Is clinical breast examination important for breast cancer detection?

BACKGROUND: Screening clinical breast examination (cbe) is controversial; the use of cbe is declining not only as a screening tool, but also as a diagnostic tool. In the present study, we aimed to assess the value of cbe in breast cancer detection in a tertiary care centre for breast diseases. METHODS: This retrospective study of all breast cancers diagnosed between July 1999 and December 2010 at our centre categorized cases according to the mean of detection (cbe, mammography, or both). A cbe was considered "abnormal" in the presence of a mass, nipple discharge, skin or nipple retraction, edema, erythema, peau d'orange, or ulcers. RESULTS: During the study period, a complete dataset was available for 6333 treated primary breast cancers. Cancer types were ductal carcinoma in situ (15.3%), invasive ductal carcinoma (75.7%), invasive lobular carcinoma (9.0%), or others (2.2%). Of the 6333 cancers, 36.5% (n = 2312) were detected by mammography alone, 54.8% (n = 3470) by mammography and cbe, and 8.7% (n = 551) by physician-performed cbe alone (or 5.3% if considering ultrasonography). Invasive tumours diagnosed by cbe alone were more often triple-negative, her2-positive, node-positive, and larger than those diagnosed by mammography alone (p < 0.05). CONCLUSIONS: A significant number of cancers would have been missed if cbe had not been performed. Compared with cancers detected by mammography alone, those detected by cbe had more aggressive features. Clinical breast examination is a very low-cost test that could improve the detection of breast cancer and could prompt breast ultrasonography in the case of a negative mammogram.

Recommendations on breast cancer screening and prevention in the context of implementing risk stratification: impending changes to current policies.

In recent years, risk stratification has sparked interest as an innovative approach to disease screening and prevention. The approach effectively personalizes individual risk, opening the way to screening and prevention interventions that are adapted to subpopulations. The international perspective project, which is developing risk stratification for breast cancer, aims to support the integration of its screening approach into clinical practice through comprehensive tool-building. Policies and guidelines for risk stratification-unlike those for population screening programs, which are currently well regulated-are still under development. Indeed, the development of guidelines for risk stratification reflects the translational aspects of perspective. Here, we describe the risk stratification process that was devised in the context of perspective, and we then explain the consensus-based method used to develop recommendations for breast cancer screening and prevention in a risk-stratification approach. Lastly, we discuss how the recommendations might affect current screening policies.

Sonographically guided directional vacuum-assisted breast biopsy using a handheld device.

OBJECTIVE: The goal of this study was to show that one can safely remove all sonographic evidence of masses in the breast less than or equal to 1.5 cm in greatest dimension using the 11-gauge handheld Mammotome, thereby reducing the possibility of a false-negative diagnosis and other shortcomings of the automated core biopsy device. SUBJECTS AND METHODS: Over a 12-week period (May 3--July 31, 2000), 124 sonographically guided breast biopsies were performed in 113 patients, using a new handheld directional vacuum-assisted biopsy device. All lesions that were less than or equal to 1.5 cm were biopsied using a handheld Mammotome; an attempt was made to continue the biopsy until no sonographic evidence of the lesion remained. RESULTS: Of these 124 lesions, 14 had infiltrating ductal carcinomas, four had infiltrating ductal carcinomas with associated ductal carcinoma in situ, one had infiltrating lobular carcinoma, one had ductal carcinoma in situ, three had atypical ductal hyperplasias, one had atypical lobular hyperplasia, and one had phyllodes tumor. Only one infiltrating ductal carcinoma was entirely removed histologically at Mammotome biopsy. There were no underestimates of disease. No cases of epithelial displacement were observed in any of the surgical excisions of malignancies. The remaining 99 lesions were benign. CONCLUSION: The handheld Mammotome diminishes the shortcomings of the automated core biopsy device. It reduces the possibility of false-negatives and underestimation of disease. It eliminates the need for multiple insertions and reduces the likelihood of epithelial displacement. As a result, we now use this device for all sonographically guided biopsies of breast masses smaller than 1.5 cm and recommend that others consider it for such use.

Acute and long-term administration of anticholinergics in Parkinson's disease: specific effects on the subcortico-frontal syndrome.

Parkinson's Disease (PD) is often associated with a subcortico-frontal syndrome (SCFS) that is mainly characterized by executive dysfunctions. The complete biochemistry of these dysfunctions remain misunderstood. Most studies have focused on the well-known nigro-striatal dopaminergic degenerations of PD, but a more satisfying understanding of the SCFS has come from the study of the cholinergic systems. We present here two new experiments carried out with long-term and acute anticholinergic treatments in PD. In the first experiment, the effects of a 2-week treatment with trihexyphenidyl were compared to those observed under placebo on a neuropsychological battery. Results showed that anticholinergic-induced deficits in PD were exclusively concerned with executive functions. In the second experiment, the effects of an acute subclinical dose of scopolamine were compared between normal controls and PD patients who were devoid of cognitive deficit on a subset of executive tasks. Results indicates that PD patients but not normal controls developed a transient SCFS for the duration of the drug action. In contrast to other populations with cholinergic depletions-such as Alzheimer's disease-cholinergic blockade in PD exacerbates specifically the SCFS. Such a discrepancy between these two neuropsychological profiles are discussed in terms of the specificity of the underlying cholinergic lesions.

Adrenoleukodystrophy: magnetic resonance follow-up after Lorenzo's oil therapy.

PURPOSE: To determine the therapeutic value of Lorenzo's oil (a mixture of glyceryl trioleate and glyceryl trierucate oils) in treating the childhood form of adrenoleukodystrophy (ALD), as indicated by magnetic resonance imaging (MRI) follow-up. PATIENTS AND METHODS: Between January 1992 and March 1994 eight males with biochemically proven ALD, ranging in age from 1 to 28 years, were referred for cerebral MRI and initiation of Lorenzo's oil dietary therapy; treatment continued for a period of 6 to 24 months. Five of the patients underwent follow-up cerebral MRI, and the images were reviewed without knowledge of medical status or chronology of imaging relative to therapy; the other three patients were excluded from the study because follow-up examinations were lacking. Signal abnormalities were evaluated according to a modified Loes scale, which yielded a minimum rating of 0 (for normal findings) and a maximum rating of 35 (for the most severe abnormalities). Because an untreated control group was not available for comparison, the Wilcoxon signed-rank test was used to analyse the results. RESULTS: There was no statistically significant improvement in the ratings of abnormalities after treatment (p = 0.31, alpha = 0.10). However, the correlation between MRI findings and clinical symptoms was good. CONCLUSIONS: The Wilcoxon signed-rank test is a useful statistical tool for evaluating the results of studies in which the sample population is small and there is no control group. The authors suggest that although Lorenzo's oil may not be curative, it may have a role in preventing the progress of ALD in asymptomatic patients. A multicentre control trial of Lorenzo's oil treatment, with emphasis on asymptomatic patients, is now underway.

Primary pulmonary hypertension associated with HIV infection.

A Haitian woman with the human immunodeficiency virus (HIV) presented with dyspnea, cough, fatigue and lower abdominal pain of recent onset. Clinical, radiologic and hemodynamic investigations demonstrated pulmonary hypertension. The patient died a few days later. The pathological findings were compatible with primary pulmonary hypertension. This case is similar to others that have been reported and indicates a possible link between HIV infection and rapidly progressive primary pulmonary hypertension.

[Acute ulcerative colitis associated with cytomegalic inclusion virus in a non-immunodepressed patient (author's transl)]. / Colite ulcéreuse aiguë avec inclusions cytomégaliques chez un sujet non immunodéprimé.

A new case of acute ulcerative colitis associated with cytomegalic inclusion virus within the colonic wall is reported. Some unusual features are discussed, such as the absent defect in cellular or humoral immunity, the location of the lesion which were limited to the sigmoid colon, and the fatal outcome of the disease. The possible pathogenic relationship between cytomegalic infection and acute a chronic ulcerative colitis are reviewed.