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Challenging Topics in Breast Cancer Diagnosis and Treatment—Volume 2
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Challenging Topics in Breast Cancer Diagnosis and Treatment—Volume 2

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 12272

Special Issue Editor

Dr. Mauro Giuseppe Mastropasqua

E-Mail Website
Guest Editor
Department of Emergency and Organs Transplantation, Section of Pathology, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
Interests: breast cancer; prognostic and predictive factors; sentinel node; DCIS; prostate cancer; urinary bladder cancer; kidney cancer; molecular pathology; pathology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Breast cancer is one of the most common oncological diagnoses around the world. In the study and treatment of breast cancer, several professionals face various challenges: radiologists face challenges in pre-surgical diagnosis through imaging and new 3D techniques; pathologists face challenges in formulating pathology reports and in the clinical management of breast lesions with uncertain malignant potential (B3: papillary lesions; pre-neoplastic diseases), as well as in determining their terminology according to 2019 WHO classification; pathologists and oncologists face challenges in the reproducibility of immunohistochemical assessment of biomarkers, intratumoral heterogeneity, reporting, and the use of new diagnostic tools, such as TILs evaluation.

A multidisciplinary team is currently the strongest and most robust instrument in the management of breast cancer patients, with widening applications in every hospital. A multidisciplinary oncological team is not a simple sum of each of its components; rather, it is the result of a multiplication of professionals’ capabilities, leading to the most appropriate choice of treatment for a given patient.

Dr. Mauro Giuseppe Mastropasqua
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • imaging in breast cancer
  • pathology report
  • pathology diagnostic
  • reproducibility
  • biomarkers
  • intratumoral heterogeneity
  • tumor-infiltrating lymphocytes
  • multidisciplinary team

Published Papers (7 papers)

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Research

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14 pages, 4419 KiB  
Article
Evaluation of Contrast-Enhanced Mammography and Development of Flowchart for BI-RADS Classification of Breast Lesions
by Kristina Klarić, Andrej Šribar, Anuška Budisavljević, Loredana Labinac and Petra Valković Zujić
Diagnostics 2023, 13(11), 1958; https://doi.org/10.3390/diagnostics13111958 - 03 Jun 2023
Viewed by 1313
Abstract
This study aimed to evaluate contrast-enhanced mammography (CEM) and to compare breast lesions on CEM and breast magnetic resonance imaging (MRI) using 5 features. We propose a flowchart for BI-RADS classification of breast lesions on CEM based on the Kaiser score (KS) flowchart [...] Read more.
This study aimed to evaluate contrast-enhanced mammography (CEM) and to compare breast lesions on CEM and breast magnetic resonance imaging (MRI) using 5 features. We propose a flowchart for BI-RADS classification of breast lesions on CEM based on the Kaiser score (KS) flowchart for breast MRI. Sixty-eight subjects (women and men; median age 61.4 ± 11.6 years) who were suspected of having a malignant process in the breast based on digital mammography (MG) findings were included in the study. The patients underwent breast ultrasound (US), CEM, MRI and biopsy of the suspicious lesion. There were 47 patients with malignant lesions confirmed by biopsy and 21 patients with benign lesions, for each of which a KS was calculated. In the patients with malignant lesions, the MRI-derived KS was 9 (IQR 8–9); its CEM equivalent was 9 (IQR 8–9); and BI-RADS was 5 (IQR 4–5). In patients with benign lesions, MRI-derived KS was 3 (IQR 2–3); its CEM equivalent was 3 (IQR 1.7–5); and BI-RADS was 3 (IQR 0–4). There was no significant difference between the ROC-AUC of CEM and MRI (p = 0.749). In conclusion, there were no significant differences in KS results between CEM and breast MRI. The KS flowchart is useful for evaluating breast lesions on CEM. Full article
(This article belongs to the Special Issue Challenging Topics in Breast Cancer Diagnosis and Treatment—Volume 2)
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15 pages, 1883 KiB  
Article
Developing a Supplementary Diagnostic Tool for Breast Cancer Risk Estimation Using Ensemble Transfer Learning
by Tengku Muhammad Hanis, Nur Intan Raihana Ruhaiyem, Wan Nor Arifin, Juhara Haron, Wan Faiziah Wan Abdul Rahman, Rosni Abdullah and Kamarul Imran Musa
Diagnostics 2023, 13(10), 1780; https://doi.org/10.3390/diagnostics13101780 - 18 May 2023
Viewed by 1381
Abstract
Breast cancer is the most prevalent cancer worldwide. Thus, it is necessary to improve the efficiency of the medical workflow of the disease. Therefore, this study aims to develop a supplementary diagnostic tool for radiologists using ensemble transfer learning and digital mammograms. The [...] Read more.
Breast cancer is the most prevalent cancer worldwide. Thus, it is necessary to improve the efficiency of the medical workflow of the disease. Therefore, this study aims to develop a supplementary diagnostic tool for radiologists using ensemble transfer learning and digital mammograms. The digital mammograms and their associated information were collected from the department of radiology and pathology at Hospital Universiti Sains Malaysia. Thirteen pre-trained networks were selected and tested in this study. ResNet101V2 and ResNet152 had the highest mean PR-AUC, MobileNetV3Small and ResNet152 had the highest mean precision, ResNet101 had the highest mean F1 score, and ResNet152 and ResNet152V2 had the highest mean Youden J index. Subsequently, three ensemble models were developed using the top three pre-trained networks whose ranking was based on PR-AUC values, precision, and F1 scores. The final ensemble model, which consisted of Resnet101, Resnet152, and ResNet50V2, had a mean precision value, F1 score, and Youden J index of 0.82, 0.68, and 0.12, respectively. Additionally, the final model demonstrated balanced performance across mammographic density. In conclusion, this study demonstrates the good performance of ensemble transfer learning and digital mammograms in breast cancer risk estimation. This model can be utilised as a supplementary diagnostic tool for radiologists, thus reducing their workloads and further improving the medical workflow in the screening and diagnosis of breast cancer. Full article
(This article belongs to the Special Issue Challenging Topics in Breast Cancer Diagnosis and Treatment—Volume 2)
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12 pages, 5483 KiB  
Article
FSTL1 Suppresses Triple-Negative Breast Cancer Lung Metastasis by Inhibiting M2-like Tumor-Associated Macrophage Recruitment toward the Lungs
by Ying Yang, Tao Lu, Xiaowei Jia and Yan Gao
Diagnostics 2023, 13(10), 1724; https://doi.org/10.3390/diagnostics13101724 - 12 May 2023
Cited by 1 | Viewed by 1339
Abstract
Immune cell infiltration into the tumor microenvironment is associated with cancer prognosis. Tumor-associated macrophages play essential roles in tumor initiation, progression, and metastasis. Follistatin-like protein 1 (FSTL1), a widely expressed glycoprotein in human and mouse tissues, is a tumor suppressor in various cancers [...] Read more.
Immune cell infiltration into the tumor microenvironment is associated with cancer prognosis. Tumor-associated macrophages play essential roles in tumor initiation, progression, and metastasis. Follistatin-like protein 1 (FSTL1), a widely expressed glycoprotein in human and mouse tissues, is a tumor suppressor in various cancers and a regulator of macrophage polarization. However, the mechanism by which FSTL1 affects crosstalk between breast cancer cells and macrophages remains unclear. By analyzing public data, we found that FSTL1 expression was significantly low in breast cancer tissues compared to normal breast tissues, and high expression of FSTL1 in patients indicated prolonged survival. Using flow cytometry, we found that total and M2-like macrophages dramatically increased in the metastatic lung tissues during breast cancer lung metastasis in Fstl1+/− mice. Transwell assay in vitro and q-PCR experimental results showed that FSTL1 inhibited macrophage migration toward 4T1 cells by decreasing CSF1, VEGF-α, and TGF-β secretion in 4T1 cells. We demonstrated that FSTL1 inhibited M2-like tumor-associated macrophage recruitment toward the lungs by suppressing CSF1, VEGF-α, and TGF-β secretion in 4T1 cells. Therefore, we identified a potential therapeutic strategy for triple-negative breast cancer. Full article
(This article belongs to the Special Issue Challenging Topics in Breast Cancer Diagnosis and Treatment—Volume 2)
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17 pages, 4104 KiB  
Article
Breast Sarcomas—How Different Are They from Breast Carcinomas? Clinical, Pathological, Imaging and Treatment Insights
by Iulian Radu, Viorel Scripcariu, Andrian Panuța, Alexandra Rusu, Vlad-Adrian Afrăsânie, Elena Cojocaru, Maria Gabriela Aniței, Teodora Alexa-Stratulat, Cristina Terinte, Cristinel Florin Șerban and Bogdan Gafton
Diagnostics 2023, 13(8), 1370; https://doi.org/10.3390/diagnostics13081370 - 07 Apr 2023
Cited by 2 | Viewed by 1423
Abstract
Breast sarcoma (BS) is a very rare and poorly studied condition. This has led to a lack of studies with a high level of evidence and to low efficacy of current clinical management protocols. Here we present our experience in treating this disease [...] Read more.
Breast sarcoma (BS) is a very rare and poorly studied condition. This has led to a lack of studies with a high level of evidence and to low efficacy of current clinical management protocols. Here we present our experience in treating this disease in the form of a retrospective case series study including discussion of clinical, imaging, and pathological features and treatment. We also compare the main clinical and biological features of six cases of BS (phyllodes tumors were excluded) with a cohort of 184 patients with unilateral breast carcinoma (BC) from a previous study performed at our institution. Patients with BS were diagnosed at a younger age, presented no evidence of lymph node invasion or distant metastases, had no multiple or bilateral lesions, and underwent a shorter length of hospital stay versus the breast carcinoma group. Where recommended, adjuvant chemotherapy consisted of an anthracycline-containing regimen, and adjuvant external radiotherapy was delivered in doses of 50 Gy. The comparison data obtained from our BS cases and the ones with BC revealed differences in diagnosis and treatment. A correct pathological diagnosis of breast sarcoma is essential for the right therapeutic approach. We still have more to learn about this entity, but our case series could add value to existing knowledge in a meta-analysis study. Full article
(This article belongs to the Special Issue Challenging Topics in Breast Cancer Diagnosis and Treatment—Volume 2)
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14 pages, 1409 KiB  
Article
Discriminatory Ability and Clinical Utility of the AJCC7 and AJCC8 Staging Systems for Breast Cancer in a Middle-Income Setting
by Chin-Vern Song, Carla H. van Gils, Cheng-Har Yip, Isabelle Soerjomataram, Nur Aishah Mohd Taib, Mee-Hoong See, Alexander Lim, Nur Fadhlina Abdul Satar and Nirmala Bhoo-Pathy
Diagnostics 2023, 13(4), 674; https://doi.org/10.3390/diagnostics13040674 - 10 Feb 2023
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Abstract
(1) Background: Differences in access to biomarker testing and cancer treatment in resource-limited settings may affect the clinical utility of the AJCC8 staging system compared to the anatomical AJCC7 system. (2) Methods: A total of 4151 Malaysian women who were newly diagnosed with [...] Read more.
(1) Background: Differences in access to biomarker testing and cancer treatment in resource-limited settings may affect the clinical utility of the AJCC8 staging system compared to the anatomical AJCC7 system. (2) Methods: A total of 4151 Malaysian women who were newly diagnosed with breast cancer from 2010 to 2020 were followed-up until December 2021. All patients were staged using the AJCC7 and AJCC8 systems. Overall survival (OS) and relative survival (RS) were determined. Concordance-index was used to compare the discriminatory ability between the two systems. (3) Results: Migration from the AJCC7 to AJCC8 staging system resulted in the downstaging of 1494 (36.0%) patients and the upstaging of 289 (7.0%) patients. Approximately 5% of patients could not be staged using the AJCC8 classification. Five-year OS varied between 97% (Stage IA) and 66% (Stage IIIC) for AJCC7, and 96% (Stage IA) and 60% (Stage IIIC) for AJCC8. Concordance-indexes for predicting OS using the AJCC7 and AJCC8 models were 0.720 (0.694–0.747) and 0.745 (0.716–0.774), and for predicting RS they were 0.692 (0.658–0.728) and 0.710 (0.674–0.748), respectively. (4) Conclusions: Given the comparable discriminatory ability between the two staging systems in predicting the stage-specific survival of women with breast cancer in the current study, the continued use of the AJCC7 staging system in resource-limited settings seems pragmatic and justifiable. Full article
(This article belongs to the Special Issue Challenging Topics in Breast Cancer Diagnosis and Treatment—Volume 2)
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Review

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27 pages, 1796 KiB  
Review
Vaccines in Breast Cancer: Challenges and Breakthroughs
by Gul Naz Fatima, Hera Fatma and Shailendra K. Saraf
Diagnostics 2023, 13(13), 2175; https://doi.org/10.3390/diagnostics13132175 - 26 Jun 2023
Cited by 3 | Viewed by 2154
Abstract
Breast cancer is a problem for women’s health globally. Early detection techniques come in a variety of forms ranging from local to systemic and from non-invasive to invasive. The treatment of cancer has always been challenging despite the availability of a wide range [...] Read more.
Breast cancer is a problem for women’s health globally. Early detection techniques come in a variety of forms ranging from local to systemic and from non-invasive to invasive. The treatment of cancer has always been challenging despite the availability of a wide range of therapeutics. This is either due to the variable behaviour and heterogeneity of the proliferating cells and/or the individual’s response towards the treatment applied. However, advancements in cancer biology and scientific technology have changed the course of the cancer treatment approach. This current review briefly encompasses the diagnostics, the latest and most recent breakthrough strategies and challenges, and the limitations in fighting breast cancer, emphasising the development of breast cancer vaccines. It also includes the filed/granted patents referring to the same aspects. Full article
(This article belongs to the Special Issue Challenging Topics in Breast Cancer Diagnosis and Treatment—Volume 2)
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Other

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8 pages, 1583 KiB  
Case Report
Secondary Breast Malignancy from Renal Cell Carcinoma: Challenges in Diagnosis and Treatment—Case Report
by Marko Spasic, Dusan Zaric, Minja Mitrovic, Sanja Milojevic, Nikola Nedovic, Marija Sekulic, Bojan Stojanovic, Dejan Vulovic, Bojan Milosevic, Filip Milutinovic and Neda Milosavljevic
Diagnostics 2023, 13(5), 991; https://doi.org/10.3390/diagnostics13050991 - 05 Mar 2023
Cited by 1 | Viewed by 2812
Abstract
Renal cell carcinoma represents about 2% of all malignant tumours in adults. Metastases of the primary tumour in the breast make up to about 0.5–2% of the cases. Renal cell carcinoma metastases in the breast are extremely rare and have been sporadically recorded [...] Read more.
Renal cell carcinoma represents about 2% of all malignant tumours in adults. Metastases of the primary tumour in the breast make up to about 0.5–2% of the cases. Renal cell carcinoma metastases in the breast are extremely rare and have been sporadically recorded in the literature. In this paper, we present the case of a patient with breast metastasis of renal cell carcinoma 11 years after primary treatment. Case presentation: An 82-year-old female who had right nephrectomy due to renal cancer in 2010 felt a lump in her right breast in August 2021, whereby a clinical examination revealed a tumour at the junction of the upper quadrants of her right breast, about 2 cm, movable toward the base, vaguely limited, and with a rough surface. The axillae were without palpable lymph nodes. Mammography showed a circular and relatively clearly contoured lesion in the right breast. Ultrasound showed an oval lobulated lesion of 19 × 18 mm at the upper quadrants, with strong vascularisation and without posterior acoustic phenomena. A core needle biopsy was performed, and the histopathological findings and obtained immunophenotype indicated a metastatic clear cell carcinoma of renal origin. A metastasectomy was performed. Histopathologically, the tumour was without desmoplastic stroma, comprising predominantly solid-type alveolar arrangements of large moderately polymorphic cells, bright and abundant cytoplasm, and round vesicular cores with focally prominent nuclei. Immunohistochemically, tumour cells were diffusely positive for CD10, EMA, and vimentin, and negative for CK7, TTF-1, renal cell antigen, and E-cadherin. With a normal postoperative course, the patient was discharged on the third postoperative day. After 17 months, there were no new signs of the underlying disease spreading at regular follow-ups. Conclusion: Metastatic involvement of the breast is relatively rare and should be suspected in patients with a prior history of other cancers. Core needle biopsy and pathohistological analysis are required for the diagnosis of breast tumours. Full article
(This article belongs to the Special Issue Challenging Topics in Breast Cancer Diagnosis and Treatment—Volume 2)
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