Tissue polypeptide antigen (TPA) in pleural effusions.

The usefulness of tumor marker assay in pleural effusions for differential diagnosis is still debated. From the observation of common antigens on tissue polypeptide antigen (TPA) and keratins 8, 18 and 19 and vimentin, all substances contained in normal and neoplastic mesothelium, we felt it opportune to evaluate the use of TPA assay in 105 pleural effusions (46 benign and 59 malignant). The values were much higher than those found in blood. In hydrothorax the median value was 454 U/l (range, 59-1923), in exudative effusions 846 U/l (range, 258-4485), in metastatic pleural effusions 1277 U/l (range, 58-32352) and in mesotheliomas 7705 (range, 759-16000). The maximum value found in nonmalignant effusions was 4485 U/l; this value was taken as a cutoff level, so only 29.9% of the tumors were positive to the test. Our results showed this assay to be not very important for a differential diagnosis of malignant and nonmalignant pleural effusions. Nevertheless, the different TPA patterns in mesotheliomas (66.6% positive) and metastatic pleural effusions (15.9%) suggest that further studies are warranted.

[Vacuum-assisted breast biopsy for diagnosis of non-palpable lesions: experience with 226 cases]. / Biopsia mammaria "vacuum-assisted" per la diagnosi di lesioni non palpabili: descrizione dei primi 226 casi.

Vacuum-assisted breast biopsy (VABB) is now available for non-palpable lesions. The present study describes the results obtained from 226 consecutive VABBs performed at "L. Sacco" Hospital, Milan, from November 2005 to July 2007 (198 stereotactic and 28 ultrasonographic procedures). Adequate tissue samples for histopathological evaluation were obtained in 225 cases (99.6%). The diagnoses were as follows: 9 normal tissues (4%), 97 benign (43%), 25 "probably benign" (11%), 4 "suspicious for malignancy" (2%) and 90 malignant (40%, 53 in situ and 37 infiltrating carcinoma). Of the 90 malignant cases, 38 (42.2%) underwent subsequent surgical excision in our Unit; 84.2% (32/38) had concordant histopathological findings. In conclusion, VABB is an accurate and safe technique for diagnosis of non-palpable lesions, and in experienced hands avoids unnecessary surgical procedures.

Carcinoembryonic antigen in pleural effusions. Diagnostic value in malignant mesothelioma.

The usefulness of the determination of carcinoembryonic antigen (CEA) in pleural effusion was assessed as an aid to the diagnosis of malignant mesothelioma. The concentration of CEA was determined by radioimmunoassay (RIA) in pleural fluid of 213 adult patients, of which 140 had malignant pleural disease and 73 had nonmalignant pleural disease. Pleural fluid CEA (PF CEA) was lower than 12 ng/ml in all 15 mesotheliomas. The statistical probability of a mesothelioma associated with PF CEA greater than 15 ng/ml was found to be zero. The CEA assay in pleural effusion proved to be a valuable adjunct to other diagnostic procedures in differentiating the malignant mesothelioma from metastatic serosal spread.

Etoposide and high-dose cisplatin in good-risk patients with advanced squamous cell carcinoma and adenocarcinoma of the lung.

Fifty patients with advanced squamous cell carcinoma and adenocarcinoma of the lung having good prognostic features (performance status less than or equal to 2; weight loss less than or equal to 10%; age less than or equal to 70 years; absence of brain metastases; and no prior treatment) were treated on an outpatient basis with etoposide (120 mg/m2 on Days 1, 3, and 5) and cisplatin (60 mg/m2 on Days 1 and 2) every 21-28 days. One complete response and 14 partial responses were observed, with a median duration of response of 170 days and an overall median survival of 230 days. Toxicity was generally mild. Despite the high-dose cisplatin employed and the choice of patients with favorable prognostic factors in this study, results of this therapy remain disappointing.

The role of concurrent determinations of pleural fluid and tissue carcinoembryonic antigen in the distinction of malignant mesothelioma from metastatic pleural malignancies.

A combined determination of pleural fluid and tissue carcinoembryonic antigen (PF-CEA and T-CEA) by radioimmunoassay and immunoperoxidase staining technique respectively was performed in patients with malignant mesotheliomas (12), metastatic pleural carcinomas (17) and benign pleural diseases (seven). All PF-CEA-positive (greater than 39 ng/ml) cases were T-CEA-positive metastatic carcinomas. In contrast, 4/30 PF-CEA-negative (less than 39 ng/ml) cases were T-CEA-positive metastatic carcinomas (three cases) and idiopathic pleuritis (one case). These results suggest that CEA, though present in the tumour, is not always released in measurable amounts in effusions. Hence T-CEA content should be determined in the PF-CEA-negative cases when an early and definite diagnosis of tumour type is required to enable correct management of these patients. These ancillary tests aim at enhancing the level of confidence of the routine morphological diagnosis of serous surface malignancies in living patients using minimal intervention instead of resorting to open chest surgery.

Adriamycin, cyclophosphamide and etoposide (ACE) in the treatment of small cell lung cancer.

Thirty-five small cell lung cancer (SCLC) patients were treated with combination chemotherapy including adriamycin, cyclophosphamide, etoposide (ACE). Out of 32 evaluable patients there were 21.9% complete responses and 53.1% partial responses with an overall median survival of 37 weeks (50 weeks for patients with limited disease and 34 weeks for patients with extended disease). Toxicity was generally well tolerated. In conclusion the ACE regimen results in being active and safe in the treatment of SCLC.

Single-agent epirubicin as primary chemotherapy in T2-T3, N0-N2, M0 breast carcinoma: 6-year follow-up.

OBJECTIVE: Single-agent epirubicin was tested as primary chemotherapy treatment in patients with early breast cancer >3 cm. METHODS: 100 women with locally advanced breast cancer >3 cm were treated with three cycles of single-agent epirubicin at a dose of 120 mg/m2. All patients showing tumor shrinkage to less than 3 cm were considered candidates for conservative surgery (quadrantectomy); in the remaining patients modified radical mastectomy was carried out. Postsurgical treatment consisted of CMF chemotherapy except for postmenopausal node-positive, estrogen-positive patients who were assigned to hormonal treatment with tamoxifen and postmenopausal node-negative, estrogen-positive ones who did not receive any treatment. RESULTS: Quadrantectomy was carried out in 71 patients. At the median follow-up time of 69 months, the relapse rate was 29.6% among patients who underwent quadrantectomy (21 out of 71) and 58.6% among patients who underwent modified radical mastectomy (17 out of 29). CONCLUSIONS: Single-agent chemotherapy with anthracyclines could appear to be an effective treatment in inducing a tumor downstaging in patients with early breast cancer >3 cm. This treatment can be administered outside clinical trials in patients who desire to preserve their body integrity. Further prospective, randomized trials are needed in order to validate and better define the role of epirubicin in the neoadjuvant strategy of breast cancer patients.