ISSN:1075-122X    

DOI:10.1111/j.1524-4741.1995.tb00221.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:A clinically relevant classification and understanding of the biology of ductal carcinoma in situ (DCIS) is mandated by the increasing numbers of mammographically detected lesions of limited size being considered for breast‐conserving therapy. DCIS is a morphologically and biologically diverse assemblage of lesions that are conventionally classified in an arbitrary and largely descriptive manner based on architectural features. Several classifications of DCIS based on nuclear grade and necrosis have been shown to stratify DCIS into subtypes associated with vastly different risks of local recurrence and invasive transformation. Breast‐conserving therapy for DCIS is dependent on adequate surgical excision, even more so than for invasive breast carcinomas, but the surgical procedure itself is made difficult by the limited ability to define the pathologic extent of the lesion on the basis of mammographic microcalcification, the vagaries of the localization procedure, and the multifocal nature of some DCIS subtypes. Proper tissue processing and interpretation, particularly with regard to the presence of or misinterpretation of microinvasion, all affect the success of breast‐conserving therapy.Irradiation would appear to have no role in the treatment of low grade DCIS that is adequately excised. The benefits of irradiation appear to be limited to high grade DCIS but the benefit diminishes with increasing follow‐up. Irradiation is not considered likely to affect local control for patients with significant residual disease who undergo breast‐conservin

ISSN:1075-122X    

DOI:10.1111/j.1524-4741.1995.tb00222.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:Irradiation is accepted as standard treatment following an excisional biopsy for stages I and II breast cancer and its equivalence to mastectomy has been demonstrated by a number of prospective randomized trials. However, the role of treatment directed to less than the entire breast for small invasive cancers has been questioned. This review has identified elderly women with primary tumors less than 2 cm and low histologic grade without an extensive intraductal component or lymphatic or vascular invasion, negative axillary nodes, and negative margins of resection as having a 15–20% risk of residual microscopic disease following an excision with a 2–3 cm margin of normal tissue. Breast recurrence rates in these patients range from 10–20% with conservative surgery alone and 5–10% with conservative surgery and irradiation This improvement in local control with irradiation has the potential for a 2–3% survival benefit. Therefore, even in this carefully selected group of patients irradiation decreases the risk of a breast recurrence. The role of wide excision and tamoxifen requires further inve

ISSN:1075-122X    

DOI:10.1111/j.1524-4741.1995.tb00223.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:Breast‐conserving surgery is the preferred operation for the majority of women with stage I or II breast cancer. It consists of the removal of primary breast cancer with a rim of adjacent normal tissues and the axillary dissection. The goal of breast‐conserving surgery is to control the local‐regional disease without removing the entire breast and to provide an accurate pathologic staging of the tumor (T) and draining nodes (N). The primary outcomes of breast‐conserving surgery in treating women with invasive breast cancer are measured by the survival rate, local disease control and cosmetic results. The consideration of the factors that have major impacts on the outcomes of this form of treatment are discussed. This article provides a framework for considering and performing breast‐conserving surgery and for critically evaluating the literature dealing with the various issues involved in the treatment of women with early brea

ISSN:1075-122X    

DOI:10.1111/j.1524-4741.1995.tb00224.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:Tumor response to preoperative chemotherapy varies from complete to partial to none. To evaluate pathologic predictors of tumor response to preoperative chemotherapy, we reviewed 287 cases of locally advanced breast carcinoma treated with chemotherapy prior to definitive surgery. The patients ranged in age from 18 to 79 years (mean, 48 years). There were 77 (26.8%) patients with stage II disease, 194 (67.6%) with stage III disease, and 16 (5.6%) with stage IV disease. Following the initial diagnosis of invasive carcinoma (by fine‐needle aspirate or cutting needle biopsy), the patients received three to four cycles of both doxorubicin‐based and cyclophosphamide‐based regimens followed by mastectomy or lumpectomy with axillary dissection. The pathologic parameters that were evaluated included stage, clinical tumor size, and tumor nuclear grade (NG). The latter was performed on fine‐needle aspirates using Black's nuclear grading system wherein NG1 was considered well differentiated; NG2, moderately differentiated; and NG3, poorly differentiated. Based on pathologic examination of the resected specimens, tumor responses were categorized into complete response, partial response, no response, or progressive disease. The overall response rate was 71% (12% complete and 59% partial responses). In univariate analyses, tumor size and nuclear grade were significantly related to pathologic tumor response to chemotherapy (p = 0.04 and p = 0.0003, respectively), while disease stage was not (p = 0.17). In multivariate analyses, size remained significant even when NG was present in the equation (p = 0.013). Similarly, when size was included, NG remained significant (p = 0.002). NG3 tumors showed better response than NG2 or NG1 tumors did. While 19.3% of NG3 tumors showed complete response, none of the NG1 tumors completely responded to chemotherapy. Initial tumor size was inversely proportional to degree of tumor response. Our findings indicate that tumor clinical size and nuclear grade are important independent predictors of response to preoperative chemotherapy and that poorly differentiated tumors and small tumors showed the most r

ISSN:1075-122X    

DOI:10.1111/j.1524-4741.1995.tb00225.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:Thirty percent of lymph node‐negative women with primary breast cancers are at high risk for early recurrence of metastatic disease and diminished survival. Identification of these high‐risk patients is a long‐term objective of our laboatory, and the epidermal growth factor receptor (EGFR) was investigated as a prognostic factor, EGFR was measured by a ligand binding assay developed in house, in the competition mode that served as the “gold standard” for assessing receptor content and activity. In contrast, measurements of mass (content) were performed by an enzyme immunoassay (EIA) from Ciba Corning Diagnostics (Alameda, CA) and by an enzyme‐linked immunosorbent assay (ELISA) from Oncogene Science (Uniondale, NY). A total of 78 breast carcinomas were examined. The median binding capacity measured with [125I]EGF was 13 fmol/mg membrane protein (range 0–981), that measured by EIA was 8 fmol/mg (range 1–125), while EGFR measured by ELISA was 135 (range 0–751). Distribution of EGFR did not appear to vary as a function of patient age. Neither the results from EIA nor those from ELISA correlated with those obtained by the ligand binding assay. However, there was a good correlation of results obtained by the two antibody‐based assays despite the fact that the calibration of standards was considerably different. These data suggest that EGFR should be measured by ligand binding assay for clinical studies; mass assays based on antibody reagents will require

ISSN:1075-122X    

DOI:10.1111/j.1524-4741.1995.tb00226.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:Patients with estrogen receptor positive breast carcinoma occasionally develop cutaneous recurrences that apparently do not contain receptors when analyzed by the dextran coated charcoal method. Since these nodules may contain only a few tumor cells, we wondered if such negative results were accurate. Our study group consisted of 19 pairs of specimens, each pair comprising a cutaneous nodule and the primary tumor from which it arose. Estrogen receptor determinations using the dextran coated charcoal method had been performed on each cutaneous specimen, and we repeated these determinations using an immunohistochemical method. We then compared the data derived from the cutaneous specimens with the estrogen receptor status of the corresponding primary tumors. The dextran coated charcoal method failed to detect receptors in about 70% of the recurrences that arose from receptor positive tumors (10 of 14 cases). The immunohistochemical staining, on the other hand, detected estrogen receptor protein in all 14 of these cutaneous nodules. In six cases, the small number of tumor cells in the cutaneous specimens could explain the discrepancy between the results of the immunohistochemical staining and the hormone binding assay. Administration of tamoxifen probably accounts for the divergent results in one other case. In the final three cases, the discrepancies remain unexplained. We conclude that cutaneous recurrences of breast carcinoma display estrogen receptors about as frequently as do primary tumors, but that the dextran coated charcoal assay may not detect the receptors in some cutaneous specimens. Physicians should bear these observations in mind when they encounter a case in which an estrogen receptor positive tumor has apparently given rise to a receptor negative cutaneous recurrence. Immunohistochemical staining of the nodule might reveal the receptors in such a case.

ISSN:1075-122X    

DOI:10.1111/j.1524-4741.1995.tb00227.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:The purpose of this study was to assess the efficacy of mammography of breast cancer in women less than 30 years old. A retrospective record review revealed 47 breast cancers in 45 women age 29 and younger who had preoperative mammography. Patients ranged in age from 22 to 29 years (mean = 27 years). All presented with clinically evident disease. Mammography revealed focal abnormality in 26 (55.3%) of 47 cases. Specific positive mammographic findings (n = 22) included uncalcified mass in ten (45.5%), calcification without mass in nine (40.9%), mass and calcifications in two (9.1%), and skin ulceration in one. Mammographic parenchymal density (n= 21) was P2 in 9 (42.9%) and DY in 12 (57.1%). The mean time interval from symptom onset to biopsy was 4.5 months, but was shorter if the mammogram was positive. High parenchymal density contributes to the diminished sensitivity of mammography in women under age 30. A positive mammogram may hasten the diagnosis of carcinoma in a young woman with palpable malignant breast disease.

ISSN:1075-122X    

DOI:10.1111/j.1524-4741.1995.tb00228.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1075-122X    

DOI:10.1111/j.1524-4741.1995.tb00229.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1075-122X    

DOI:10.1111/j.1524-4741.1995.tb00230.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY