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The biological behavior and prognosis of breast cancer is often unpredictable with a number of factors contributing to the outcome. Nottingham's Prognostic Factor (NPI) takes into account the tumor size, nodal status, and histological grade of tumor. The receptor status considers the hormone receptor and HER2 status. The aim of the study was to correlate the NPI score with the receptor status expression in Indian women with breast cancer. A total of 78 breast cancer patients who underwent upfront modified radical mastectomy were recruited. NPI score and receptor status assessment was done at histopathological examination of the specimen. Hormone receptor negative breast cancer tended to have a higher NPI score compared to hormone receptor positive patients. However, this difference did not achieve statistical significance. NPI score parameters except for the histological grade are a reflection of the duration or time span of the tumor. On the contrary, the receptor status is indicative of the tumor biology and not of its time duration. A scoring system which incorporates the three parameters of the NPI as well as the receptor status would be the best prognostic index as well as predictive regarding the choice of adjuvant therapy. [ABSTRACT FROM AUTHOR]

An integral part of management of breast cancer is the appropriate treatment of the involved lymph nodes. While axillary nodes are always assessed and managed by sentinel node biopsy or an axillary clearance, the extra-axillary nodes do not receive equivalent attention even though they may influence staging, treatment, and prognosis. The purpose of this study was to assess the extra-axillary nodes by Doppler ultrasonogram in 228 patients with breast cancer over an 8-year period from January 2012 to January 2020. It is a case series analysis to evaluate axillary and extra-axillary lymph node basins in newly diagnosed breast cancer patients using linear array transducer ultrasonogram. It was found that while patients with T1 and T2 lesions did not have extra-axillary nodal involvement, 12% of T3 lesions (102 patients) and 50% of T4 lesions (48 patients) exhibited extra-axillary node involvement. Among the extra-axillary sites, internal mammary nodes were most often involved (24 patients) followed by infra-clavicular (8 patients) and supra-clavicular (4 patients) sites. Clinical examination by palpation could detect only the supra-clavicular nodes but was false negative in all patients who had an internal mammary or infra-clavicular node detected on ultrasound. Failure to identify internal mammary, supra-clavicular, and infra-clavicular lymph nodes can result in erroneous understaging in breast cancer patients leading to inadequate treatment and worse than anticipated prognosis. Therefore, all breast cancer patients as part of their pre-treatment protocol should undergo focused ultrasonogram evaluation of their axillary as well as extra-axillary lymph nodes. [ABSTRACT FROM AUTHOR]

Ultrasonogram-guided fine needle aspiration cytology of the axillary lymph nodes using a 7–12 MHz linear transducer was carried out on 102 breast cancer patients in whom there was no clinically palpable lymph node in the axilla. Ultrasound was able to visualize an axillary node in 55 patients (54%) while in 47 patients (46%), no node was visualized. USG-guided FNAC on the 55 patients found 9 (16%) patients to be positive for metastases, 27 (49%) to be negative, and 19 (35%) in whom an inconclusive or inadequate sample was reported. On correlation with post-modified radical mastectomy (MRM) histopathology, the preoperative USG-guided FNAC had a sensitivity of 60%, specificity of 100%, and an overall diagnostic accuracy of 58%. It can be concluded that patients with a positive for malignancy USG-guided FNAC report on the axilla should be treated as such. Patients who have a negative for malignancy or inconclusive/inadequate FNAC report or in patients in whom no axillary node is visualized on USG should undergo a sentinel node biopsy procedure for further evaluation of the axilla. [ABSTRACT FROM AUTHOR]

Evaluation of expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2/neu) receptor was carried out on 80 breast cancer patients before and after neoadjuvant chemotherapy (NAC). No differences in expression were noted in 89% with reference to ER, 95% with reference to PR, and 91% with reference to HER2/neu status. A change in receptor status from positive to negative was noted in 12% for ER, 5% for PR, and 21% for HER2/neu after NAC. A negative to positive shift was noted in 11% for ER, 4% for PR, and 4% for HER2/neu after NAC. The possible reasons ascribed for change in receptor status after NAC are as follows: (1) Selection of chemoresistant clones with different receptor expression after NAC. (2) Tumor heterogeneity with variable receptor expression in different areas. (3) Ovarian suppression during NAC leading to alteration in receptor expression. (4) Technical considerations such as staining techniques and intra-observer and inter-observer differences in IHC slide interpretation before and after NAC. [ABSTRACT FROM AUTHOR]

The intracellular redox environment plays an important role in the maintenance of proper cellular homeostasis and functions. Disturbances in redox equilibrium of cells result in pro-inflammatory conditions, and these inflammatory conditions can induce carcinogenesis or increase the malignant potential of the tumor. Oxidative stress or tissue damage can trigger toll-like receptor (TLR) family of receptors that are involved in altering the innate immune system. The present study was aimed at evaluating the level of oxidative damage markers in breast diseases by measuring the 8-hydroxydeoxyguanosine (8-OHdG), protein carbonyl (PC), malondialdehyde (MDA), and total antioxidant status (TAS) alterations in relation to expression of TLR-9. A significant increase in the level of oxidative damage markers was observed in breast carcinoma patients in comparison to benign and normal controls, which was accompanied by a significant decrease in TAS and expression of TLR-9 concentrations. 8-OHdG, PC, and MDA were negatively correlated with expression of TLR-9 and TAS levels. Altered levels of biomarkers of oxidative stress and TLR-9 among the malignant, benign, and controls suggest a correlation of oxidative stress and TLR signaling in the progression of disease in breast carcinoma patients. Receiver operating characteristic analysis depicts that expression of TLR-9 is a good indicator for distinguishing cancer patients from benign and normal controls. High accuracy, specificity, and sensitivity of oxidative stress markers and expression of TLR-9 can be used as discriminatory marker/s for efficient diagnosis. [ABSTRACT FROM AUTHOR]