of assisted reproduction techniques (IVF) or greater availability of diagnostic tools such as breast ultrasound or MRI that allow their better detection. The aim of this study is to determine the extent of axillary involvement in both SLN and NSLN in patients with ILC Patients and Methods 369 cases of infiltrating carcinoma candidates for SLNB technique between April 2010 and April 2013 were reviewed retrospectively. Patients must have a diagnosis of breast cancer of any histological type, with a screening ultrasound without clinical suspicion of axillary involvement. Cases of intraductal carcinoma that underwent SLNB were excluded and even those that were performed prior to neoadjuvant treatment Data on age, histological type, positivity / negativity of the SLN, implementation or not of axillary lymphadenectomy and outcome of involvement of NSLN were collected. Statistical calculations were performed with SPSS. Results Of the 369 selected patients, 291 (79.9%) had invasive ductal carcinoma (IDC), 55 (15.1%) ILC and 18 other histological types (mucinous, colloid, tubular, papillary or mixed). The median age was 58.6 years. SLN could not be found in 5 patientes. 225 (61.8%) had a negative SLN. In 139 (38.2%) patients, SLN was positive, 64 of these cases showed micrometastasis while 75 presented macrometastasis. Among IDC, 108 (37.1%) of the cases had a positive SLN, 53 (49.1%) of them with macrometastases. Among ILC, 27 (49.1%) of the cases presented positive SLN, in 20 of them (74.1%) with macrometastasis. Differences in both the SLN involvement and the presence of macrometastases observed between IDC and ILC were statistically significant (p Conclusions Axillary lymph node involvement in the case of candidates for SLNB is more frequent and more extensive in patients with ILC than in patients with IDC. Citation Format: Pilar Zamora, Covadonga Marti, Ana Roman, Jose M Oliver, Javier de Santiago, Jose I Sanchez-Mendez. Axillary involvement in lobular breast cancer [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 P2-01-29.

Imaging Technologies and Applications in Early Diagnosis and Prognosis for Breast Cancer

There is increasing interest in the development of imaging tests to screen for breast cancer, especially in high-risk groups where conventional technology falls short. Breast imaging has made huge advances in the last decade, and along with newer techniques to diagnose primary breast cancer, many novel methods are being used and look promising in detecting distant metastasis and recurrent disease and assessing response to treatment. While screening mammography, which is the most extensively studied technique, is recognized as the most effective method for early detection of breast cancer, and many screening procedures have been discussed, this modality has limitations that are the driving force behind efforts to refine existing mammography technologies and develop new ones offering improved detection of breast cancer. Recent studies have shown that these techniques can enhance the radiologist’s ability to detect cancer and assess disease extent, which is crucial in treatment planning and staging.

Fibrin sealant for the prevention of axillary seroma formation after axillary lymph node disection. A prospective randomized study.

Abstract #4139 Background The most frequent postoperative complication after axillary limph node dissection is the axilary seroma (AS) formation. Currently accepted practice includes insertion of one or more drainage system for fluid evacuation. Several methods have been proposed to decrease AS formation, such as closed suction catheters, shoulder immobilisation, tetracycline sclerotherapy, talc podrage and closure of dead space; however no of them have reduced the incidence of AS. Seromas are associated with wound infection, wound dehiscence and skip flap necrosis, which prolong the recovery and can extend patient´s stay in Hospital.
 The aim of this prospective randomized controlled trial was to evaluate the efficacy of fibrin sealant (FS) on the prevention of AS.
 Material and Methods Sixty-two patients undergoing axillary lymph node dissection were randomized to treatment with drainaje alone (arm A, n=49), drainage plus FS (arm B, n=12), or FS alone (arm C, n=53). Arm B was cancelled after primary results. Efficacy was evaluated in terms of lengh of hospital stay, volumen of fluid drainage and rate of wound related complications (seroma, hematoma, infection, dehiscence) in each arm.
 Results No significative differences are detected neither type of surgery, nor histlogycal characteristics.
 The mean result is a difference of almost minus 3 days in postoperative stay in the FS group.
 Conclusions 1- Application of fibrin sealant reduces the amount of serosanguinous drainage and the length of postoperative stay in patients who have undergone axillary lymph node dissection.
 2- Fibrin sealant allows to avoid the insertion of an axillar drainage system
 3- It is very important the correct preparation and application of the fibrin sealant and it should be performed by a qualified surgeon.
 4- Future clinical trials toasses the role of fibrin sealant seroma are warranted. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4139.