ISSN:8756-0437    

DOI:10.1002/ssu.2980070502

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractSince its early clinical use during the 1960s, mammography has become a widely accepted screening method for breast cancer. Its utilization may be capable of diminishing mortality by 40%. Screening programs have been instituted, and their cost effectiveness depends on the locale and age of the population screened. Mass screening has resulted in large numbers of nonpalpable lesions being biopsied. Needle localization techniques allow for these to be performed with a minimal chance of missing the lesion, while removing only a small volume of breast tissue. Although most lesions biopsied will be benign, 20–30% of those excised at any institution should be malignant. Consultation with experienced mammographers may be desirable when recommending mammography‐based biopsy. The rate of detection of malignancy is higher in women who have a prior history of ipsilateral or contralateral breast can

ISSN:8756-0437    

DOI:10.1002/ssu.2980070503

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThere is an increasing need for needle localization biopsies. Cancers so detected are usually at an earlier stage and should result in an increased cure rate. The surgeon involved in these procedures should, of necessity, be proficient in evaluating mammographic abnormalities, since there is considerable variation in the way they are reported by various radiologists. Localization can be accomplished with various hooked wires or dye, but accuracy of placement is more important than the method used and this point is well understood by cooperative radiologists. Since 70–80% of these lesions will be benign, cosmesis should be kept in mind. Incisions should be placed centrally, if possible, and the volume excised should be minimal and not lead to deformity. When poorly localized, excision of these lesions can be a trying experience for the experienced surgeo

ISSN:8756-0437    

DOI:10.1002/ssu.2980070504

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractEffective pathological examination of breast specimens from patients with nonpalpable radiologically detected lesions requires close cooperation among the pathologist, surgeon, and radiologist. Whenever possible, excision of the lesion should be documented by specimen radiography of the intact excisional biopsy. Diagnosis of the lesion and evaluation of margins should be based on permanent paraffin sections. Frozen section examination is not recommended routinely but may be employed in exceptional circumstances. Thermal damage to the tissue caused by electrocautery scalpels can reduce hormone receptor levels and can interfere with histological diagnosis.

ISSN:8756-0437    

DOI:10.1002/ssu.2980070505

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractWhile breast cancer is affecting American women at an epidemic rate, certain patients are identified as being at particularly high risk because of environmental, endocrine, genetic, and pathologic risk factors. Risk assessment, dietary, and psychological counseling, as well as breast cancer screening, are the function of a high‐risk breast cancer program. Our own program is discusse

ISSN:8756-0437    

DOI:10.1002/ssu.2980070506

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractDuctal carcinoma in situ (DCIS) is increasing in frequency, primarily because of the increasing use of routine screening mammography. The management of DCIS has become one of the more controversial aspects in the treatment of breast cancer. Although total mastectomy provides local control and long‐term survival approaching 100%, the move to breast conservation with early invasive breast cancer has forced a re‐evaluation of the treatment of in situ breast cancer. Recent advances in the evaluation and subclassification of DCIS according to histologic subgroupings and sizings have provided valuable insight into the biology of the disease. These biologic parameters may help to identify those lesions amenable to breast conservation. In properly selected patients, breast conservation affords a 1%/year local failure rate, with approximately one‐half of the recurrences being inv

ISSN:8756-0437    

DOI:10.1002/ssu.2980070507

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractAdequate local‐regional treatment of patients with primary operable breast cancer involves controlling multicentric disease in the breast, and axillary dissection to stage the disease and control it in the axilla, when present. Two options, showing equal survival rates in prospective, randomized studies, are breast preservation and mastectomy. In breast preservation, adequate tumor excision with clear histologic margins and axillary dissection is followed by breast irradiation. The mastectomy option involves no radiation therapy and can be followed by reconstruction. Careful selection of patients and detailed description of the pros and cons of each approach should be undertaken on an individual basi

ISSN:8756-0437    

DOI:10.1002/ssu.2980070508

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractRadiation has played a continuous but changing role in the management of breast cancer. At Memorial Hospital, the past 10 years have seen a marked increase in breast conserving therapy, and changing indications for postmastectomy adjuvant radiation.

ISSN:8756-0437    

DOI:10.1002/ssu.2980070509

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractSytemic therapy (chemotherapy or hormonal therapy) as an adjuvant to modalities of local control is now an integral part of the management of almost all patients with primary brest cancer metastatic to axillary lymph nodes. In addition, recent data suggest an expanding role for such treatments in patients without axillary involvement. Although some node‐negative patients should probably not receive adjuvant therapy, the precise criteria to be used for selection are still under active discussion in the literature. Of the two types of systemic treatment, it is generally accepted that chemotherapy is indicated for premenopausal patients and that tamoxifen is useful for postmenopausal patients whose tumors contain estrogen or progesterone receptors. The recent analysis of several studies has suggested that chemotherapy may add to the benefits of tamoxifen in some postmenopausal patients as well. A possible role for tamoxifen in younger patients is beign evaluated. For patients at relatively low risk of systemic relapse (i.e., those with zero to three involved axillary lymph nodes), no chemotherapy regimen has yet shown an advantage over 6 months of cyclophosphamide, methotrexate and 5‐fluorouracil. For patients at high risk, however, doxorubicin‐based regimens have demonstrated benefits. Highdose chemotherapies, some involving autologous bone marrow support, are being investigated for patients with ten or more involved nodes who are at very high risk of the eventual development of stage IV dea

ISSN:8756-0437    

DOI:10.1002/ssu.2980070510

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractLocal‐regional relapse after breast‐conserving surgery and radiation therapy is operable and not associated with concurrent distant metastases in most cases. Salvage mastectomy results in local‐regional control for most patients. The extent of the surgery relates to the extent of the local‐regional recurrence and does not carry an increased complication rate. The outcome of salvage mastectomy depends on the disease‐free interval from initial breast‐conserving surgery and radiation therapy to local‐regional recurrence. Additional factors, such as the extent and histologic type of the recurrence, as well as the axillary lymph node status, either at the time of initial breast conservation or at salvage mastectomy, may influence outcome and require further studyProspective trials are required to determine the safety of further breast‐conserving surgery after local‐regional relapse and the role of systemic therapy in improving pos

ISSN:8756-0437    

DOI:10.1002/ssu.2980070511

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY