ISSN:8756-0437    

DOI:10.1002/ssu.2980050202

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractSince 1970 fine‐needle aspiration cytology for breast tumours has grown in popularity and is now routinely used in the initial diagnosis of palpable breast masses in the United States and other parts of the world. Fast staining methods of the aspirate enables reporting within 10 minutes of the aspirate being performed. Training and experience is important in obtaining satisfactory smears for diagnosis, and pitfalls are false‐negative and false‐positive findings, which may have dire consequences for the patient if cytological diagnosis is the final arbiter. Conditions such as benign mammary dysplasia and sclerosing adenosis are the most common sources of highly cellular smears and often show marked atypia, which makes distinction from carcinoma difficult. Also, atypical papillary formations present a diagnostic problem, and biopsy is indicated to exclude a papillary carcinoma. Fine‐needle aspirations very seldom cause traumatic complications, and these are usually of a minor degree. Seeding along the needle track has occurred, but in most cases with a larger‐caliber (18 s.e.g.) needle. Aspiration itself has been shown to have no effect on the survival rates in breast carcinoma. Contemporary reports show that around 90% of cases of breast cancer can be detected with confidence by means of this procedure. The reduction in scar formation facilitates future evaluation of the patient as scar tissue often interferes with the interpretation of mammograms. Cost effectiveness is evident in terms of decreased use of anaesthetics and operating time and a reduction in the use of frozen section histology by about 80%. Evidence from the literature and firsthand experience for over 10 years commend the technique to both clinicians and pathologists for its simplicity and usefulness in their own practices, preferably in collaboration with each other and with awareness of the potential pitfalls described. Tissue‐obtaining techniques, such as open biopsy with frozen section, and tissue‐obtaining needle techniques are described. The disadvantages of drill biopsy outweigh its advantages, and the technique is not widely used. Trademarked cutting needle biopsy techniques have been developed, and their efficacy is discussed

ISSN:8756-0437    

DOI:10.1002/ssu.2980050203

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractIn the diagnosis of clinically inapparent breast cancer, mammography remains the most effective imaging modality, which is due in large part to its ability to detect microcalcifications. Of the ancillary modalities, sonography is the most useful because it readily differentiates cysts from other breast lesions. Internal mammary and axillary node imaging have been tried with varying levels of success, but false‐positive and false‐negative rates remain high with available techniques. Pulmonary metastases are best evaluated by chest X‐ray with specificity increased by other imaging techniques. Liver and bone metastases may be screened for with isotope scans with computerized tomography, sonography, and magnetic resonance imaging, increasing the specificity of abnormal scans. CT and MRI are the most effective tools for evaluating CNS di

ISSN:8756-0437    

DOI:10.1002/ssu.2980050204

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractThe results to date are convincing enough to justify recommending large scale mammography screening. The International Union Against Cancer (UICC) Workshop on screening for breast cancer in 1986 concluded that “In countries where breast cancer is common and where the necessary resources are available, screening using mammography alone or mammography plus physical examination is applicable as public health policy.” The Swedish government has recommended screening with mammography for all women aged 40–74. This recommendation repeatedly emphasizes the necessity of high‐quality examinations interpreted by well‐trained radiologists. Screening with mammography is bringing breast cancer patients to therapy at a far earlier stage in the development of the disease. This calls for a re‐evaluation of therapeu

ISSN:8756-0437    

DOI:10.1002/ssu.2980050205

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractThere are several independent but interrelated prognostic factors predictive of recurrence and survival in breast cancer. These include axillary nodal status, histopathology, steroid receptors, proliferative rate, ploidy, and oncogene amplification. Axillary nodal status has been the traditional mainstay predictor for recurrence and survival in primary breast cancer. In addition, the presence of the estrogen and progesterone receptors has correlated with longer disease‐free interval and overall survival in stage I and II breast cancer. Thymidine‐labeling index and percent S‐phase as measured by flow cytometry are indices of cell proliferation that correlate with relapse rate in pre‐ and postmenopausal women with breast cancer. Estrogen and progesterone receptor‐negative tumors are more commonly aneuploid, and have higher percent S‐phase, factors that predict for recurrence in Stage I br

ISSN:8756-0437    

DOI:10.1002/ssu.2980050206

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractHormone Receptorconcept provides better prediction of hormone dependency ofbreast cancertherefore proper selection of therapy. The fate of receptors following hormonal manipulation is not clearly understood. It is suggested that in a hormone‐dependent breast cancer, the cessation of response to one form of hormonal therapy is not an indication of emergence of hormone independence of the cancer. Contrary to the present belief, the author suggests that the hormone‐dependent tumors retain their biological and biochemical characteristics in the recurrent tumor and therefore will respond to other forms of endocrine therapy. The presence ofExtraglandular synthesisofestrogenis considered as a major reason for the relapse of a regressing breast cancer following endocrine manipulation. A hypothesis is advanced for test in a clinical tr

ISSN:8756-0437    

DOI:10.1002/ssu.2980050207

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractAxillary lymph node status remains the single most useful prognostic parameter in breast cancer patients. As clinical examination, imaging techniques, and lymph node sampling methods cannot accurately assess the axillary node involvement, a complete axillary dissection should always be performed. Moreover, this technique provides an excellent treatment modality for regional disease, abolishing the need for radiotherapy to the axilla. The status of the internal mammary lymph nodes is of less importance in the management of the breast cancer patient.

ISSN:8756-0437    

DOI:10.1002/ssu.2980050208

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractAxillary metastasis in breast cancer is a time‐dependent phenomenon that varies greatly from tumour to tumour. It is discussed in relation to tumour diameter and the growth rate of the tumour cells. It parallels the former but is not directly related to either. A tumour age coefficient (Tac) is presented that demonstrates this lack of interrelationship. Tumour growth in the axillary nodes is progressive and in general mimics the potential tumour load elsewhere in the body. Qualitative rather than quantitative assessment is needed. This can be provided by simple means, using hilar nodal sections from standardised nodal samples. There is, however, as yet no definitive method of predicting the presence/absence of occult distant metastatic spread in either node‐negative or node‐positive cases. Treatment is thus based on statistical probability, which may or may not be relevant in the individual

ISSN:8756-0437    

DOI:10.1002/ssu.2980050209

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractFrom the available evidence it is clear that mastectomy is associated with a substantial psychological and psychiatric morbidity. To date there is no convincing evidence that counseling can prevent this morbidity, but monitoring of women's psychological adjustment can lead to early detection and effective treatment of their problem. The use of immediate or delayed implantation or reconstruction appears to reduce the psychiatric morbidity in those women who are particularly concerned about their appearance at the time of surgery. Psychiatric morbidity is further increased when adjuvant chemotherapy is used and when treatment results in persistent arm pain and swelling. A shorter course of adjuvant chemotherapy and reduction of surgery within the axilla could reduce psychiatric morbidity. The role of radiotherapy is still unclear, but in some studies a link has been found between the amount of radiotherapy given, adverse effects, and psychiatric morbidity. In women undergoing breast conservation the reduction in body image problems is offset by greater anxiety about recurrence and depression caused by radiotherapy. Exploring and allowing choice when a patient has a strong preference for breast conservation or mastectomy appears to reduce morbidity. But attention still needs to be paid to the early recognition and treatment of psychological problems in patients with breast cancer, and guidelines are provided.

ISSN:8756-0437    

DOI:10.1002/ssu.2980050210

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractMinimal breast cancer includes three different entities: lobular carcinoma in situ, noninfiltrating intraductal carcinoma, and invasive carcinoma less than 0.5 cm. The common feature is their small dimensions and the fact that they are often clinically occult. For lobular carcinoma in situ the risk of developing an invasive carcinoma varies from seven to nine times compared with the general population and a careful follow‐up of the patients with frequent mammograms is therefore suggested. Intraductal noninfiltrating carcinoma should be locally treated as an invasive carcinoma of small size, and therefore an extensive mammary resection like the quadrantectomy, plus radiotherapy is the recommended form of treatment, while the axillary dissection may be avoided. Finally, small invasive carcinomas should be treated with conservative procedures, including a total axillary dissectio

ISSN:8756-0437    

DOI:10.1002/ssu.2980050211

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY