Imperfect Correlation of Mammographic and Clinical Breast Tissue Density

Background: Clinicians determine degree of mammographic density based on tissue firmness on breastexamination. The study aimed to compare breast density in mammography and clinical breast examination.Materials and Methods: Six-hundred sixty three women 40 years of age or older were studied. The breast examdensity was graded from 1 to 4 by two expert surgeons and the mammographic parenchymal density by twoexpert radiologists. Then for practical reasons, grades 1 and 2 were considered as low-density and grades 3 and 4as high-density. Results: High and low densities were detected in 84.5% and 15.5% of clinical breast examinationsand 59.7% and 40.3% of mammographies, respectively. The statistical analysis showed a significant differencebetween the breast tissue densities in breast examination with those in mammography. Conclusions: A clinicallydense breast does not necessarily imply a dense mammographic picture.     

Differences Between Breast Cancer Patients Younger and Older than 40 Years: Mammographic Findings

Objective: To compare the mammogarphic appearance between breast cancer patients aged <40 and ≥40 years. Methods: Needle localization and biopsy of suspicious mammographic lesions identified 1,959 breast carcinomas in a single institution from Jun 2012 to Apr 2013. According to the age, we divided patients into two groups: <40 and ≥40 years old, and analyzed mammographic appearance separately. Results: Young patients had 44.2% foci with calcification, but old patients only had 39.4% (P<0.001). In younger group, the ratios of cases according to mass density were 41.8% or higher, 58.2% equivalent and lower. In older group, the ratios were 55.5 % and 44.5%, respectively. There were statistical differences between high density and others (P<0.05). The ratios of cases according to mass margin were 13.9% circumscribed and microlobulated, 86.1% indistinct and spiculated in the younger group, as compared to 6.5% and 93.5%, respectively, in the older group (P<0.05). Conclusions: Mammographic findings differ between young and old patients with breast cancer, for example regarding mass density, mass margin and microcalcification ratios.     

乳腺浸润性导管癌分子分型与临床特征的关系

目的探讨乳腺浸润性导管癌不同分子亚型的分布,并分析各分子亚型与临床特征的关系。方法收集2006年1月-2011年6月明确诊断为乳腺浸润性导管癌病例100例,根据雌激素受体（ER）、孕激素受体（PR）、表皮生长因子受体-2（HER-2）的表达情况划分为四型,进一步分析不同分子亚型与浸润性导管癌临床特征的关系。结果100例中Luminal A型所占比例最大为65%,7%为Luminal B型, Triple Negative型占17%,Her-2(+)型占11%。各分子亚型乳腺浸润性导管癌患者发病年龄主要集中在40~59岁之间,占73%,Luminal A型发病年龄主要集中在40~49岁,而其他三型主要分布于50~59岁,四型在不同年龄组的分布上差异有统计学意义（P＜0.05）;Luminal A型淋巴转移发生率仅为30.1%,而Luminal B型与Her-2(+)型淋巴转移发生率较高,分别为71.4%及63.6%,各分子亚型的腋窝淋巴结转移率有显著差异（P＜0.05）;病理组织学分级Ⅰ级中Luminal A型所占比例最高,而Triple Negative型主要以Ⅲ级为主,差异具有统计学意义（P＜0.05）。结论乳腺浸润性导管癌各分子亚型分布差异具有统计学意义,各分子亚型与其临床特征关系密切。     

Relationship Between Certain Radiographic and Biologic Characteristics in Breast Cancer

The relationship between mammographic appearance of micro-calcifications and tumor stage, malignancy grade, estrogen receptor (ER) content and nuclear DNA pattern was studied in 92 mammary carcinomas. The results indicate that no complementary prognostic guidance can be obtained from the radiographic appearance of a tumor apart from a high probability of a spiculated cancer being ER-rich. The finding of a relatively high proportion of aneuploid and ER-poor carcinomas among tumors with microcalcifications indicates that this radiographic characteristic might be associated with increased growth potential.     

乳腺癌腋下淋巴结CT测定与病理对照

目的:评价不同的CT诊断标准与临床体检在乳腺癌术前诊断腋淋巴结转移中的价值.方法:对93例乳腺癌患者于临床体检后1个月内行术前胸部CT检查,分别以腋淋巴结最短径≥5mm和≥10mm作为CT诊断淋巴结阳性的标准,并均在2周内行外科手术治疗,标本作病理检查.将病理与CT诊断和临床检查结果分别进行双盲法对照.数据行统计学处理.结果:临床体检与以腋淋巴结最短径≥5mm和≥10mm作为CT诊断淋巴结阳性标准,与病理证实腋淋巴结转移诊断的符合率分别为72.0%、86.0%和65.6%;敏感性为71.7%、95.0%和51.7%;特异性为72.7%、69.7%和90.9%.以腋淋巴结最短径≥5mm作为CT诊断淋巴结阳性的标准,其与病理证实腋淋巴结转移的诊断符合率显著优于临床体检(P＜0.05)和以腋淋巴结最短径≥10mm作为CT诊断淋巴结阳性的标准(P＜0.01).结论:以腋淋巴结最短径≥5mm作为CT诊断淋巴结阳性的标准具有临床意义,是直接评估乳腺癌腋淋巴结状态较准确且无创伤的方法.     

Clinicopathologic Features of Breast Carcinomas Classified by Biomarkers and Correlation with Microvessel Density and VEGF Expression: A Study from Thailand

Background: To correlate breast cancer subtypes with prognostic factors, microvessel density (MVD),vascular endothelial growth factor (VEGF) expression and clinical features. Materials and Methods: Onehundred cases of primary breast carcinoma were classified using biomarkers on tissue microarray as: luminalA [estrogen receptor (ER)+, HER2-, Ki-67≤14%], luminal B [ER+, HER2+ or ER+, HER2-, Ki-67>14%],HER2, triple negative basal-like (TNB) [any basal cytokeratins (CKs, 5, 14, 17) and/or endothelial growth factorreceptor (EGFR) expression], and TN without such markers [TNN, null], and assessed for p53, vimentin, VEGFand CD31 immunoperoxidase. Results: Of the 100 cases (mean age, 51 years; mean tumor size, 3.2cm; 56%with nodal metastasis; 89 invasive ductal carcinomas, not otherwise specified, 4 invasive lobular carcinomas,3 metaplastic carcinomas, and 4 other types) there were 39 luminal A, 18 luminal B, 18 HER2, 15 TNB and10 TNN. The positivities of basal-like markers in the basal-like subtype were 78.3% for CK5, 40% for CK14,20% for CK17, 46.7% for EGFR. There was no significant difference in age distribution, tumor size, degreeof tubular formation, pleomorphism, lymphovascular invasion, nodal metastasis, MVD, VEGF expression andsurvival among subgroups. TNs demonstrated significantly higher tumor grade, mitotic count, Ki-67 index, p53and vimentin and decreased overall survival compared with nonTN. Conclusions: The distribution of breastcancer subtypes in this study was similar to other Asian countries with a high prevalence of TN. The high gradecharacter of TN was confirmed and CK5 expression was found to be common in our basal-like subtype. Nosignificant elevation of MVD or VEGF expression was apparent.     

膨胀型肝癌的超声影像、病理特征及其临床意义探讨

目的：研究膨胀型肝癌的超声表现、病理形态及其临床意义间的关系。方法：对700例肝细胞癌患者术前超声检查与术后切除标本的病理及术后生存情况进行分析。结果：按照Nakashima分型，膨胀型420例，浸润型280例。与浸润型肝癌不同，膨胀型肝癌有4种独特超声表现，分别称之为弱回声型、声晕型、外生型和小结节型，它们分别有不同的病理基础。膨胀型肝癌的发生率虽不高，但其手术切除率却非常显著高于发生率较高的浸润型肝癌（P＜0．01）。结论：膨胀型肝癌是一类有明显临床意义的肝细胞癌，术前超声诊断有助于临床重点治疗。     

p53 Mutations and c-erbB-2 Amplification in Intraductal and Invasive Breast Carcinomas of High Histologic Grade

In order to clarify the clinical significance of mutations of the p53 gene and amplification of the c- erb B-2 gene in breast carcinoma, these gene alterations were examined in 101 invasive, seven predominantly intraductal and 10 intraductal breast carcinomas by single-strand conformation polymorphism-direct sequencing or Southern blot-hybridization analysis. p53 mutations were detected in 32 (32%) of the invasive cases and two (12%) of the 17 intraductal/predominantly intraductal cases, whereas c- erb B-2 amplification was detected in 14 (14%) of the invasive and six (35%) of the intraductal/predominantly intraductal cases. Irrespective of differences in the positions and types of the mutations, cases carrying p53 mutations were almost always Grade 3 histologically and with a low hormone-receptor value. Since p53 mutations as well as c- erb B-2 amplification were detected almost selectively in Grade 3 cases but were not associated with lymph nodal status in invasive breast cancer, these two gene alterations could be indicators of prognosis of disease independent of lymph nodal status. Even in intraductal/predominantly intraductal carcinoma, these gene alterations were almost always detected in tumors of higher histologic grade. Thus, it is suggested that these gene alterations occur in breast cancers showing a high proliferation rate irrespective of the presence of invasion, and that other molecular alterations are involved in the process of breast cancer invasion.     

Breast Cancer in Tunisia: Clinical and Pathological Findings

Introduction: The aim of this study was to survey the clinical and pathological features of breast cancer inthe Center of Tunisia. Design: Characteristics of all breast cancer cases diagnosed in the Pathology Department,Farhet Hached Hospital, Sousse, Tunisia during a 15-year period (1993-2007) were analyzed. Results: A total of2,404 new cases of breast cancer were recorded, only 48 being diagnosed in men. The age-standardized incidencerate was 0.7 and 29.2 per 100,000 in men and women, respectively, with median ages of 48.0 and 64.5 years.Invasive ductal carcinoma was the most common (2,012 cases). Stage II was the most frequent (47.7%) followedby advanced stages (Stage III and IV, 41%). Conclusion: Cancer of the breast remains the most common cancerin the absence of specific screening measures among Tunisian women. Our study justifies the need to plan anddevelop effective programs aiming at the control and prevention of the spread of breast cancer in Tunisia.     

18F-FDG PET/CT SUVmax与乳腺浸润性导管癌临床病理特征及新辅助化疗疗效的相关性

 目的 探讨¹⁸F-脱氧葡萄糖（FDG）正电子发射计算机断层扫描（PET/CT）显像治疗前病灶最大标准摄取值（maximum standard uptake value, SUV_max）与乳腺浸润性导管癌临床病理特征的关系及与新辅助化疗疗效的相关性，以指导临床个体化治疗。方法 选取佛山市第一人民医院行¹⁸F-FDG PET/CT显像的272例初治乳腺浸润性导管癌患者的临床资料进行回顾性分析，测定原发病灶的SUV_max，分析临床病理特征、分子分型及新辅助化疗疗效与原发灶SUV_max的相关性。结果 乳腺癌原发灶的SUV_max在不同T分期、不同组织学分级、有无淋巴结转移方面差异均有统计学意义（P<0.05），雌激素受体（ER）和（或）孕激素受体（PR）阳性组与阴性组的SUV_max差异有统计学意义（P<0.05），人表皮生长因子受体2（HER2）阳性组与阴性组的SUV_max差异无统计学意义（P>0.05），Ki-67高表达者SUV_max高于低表达者（P<0.05）。Basal-like型和HER2过表达型SUV_max均高于Luminal A型乳腺癌（P<0.05）。病理完全缓解组与未达到病理缓解组SUV_max差异有统计学意义（P<0.05）。结论 ¹⁸F-FDG PET/CT SUV_max与乳腺癌的临床病理特征具有较大的相关性，原发病灶SUV_max较高者更能从新辅助化疗中获益。     

176例乳腺癌数字化摄影的X线征象与临床病理关系的探讨

目的:探讨乳腺癌X线特点与临床、病理的关系。方法:将176患者的病灶特点,与临床资料、病理类型、腋淋巴结转移对照。结果:以单纯钙化为表现的乳腺癌多为年轻患者,50岁以下占84.4%;以钙化合并肿块者多为老年患者。导管内癌和导管内癌早期浸润的乳腺癌X线表现多为单纯钙化。以钙化合并毛刺样肿块为表现的乳腺癌具有较高的腋淋巴结转移率;以单纯蠕虫样钙化、单纯毛刺样肿块及单纯非蠕虫样钙化为表现者,腋淋巴结转移率亦较高。单纯蠕虫样钙化伴腋淋巴结转移4～9枚占75.0%(6/8);钙化合并毛刺样肿块者,腋淋巴结转移4～9枚占27.8%(10/36),10枚以上占16.7%(6/36)。结论:单纯钙化多见于年轻患者,多为早期乳腺癌。蠕虫样钙化、毛刺样肿块与腋淋巴结转移阳性关系密切,是预后不良的指标。     

Breast Cancer Screening Disparity among Korean American Immigrant Women in Midwest

Purpose: Using three breast cancer screening methods such as mammogram, Clinical Breast Examination (CBE), and Breast Self-Examination (BSE), this study investigated breast cancer screening rates and its associated factors in Korean American immigrant women. Method: Cross-sectional data were obtained from 168 Korean immigrant women aged 40 and older in Midwest. The Andersen’s Behavioral Model (1995) theoretically guided this study and logistic regression was used to examine factors associated with screening receipt and performance. Results: Study participants reported low screening rates, specifically mammography and CBE uptake. About 71% of the women had a mammography at least once in their lifetime, while about 36% indicating receipt of a mammogram in the last three years. About 59% of the women received a CBE at least once in their lifetime, while about 32% had CBE in the past three years. About 74% of study participants have performed BSE at least once in their life time, while about 69% have done it in the past three years. Knowledge of screening method was consistently correlated with participant’s three breast cancer screening uptake. Additional factors that were positively associated with screening included older age, low barriers to mammograms, and lower educational attainment. Conclusions: Overall, study participants reported low rates of breast cancer screening receipt and performance. It is required to promote screening uptake among Korean immigrant women, especially women with young age, a lower level of education, and lack of health accessibility. A community-based language-appropriate health education program should be developed to increase health care access.     

Breast Cancer Screening in Asian Women with Dense Breast by Mammography: A Cross-Sectional Observational Study

Objective: Mammography density of Asian women is known to be higher than Western women. After 2009, the Korean National Cancer Screening Program (NCSP) has started to notify mammography density (MD). To investigate the effect of MD notification, we integrated screening results with national health insurance claim data from 2009 to 2013. Patients and Methods: We performed a cross-sectional observational study which investigated the crude detection rate (CDR), positive predictive value (PPV), and incidence rate of Interval Cancer (IC). IC was defined as breast cancer, where the interval between the screening date and date of diagnosis was more than 12 months and less than 24 months among participants with previous normal results. Results: CDR and PPV per 100,000 results increased from 510.9 to 756.2 and from 1842.5 to 3364.9, respectively. The incidence rate of IC per 100,000 negative results increased from 623.3 to 676.2. Women younger than 50 years had a high incidence of ICs. Conclusion: After notifying MD, the incidence rate of IC less increased comparing with CDR or PPV. Screening mammography could be more useful to Asian women when reporting MD.     

Clinical and Radiologic Assessments to Predict Breast Cancer Pathologic Complete Response to Neoadjuvant Chemotherapy

SummaryPurpose. To prospectively compare the ability of clinical examination, mammography, vascularity-sensitive ultrasound, and magnetic resonance imaging (MRI) to determine pathologic complete response (CR) in breast cancer patients undergoing neoadjuvant chemotherapy.Patients and methods. Participants were women with primary measurable, operable invasive breast cancer (Stages I–III) who presented to the University of Michigan Breast Care Center. Eligibility criteria were based on clinical need for chemotherapy as part of the overall treatment plan. The chemotherapy consisted of doxorubicin and docetaxel administered every 3 weeks for four cycles. Tumor size measurements by physical examination and by the three imaging modalities were performed before chemotherapy was initiated and after its completion, prior to definitive surgery. Response criteria were pre-specified in this prospective design, and study radiologists analyzed the mammographic, sonographic and MRI image sets blinded to information from the other modalities and blinded to final histological diagnosis. The pathologic CR rate obtained by the clinical and imaging modalities was compared to pathologic CR as determined pathologically.Results. 41 of 43 enrolled patients had a determination of pathologic response, and 4 patients had a pathologic CR to this chemotherapy (9.8%). The accuracy of physical examination, mammography, ultrasound, and MRI in determining pathologic CR was 75, 89, 82, and 89% respectively (NS).Conclusion. Biopsy after neoadjuvant chemotherapy remains absolutely necessary to determine pathologic CR to neoadjuvant chemotherapy, as the accuracy of current imaging modalities is insufficient to make this determination. The accuracy of mammography, vascularity-sensitive ultrasound, and MRI were not observed to be significantly different.     

33例肺上沟癌的临床特点及放疗疗效

目的　探讨肺上沟癌的临床特点及放疗疗效和不良反应。方法　回顾性分析 3 3例肺上沟癌住院病人的临床特征和常规放疗的疗效。结果　肺上沟癌占原发性支气管肺癌的 2 9% ,常见症状为 :患侧肩、背和上肢疼痛 ( 78 8% ) ,后 1,2 ,3肋骨或椎骨破坏( 5 7 6% ) ,Horner’s综合征 ( 3 6 7% ) ;少见的症状为 :咳嗽 ( 2 7% ) ,咯血 ( 9% ) ;中位生存期为 8 4月 ;1,3 ,5年生存率分别为 3 5 6% ,12 3 % ,4 6% ;放疗反应可耐受。结论　肺上沟癌相当少见 ,其临床特征基本符合pancoast综合症 ,本病预后差 ,但放疗可缓解疼痛 ,提高生存质量。     

Invasive Pleomorphic Lobular Carcinoma of the Breast: Clinicopathologic Characteristics and Prognosis Compared with Invasive Ductal Carcinoma

Purpose

Invasive pleomorphic lobular carcinoma (IPLC) is a very rare and distinct morphological variant of invasive lobular carcinoma (ILC), characterized by nuclear atypia and pleomorphism contrasted with the cytologic uniformity of ILC. This study evaluated clinicopathologic characteristics and prognosis of IPLC compared with invasive ductal carcinoma (IDC).

Methods

We retrospectively reviewed the medical records of 35 patients with IPLC and 6,184 patients with IDC, not otherwise specified. We compared the clinicopathologic characteristics, relapse-free survival (RFS) and disease specific survival (DSS) of patients who were surgically treated between January 1997 and December 2010.

Results

Patients with IPLC presented at an older age with larger tumor size, worse histologic grade, higher rates of N3 stage, more multifocal/multicentric tumors, and more nipple-areolar complex involvement than those of patients with IDC. During the follow-up period, the IPLC group experienced five cases (14.3%) of disease recurrence and three cases (8.6%) of disease specific mortality compared with 637 cases (10.4%) of recurrence and 333 cases (5.4%) of disease specific mortality in the IDC group. Univariate analysis using the Kaplan-Meier method revealed that the IPLC group showed a significantly poorer prognosis than that of the IDC group (RFS, p=0.008; DSS, p<0.001). However, after adjusting for clinicopathologic factors, a multivariate analysis showed no statistical differences in RFS (p=0.396) and DSS (p=0.168) between the IPLC and the IDC groups.

Conclusion

Our data suggest that patients with IPLC present with poor prognostic factors such as large tumor size, poor histologic grade and advanced stage at diagnosis. These aggressive clinicopathologic characteristics may result in poor clinical outcomes. Although our study could not link IPLC histology to poor prognosis, considering the aggressive characteristics of IPLC, early detection and considerate treatment, including proper surgical and adjuvant intervention, could be helpful for disease progression and survival.     

No Strong Association Between HER-2/neu Protein Overexpression and Gene Amplification in High-grade Invasive Urothelial Carcinomas

The generation of urothelial carcinoma is caused by the accumulation of various molecular changes, as in most malignancies. There are conflicting data about the status of HER-2/neu oncogene in urothelial carcinomas. The aim of this study was to determine the status of HER-2/neu oncogene in high-grade invasive urothelial carcinoma of urinary bladder both in protein and DNA level. We evaluated HER-2/neu protein overexpression by immunohistochemistry (IHC) and gene amplification by fluorescent in situ hybridization (FISH) and real-time quantitative PCR in paraffin-embedded samples of high-grade invasive urothelial carcinoma obtained from 36 patients. Polysomy 17 was also assessed by FISH. Immunohistochemically, HER-2/neu protein overexpression was observed in 22 (61.1%) tumors (ten tumors with score 3+ and 12 with score 2+). Fourteen of 36 tumors (38.9%) were evaluated as negative (score 0 or 1+). Complete concordance between FISH and the PCR was seen in all of the samples scored as 0 and 1+ by IHC. HER-2/neu gene amplification was observed in three of 27 (11.1%) tumors by FISH (nine samples were non-informative) and in eight of 36 (22.2%) tumors by the PCR. The complete concordance between HER2-2/neu protein overexpression and gene amplification was seen only in three of 27 tumors. Polysomy 17 was seen in nine tumors (33.3%). The results indicated that, in contrast to breast cancer, there was no strong association between HER-2/neu overexpression and gene amplification in invasive urothelial carcinomas, and polysomy 17 was higher in tumors showing HER-2/neu overexpression.     

眼眶血管外皮细胞瘤：20例临床病理分析及超微结构观察

眼眶血管外皮瘤２０例，其病理特点为Ｌ丰富的血管网，血管之间大量增生的梭形细胞，单个瘤细胞外有网状纤维包绕。根据肿瘤的异形程度及核分裂的数量诊断为良性，低度恶性及恶性血管外皮瘤．１０刚以下患诊诊断性要慎重。