Background: The evaluation of regional lymph nodes in patients with breast cancer is one of the main predictive and prognostic factors for treatment. The most frequently methods of percutaneous evaluation for suspicious lymph nodes are fine needle aspiration (FNA) and core needle biopsy (CNB). According to the international literature, CNB and FNA are considered diagnostic methods with high specificity (98% vs. 99%), however FNA can present up to 21% of inconclusive results due to insufficient material, which leads to recall and delay in treatment approach. Although CNB is well established as a percutaneous method for the diagnostic evaluation of suspicious breast lesions, the literature is still scarce regarding the use of this method for the evaluation of suspicious regional lymph nodes in patients with breast cancer. Objectives: To analyze the results of percutaneous biopsies performed in suspected lymph nodes according to the topography and the type of needle used, and to verify the preferred method used. Methods: This was a retrospective study evaluating a public Hospital in São Paulo – Brazil (Pérola Byington Hospital database). Patients who underwent ultrasound-guided percutaneous lymph node biopsy from May 2015 to November 2017 were included. Data were analyzed and the type of biopsy (FNA or CNB) and the results were analyzed. Results: 106 medical records of patients with previous breast cancer and that underwent lymph node biopsy were reviewed. The mean age was 54.7 years (SD±12.4) in the CNB group and 54.7 years (SD±10.8) in the FNA group. Most of the patients were submitted to CNB (66% - 71 patients) and 34% were evaluated with FNA (35 patients). According to the topography of the lymph nodes, 80% were in the axilla (n=84), 10% in the supraclavicular region (n=11) and 10% in the cervical region (n=11). When analyzing the FNA results, 31% did not present sufficient material (n=11), 37% were malignant (n=13), 20% were benign (n=7) and 12% showed cellular atypia (n=12). Among the CNB performed in suspected lymph nodes, 53% were malignant (n=38) and 31% were benign (n=33), and no one had insufficient material. There were no reports of complications related to the procedures. In the insufficient material group, 27% (n=3) of the patients underwent a new percutaneous biopsy (2 CNB with malignant result and 1 FNA with inconclusive result) and 73% (8) were maintained in follow-up. The mean follow-up time was 24 months, and clinical and imaging stability was confirmed after this period. In the CNB group with malignant result, 10% (4) were diagnosed with neoplasia of other sites (cervix, lymphoma, melanoma and gastrointestinal), 78% (30) presented immunohistochemistry in agreement with that of the breast, 3% (1) presented different immunohistochemistry and in 9% (3) this evaluation was not performed. Conclusion: CNB was the preferred diagnostic method in our Hospital (66% vs 34%), being considered a viable procedure to evaluate lymph nodes in various topographies and with low rates of inconclusive results. Besides that, immunohistochemistry was done in 91% of the cases showing the importance of this analysis in the treatment of the recurrence or even in the diagnosis of other primary tumors. In the future, studies that assess indirect costs may confirm the applicability of CNB in patients with suspicious lymph nodes in terms of achieving greater agility and resolution. Citation Format: Marina Diogenes, ANDRE MATTAR, Andressa Amorim, Maria Isabela Caldas Sawada, Luiz Henrique Gebrim, Jorge Shida. Regional Lymph node percutaneous analysis in patients with breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-47.
Background: HER2 is a tyrosine kinase receptor belonging to the human epidermal receptor family and is considered an important proto-oncogene in the biology of breast carcinoma. HER2 overexpression is determined by a +3 score on the immunohistochemistry (IHC) assay. In addition, tumors with IHC results of +1 or +2 with ISH negative were defined as HER2-low. Recent studies have shown that the clinicopathological characteristics of HER2-low tumors, pointing out potential differences regarding hormone receptor status and new treatment possibilities in this patients. Objective: To assess the frequency and clinicopathological differences between cancer subtypes, as well as the survival of these patients. Methods: All patients with breast cancer diagnosed between 1987 and 2021 included in the Pérola Byington Hospital database were eligible. Patients were excluded if they had bilateral disease, had participated in clinical studies, or had incomplete data. The primary endpoint was overall survival stratified by cancer subtype, secondary endpoints were clinicopathological differences between cancer subtypes and death probability. Both the t-test and the chi-square test were used to analyze the association of each variable between the groups. Multivariate analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the death outcome. Cox regression was used for survival analysis, with the Log-rank method and the results were presented in a survival graph using the Kaplan-Meier method. The R software version 4.1.1 was used to perform all analyzes, with a p-value < 0.05 being considered statistically significant. Results: 11,234 patients were included: 4,541 (40.42%) had Luminal cancer subtype, 2,955 (26.30%) HER2 Low, 2,242 (19.96%) triple negative, and 1,496 (13.32%) HER2 overexpression. Age, self-reported ethnicity, BMI, presence of comorbidities, clinical stage, nuclear grade, histological grade, family history, radiotherapy, chemotherapy, surgery, local, and systemic recurrence, and death showed statistically significant differences between cancer subtypes (table 1). In the multivariate regression (adjusted for the other evaluated characteristics), patients with HER2 overexpression cancer subtype showed a 44.8% greater probability of death than patients with HER2 Low (OR 1.448, 95%CI 1.046-2.004, p=0.026), while the patient with triple-negative cancer had a 26.1% lower probability of evolving to death when compared to the HER2 Low patient (OR 0.739, 95%CI 0.562-0.969, p=0.0229). The luminal subtype showed no statistically significant difference when compared to the patient with HER2 Low. Overall survival showed a statistically significant difference between cancer subtypes, with a median of 12 years for Luminal HR 0.816 (0.73-0.913), 15 years for HER2 overexpression HR 1.154 (1.003-, 327), and no statistical difference for triple negative HR 0.978 (0.859-1.114) compared to 12 years for HER2 Low. Conclusion: This study in breast cancer patients demonstrates significant differences between cancer subtypes, with a higher probability of progression to death for patients with HER2 overexpression, while patients with Luminal subtype had a lower probability, when compared with HER2 Low. More studies are needed to clarify the impact of these differences between cancer subtypes on response to therapy. Association between cancer subtype and other variables (n=11,234). Citation Format: ANDRE MATTAR, Andressa Amorim, Marina Diogenes, Jorge Shida, Luiz Henrique Gebrim. Clinical and pathological differences between HER2 Low and other cancer subtypes in breast cancer patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-04-17.
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