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Showing 13 results for Breast Neoplasms

Sara Rostami, Leila Kohan, Mohammad Mohammadian Panah, Fereshteh Fereiduni,
Volume 72, Issue 6 (9-2014)
Abstract

Background: Leptin is an adipokine made by fat cells and plays a key role in proliferation, cell survival, migration and immune response. Several studies have suggested that individuals with high serum leptin concentrations would increase the risk of breast cancer. G -2548A polymorphism in the leptin gene is located in the promoter region and is associated with the change of leptin serum level. In this study, the association between G -2548A polymorphism in leptin gene and breast cancer susceptibility was investigated. Methods: This case-control study was done on 374 Iranian women. This study was performed from March 2013 to February 2013. Blood samples from 203 women with breast cancer and 171 age (±5)- matched healthy women were collected. Breast cancer patients were selected from Namazi Hospital in Shiraz city. Genomic DNA was extracted from blood samples. The G -2548A polymorphism of leptin gene was determined using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Data analysis was performed by SPSS version 18. Logistic regression analysis was used for association of breast cancer susceptibility and G -2548A polymorphism of leptin gene. Results: The A allele frequency was 60% in control group and 72% in breast cancer patients. There was a significant association between A allele in -2548 position of leptin gene and breast cancer susceptibility (OR: 1.8, 95% CI: 1.3-2.4, P<0.001). In the reces-sive effect of the A allele (comparison between AA vs. AG+GG), AA genotype in -2548 region of leptin promoter sequence was significantly increased the risk of breast cancer (OR=2.2, 95% CI: 1.5-3.4, P<0.001). Conclusion: It is concluded that A allele in the -2548 promoter region of leptin gene may act as a recessive allele and increase the breast cancer risk.
Samila Farokhimanesh , Mahdi Forouzandeh Moghadam , Marzieh Ebrahimi ,
Volume 73, Issue 1 (4-2015)
Abstract

Background: Metastasis associated miRNA (metastamiR) opened a new field of anti-metastatic therapy which have a great potential of treatment for the most lethal aspect of cancer, metastasis. The pleiotropic nature of gene regulation exhibited by certain miRNAs that showed that miRNAs might be endowed with a capacity to function as crucial modulators of tumor metastasis. MiR-31 is a pleiotropic anti-metastatic miRNA whose expression decreased significantly in metastatic breast cancer cells. MiR-31 has multiple roles in metastasis cascade. Therefore, using the miR-31-restoration based therapy could be an efficient anti-metastatic strategy for cancer therapy. Methods: This research was performed from May 2014 to October 2015 in Tarbiat Modares University in Tehran, Iran. The double-strand oligo of mature miR-31 was cloned into pcDNA 6.2gw/EmGFP according to the manufacturer instruction. The MDA-MB231, MCF-7 breast cancer cell lines were cultured and their miRNAs have been extracted. The expression of miR-31 has been quantified by Real time-PCR be-fore transfection of construct contained miR-31 into two cell lines and in normal breast cells. Then the constructs contain miR-31 have been transfected in to two cell lines. The expression of miR-31 has been quantified after 48 hours. Scratch and invasion as-say have been carried out for assessing the level of migration and invasion. Results: The result of Real time-PCR before transfection of constructs contained miR-31 have been shown 4 fold and more than 100 fold reduction in expression of miR-31 in MCF-7 and MDA-MB231 respectively in comparison to miR-31 expression in nor-mal breast cells, but after transfection of miR-31 construct to MDA-MB231 the quan-tification of expression showed the significant increase in mir-31 expression and 20 fold reduction in invasive and 10 fold reduction in migratory characteristics of MDA-MB231 in comparison to MCF-7. Conclusion: Metastasis associated miRNA have been represented a promising candi-dates in the field of anti-metastatic therapy and miR-31 as a powerful member of this family can function very effectively in order to inhibit the metastasis and introduce the new possibility of metastasis inhibition.
Fatemeh Ganjzadeh , Reza Shirkoohi ,
Volume 73, Issue 1 (4-2015)
Abstract

Background: Breast cancer is the second most common cancer in the world after lung cancer also is the fifth cause of cancer mortality. About 90 percent of cancer mortality is because of metastasis and devastating between cell attachments, especially tight cell junctions. Epithelial mesenchymal transition is a phenomena involved in metastasis and starts with cell detachment. Occludin is the integral membrane protein which is located in tight junctions. Obviously distressing tight junction, which facilitates the stages of metastasis in cancer cells are very critical step. The aim of this study was to demonstrate the importance of occludin expression and its relationship with invasiveness in human breast cancer. Methods: In a cross sectional study we evaluated 30 patients who were referred to Caner Institute of Imam Khomeini Hospital Complex, Tehran, Iran, from March 2013 to April 2013. Samples were derived from fresh frozen tumor of patients suffering from breast cancer after inform consent assignment in the Tumor Bank of Iran (TBI). RNA was extracted from tumor tissue followed by reverse transcription, polymerase chain reaction (PCR), conventional Real-time PCR and data analysis for the occludin gene expression. Data were analyzed based on clinical staging of breast cancer patients which were cited in data bank of TBI. Results: Results of this study have demonstrated that the occludin gene expression was increased with the advanced stage. In 22 of patients the expression of gene was elevated compared with normal samples. On the other hand, the expression was significantly increased in stage II in comparison with stage I. Conclusion: The expression of occludin has increased by elevation of stage compared with normal tissue. It is suggested that alteration in the expression of this gene might be a possible factor which could affect on patient’s prognosis the same as other factors which are belonging to the same family. Increasing in expression of this gene might be considered as one of the possible markers which predict the possibility of invasion and metastasis.
Hayedeh Haeri , Fatemeh Movarrei , Ghazaleh Shaker ,
Volume 73, Issue 5 (8-2015)
Abstract

Background: Breast cancer is not only considered as the most common cancer in women but also is known as the second cause of death among them. One of the main causes of death in breast cancer patients is metastasis to different organs such as lymph nodes, bones, lung, liver, brain or other parts of the body. Metastasis to genital organs especially uterus is rare and a few cases are reported. Case Presentation: In this report we present a case of invasive ductal breast carcinoma metastasizing to a uterine leiomyoma in a 52 year old woman who was admitted to Imam Khomeini Hospital, Tehran, in September 2013, diagnosed and treated by modified radical mastectomy of the right breast six years ago. Currently, she presented with complaint of persistent abnormal uterine bleeding for which hysterectomy was performed. The histopathologic examination of the uterine specimen revealed a focus in the myometrial wall composed of spindle cell proliferation without signs of atypia which was accompanied by epithelial glandular structures with cells containing hypochromatic nuclei embedded in a desmoplastic stroma. Considering the history of invasive ductal breast carcinoma in this patient, the diagnosis of stromal nodule or metastasis from a breast origin was suggested as the main differential diagnosis. The Immunohistochemical study performed with different markers showed positivity for GCDFP15 staining confirming metastasis from the breast carcinoma. Conclusion: Although metastasis of breast cancer to the genital organs is an uncommon event, breast carcinoma is still considered the second source of extragenital malignant metastasis to the uterus. Overall, the most popular sites for metastasis of breast carcinoma to the female reproductive system include the ovaries and the uterine cervix. The uterine corpus is the least common site involved. In this regard metastasis to a uterine leiomyoma is a rare event.
Tayebeh Bagheri , Elham Moslemi ,
Volume 73, Issue 6 (9-2015)
Abstract

Background: Breast cancer is the most common non- skin cancer among women and it’s the second leading cause of cancer related death in women. Ubiquitin and ubiquitin like proteins are member of signal transduction pathways which have several cellular functions. It has shown that Ubiquitin like protein D (UBD) has accelerated the cancer progress. The aims of this study is evaluation of UBD gene expression in women suffering from breast cancer and its correlation with disease progression. Methods: In this study 30 FFPE (Formalin-fixed, paraffin-embedded) samples 20 cases from breast cancer and 10 cases from mammoplasty were collected from Parsian and Kasra Hospitals in Tehran after confirmation by pathologist. For each sample collection characters included ER-positive, lymph node negative, tumor size less than 5 cm in diameter were considered. Samples belonged to May 2010 up to April 2012. At first paraffin was removed by adding xylene then xylene removed with replacing ethanol 98%. After removing ethanol, RNA was extracted from samples by using RNX plus solution and cDNA synthesis were performed by using Moloney murine leukemia virus (M-MuLV) enzyme. UBD gene expression were examined in all samples cDNA by relative Real Time PCR. In this study GAPDH gene expression was also used as internal control. Results: UBD gene expression was obtained by calculating ΔΔCT and RQ. The average incensement of UBD gene expression in comparison of normal samples was 11 times. The results have shown that the level of UBD expression was related to the development and extend of the disease. In patients with stage 1 of disease, UBD gene expression had 2.73 times increase (P=0.001) compared to the control samples. However in stage 4 of disease, this number has increased up to 19.4 times (P=0.0005) more than normal. Conclusion: Considering the results of this study, it could be said that UBD gene expression as useful biomarker has an important role in detection of breast cancer. In addition as UBD gene expression levels increased stages of disease increased too. So that evaluation of UBD gene expression can be useful in early detection of disease.
Saba Garshasbi , Dariush Salimi , Abbas Doosti ,
Volume 73, Issue 7 (10-2015)
Abstract

Background: Cancer and obesity are two major public health concerns. More than 12 million cases of cancer are reported annually. Many reports confirmed obesity as a risk factor for cancer. The molecular relationship between obesity and breast cancer has not been clear yet. The purpose of this study was to investigate priorities of effective genes in the molecular relationship between obesity and breast cancer. Methods: In this study, computer simulation method was used for prioritizing the genes that involved in the molecular links between obesity and breast cancer in laboratory of systems biology and bioinformatics (LBB), Tehran University, Tehran, Iran, from March to July 2014. In this study, ENDEAVOUR software was used for prioritizing the genes and integrating multiple data sources was used for data analysis. Training genes were selected from effective genes in obesity and/or breast cancer. Two groups of candidate genes were selected. The first group was included the existential genes in 5 common region chromosomes (between obesity and breast cancer) and the second group was included the results of genes microarray data analysis of research Creighton, et al (In 2012 on patients with breast cancer). The microarray data were analyzed with GER2 software (R online software on GEO website). Finally, both training and candidate genes were entered in ENDEAVOUR software package. Results: The candidate genes were prioritized to four style and five genes in ten of the first priorities were repeated twice. In other word, the outcome of prioritizing of 72 genes (Product of microarray data analysis) and genes of 5 common chromosome regions (Between obesity and breast cancer) showed, 5 genes (TNFRSF10B, F2, IGFALS, NTRK3 and HSP90B1) were the priorities in the molecular connection between obesity and breast cancer. Conclusion: There are some common genes between breast cancer and obesity. So, molecular relationship is confirmed. In this study the possible effect of gene F2 polymorphism in making breast cancer associated with obesity risk factor was confirmed, the fact that past studies have not been reported.


Sanambar Sadighi, Hosein Kamranzadeh, Easa Jahanzad , Saghi Vaziri ,
Volume 73, Issue 8 (11-2015)
Abstract

Background: Breast cancer is the most common cancer in women around the world. It has been known for over a century that androgens and androgen receptor (AR) play a role in normal and neoplastic breast cells. The aim of this study was to determined the AR expression on tumor cells and its correlation with other prognostic and predictive factors as well as contribution of AR in patients overall survival (OS) and disease- free survival (DFS). Methods: This retrospective cross-sectional study performed on 189 patients who referred to Medical Oncology Ward of Cancer Institute, Tehran University of Medical Sciences, from April 2007 to February 2010. We performed an immunohistochemistry study for AR (AR441 clone, Dako, Germany) (10% cut-off point) and Ki-67 MIB-1 clone, Dako, Germany) on paraffin embedded blocks. Other data were extracted from patients’ documents. Results: Overall, AR expression was 49.1%. Mean age of the patients with and without AR was 47.86 and 48.49 years, respectively. AR positive tumors presented more in stage I/II than III/IV (P=0.02) and AR were more positive for estrogen receptor positive, lower grade of tumor (grade I/II versus III) and lower Ki-67 (P=0.01). AR positivity had neither correlation with progesterone receptor, HER2/neu, P53 expression or menopausal status. OS and DFS were higher in AR positive patients but did not reach statistical significance. In triple-negative breast cancer (TNBC) group, 25% of tumors showed AR expression. AR had non-significant positive correlation with OS in TNBC cancer patients. OS and DFS had significant statistic positive correlation with ER, PR and stage regardless of AR status. Conclusion: Based on this study, although androgen receptor expression showed correlation with other prognostic factors for survival in patients, we didn’t find statistically significant independent relationship between AR and overall survival in patients. As far as there isn’t any targeted therapy for triple-negative breast cancer (TNBC), prospective basic and clinical studies regarding AR inhibitors in the treatment of TNBC seems to be logical and valuable.


Amir Tajbakhsh, Fahimeh Afzal Javan , Mostafa Fazeli, Mahdi Rivandi, Mohammad Mahdi Kushyar, Mohammadreza Nassiri, Alireza Pasdar,
Volume 75, Issue 5 (8-2017)
Abstract

Breast carcinoma is the most common cause of cancer mortality among women globally. Primary and secondary prevention through avoiding known risk factors, screening for early detection of tumors with different methods as well as timely treatment, can be effective in reduction of the burden of this devastating disease. This can in turn prevent death and also increase survival in patients with breast cancer. Both environmental and genetic factors are involved in the pathogenesis of breast cancer. Multiple genetic factors can influence the risk and development of breast cancer. Identification of genetic variants including single nucleotide polymorphisms (SNPs), which are associated with the risk of breast cancer development, are mostly done through genetic association studies. It is demonstrated that SNP allele frequencies vary amongst different populations. It has been shown that genetic risk factors like variations in TOX high mobility group box family member 3 (TOX3), which affect the liability for neoplasm, play an important role in the development of breast cancer. Although TOX3 is expressed mainly in the brain, its expression in other tissues especially breast has also been reported. TOX3 maps to chromosome 16q12 and encodes the nuclear high-mobility group (HMG)-box. It has calcium (Ca2+)-dependent transcriptional activities and is a co-factor of cAMP response element (CRE)-binding protein (CREB) and CREB-binding protein (CBP). TOX3, activated with Ca2+, is related with activation of the promoter of some other genes including BCL2 and C3 complement and also CITED1 gene expression. It also induces activation of the c-fos promoter and therefore its expression. Genome-wide association studies (GWAS) in different populations including European, Asian and African-American have demonstrated that a SNP near its 5ʹ end and the promoter of TOX3 gene appears to be significantly associated with breast cancer susceptibility. Furthermore, breast cancer–associated SNPs lead to enhanced FOXA1 bindings and in turn, a reduction in TOX3 gene expression. This review has highlighted the importance of TOX3 function, SNPs and its association with breast cancer risk and also its potential effects on breast cancer treatment; TOX3 plays dual and somehow conflicting roles in cancer initiation and progression which remains to be further investigated.

Soudabeh Shahid Sales , Malihe Hasanzadeh , Seyyedeh Sania Saggade , Seyed Amir Al Davoud ,
Volume 75, Issue 5 (8-2017)
Abstract

Background: Breast cancer is the most common cancer in women and can have several profound effects on women’s life. Estrogen and androgens reduction cause sexual problems. Reduction of hormones produce problems such as vaginal dryness, vaginal and vulvar tissue thinning, loss of elasticity of the vagina, hot flashes and other problems. Depression in these patients is also a factor in reducing sexuality. Disruption at any sexual stage can cause sexual problems. In this article; we compare sexual dysfunction in patients with breast cancer and healthy people.
Methods: According to the women’s case-control study with simple un-randomized sampling method a total of 245 patients with breast cancer in Ghaem and Emam Reza and Omid hospital from july 2011 to july 2013 entered the study. All patients were on follow-up after therapy, and had a therapy portfolio. In order to achieve better results, questionnaires were distributed among 126 healthy subjects that matched our patient group in terms of age and other factors and were used as the control group. Female sexual function index (FSFI) questionnaire was filled out by an independent interviewer and all medical, personal and social ethics were applied. The data was then gathered and the score were analyzed with statistical tests.
Results: The study was performed on patients 20 to 50 years, mainly in patients aged 35 to 45 years (51.8%). The average age was 41.44±5.87 years. In our study, the most dysfunction was in sexual desire (57.6%), vaginal moisture (53.1%), sexual excitement (48.2%), orgasm (44.1%), and dyspareunia (52.2%) in breast cancer patients. There was significant difference between two group (P<0.001).There is no difference about sexual satisfaction between two groups (P=0.262).
Conclusion: Sexual dysfunction is common in breast cancer patients compared to healthy women. Dysfunction in orgasm, dyspareunia, reducing vaginal moisture and sexual desire were common in the breast cancer patient. The results of this study should be used to inform patients and physician about sexual problems.

Masumeh Gity , Ali Borhani , Mehrdad Mokri , Majid Shakiba , Morteza Atri , Nasim Batavani ,
Volume 76, Issue 8 (11-2018)
Abstract

Background: Estrogen-negative breast cancers have different clinical course, prognostic features and treatment response in comparison to estrogen receptor-positive (ER-positive) breast cancers. Human epidermal growth factor receptor 2 (HER2) oncoprotein has found to have a pivotal role in natural cell growth and cell division and is suggested to be directly related to tumor invasiveness in breast cancer patients. The purpose of this study was to retrospectively assess the mammography, ultrasound, and magnetic resonance imaging (MRI) features of estrogen negative breast cancers with and without overexpression of HER2/neu receptor.
Methods: In this cross-sectional retrospective study, mammographic, ultrasound and MRI features as well as HER2 status were assessed in patients with ER-negative breast cancer that were referred to Cancer Institute of Imam Khomeini Hospital Complex in Tehran from October 2015 to October 2017. Clinicopathologic data and mammography, ultrasound, and MRI features were reviewed and were correlated with HER2 status of estrogen-negative tumors.
Results: Of the 172 patients with ER-negative breast cancer, 101 patients were positive for HER2/neu receptor (58.8%). There was a significant correlation between HER2-positivity and tumor type (P=0.004). Among estrogen negative breast cancers, significant association were found between HER2 and tumor histologic grade (P=0.024) and TNM stage (P=0.021). HER2-positive tumors were more likely to present with microcalcification (P=0.007) and have irregular shapes (P=0.034) in mammography than HER2-negative tumors. No association was found between HER-2 status and tumor size, shape, margin, posterior feature, halo or orientation of the tumor in ultrasound. We also found no correlation between HER2 status and MRI features including mass shape or margin, internal enhancement pattern or curve type among estrogen-negative breast cancers.
Conclusion: Findings of this study showed that among estrogen-negative breast cancers, HER2/neu positive tumors are more likely to be diagnosed at higher stage and have higher histologic grade at the time of diagnosis. Tumor mass shape and microcalcification in mammography are found to be associated with HER2 status among patients with estrogen-negative breast cancer. 

Milad Pezeshki , Jamshid Ansari ,
Volume 76, Issue 10 (1-2019)
Abstract

Background: Breast cancer is one of the most common worldwide malignancies among women. Biological data suggest that damage induced by endogenous and exogenous factors affects the integrity of DNA and associated with susceptibility to breast cancer. Single nucleotide polymorphisms (SNPs) in DNA repair genes can associated with differences in the repair efficiency of DNA damage and may affect breast cancer. The XRCC3 protein participates in DNA double-strand breaks and recombinational repair, in other words the product of XRCC3 gene, plays a key role in homologous recombination repair of DNA double-strand breaks. The polymorphism of FokI plays critical roles in breast cancer development. The aim of the present study was to evaluate associations between the risk of breast cancer and FokI polymorphism in the XRCC3 gene.
Methods: This case-control study was carried out on the women with breast cancer and healthy women located in Markazi province at Arak University Research, Iran, from October 2016 to March 2017. In the present study, the association of FokI polymorphisms and the risk of breast cancer was assessed by Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) techniques. In this method, genomic DNA was extracted from blood samples using the kit procedure. Then, PCR was performed and the SNP-containing DNA amplicons were subjected to digestion of enzymes. Following digestion, each sample was immediately analyzed by 3% agarose gel electrophoresis. Statistical analysis was done using SPSS and SNP Analyzer softwares and the final results were determined.
Results: No statistically significant difference was observed between the two groups of patients and controls for three genotypes the site rs1799794 (P=0.435). Genotype AG (P=0.384, OR=0.614, CI=95%, 0.205-1.840) and GG (P=0.867, OR=0.911, CI=95%; 0.308-2.699) had no significant associations with risk of breast cancer.
Conclusion: There was no significant association between FokI polymorphisms of the XRCC3 and risk of susceptibility to breast cancer, which was in accordance to some researchers. FokI polymorphisms of XRCC3 gene cannot be used as a biomarker in clinical predictive studies in relation to risk of breast cancer.

Masoumeh Gity , Behnaz Moradi, Rasool Arami , Ali Arabkheradmand, Mohamad Ali Kazemi,
Volume 77, Issue 1 (4-2019)
Abstract

Background: Diffusion-weighted imaging (DWI) is one of methods in evaluation of breast lesions. We aimed to investigate the apparent diffusion coefficient (ADC) values in breast tumors and their accuracy in differentiating benign versus malignant lesions.
Methods: In this cross-sectional study, 72 patients with 88 breast lesions were investigated by 1.5-T breast MRI from 2015 to 2017 in Athari Imaging Center in Tehran, Iran. Nearly all patients has undergone histopathology evaluation. One small region of interest (ROI) were placed on the most restricted region inside the solid part on the ADC map. Care was taken to avoid cystic or necrotic, fatty regions and hematoma inside the mass. A large round ROIs were placed in healthy fibroglandular tissue of contralateral breast ADC values were measured and compared in normal breast tissue and in most restricted parts of breast lesions (mass and non-mass). After determining cut-off for differentiation of benign and malignant lesions, sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated.
Results: Mean age of patients was 43.3 years. The average tumor size of benign and malignant lesions were calculated 26.0 mm, 35.3 mm respectively and 23 mm and 46 mm in mass and non-mass respectively. Invasive ductal carcinoma include the majority of pathology result (in 37.5% of the patients). Our results revealed that the measured ADC values in normal breast tissue were higher than breast lesions (P≤0.01). Mean ADC value in benign lesions was 1.40×10-3 mm²/s and for malignant lesion was 1.08×10-3 mm²/s. ADC value in the normal breast tissue was 1.79×10-3 mm2/s and was significantly higher than ADC value of breast lesions (benign and malignant). Cut-off value in non-mass was not valid, but in mass was 1.19×10-3 mm²/s with sensitivity, specificity, positive predictive value, negative predictive and accuracy of 89.7%, 83.8%, 87.5%, 86.6%, and 87.1% respectively.
Conclusion: In DWI imaging, ADC value can differentiate benign and malignant masses with high sensitivity and specificity but not helpful in non-mass lesions.

Shahrbanoo Keihanian , Nafiseh Koochaki , Majid Pouya , Maryam Zakerihamidi ,
Volume 77, Issue 8 (11-2019)
Abstract

Background: Breast cancer is the most commonly diagnosed and the leading cause of cancer death among females worldwide. The rate of breast cancer incidence among Iranian women is 17% of all cancers, it has been ranked first in Iran. This study aimed to investigate the factors affecting axillary lymph node involvement in female patients with breast cancer.
Methods: A cross-sectional study was conducted on 167 patients with breast cancer diagnosed between March 2012 and March 2015 at Shahid Beheshti of Babol, Shahid Rajaei of Tonekabon and Imam Sajad of Ramsar hospitals. A researcher-made questionnaire was used to collect information on the patients and pathology report of tumor and lymph nodes was completed.
Results: The rate of axillary lymph node involvement was observed in 117 patients (70.1%). Mean age was 49.64±11.62 years in the patients with breast cancer. The highest frequency of lymph node involvement was observed in the 40-49 age group (24%). The average size of tumor was 3.39 cm and the majority of patients had a tumor 2-5 cm (T2) but the most involvement was related to T3 (>5cm). The most common type of cancer and grading were invasive ductal carcinoma (93.4%) and tumor grade 2 (52.1%), respectively. Most lymph node involvement was observed in invasive ductal carcinoma and 85.1% of patients had tumor degree 3. 22.2% of patients with vessels involvement had axillary lymph node involvement. 63% of patients’ tumors had receptors of estrogen and progesterone. A statistically significant association was observed between axillary lymph node involvement and tumor size (P=0.031), tumor type (P=0.007), tumor grade (P=0.011), estrogen receptor (P=0.008) and progesterone receptor (P=0.038).
Conclusion: There was a statistically significant association between axillary lymph node involvement and tumor size, type and grade, estrogen and progesterone receptor status, but there was no statistically significant association between axillary lymph node involvement and age and estrogen as well as progesterone receptor status.


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