Factors Associated With Positive Margins in Women Undergoing Breast Conservation Surgery

Objective

To identify factors predicting positive margins at lumpectomy prompting intraoperative reexcision in patients with breast cancer treated at a large referral center.

Survival after breast cancer treatment: the impact of provider volume

BACKGROUND: Research has not paid sufficient attention to the need for adequate case-mix adjustment in studies of the relationship between provider volume and performance. This study attempted to address this limitation by capturing and including 5-year survival outcomes and a wide range of case-mix variables in multivariate analyses of the volume-outcome relationship relating to breast cancer treatments. METHODS: All patients diagnosed with invasive primary breast cancer during 1996 (n = 809) were included. Patient, disease and treatment data were extracted from medical records; survival data were corroborated using official death registrations. A Cox proportional hazards approach was used to model relationships between patient, disease and service variables and risk of death. RESULTS: There were 262 deaths among 807 patients followed up; overall 5-year survival was 70%. Advancing age, higher levels of co-morbidity, late-stage disease, more positive nodes, and high-grade tumour were independently associated with lower survival (P < 0.05). Patients who received hormonal therapy (HR 0.50, 95% CI 0.28-0.89) and radiotherapy (HR 0.73, 95% CI 0.53-1.03) had a survival advantage. Using a cut-off point of > or =30 cases per annum, survival was lower for patients treated in low volume settings (HR 1.47, 95% CI 1.09-1.96) after adjustment for case mix. CONCLUSIONS: There was some evidence to support treatment in high volume settings although patient and disease variables were the major determinants of survival for patients with breast cancer.     

Chemotherapy for gynecological malignancies--a contraindication during pregnancy?

Even though a malignant tumor during pregnancy is very rare it occurs in 0.02-0.1%. With the tendency in society to postpone childbirth to an older age, there will be more cancers diagnosed during pregnancy. The coincidence of malignant disease with pregnancy leads to an enormous emotional burden to the patient, the couple and the medical staff. Surgery for malignant tumors during pregnancy seems to be save. Radiotherapy on the other hand should be avoided. Chemotherapy is regarded to be save during the second and third trimester but it should not be applied during the first trimester because of its teratogenic effects. The most frequent malignant disorders during pregnancy are cervical cancer, breast cancer, melanoma and Hodgkin lymphoma. We discuss possible treatment options for breast cancer and gynecological tumors during pregnancy. Ovarian Cancer is a rare event during pregnancy. Because of frequent prenatal visits most of them are diagnosed at an early stage, with good prognosis. In case of advanced stage of ovarian cancer chemotherapy besides surgery is necessary. The former usually is preferred as monotherapy during pregnancy. To treat breast cancer during pregnancy a mastectomy with axillary lymphonodectomy is necessary to avoid radiotherapy. Indications for chemotherapy are the same as for not pregnant patients. Usually AC with and without 5-FU is used. For invasive cervical cancer surgery or radiotherapy +/- chemotherapy is indicated after induced abortion or cesarean section. Early termination of pregnancy is of no survival benefit to the mother in case of breast cancer and ovarian cancer. In these cases systemic therapy during pregnancy and delivery at 34 weeks is recommended.     

MCM4与c-erbB-2蛋白在乳腺浸润性导管癌组织中的表达及其临床意义

目的检测MCM4、C—erbB-2蛋白在乳腺浸润性导管癌（IDC）组织中表达的改变及其在癌发生、发展中的作用。方法采用免疫组化SP法检测80例IDC、20例乳腺不典型增生和30例乳腺腺病等非癌病变旁正常乳腺组织中MCM4、c-erbB-2蛋白的表达情况。结果80例IDC、20例不典型增生组织中MCM4蛋白的阳性率分别为86．25％、70％,与正常对照组比较差异极显著（P〈0．01）。IDC组织中c—erbB-2蛋白的阳性率为65％,与不典型增生组及正常对照组比较差异显著（P〈0．05）。乳腺癌组中MCM4蛋白的阳性表达与组织学分级、TNM分期、淋巴结转移及肿瘤大小有关（P〈0．05）,与年龄无关。c-erbB-2蛋白的阳性表达与淋巴结转移有关（P〈0．05）,而与组织学分级、TNM分期、肿瘤大小及年龄无关。MCM4蛋白的阳性表达与c—erbB-2的表达呈正相关（r=O．240,P〈0．05）。结论MCM4蛋白阳性表达可作为乳腺癌发生、发展的生物学指标,联合c-erbB-2检测有助于乳腺癌预后的判断及I临床治疗的指导。     

乳腺癌组织中CerbB-2、ER与PR表达以及对预后的影响

目的 观察乳腺癌患者CerbB-2、雌激素受体(ER)、孕激素受体(PR)表达与其他临床预后因素的相关性,以及对预后的影响.方法 选择我院确诊并行乳腺癌根治术或改良根治术80例,采用免疫组织化学技术s-p法检测手术切除标本乳腺癌组织中CerbB-2、ER、PR的表达状况,并分析其与乳腺癌淋巴结转移及复发间的关系.结果CerbB-2在ER、PR均阳性组的表达低于两者均阴性组的表达(P＜0.05).ER与PR的阳性表达与腋淋巴结转移及复发呈负相关(P＜0.05);CerbB-2的阳性表达与腋淋巴结转移及复发呈正相关(P＜0.05).结论 乳腺癌组织中CerbB-2、ER、PR的表达具有相关性,且CerbB-2、ER、PR的表达与淋巴结转移及乳腺癌预后密切相关,联合检测三项指标可用以指导乳腺癌的临床治疗和预后判断.     

Atypical lobular and papillary lesions of the breast: a follow-up study of 30 cases.

Sections from 879 consecutive breast biopsies performed for clinically and grossly benign disease between 1962 and 1966 were reviewed. Twenty-four cases of undiagnosed lobular carcinoma in situ or atypical lobular hyperplasia and six cases of intraductal papillary carcinoma were found. Only one patient later developed invasive carcinoma, an infiltrating lobular carcinoma in the ipsilateral breast, which was diagnosed seven years after the biopsy containing lobular carcinoma in situ. Invasive cancers have not been found in other patients who have a median follow-up period of eight years.     

妊娠期乳腺癌临床特点及超声诊断

目的探讨妊娠期乳腺癌的临床、超声和病理学特征。方法回顾性分析7例妊娠期诊断为乳腺癌的患者的临床、超声和病理学特征。结果 1例患者在早孕期获得诊断,6例在中晚孕期诊断;对5例行术前超声检查,均表现为形态不规则、边界不清的低回声,其中4例血流丰富,术前均正确诊断为恶性病变;7例患者均接受患侧乳癌改良根治术,孕期未接受化疗及放疗;病理示病灶大小1.7～5.5cm;术后病理5例为浸润性导管癌,1例导管内癌,1例浸润性多形性癌;3例有患侧腋窝淋巴结转移。结论妊娠期乳腺癌恶性度高,预后差,超声有助于早期、正确诊断妊娠期乳腺癌。     

Serum tumor markers in breast cancer: are they of clinical value?

BACKGROUND: Although multiple serum-based tumor markers have been described for breast cancer, such as CA 15-3, BR 27.29 (CA27.29), carcinoembryonic antigen (CEA), tissue polypeptide antigen, tissue polypeptide specific antigen, and HER-2 (the extracellular domain), the most widely used are CA 15-3 and CEA. METHODS: The literature relevant to serum tumor markers in breast cancer was reviewed. Particular attention was given to systematic reviews, prospective randomized trials, and guidelines issued by expert panels. RESULTS: Because of a lack of sensitivity for early disease and lack of specificity, none of the available markers is of value for the detection of early breast cancer. High preoperative concentrations of CA 15-3 are, however, associated with adverse patient outcome. Although serial determinations of tumor markers after primary treatment for breast cancer can preclinically detect recurrent/metastatic disease with lead times of approximately 2-9 months, the clinical value of this lead time remains to be determined. Serum markers, however, are the only validated approach for monitoring treatment in patients with advanced disease that cannot be evaluated by use of conventional criteria. CONCLUSIONS: CA 15-3 is one of the first circulating prognostic factors for breast cancer. Preoperative concentrations thus might be combined with existing prognostic factors for predicting outcome in patients with newly diagnosed breast cancer. At present, the most important clinical application of CA 15-3 is in monitoring therapy in patients with advanced breast cancer that is not assessable by existing clinical or radiologic procedures.     

Incidental detection of breast apocrine carcinoma via endometrial cytology

Breast apocrine carcinoma is a rare malignancy characterized histologically by a predominance of acidophilic tumor cells exhibiting apocrine metaplasia. Apocrine tumors represent only about 0.4% of all breast cancers. Many cases are diagnosed at stage I or II; thus, the prognosis is better than that for other types of breast cancer. Here we present a 57-year-old female patient with primary apocrine breast carcinoma that was incidentally discovered by endometrial cytology. The patient had undergone routine uterine cancer screening at the age of 56 with resulting positive endometrial cytology. Subsequent histological examination of an endometrial biopsy revealed suspected metastatic uterine adenocarcinoma. Further evaluation revealed a 3-cm mass in the left breast, which was histopathologically diagnosed as breast cancer. Dual procedures were performed at the departments of gynecology and breast surgery. The patient underwent a modified radical mastectomy of the left breast and left axillary lymph node dissection. Laparotomy revealed multiple adhesions throughout the peritoneal cavity that suggested invasive metastatic cancer, and a right adnexectomy was performed. Histopathological examination of the resected left breast and right ovary tissues revealed apocrine carcinoma. Thus, stage IV breast cancer was diagnosed. The patient finished 6 cycles of paclitaxel and is now under observation on an outpatient basis. In this patient, breast cancer was discovered incidentally through a detailed work-up after a positive result of endometrial cytology. Uterine cancer screening has the potential, although rare, to detect metastatic cancer originating elsewhere. This should be taken into consideration during the work-up due to positive endometrial cytology.     

Advances in screening, diagnosis, and treatment of breast cancer

Breast cancer is the most common cancer in women in the United States; this year, approximately 215,900 new cases will be diagnosed. Mammography remains the cornerstone of screening, with technologies such as ultrasonography and magnetic resonance imaging having an increasingly defined role. Improved risk assessment and prevention strategies have been implemented, and current research in these areas includes better identification of patients at risk, the use of aromatase inhibitors and other agents to reduce risk, and the use of surrogate markers. Breast cancer staging has been optimized recently; also, local management of breast cancer, adjuvant systemic therapies, and treatment of patients with advanced disease have been evolving. Advances in screening, diagnosis, and treatment of breast cancer continue to influence our approach to patients with this disease. Many improvements have been made as well in supportive care, including increased tolerability of therapy and notable amelioration of disease symptoms.     

Similarities and differences in tumor growth, skeletal remodeling and pain in an osteolytic and osteoblastic model of bone cancer

More than 1.3 million cases of cancer will be diagnosed in 2006 in the United States alone, and 90% of patients with advanced cancer will experience significant, life-altering cancer-induced pain. Bone cancer pain is the most common pain in patients with advanced cancer as most common tumors including breast, prostate, and lung have a remarkable affinity to metastasize to bone. Once tumors metastasize to bone they are a major cause of morbidity and mortality as the tumor induces significant skeletal remodeling, pain and anemia, which reduce the survival and quality of life of the patient. Currently, the factors that drive cancer pain are poorly understood; however, several recently introduced models of cancer pain are not only providing insight into the mechanisms that drive bone cancer pain but are guiding the development of novel mechanism-based therapies to treat the pain and skeletal remodeling that accompanies metatstatic bone cancer. As analgesics can also influence disease progression, findings from these studies may lead to therapies that have the potential to improve the quality of life and survival of patients with skeletal malignancies.     

超声弹性成像诊断特殊类型乳腺癌

目的 探讨超声弹性成像在特殊类型乳腺癌诊断中的价值.方法 回顾性分析13例经手术病理证实的几种特殊类型乳腺癌的超声声像图表现、肿瘤内部的血流图以及超声弹性图像表现.结果 黏液癌、炎性乳腺癌、1例哺乳期乳腺癌、浸润性微乳头状癌、乳腺小管癌及2例浸润性小叶癌的超声弹性图评分为4～5分,仅1例浸润性小叶癌弹性图评分为1分,1例哺乳期乳腺癌弹性图评分为3分.本组各病灶的血流图表现呈多样化,乳腺派杰病腺体内未见明显病灶.结论 超声弹性成像对炎性乳腺癌、哺乳期乳腺癌、浸润性微乳头状癌、小叶癌及乳腺小管癌有一定的诊断价值.乳腺派杰病的早期确诊多依赖于病理检查.     

False Negative Results of Preoperative Axillary Ultrasound in Patients with Invasive Breast Cancer: Correlations with Clinicopathologic Findings

The purpose of this study was to investigate false-negative results of preoperative axillary ultrasound (US) and to evaluate clinicopathologic factors related to false-negative results in patients with invasive breast cancer. Four-hundred eighty-two patients with 483 invasive breast cancers who had no suspicious findings on preoperative axillary US were included in this study. All patients underwent sentinel lymph node biopsy (SLNB) or axillary lymph node dissection. False-negative and true-negative results were compared in terms of age, body mass index (BMI), T-stage, pathologic N-stage and final diagnosis of breast cancer. Statistical analyses were performed using the chi-square or Fisher's exact tests. Of the 483 axillae with negative results on axillary US, 93 axillae of 93 patients showed false-negative results and the negative predictive value of axillary US was 80.8% (390/483). Seventy-five axillae (15.5%, 75/483) had N1 and 18 axillae (3.7%, 18/483) had N2 or N3 disease. Eighteen false-negative results with N2/N3 disease showed a significantly higher T stage (T2/T3) than those with N1 disease. As the T-stage increased, false-negative results were found more often on preoperative axillary US (p < 0.05). Age, BMI and final diagnosis of primary breast cancer were not associated with false-negative results on preoperative axillary US. Preoperative axillary US alone is insufficiently specific to obviate the need for SLNB because of the substantial number of false-negative results in patients with invasive breast cancer, although preoperative axillary US alone may exclude most cases of N2 and N3 disease.     

Breast Cancer Among Men: Raising Awareness for Primary Prevention

The American Cancer Society estimated that in 1993 1,000 new cases of male breast cancer would be diagnosed in the United States and 300 men would die from the disease. The clinical picture of breast cancer among men resembles that seen in women, and the development of the disease among men has been attributed to similar hormonal and genetic causes. The mortality rate from breast cancer is also similar, when corrected for chronological age and stage of the disease at the time of diagnosis and treatment. Guidelines for patient education, health screening, and patient support are presented.     

Risk factors for breast cancer

Despite the numerous risk factors for the development of breast cancer that have been investigated, only a few demonstrate a clear association with breast cancer development. Female gender and increasing age are the most important factors, followed by factors involving a woman's menstrual, reproductive, and family history. The risks related to menstruation and reproduction are probably related to the duration of estrogenic breast stimulation. The relationship of family history and breast cancer risk is unclear, but there may be a true genetic basis. The previous occurrence of breast cancer (invasive or in situ), the presence of proliferative pathological changes, especially with atypia, and the presence of other malignancies (e.g., primary ovarian and endometrial cancer) are histological risk factors for the development of new or recurrent breast cancer. Radiation exposure, the use of exogenous estrogens (both estrogen replacement therapy and oral contraceptives), diet (especially fat consumption), and alcohol intake may all play a role in cancer risk. Certain medications as well as patient demographics may also have a weak association. Cigarette smoking, caffeine consumption, and stress presently have little support for an association with breast cancer risk. It should be noted that in only one in four patients can breast cancer be accounted for by the known risk factors. This demonstrates that although presently known risk factors may help in screening for the early detection of breast carcinoma, in its possible prevention by modulation of influenceable factors, and in advising patients about their risks, these factors are merely strong associations with breast cancer incidence and not actual causations. The mechanisms of the development of breast cancer are as yet unknown.     

Biological characteristics of breast cancer at the primary tumour and the involved lymph nodes

Diminished oestrogen receptor (ER) expression in the involved axillary lymph nodes (ALN) in breast cancer compared with the primary tumour has been reported in previous studies. We have assessed a wider spectrum of tumour markers (ER, progesterone receptor (PgR), p53, Ki-67 and HER-2/neu) and compared extent and staining intensities at the primary tumour and the involved ALN on specimens of 22 cases with invasive ductal breast cancer. At the involved ALN, both the quantity of positive staining cells and the staining intensities for ER and PgR were decreased (p < 0.001 and p = 0.003, respectively). In contrast, the quantity of positive staining cells (p < 0.004) and the staining intensities for Ki-67 were increased. The differences for HER-2/neu and p53 staining at both sites were insignificant. The immunohistochemical staining properties of both the primary tumour and the ALN metastases showed no correlation with the number of involved ALN (p > 0.05). This study suggested that ALN metastasis might indicate a more unfavourable expression pattern of ER, PgR and Ki-67 in invasive ductal breast cancer.     

乳腺癌并发甲状腺癌的超声诊断价值

【目的】探讨乳腺癌术后患者应用高频超声诊断甲状腺癌的价值。【方法】对本院2004年1月至2009年10月917例乳腺癌行乳腺癌改良根治术894例和保留乳房的乳腺癌切除术23例。在对乳腺癌患者术后检查和随访时同时应用超声检查甲状腺,发现可疑恶性结节,立即行超声指导下细针抽吸细胞学检查。【结果151例有可疑发现,24倒（47．1％）超声指导下细针抽吸细胞学检查组织中有可疑恶性细胞。917例乳腺癌患者中,有18例（2％）甲状腺术后诊断为癌,并且均为乳头状癌,与普通人群比较差异具有极显著性（P〈0．01）。【结论】乳腺癌患者有极高的甲状腺癌发病率（2％）。超声扫描是早期发现甲状腺癌的重要方法。     

HER-2、CA153及HE4联合检测对乳腺癌的诊断价值

目的探讨联合检测血清人表皮生长因子2(HER-2)、癌抗原153(CA153)及人附睾蛋白4(HE4)对乳腺癌的诊断价值。方法选取该院收治的乳腺癌患者60例(乳腺癌组),乳腺良性疾病患者80例(乳腺良性疾病组)及同期的体检健康妇女60例(对照组)为研究对象。比较3组患者血清HER-2、CA153及HE4水平,并分析3项指标单独及联合检测对乳腺癌的诊断价值。结果乳腺癌组患者血清HER-2、CA153及HE4水平[(27.64±7.49)mg/mL、(48.25±11.36)U/mL、(183.46±27.39)pmol/L]显著高于乳腺良性疾病组和对照组[(13.57±3.51)mg/mL、(20.14±6.24)U/mL、(81.35±21.46)pmol/L;(10.26±2.37)mg/mL、(14.37±3.92)U/mL、(43.77±14.51)pmol/L],差异有统计学意义(P<0.05)。乳腺癌组HER-2、CA153及HE4表达阳性率(30.0%、48.3%、36.7%)显著高于乳腺良性疾病组和对照组(5.0%、13.8%、8.8%;0.0%、3.3%、1.7%),差异有统计学意义(P<0.05),且乳腺癌患者CA153表达阳性率(48.3%)显著高于HER-2和HE4(30.0%、36.7%),差异有统计学意义(P<0.05)。乳腺癌患者Ⅳ期血清HER-2、CA153及HE4水平[(40.27±12.45)mg/mL、(78.25±17.36)U/mL、(193.82±32.66)pmol/L]显著高于Ⅰ~Ⅱ期和Ⅲ期[(12.48±3.14)mg/mL、(25.73±7.48)U/mL、(142.16±21.37)pmol/L;(22.63±6.38)mg/mL、(43.61±13.62)U/mL、(153.49±25.61)pmol/L],Ⅲ期血清HER-2、CA153及HE4水平[(22.63±6.38)mg/mL、(43.61±13.62)U/mL、(153.49±25.61)pmol/L]显著高于Ⅰ~Ⅱ期[(12.48±3.14)mg/mL、(25.73±7.48)U/mL、(142.16±21.37)pmol/L],差异有统计学意义(P<0.05)。血清HER-2、CA153及HE4联合检测的灵敏度(71.9%)及准确度(80.0%)均显著提高(P<0.05)。结论血清HER-2、CA153及HE4联合检测可提高对乳腺癌的检出率,且还可作为病情严重程度和治疗监测的辅助检查指标。     

ER、PR及HER-2受体在乳腺癌原发灶及复发灶间表达差异及意义

目的:乳腺癌内分泌治疗及免疫靶向药物赫赛汀生物治疗的前提是相应的雌激素受体、孕激素受体的阳性表达及HER-2癌基因蛋白的过表达。目前对复发转移的乳腺癌病例受体表达情况的判断主要依据原发灶,而忽略了原发灶和复发转移灶之间可能存在的差异。本研究着重研究ER、PR及HER-2癌基因蛋白在乳腺癌原发灶及复发转移灶之间的表达差异,探讨其临床意义。方法:采用免疫组织化学检测45例乳腺癌患者原发灶及复发灶中ER、PR及HER2表达,分析研究ER、PR及HER2的变化率。结果:原发灶中ER、PR的阳性率分别为62.2%,60%(28/45,27/45),明显高于复发灶(37.8%17/45,31.1%14/45)(P<0.01)。复发灶中HER-2阳性率为62.2%(28/45),明显高于原发灶(26.7%12/45)(P<0.01)。结论:ER、PR及HER-2癌基因蛋白在乳腺癌原发灶和复发灶之间的表达存在显著性差异,所以在对复发乳腺癌进行临床治疗时,应考虑上述3种指标在复发灶中的确切状况。