Bilateral synchronous breast cancer: a population-based study of characteristics,method of detection,and survival

BACKGROUND: The frequency of bilateral synchronous breast cancer (BSBC) is reportedly about 1%-3%, but there is limited information from population-based cancer registries regarding the clinical and prognostic features of these cancers. METHODS: The population-based Connecticut Tumor Registry (CTR), which is part of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program of registries, was used to identify BSBC (ie, a second cancer diagnosed within 3 months of the first). Information was obtained on the method of detection of BSBC, and clinical characteristics and survival (through 2000) were compared with unilateral cases. RESULTS: Of 15,542 patients reported to the CTR, 300 (1.9%) had BSBC. BSBC was detected most often by mammography of both breasts (35%) or contralateral mammography after a palpable first cancer (18%). Compared to unilateral cases, BSBC patients did not differ in age or stage at diagnosis, but lobular histology was statistically significantly more frequent and use of total mastectomy (vs lesser surgery) was more common. Although length of follow-up was limited, risk of death was statistically, significantly higher among BSBC than unilateral patients. Among BSBC patients, risk of death was higher among those with cancers detected by breast exam/symptoms versus mammography. CONCLUSIONS; While uncommon, BSBCs differ from unilateral cancer in histology and survival, and their study emphasizes the opportunity for detection of contralateral cancers at an early stage.     

Association between mode of breast cancer detection and diagnosis delay

We investigated the association between mode of breast cancer (Bca) detection and diagnosis delay in a case-series of primary, histologically confirmed Bca patients from Southern Italy.Nine hundred and fifty nine women diagnosed with incident, primary Bca were recruited in two southern Italian regions. We grouped the mode of detection into two categories: Self-Detection (S-D) and Mammography (MG). Diagnosis delay was defined as the time between detection and a histologically confirmed diagnosis of invasive Bca.20.9% detected Bca with MG while 79.1% had S-D Bca. Women who detected Bca themselves (S-D) were more likely to delay breast cancer diagnosis than women who were diagnosed by a mammography (MG) (OR: 2.0; 95% CI: 1.39–2.87); when considering the model adjusted for health system-related characteristics, the risk increased (OR: 2.13; 95% CI: 1.47–3.09).Our study indicates a disadvantage in terms of diagnostic delay for women who were admitted and treated in community hospitals compared to women admitted and treated in breast health services.     

Bilateral cancer of the breast: a review of clinical, histologic, and immunohistologic characteristics.

The clinical, histologic, and immunohistologic characteristics of 19 synchronous and 47 metachronous bilateral breast cancers was compared. Patients with metachronous tumors were 5 years younger and more likely to have a family history of breast cancer than those patients with synchronous cancers. The nondominant synchronous cancer was usually discovered mammographically accounting for small, node-negative tumors, and high prevalence of in situ lesions. The same was true of the second metachronous tumor when discovered mammographically. Patients with metachronous cancers who were not in a follow-up program had second cancers with characteristics similar to incidentally diagnosed unilateral cancer. The mean interval between metachronous cancers was 101 months. Significantly more first metachronous tumors were invasive lobular cancers. Histologic type of the first and second tumor was the same in only 68% of synchronous and 61% of metachronous cancers. Combined histologic evidence and differentiation was concordant in only 13% and 22% of tumors, respectively. Immunoperoxidase studies were performed with two human milk fat globule antibodies. Each antibody reacted similarly in the first and second tumor in less than 50% of tumors and concordance was less than 25% when both antibody reactions were assessed. Differences in histologic evidence, differentiation, and immunohistologic reaction suggest that both synchronous and metachronous cancers are morphologically and functionally dissimilar.     

双侧同时原发性乳腺癌2例

双侧原发性乳腺癌按双侧癌肿发生间隔时间分为同时性及异时性，一般以6个月为界。双侧同时原发性乳腺癌发病率低，据统计约在0．2％左右，而在临床工作中，以“双侧乳腺包块”就诊而诊断为“双侧同时原发性乳腺癌”的患则非常罕见，作自1996年至今共发现2例，报告如下。     

Prognosis of synchronous bilateral breast cancer

Background:

The prognosis of patients with synchronous bilateral breast cancer (SBBC) is usually based on the tumour with the worst pathological features. There is little evidence in the literature for this assumption, potentially impairing reasoned decisions on optimal adjuvant therapy.

Methods:

This was a case–control study in which 68 women with SBBC were matched with 128 women with unilateral breast cancer. Both the GuysRisk prognostic model and the Nottingham Prognostic Index were used to determine the bilateral tumour with the poorer prognosis. Controls were matched for age, menopausal status, date of diagnosis, histological type and grade, and oestrogen receptor and axillary node status.

Results:

Both prognostic models indicated the same side tumour with the worst prognosis. Kaplan–Meier survival curves for both disease‐free and overall survival showed no significant difference in outcome between the two groups.

Conclusion:

Prognosis was determined by the tumour with the worst prognosis, with no additional worsening of outcome incurred from the second tumour. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.     

Evaluation of volume and shape of breasts: comparison between traditional and three-dimensional techniques

There have been many attempts to evaluate the shape, volume, and contour of breasts both before and after operation. To evaluate and compare results objectively in a reproducible, low-cost way is difficult. The aim of this study was to compare three-dimensional techniques with traditional methods in evaluating the volume and shape of breasts. Twelve patients with breast cancer were evaluated, 6 patients preoperatively and 6 patients postoperatively, using plastic cups, thermoplastic casts, magnetic resonance imaging (MRI), and three-dimensional imaging techniques. Thermoplastic casts and plastic cups measured better accordance with the volume of the operated breast than either the three-dimensional technique or MRI, which resulted in significantly higher values. The three-dimensional technique offered a new possibility to evaluate the shape of breasts objectively.     

乳腺癌分子亚型与MRI表现的相关性

目的探讨不同分子亚型乳腺癌与MRI表现的相关性。方法回顾性分析121例经手术病理证实的乳腺癌患者,根据雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体(HER-2)表达状态,将乳腺癌分为HER-2过表达型、Luminal A型、Luminal B型和三阴性型,观察不同亚型乳腺癌MRI表现及其与分子亚型的相关性。结果 4种分子亚型乳腺癌T1WI多呈稍低信号[HER-2过表达型:68.00%(17/25),Luminal A型:66.67%(38/57),Luminal B型:76.19%(16/21),三阴性型55.56%(10/18)];HER-2过表达型多呈非肿块样强化[84.00%(21/25)],Luminal A型多呈不均匀强化[75.44%(43/57)],Luminal B型和三阴性型多呈环形强化[52.38%(11/21)、83.33%(15/18)];HER-2过表达型、Luminal B型和三阴性型时间-信号强度曲线多为廓清型[76.00%(19/25)、80.95%(17/21)和77.78%(14/18)],LuminalA型多为平台型[82.46%(47/57)];HER-2过表达型、Luminal B型和三阴性型多有伴随征象[80.00%(20/25)、76.19%(16/21)、66.67%(12/18)],Luminal A型49.12%(28/57)有伴随征象。乳腺癌增强MRI强化方式与分子亚型呈高度相关(C=0.737,P0.001),时间-信号强度曲线类型与分子亚型呈中度相关(C=0.567,P0.001)。结论乳腺癌分子亚型与MRI表现具有一定相关性,可通过MRI特征初步判断乳腺癌分子亚型。     

三阴性乳腺癌和非三阴性乳腺癌临床特征的比较

目的 比较三阴性和非三阴性乳腺癌的临床特征,丰富三阴性乳腺癌的防治资料,为乳腺癌的个体化综合治疗寻找理论依据.方法 回顾性分析2002年收治的乳腺癌患者病例,选择接受手术治疗、资料完整并经免疫组织化学方法明确判定受体状况的408例患者进行分析.通过与非三阴性乳腺癌的比较,分析三阴性乳腺癌的临床特征、复发及生存情况.结果 本组资料中确认三阴性乳腺癌77例,占乳腺癌患者的18.9%(77/408).所有患者中位随访64个月(3～79个月).408例病例中,复发或转移58例,死亡51例,三阴性乳腺癌中复发或转移19例,死亡12例.三阴性乳腺癌患者的年龄较轻,肿瘤体积较大,局部复发率和远处转移率均显著性高于非三阴性乳腺癌患者(P均<0.05).生存分析显示,三阴性乳腺癌患者的3年和5年总生存率(86.4%和77.7%)均显著低于非三阴性乳腺癌患者(93.4%和87.9%)(P均<0.05);三阴性乳腺癌患者的3年和5年无病生存率(78.4%和72.8%)均显著低于非三阴性乳腺癌患者(92.4%和85.8%)(P均<0.05).结论 三阴性乳腺癌具有特定的临床特征,预后比非三阴性乳腺癌差,需要进一步开展三阴性乳腺癌的个体化治疗的研究.     

Cytologic and histologic features of superficial bladder cancer.

Despite technologic advances in diagnostic skills, cytologic and histologic evaluation is still the standard for the identification of bladder cancer, and these two techniques are critical in therapy selection and post-treatment surveillance. The key to the proper interpretation of cytologic specimens lies in appropriate collection and handling of the sample. Because treatment differs according to the histologic type of a tumor, when a mixture of types is found, all should be listed with their relative proportions. Both pathologists and urologists must be aware of the importance of the muscularis mucosae; a transitional-cell carcinoma may invade this layer without extending into the true muscle.     

Bilateral orchidopexies: synchronous or metachronous? Survey of BAPS and BAPU members and single-centre comparison

Background/Aim

Approximately 20% of undescended testes (UDT) are bilateral. It is unclear whether bilateral orchidopexy (BO) should be undertaken synchronously (SBO) or metachronously (MBO). Our aim was to investigate current UK practice and the complications of SBO vs MBO.

年轻与老年女性乳腺癌的临床病理比较分析

目的:探讨年轻女性乳腺癌的临床病理特点,为年轻女性乳腺癌的诊治提供依据.方法:对病理组织学确诊的年轻(≤35岁)女性乳腺癌181例及老年(≥60岁)女性乳腺癌186例患者的临床病理资料进行回顾性比较分析.结果:年轻女性乳腺癌患者以31～35岁居多,发病部位左乳多于右乳,2组发病位置均以外上象限居多,多为单发,均以浸润性导管癌为主,年轻组患者的肿瘤大小、组织学分级、TNM分期及腋窝淋巴结转移均明显高于老年组(P<0.05).结论:年轻女性乳腺癌较老年女性乳腺癌侵袭性强,恶性度高.临床应加强对年轻女性乳腺癌的认识和早期诊断.     

Rapid review: Estimates of incremental breast cancer detection from tomosynthesis (3D-mammography) screening in women with dense breasts

High breast tissue density increases breast cancer (BC) risk, and the risk of an interval BC in mammography screening. Density-tailored screening has mostly used adjunct imaging to screen women with dense breasts, however, the emergence of tomosynthesis (3D-mammography) provides an opportunity to steer density-tailored screening in new directions potentially obviating the need for adjunct imaging. A rapid review (a streamlined evidence synthesis) was performed to summarise data on tomosynthesis screening in women with heterogeneously dense or extremely dense breasts, with the aim of estimating incremental (additional) BC detection attributed to tomosynthesis in comparison with standard 2D-mammography. Meta-analysed data from prospective trials comparing these mammography modalities in the same women (N = 10,188) in predominantly biennial screening showed significant incremental BC detection of 3.9/1000 screens attributable to tomosynthesis (P < 0.001). Studies comparing different groups of women screened with tomosynthesis (N = 103,230) or with 2D-mammography (N = 177,814) yielded a pooled difference in BC detection of 1.4/1000 screens representing significantly higher BC detection in tomosynthesis-screened women (P < 0.001), and a pooled difference for recall of −23.3/1000 screens representing significantly lower recall in tomosynthesis-screened groups (P < 0.001), than for 2D-mammography. These estimates can inform planning of future trials of density-tailored screening and may guide discussion of screening women with dense breasts.     

The role of mammography in detecting breast cancer in augmented breasts

Recent reports suggest that mammographic findings may be compromised in patients who have undergone augmentation mammoplasty. Therefore, early detection of breast cancer by mammography may be obscured. We reviewed records for our patients with breast cancer after augmentation mammoplasty to define further the role and accuracy of mammography. Six patients aged 34 to 52 years (mean, 42 years) had a diagnosis of breast carcinoma 4 to 14 years (mean, 7.2 years) after augmentation mammoplasty. Five patients had preoperative mammographic examinations. Suspicious lesions were seen in 4 patients, and microcalcifications were identified in the fifth. The sixth patient had a normal xeromammogram. Pathological diagnosis was infiltrating ductal carcinoma in 5 patients and intraductal carcinoma in 1. Findings for lymph nodes were negative in 3 patients; 2 others had positive findings in one lymph node, and 1 had positive results in four lymph nodes. Five patients had a suspicious mass that was palpated on self-examination or by the patient's plastic surgeon, and the sixth patient had a routine screening mammogram. Two of 3 patients with positive lymph nodes received adjuvant chemotherapy. This report confirms the role of mammography as a screening tool in making the diagnosis of breast cancer in women who have undergone augmentation mammoplasty. The importance of self-examination and follow-up by the plastic surgeon is stressed. The data suggest that mammography remains an accurate method for detecting breast lesions.     

环氧化酶-2与乳腺癌关系的研究现状及进展

环氧化酶2(cycloxygenase-2,COX-2)在人类多种肿瘤的发生发展过程中起着重要作用,其在乳腺癌中也存在着过度表达.因此,进一步深入研究COX-2与乳腺癌的关系,开发理想的COX-2抑制剂,以期开辟乳腺癌防治的一条新途径.     

Metaplastic breast cancer: clinical features and outcomes

Metaplastic carcinoma of the breast, a neoplasm with both epithelial and mesenchymal elements, represents less than 1 per cent of all breast cancer. We reviewed the records of all patients diagnosed with localized metaplastic breast cancer from 1991 to 2003 at our institution. We identified 21 patients. Mean primary tumor size was 4.62 cm. Eight patients (38%) had axillary node involvement at presentation. All the tumors were high grade. Only two (10%) of the tumors were hormone receptor positive. Seventeen (81%) of the patients received adjuvant chemotherapy, and 12 (57%) of the patients received radiation. Ten (29%) patients suffered a local recurrence. With a mean follow-up of 46 months, the 5-year disease-free and overall survival was 42 per cent (95% CI: 20% to 65%) and 71 per cent (95% CI: 46% to 96%), respectively. Stage-specific overall survival was 100 per cent, 83 per cent, and 53 per cent for stages I, II, and III, respectively. By multivariate analysis, there was no impact on recurrence or survival with regard to size, age, menopausal status, nodal status, histologic subtype, adjuvant therapy, or extent of surgery. Metaplastic breast cancer is a unique neoplasm that tends to present at an advanced stage and has a propensity for local recurrence. When stratified by stage, however, survival appears similar to that of adenocarcinoma of the breast, and these tumors should be treated as such.