European Journal of Cardiovascular Medicine

Background: Breast cancer is the most common cancer in women, affecting 2.1 million women per year and accounting for the majority of cancer-related deaths among women. The use of neoadjuvant chemotherapy in the treatment of breast cancer has been shown to be effective in down staging primary tumors, clear surgical  margins and improve patient’s overall outcome. The aim of this study is to look at various factors affecting the clinical and pathological response in patients with locally advanced breast cancer after of neoadjuvant chemotherapy. Study Design: A prospective cohort study Patients and methods: This was a prospective cohort study on patients who received neoadjuvant chemotherapy for locally advanced breast carcinoma. A total of 58 patients who presented with locally advanced breast cancer (LABC) were treated with neoadjuvant chemotherapy for 3 cycles and then were assessed for response,patients with adequate response to chemotherapy were continued further for 3 more cycles of NACT . Patients not responding to NACT after 3 cycles underwent Modified radical mastectomy. The clinical response was assessed with RECIST criteria before the start of NACT and then after 3 cycles or at end of therapy. The pathological response was checked with Chevallier’s criteria before the start of NACT and then after completion of 3 cycles or at the end of NACT. Results: A total of 58 female patients who received neoadjuvant chemotherapy for locally advanced breast carcinoma from February 2021 to July 2022 were studied. The median age of the patients at the time of diagnosis was 53.5 years (28 – 84 years). In terms of menopausal status, 10 patients (17.3%) were pre-menopausal and 48 patients (82.7%) were post-menopausal. Histological classification showed infiltrating ductal carcinoma in 54 patients (93.2%), infiltrating lobular carcinoma in 2 patients (3.4%) patients and squamous cell carcinoma in 2 patients (3.4%). Among 58 patients, 15 patients (25.9%) had clinically complete remission (cCR), 23 patients (39.7%) had partial remission, 14 patients (24.1%) had stable disease and 6 patients (10.3%) had progressive disease. Also among 58 patients, 17 patients(29.3%) had pathological complete response (pCR) followed by 2 patients who had near to complete pathological response. Our study showed downstaging of tumor in 37 patients (63.7%) with T3 and T4 stage. Conclusion: Preoperative chemotherapy downstages the primary tumors and axillary metastasis in patients with locally advanced breast carcinomathus, it help in achieving surgically clear margins and elimination of micrometastases which may further decrease the recurrence rates and morbidity/mortality in patients

The Nottingham prognostic index (NPI) is a tool that takes into account the histological features of the tumor, which helps in the prediction of outcomes and supports clinical decision making while managing breast cancer patients. Hormonal receptors particularly estrogen, progesterone and HER2NEU receptors are present in the tumor tissue, considered as an important advancement in the evaluation of breast cancer. Objective: To calculate Nottingham Prognostic Index in newly diagnosed patients of breast carcinoma and to compare prognostic efficacy of molecular markers ER, PR, HER2NEU expression with Nottingham prognostic index. Material and Methods: A total 125 diagnosed cases of breast cancer were enrolled. Nottingham Prognostic Index was calculated from the histopathology report and molecular markers. Prognostic efficacy of molecular markers was compared with Nottingham prognostic index. Results:  After statistical analysis, ER expression was positive in 66 (53%) patients, PR expression in 55 (44%) patients and HER-2-neu expression was positive in 22 (18%) cases. Mean Nottingham Prognostic Index was found to be 4.99±1.23 SD. Molecular Markers were found to have an excellent prognosis in majority of group and Nottingham Prognostic Index show majority group has moderate prognosis value. No significant difference was observed between the Nottingham Prognostic Index and molecular markers receptors cases (p>0.05). Conclusion: The Nottingham Prognostic index is a better tool for prognosis determination than Immunohistochemistry markers in diagnosed cases of carcinoma breast

Background and Objective: Neoadjuvant chemotherapy (NACT) is currently a standard therapeutic approach to downstage the locally advanced breast cancer. This study aimed to 1) Evaluate the post NACT histopathological changes in the mastectomy specimens and lymph nodes, 2) Compare the immuno-histochemistry profiles of hormone receptor status ER, PR and HER2/NEU before and after NACT, 3) Categorize the patients according to the pathological response. Methods: Hospital based prospective study was conducted on 50 cases, diagnosed as carcinoma breast on trucut biopsies and assessed for ER, PR and HER2/NEU receptor status. Following NACT, modified radical mastectomy specimens were evaluated for histopathological changes, residual tumor and patients were categorized according to pathological response. The specimens with residual tumor were again subjected to ER, PR and HER2/NEU receptor status. Then comparison of ER, PR and HER2/NEU status was done between pre and post NACT specimens which showed residual tumor. Results: Histopathological changes observed were DCIS (14%), inflammation (88%), necrosis (74%), fibrosis (90%), calcification (12%) and LVI (20%). Among 50 cases, 14% showed pathological complete response, 48% showed pathological partial response and 38% showed pathological no response. Among 43 cases, comparison of ER, PR and HER2/NEU status between pre and post NACT cases documented a statistically significant loss of ER expression (p=0.020) and PR expression (p= 0.014) while no significant difference was observed in HER2/NEU expression. Conclusions: This study highlights the NACT induced histopathological, hormonal receptor- ER, PR and HER2/NEU changes along with assessment of pathological response to therapy which provides valuable prognostic information and helps in directing the effective hormonal/targeted treatment.

Background: Breast cancer is a heterogeneous disease, with molecular subtypes playing a critical role in determining prognosis and treatment strategies. The expression of Ki-67, a marker of cellular proliferation, has been widely used to assess the aggressiveness of breast cancer. This study aimed to analyze the distribution of molecular subtypes of invasive breast cancer and their association with clinicopathological features, with a focus on Ki-67 expression. Methods: A cross-sectional study was conducted on 400 breast cancer patients diagnosed at SCB Medical College, Cuttack, between January 2019 and December 2021. Tumors were classified into molecular subtypes using immunohistochemistry (IHC) for estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki-67. Clinicopathological data, including age, tumor size, grade, lymph node involvement, and Ki-67 expression, were collected and analyzed. Results: The most common molecular subtype was Luminal B (38.3%), followed by Luminal A (20.8%), HER2-enriched (12.8%), and triple-negative breast cancer (TNBC) (12.8%). High Ki-67 expression was observed in 65% of tumors, with significantly higher rates in the Luminal B, HER2-enriched, and TNBC subtypes. High Ki-67 expression was significantly associated with younger age, higher tumor grade, and lymph node involvement (p < 0.05). Additionally, high Ki-67 expression was more common in premenopausal women, particularly in the HER2-enriched and TNBC subtypes. Conclusions: This study highlights the significant role of molecular subtypes and Ki-67 expression in determining the clinicopathological characteristics of breast cancer. The findings emphasize the need for personalized treatment strategies, with particular attention to the aggressive nature of Luminal B and TNBC subtypes. Ki-67 expression emerges as an important marker for assessing tumor aggressiveness and guiding therapeutic decisions, particularly in premenopausal women. Further multicenter studies are needed to validate these findings and establish Ki-67 as a standard marker in clinical practice.

Introduction: Breast cancer remains one of the leading causes of cancer-related mortality among women worldwide. Biochemical markers offer a promising avenue for early detection and prognosis. Beyond traditional histopathological parameters, biochemical markers have emerged as crucial components for early detection, prognosis, and therapeutic decisions. This study evaluates the correlation between specific biochemical indicators such as CA 15-3, CEA, HER2, and hormone receptor status with histological features of tumor progression in breast cancer. Materials and Methods: This hospital-based observational study was conducted in the Department of Pathology and Biochemistry at a tertiary care Teaching Hospital over a period of 18 months. A total of 150 histologically confirmed breast cancer patients were enrolled. Detailed clinical evaluation, imaging studies, and staging (TNM classification) were performed. Blood samples were collected before surgery or biopsy. Serum levels of CA 15-3 and CEA were measured using enzyme-linked immunosorbent assay (ELISA). Tumor tissues were subjected to immunohistochemistry (IHC) for estrogen receptor (ER), progesterone receptor (PR), and HER2 status.  Results: The cohort has predominantly intermediate (Grade II, 46.7%) and high-grade (Grade III, 33.3%) tumors. Low-grade (Grade I) tumors are less common (20%). There's a strong inverse relationship between tumor grade and hormone receptor (ER/PR) positivity. Grade I: Highly hormone receptor positive (83.3% = 25/30). Grade II: Moderately hormone receptor positive (71.4% = 50/70). Grade III: Predominantly hormone receptor negative (60.0% = 30/50 ER/PR negative). A normal CEA is strongly associated with the absence of lymph node involvement (88.9% NPV = 80/90 patients with normal CEA were node negative). HER2 positivity is significantly more common in Ductal Carcinoma (45% = 45/100) compared to Lobular Carcinoma (10% = 5/50). Conclusion: Biochemical markers like CA 15-3, CEA, HER2, ER, and PR serve as valuable indicators of tumor aggressiveness and histopathological features. Their integration into diagnostic protocols can enhance personalized treatment approaches.