Subject(s)
Adenoma/veterinary , Anal Gland Neoplasms/diagnosis , Dog Diseases/diagnosis , Adenoma/diagnosis , Adenoma/pathology , Anal Gland Neoplasms/pathology , Animals , Dog Diseases/pathology , Dogs , Female , Neoplasms, Ductal, Lobular, and Medullary/diagnosis , Neoplasms, Ductal, Lobular, and Medullary/pathology , Neoplasms, Ductal, Lobular, and Medullary/veterinaryABSTRACT
The role of routine preoperative magnetic resonance imaging (MRI) in newly diagnosed breast cancer patients planned for breast conserving surgery is presently being debated. In our medical center we practice selective use of preoperative MRI; we sought to examine the yield of MRI in this highly selected group of patients. A retrospective study of all newly diagnosed breast cancer patients presenting between January 2007 and July 2010 to the Tel Aviv Sourasky Medical Center (Tel Aviv, Israel) was completed. Patients planned for breast conserving surgery who underwent preoperative MRI were included in this study. Patients and tumor characteristics, indication for MRI, findings on MRI, consequent workup, and impact on surgical treatment were recorded. Association between preoperative characteristics and yield of MRI was examined. During the study period, 105 patients that were candidates for breast conserving surgery underwent preoperative evaluation with MRI. Use of breast MRI increased over time. Rates of mastectomy were stable throughout the study years. Dense mammogram was the most frequent (51, 68%) indication for MRI. Additional suspicious findings were found in 41 (39%) patients, prompting further workup including 36 biopsies in 25 patients, of which 22 (61%) were with cancer. These additional findings prompted a change in the surgical plan in a third of the patients. In most patients (92; 88%) clear margins were achieved. Limiting the use of MRI in the preoperative workup of breast cancer patients to a selected group of patients can increase the yield of MRI.
Subject(s)
Breast Neoplasms/diagnosis , Magnetic Resonance Imaging , Mastectomy, Segmental , Neoplasms, Ductal, Lobular, and Medullary/diagnosis , Preoperative Care , Adult , Aged , Aged, 80 and over , Breast Neoplasms/surgery , Decision Support Techniques , Female , Humans , Middle Aged , Neoplasms, Ductal, Lobular, and Medullary/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: To analyze the role of vascular endothelial growth factor (VEGF) secreted by tumor cells in angiogenesis of breast carcinoma using image morphometry. STUDY DESIGN: Thirty-four cases of node-negative breast carcinoma were used in the study. There were 6 grade 1, 20 grade 2 and 8 grade 3 tumors. For each case, 2 consecutive sections from the same block were cut. Immunostaining for VEGF and CD31 was carried out, and areas of highest staining density were marked. Those marked "hot spots" for CD31 and VEGF for each case were subsequently compared morphometrically. The area and intensity of immunostaining on each slide were also scored. RESULTS: The total scores for VEGF and CD31 were 5.15 and 3.79, respectively. All 34 cases showed cytoplasmic positivity for VEGF within the tumor cells. The average number of hot spots for VEGF and CD31 were 2.41 and 2.47, respectively, and the average number of hot spots that matched between these 2 groups were 0.79. Statistical analysis using Pearson's coefficient of correlation showed no significant match between the hot spots for CD31 and VEGF. Also, there was no significant difference between the total scores of CD31 and VEGF. CONCLUSION: VEGF is expressed in most breast carcinomas. However, the lack of topographic correlation between microvessel density and VEGF expression supports the notion that multiple angiogenic factors may play a role along with VEGF in the angiogenic process.
Subject(s)
Breast Neoplasms/pathology , Lymphatic Metastasis/pathology , Neoplasms, Ductal, Lobular, and Medullary/pathology , Neovascularization, Pathologic , Vascular Endothelial Growth Factor A/metabolism , Breast Neoplasms/diagnosis , Breast Neoplasms/secondary , Female , Humans , Immunohistochemistry , Neoplasms, Ductal, Lobular, and Medullary/diagnosis , Neoplasms, Ductal, Lobular, and Medullary/secondary , Platelet Endothelial Cell Adhesion Molecule-1/metabolismABSTRACT
Our purpose was to determine the respective prognostic significance of CD105 and CD31 immunoexpression in node negative patients with breast carcinoma, since angiogenesis induces blood borne metastases and death in carcinomas. CD105 (endoglin) has been reported as expressed by activated endothelial cells and consequently should better reflect neoangiogenesis in malignant tumors. Comparison of CD31 and CD105 immunocytochemical expression was undertaken in a series of 905 breast carcinomas. Results were compared to patients' long-term (median = 11.3 years) outcome. Univariate (Kaplan-Meier) analysis showed that the number of CD105+ microvessels (cut-off 15 vessels) correlated significantly with poor overall survival (p=0.001). This correlation was less significant in node negative patients (p=0.035). The number of CD31+ microvessels (cut-off 25 vessels) similarly correlated with poor survival (p=0.032) but not in the subgroup of node negative patients. Marked CD105 expression also correlated with a high risk for metastasis in all patients (p=0.0002) and in the subset of node negative patients (p=0.001). Similarly metastasis risk in node negative patients correlated with marked CD31 immunocytochemical expression (p=0.02). Multivariate analysis (Cox model) identified CD105, but not CD31 immunoexpression, as an independent prognostic indicator. Our results suggest that: i) in breast carcinomas, immunoselection of microvessels containing activated CD105 labelled endothelial cells is endowed with a stronger prognostic significance, as compared to CD31 vessels labelling; ii) the CD105 immunoexpression may be considered as a potential tool for selecting node negative patients with a poorer outcome and higher metastasis risk; iii) in these patients specific antiangiogenic therapy targeted by anti-CD105 conjugates can be further developed.
Subject(s)
Breast Neoplasms/blood supply , Neoplasms, Ductal, Lobular, and Medullary/blood supply , Neovascularization, Pathologic/metabolism , Platelet Endothelial Cell Adhesion Molecule-1/metabolism , Vascular Cell Adhesion Molecule-1/metabolism , Adult , Aged , Aged, 80 and over , Antigens, CD , Breast Neoplasms/diagnosis , Breast Neoplasms/metabolism , Endoglin , Female , Gene Expression Regulation, Neoplastic , Humans , Immunoenzyme Techniques , Lymph Nodes/pathology , Lymphatic Metastasis , Microcirculation , Neoplasms, Ductal, Lobular, and Medullary/diagnosis , Neoplasms, Ductal, Lobular, and Medullary/metabolism , Neovascularization, Pathologic/pathology , Predictive Value of Tests , Prognosis , Receptors, Cell Surface , Risk Factors , Treatment OutcomeABSTRACT
PURPOSE: To test the hypothesis that prognostic information in breast cancer may be derived from an accurate assessment of epithelial cell cycle entry, as indicated by expression of minichromosome maintenance (MCM) proteins. MATERIALS AND METHODS: We used immunohistochemistry to examine the distribution of Mcm-2 in breast tissue. Power calculations based on a pilot study of 67 whole tissue sections led to selection of an independent 347-core breast carcinoma tissue microarray validation set. We tested for associations between Mcm-2 (and Ki-67) labeling index (LI) and various clinicopathologic parameters. RESULTS: Mcm-2 was expressed more frequently than the standard proliferation marker Ki-67 in whole tissue sections of normal breast (P =.0003) and breast carcinoma (P <.0001). In 221 assessable cores of invasive carcinoma, the Mcm-2 LI showed a positive association with tumor size (P =.002), mitotic index (P <.0001), histologic grade (P <.0001), and the Nottingham Prognostic Index (NPI) score (P <.0001). Using a cutoff value of 50%, Mcm-2 LI was associated with overall survival (P =.0007), disease-free interval (P =.0002), and with the development of regional recurrence (P =.011) and distant metastases (P =.0016). Cox regression analysis suggested that the Mcm-2 LI is a strong prognostic factor in breast cancer that is independent and superior to histologic grade, lymph node stage, and Ki-67 LI, but not the NPI score. CONCLUSION: Mcm-2 may be of utility as a prognostic marker to refine the prediction of outcome in breast cancer, for example when combined with parameters currently used in the NPI.
Subject(s)
Biomarkers, Tumor/metabolism , Breast Neoplasms/diagnosis , Breast Neoplasms/metabolism , Neoplasm Proteins/metabolism , Nuclear Proteins/metabolism , Adult , Aged , Breast Neoplasms/pathology , DNA Replication , Disease Progression , Female , Humans , Immunoenzyme Techniques , Ki-67 Antigen/metabolism , Middle Aged , Minichromosome Maintenance Complex Component 2 , Neoplasm Invasiveness/diagnosis , Neoplasm Invasiveness/pathology , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/metabolism , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Neoplasms, Ductal, Lobular, and Medullary/diagnosis , Neoplasms, Ductal, Lobular, and Medullary/metabolism , Neoplasms, Ductal, Lobular, and Medullary/pathology , Pilot Projects , Premenopause , PrognosisABSTRACT
Mammography is the standard of reference for the detection of breast carcinoma, yet 10%-30% of breast cancers may be missed at mammography. Possible causes for missed breast cancers include dense parenchyma obscuring a lesion, poor positioning or technique, perception error, incorrect interpretation of a suspect finding, subtle features of malignancy, and slow growth of a lesion. Recent studies have emphasized the use of alternative imaging modalities to detect and diagnose breast carcinoma, including ultrasonography (US), magnetic resonance imaging, and nuclear medicine studies. However, the radiologist can take a number of steps that will significantly enhance the accuracy of image interpretation at mammography and decrease the false-negative rate. These steps include performing diagnostic as well as screening mammography, reviewing clinical data and using US to help assess a palpable or mammographically detected mass, strictly adhering to positioning and technical requirements, being alert to subtle features of breast cancers, comparing recent images with earlier mammograms to look for subtle increases in lesion size, looking for additional lesions when one abnormality is seen, and judging a lesion by its most malignant features.
Subject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/diagnosis , Diagnostic Errors , Mammography/methods , Adult , Aged , Carcinoma, Ductal, Breast/diagnosis , Carcinoma, Ductal, Breast/diagnostic imaging , Clinical Competence , Female , Humans , Middle Aged , Neoplasms, Ductal, Lobular, and Medullary/diagnosis , Neoplasms, Ductal, Lobular, and Medullary/diagnostic imagingABSTRACT
This article reviews staging of breast cancer and treatment protocols for the disease, then examines several different types of breast cancer. Each type is described in terms of its mammographic, sonographic and histologic appearance, along with its treatment and prognosis. The author concludes with a discussion of magnetic resonance imaging's role in breast cancer detection and treatment planning.
Subject(s)
Adenocarcinoma, Mucinous/diagnosis , Breast Neoplasms , Breast Neoplasms/diagnosis , Neoplasms, Ductal, Lobular, and Medullary/diagnosis , Adenocarcinoma, Mucinous/pathology , Adenocarcinoma, Mucinous/therapy , Breast Neoplasms/pathology , Breast Neoplasms/therapy , Female , Humans , Magnetic Resonance Imaging , Mammography/methods , Neoplasm Staging , Neoplasms, Ductal, Lobular, and Medullary/pathology , Neoplasms, Ductal, Lobular, and Medullary/therapyABSTRACT
Antecedentes: Siguiendo la amplia resección local de los cánceres de mama, 1 de cada 4 pacientes tiene enfermedad residual en la retumorrectomía o en la pieza de mastectomía. Objetivos: Determinar si el carcinoma residual de mama se correlaciona con mayor recidiva local o distinta supervivencia global. Lugar de aplicación: División de Cirugía General y práctica privada. Diseño: Estudio retrospectivo y descriptivo. Población: 139 pacientes consecutivos con mastectomía o tratamiento conservador luego de una biopsia diferida del tumor. Método: Revisión de las historias clínicas. Luego de la resección de carcinomas de mama palpables o no palpables en los que existen bordes comprometidos en la pieza de resección o sospecha mamográfica de carcinoma residual, se estudia el especímen de la retumorrectomía o la pieza de mastectomía. Los pacientes fueron seguidos una media de 63 meses y fueron documentadas las recidivas locales y la supervivencia. Resultados: El estudio retrospectivo de los 139 pacientes tratados con cirugía conservadora o mastectomía identificó 53 (38,1 por ciento) de carcinomas residuales, 42,5 por ciento para los carcinomas invasores (43/101) y 26,3 por ciento para los no invasores (10/38). De los 52 pacientes con tratamiento conservador, 15 (28,8 por ciento) tenían carcinoma residual. No hubo diferencia estadísticamente significativa ni para las recidivas locales (p = 0,56) o supervivencia entre los pacientes con o sin carcinoma residual. No fue demostrada ninguna relación de acuerdo a la edad los pacientes, el componente intraductal extensivo o el compromiso axilar. Conclusiones: El hallazgo de carcinoma residual de mama luego de amplia biopsia diferida no afecta la recidiva local o la supervivencia en pacientes con tratamiento conservador o mastectomía. Para minimizar el riesgo del carcinoma residual, se debe considerar la amplia excisión de las lesiones o la mastectomía en el manejo del carcinoma multifocal y de los no palpables radiológicamente multicéntricos