Tc-99m-sestamibi scintigraphy used to evaluate tumor response to neoadjuvant chemotherapy in locally advanced breast cancer: A quantitative analysis

To evaluate the tumor response to neoadjuvant chemotherapy, Tc-99m-sestamibi breast scintigraphy was proposed as a quantitative method Fifty-five patients with ductal carcinoma were studied They underwent breast scintigraphy before and after neoadjuvant chemotherapy, along with clinical assessment and surgical specimen analysis The regions of interest on the lesion and contralateral breast were identified, and the pixel counts were used to evaluate lesion uptake in relation to background radiation The ratio of these counts before to after neoadjuvant chemotherapy was assessed The decrease in uptake rate due to chemotherapy characterized the scintigraphy tumor response The Kruskal-Wallis test was used to compare the mean scintigraphic tumor response and histological type Dunn's multiple comparison test was used to detect differences between histological types The Mann-Whitney test was used to compare means between quantitative and qualitative variables scintigraphic tumor response vs clinical response and uptake before chemotherapy vs scintigraphic tumor response The Spearman's test was used to correlate the quantitative variables of clinical reduction in tumor size and scintigraphic tumor response All of the variables compared presented significant differences The change in Tc-99m-sestamibi uptake noted on breast scintigraphy, before to after neoadjuvant chemotherapy, may be used as an effective method for evaluating the response to neoadjuvant chemotherapy, since this quantification reflects the biological behavior of the tumor towards the chemotherapy regimen Furthermore, additional analysis on the uptake rate before chemotherapy may accurately predict treatment response

Accuracy of Tc-99m-sestamibi scintimammography for breast cancer diagnosis

Scintimammography using Tc-99m-sestamibi is a noninvasive and painless diagnostic imaging method that is used to detect breast cancer when mammography is inconclusive Because of the advantages of labeling v '7,ith Tc-99m-sestamibi and its high efficiency in detecting carcinomas, it is the most widespread agent for this purpose Its accumulation in the tumor has multifactorial causes and does not depend on the presence of architectural distortion or local or diffuse density variation in the breast The objective of tfiis study was to evaluate the accuracy of scintimammography 1 for detecting breast cancer One hundred and fifty-seven patients presenting 158 palpable and non-palpable breast nodules were evaluated Three patients were male and 154 were female, aged between 14 and 81 years All patients underwent scintimammography, and the nodule was subjected i to cytological or histological study, i e, the gold standard for diagnosing cancer One hundred and eleven malignant and 47 benign nodules were detected, with predominance of ductal carcinomas (n=94) and fibroadenoma/fibrocysiic condition (n=11/n=11), respectively The mean size was 3 11 cm (7-10 cm) among the malignant nodules and 2 07 cm among the benign nodules (0 5-10 cm) The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 89, 89, 95, 78 and 89%, respectively Analysis on the histological types showed that the technique was more effective on tumors that were more aggressive, such as ductal carcinoma In this study, Tc-99m-sestamibi scintim immography was shown to be an important tool for diagnosing breast cancer when mammography was inconclusive

Physiotherapeutic stimulation: Early prevention of lymphedema following axillary lymph node dissection for breast cancer treatment

The aim of this study was to confirm the effectiveness of early physiotherapeutic stimulation for lymphatic flaw progression in patients with breast cancer undergoing axillary dissection This was a randomized experimental study oil 22 patients who underwent lymphoscintigraphy in their arms on two different occasions, firstly without stimulation and secondly after randomization into two groups without physiotherapeutic stimulation (WOPS, n=10) and with physiotherapeutic stimulation (WPS, n=12) The lymphoscintigraphy scan was performed with (99m)Tc-phytate administered into the second interdigital space of the hand, ipsilaterally to the dissected axilla, in three phases dynamic, static, and delayed whole body imaging Physiotherapeutic stimulation was earned out using Foldi's technique In both groups, images from the two examinations of each patient were compared Flow progression was considered positive when, on the second damnation, the radiopharmaceutical reached areas more distant from the injection site Statistical analysis was used to evaluate frequencies, percentages and central trend measurements, and non-parametric tests were conducted Descriptive analysis showed that the WPS and WOPS groups were similar M terms of mean age, weight, height, body mass index and number of lymph nodes removed There were statistically significant associations between physiotherapeutic stimulation and radiopharmaceutical progression at all three phases of the study (p < 0 0001) Early physiotherapeutic stimulation in beast cancer patients undergoing radical axillary dissection is effective, and can therefore be indicated as a preventive measure against lymphedema

Adjuvant therapy with GnRH agonists/tamoxifen in breast cancer should be a good council for patients with hormone receptor-positive tumours and wish to preserve fertility

Infertility represents one of the main long-term consequences of the chemotherapy used for the adjuvant treatment of breast cancer. Approximately 60-65% of breast cancers express the nuclear hormone receptor in premenopausal women. Adjuvant endocrine therapy is an integral component of care for patients with hormone receptor-positive (HR+) tumours. The GnRH agonist (GnRHa) alone or in combination with tamoxifen produces results at least similar to those obtained with the different chemotherapy protocols in patients with HR+ breast cancer with respect to recurrence-free survival and overall survival. It is time to indicate adjuvant therapy with GnRHa associated with tamoxifen for patients with breast cancer (HR+ tumours) if they want to preserve their reproductive function. The evaluation of ovarian reserve tests: follicle stimulating hormone (FSH), anti-Mullerian hormone (AMH), inhibin B, antral follicle count (AFC) and ovarian volume 6 months, and 1 year after the end of therapy with GnRHa/tamoxifen must be realised. The recurrence-free survival and overall survival should be analysed. The major implication of this hypothesis will be to avoid adjuvant chemotherapy for patients with breast cancer (HR+ tumours) that request fertility preservation. It is expected that ovarian function should not be altered in almost all cases and subsequent pregnancy a real possibility. (C) 2012 Elsevier Ltd. All rights reserved.

Feasibility of oncoplastic techniques in the surgical management of locally advanced breast cancer

Background: Locally advanced breast cancer (LABC) is still common in developing countries. The association between neoadjuvant chemotherapy (NC) and oncoplastic surgery (OS) might provide an oncological treatment with satisfactory aesthetic results.Purpose: The goal was to demonstrate if oncoplastic surgical techniques can be utilized to treat LABC which was submitted to neoadjuvant chemotherapy.Methods: This prospective clinical trial included breast cancer patients, clinical stage III, who underwent established NC regimen. All patients underwent preoperative planning to control the tumor size and to define the surgical technique. A detailed analysis of the pathological specimen was performed.Results: 50 patients were assessed and surgically treated. Tumor size ranged from 3.0 to 14.0 cm (median 6.5 cm). Pathologic response was rated as stable, progressive, partial response, and complete response in 10%, 8%, 80% and 2% of the cases, respectively. Seventeen (34%) patients were submitted to OS. No patient had positive margins. Skin involvement was presented in 36% of pathologic specimen.Conclusions: Oncoplastic surgical techniques for selected patients decrease the rates of radical surgery despite large tumors. (www.clinicaltrials.gov, NCT00820690). (C) 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Influence of estradiol and triiodothyronine on breast cancer cell lines proliferation and expression of estrogen and thyroid hormone receptors

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Evidence of epigenetic regulation of the tumor suppressor gene cluster flanking RASSF1 in breast cancer cell lines

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Estimating genomic instability mediated by Alu retroelements in breast cancer

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Profile of thyroid hormones in breast cancer patients

Estrogen involvement in breast cancer has been established; however, the association between breast cancer and thyroid diseases is controversial. Estrogen-like effects of thyroid hormone on breast cancer cell growth in culture have been reported. The objective of the present study was to determine the profile of thyroid hormones in breast cancer patients. Serum aliquots from 26 patients with breast cancer ranging in age from 30 to 85 years and age-matched normal controls (N = 22) were analyzed for free triiodothyronine (T3F), free thyroxine (T4F), thyroid-stimulating hormone (TSH), antiperoxidase antibody (TPO), and estradiol (E2). Estrogen receptor ß (ERß) was determined in tumor tissues by immunohistochemistry. Thyroid disease incidence was higher in patients than in controls (58 vs 18%, P < 0.05). Subclinical hyperthyroidism was the most frequent disorder in patients (31%); hypothyroidism (8%) and positive anti-TPO antibodies (19%) were also found. Subclinical hypothyroidism was the only dysfunction (18%) found in controls. Hyperthyroidism was associated with postmenopausal patients, as shown by significantly higher mean T3 and T4 values and lower TSH levels in this group of breast cancer patients than in controls. The majority of positive ERß tumors were clustered in the postmenopausal patients and all cases presenting subclinical hyperthyroidism in this subgroup concomitantly exhibited Erß-positive tumors. Subclinical hyperthyroidism was present in only one of 6 premenopausal patients. We show here that postmenopausal breast cancer patients have a significantly increased thyroid hormone/E2 ratio (P < 0.05), suggesting a possible tumor growth-promoting effect caused by this misbalance.

Triiodothyronine mimics the effects of estrogen in breast cancer cell lines

MCF-7 (estrogen receptor positive - ER(+)) and MDA-MB-231 (estrogen receptor negative - ER(-)) are human breast cancer cell lines which express functional thyroid hormone receptors (c-erb A alpha 1 and c-erb beta 1) as indicated by stimulation of mitochondrial alpha-glycerophosphate dehydrogenase. In MCF-7, mimicking E(2), T-3 stimulated growth in a dose-dependent (10(10) M-10(-8) M) manner, induced the expression of progesterone receptor and growth factor TGF alpha mRNAs and inhibited that of TGF beta mRNA; T-3 also increased progesterone binding and LDH5 isozyme activities. None of these effects were observed in (ER(-)) MDA-MB-231 cells. 10(-6) M tamoxifen (TAM) reverted growth stimulation, suppressed progesterone receptor and TGF alpha mRNA induction and restored TGF beta mRNA to control levels in T-3-treated MCF-7 cells. That T-3 is acting in MCF-7 cells via its binding to ER is suggested by the immunoprecipitation of pre-bound I-125-T-3 from MCF-7 nuclear extracts by an ER-specific monoclonal antibody and by the displacement of H-3-estradiol binding to ER by radioinert T-3. Copyright (C) 1996 Elsevier B.V. Ltd.