Histologic grade of locally advanced infiltrating ductal carcinoma after treatment with induction chemotherapy.

Multiagent chemotherapy is often used to treat patients with locally advanced infiltrating breast carcinoma before mastectomy. One of the most important prognostic factors, histologic grade, may be altered by induction chemotherapy. Because locally advanced infiltrating breast carcinomas are frequently diagnosed by fine-needle aspiration, histologic grade can be determined in the mastectomy specimens only after chemotherapy. Histologic grade, with its three components, was examined in 30 mastectomy specimens after induction chemotherapy for infiltrating ductal carcinoma and compared with findings in available pretreatment incisional biopsy specimens. Histologic grade for the 24 axillary lymph node-positive carcinomas treated with induction chemotherapy was compared with the grade for 24 axillary lymph node-positive ductal cancers that had been treated by surgery only. Complete, partial, or no clinical response was seen in 4 (13%), 21 (70%), and 5 (17%) patients after chemotherapy. In six of seven tumors, there was complete agreement between biopsy and postchemotherapy mastectomy specimens in grade and in scores for the three components. Half of the 24 node-positive tumors from patients treated with chemotherapy and 21% of node-positive neoplasms from patients treated initially with surgery had a mitotic count score of 1. In these two node-positive groups, 71% of tumors from patients treated with surgery and 92% of cancers from patients treated with induction chemotherapy showed a nuclear pleomorphism score of 3. For these two groups, however, there were no statistically significant differences in histologic grade or in any of its three components.

Preoperative staging of rectal carcinoma with MR imaging: surgical and histopathologic correlation.

Twenty-nine patients with rectal carcinoma were examined with magnetic resonance (MR) imaging at 1.0 T. In most patients a Helmholtz coil was used and a bowel distention obtained with a barium enema balloon tip. The MR findings were graded according to the modified Astler-Coller staging classification and correlated with the surgical or histopathologic results. Correct diagnosis was made in nine of the 12 patients with stage A and B1 tumors. Overestimation occurred in the other three patients, who had previously undergone radiation therapy or surgery. Local stage was correctly assessed in 11 patients with stage B2 carcinoma and in six patients with stage B3 tumors. Enlarged lymph nodes were detected in four of seven patients with nodes containing carcinoma. In two other patients with enlarged nodes, no carcinoma was identified at histologic examination. MR imaging may enable correct staging of local extent of rectal carcinoma, particularly in patients who have not previously undergone radiation therapy or surgery. However, evaluation of lymph nodes is less accurate.

Mediastinal fibrin glue: hemostatic effect and tissue response in calves.

There is continued controversy regarding the effectiveness and potential adverse effects of fibrin glue. Thus, we chose to evaluate it in a model of experimental calf aortic valve replacement that has been previously well established. Concentrated fibrinogen and topical thrombin were sprayed to form a thin layer of fibrin glue over the mediastinal tissues of 20 consecutive calves undergoing aortic valve replacement. Chest tube outputs of these animals were compared with those of the preceding 20 consecutive calves undergoing aortic valve replacement without fibrin glue. All procedures were performed by the same surgeon, and no other technical changes were made between the two series. Total postoperative chest tube output (mean +/- standard error) was 553 +/- 50 mL for the calves treated with fibrin glue and 1,155 +/- 103 mL for the control calves (p less than 0.001). On histological examination of mediastinal tissues from 5 treated calves killed 6 weeks after operation, there was no evidence of inflammation, fibrosis, or residual fibrin. To our knowledge, this is the first controlled laboratory study to show that fibrin glue spray is an effective hemostatic agent and that it produces no long-term tissue reaction.