Características de los tumores adicionales detectados en tomosíntesis de mama: nuestra experiencia / Characteristics of additional tumors detected by tomosynthesis: our experience

Objetivo. Evaluar las características semiológicas radiológicas e histológicas de los tumores adicionales detectados por tomosíntesis comparativamente con los detectados por mamografía convencional. Material y métodos. Sobre una muestra de 166 pacientes se analizaron retrospectivamente los hallazgos radiológicos y anatomopatológicos de los tumores detectados únicamente por mamografía (105 casos) y de los tumores adicionales detectados por tomosíntesis (61 casos). Resultados. Se encontraron diferencias en la semiología radiológica de los 2 grupos (p < 0,01). En los 105 tumores detectados mediante mamografía, los patrones de presentación más frecuente fueron los nódulos (40%) y el patrón mixto (29,4%), destacando también los detectados por microcalcificaciones (21%). En los 61 tumores adicionales detectados por la tomosíntesis, la forma de presentación más frecuente fueron las distorsiones (44,3%) y los nódulos (34,4%). En este grupo no se detectó ningún tumor adicional por la presencia de microcalcificaciones no detectadas en la mamografía previa. En cuanto a la histología, se detectó una mayor proporción (p < 0,001) de carcinomas tubulares en el grupo de tomosíntesis. No se encontraron diferencias significativas entre los 2 grupos respecto de la proporción de carcinomas infiltrantes-carcinomas in situ, carcinomas ductales infiltrantes o carcinomas lobulillares infiltrantes. Conclusión. La manifestación radiológica más frecuente de los tumores adicionales fue la distorsión arquitectural. La tomosíntesis conllevó una mayor detección de distorsiones arquitecturales y de carcinomas tubulares (AU)

Objective. To evaluate the radiological and histological features of additional tumors detected by tomosynthesis compared with those detected by conventional mammography. Material and methods. Radiological and histological findings were retrospectively analyzed in a sample of 166 patients. A total of 105 tumors were detected by mammography alone and 61 additional tumors were detected by tomosynthesis. Results. Differences were observed in the radiological findings in both groups (P < .01). The most frequent presentation of the 105 tumors detected by conventional mammography were nodules (40%), mixed pattern (29.4%), and microcalcifications (21%). The most frequent presentation of the 61 additional tumors detected by tomosynthesis were distortions (44.3%) and nodules (34.4%). In this group, no additional tumors were detected by the presence of microcalcifications not detected previously with conventional mammography. A higher proportion of tubular carcinomas was detected in the tomosynthesis group (P < .001). There were no differences in the proportion of invasive carcinomas-carcinomas in situ, invasive ductal carcinomas, and invasive lobular carcinomas between the 2 groups. Conclusion. The most frequent radiological feature of additional tumors was distortions. Tomosynthesis detected more distortions and tubular carcinomas (AU)

Carcinoma medular quístico de mama / Cystic medullary breast carcinoma

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Multicentric study on 18F-FDG-PET/CT breast incidental uptake in patients studied for non-breast malignant purposes / Estudio multicéntrico sobre la captación incidental en la mama con 18F-FDG-PET/TAC en pacientes evaluados con fines oncológicos no relacionados con la patología mamaria

Aim. Our study has aimed to establish the prevalence and pathological nature of fluorine-18-fluorodeoxyglucose (18F-FDG) breast incidental uptake (BIU) in patients studied for non-malignant breast tumours and then to compare our data obtained in three Italian nuclear medicine centres with those available in literature. Material and methods. We retrospectively evaluated 42,927 18F-FDG-PET/CT scans performed on patients studied in three Italian Nuclear Medicine Centres. All patients underwent 18F-FDG-PET/CT for oncologic purposes not related to breast disease. Results. Among 42,927 scans, a BIU was identified in 79 (0.18%) patients, 75 (95%) female and 4 (5%) male with an average age of 62 ± 17 years. Twenty-five out of 35 (71.5%) BIUs were malignant and 10/35 (28.5%) benign. Among the 25/35 incidentalomas that were malignant, 12/25 (48%) were infiltrating ductal carcinoma, 5/25 (20%) ductal carcinoma (infiltrating and in situ), 4/25 (16%) lobular carcinoma, 2/25 (8%) ductal carcinoma in situ and 2/25 (8%) were metastases from the primary tumour under investigation. Of the 10 BIUs that were benign in the histological examination, after further investigations it was found that 9/10 (90%) were fibroadenomas and 1/10 (10%) was a benign lesion not better specified. The lesion to liver or to blood-pool SUVmax ratio in malignant lesions is significantly higher than in benign ones. Conclusions. Our multicenter study demonstrates that, although they are uncommon, BIUs show a high percentage of malignancy and therefore requires further research (AU)

Objetivo. Objetivo de nuestro estudio fue establecer la prevalencia y el carácter patológico de la captación incidental en la mama (CIM) de 18F-FDG en pacientes evaluados para tumores malignos de origen no-mamario y luego comparar nuestros datos obtenido en tres centros Italianos de Medicina Nuclear con los que están disponibles en literatura. Material y métodos. Hemos evaluado retrospectivamente 42.927 estudios 18F-FDG-PET/TAC de pacientes en tres centros Italianos de Medicina Nuclear; todos los pacientes se han sometidos a una exploración 18F-FDG-PET/TAC por fines oncológicos no relacionados con la patología mamaria. Resultados. Entre 42.927 exploraciones, una CIM fue identificada en 79 (0.18%) pacientes, 75 (95%) mujeres y 4 (5%) hombres, con una edad media de 62 ± 17 años. Veinticinco de 35 (71.5%) CIM fueron malignas y 10/35 (28.5%) benignas. Entre los incidentalomas malignos, 12/25 (48%) eran carcinomas ductales infiltrantes, 5/25 (20%) carcinomas ductales (infiltrantes e in situ), 4/25 (16%) carcinomas lobulares, 2/25 (8%) carcinomas ductales in situ y 2/25 (8%) eran metástasis de tumour primario objeto de investigación. Entre 10 CIM que fueron identificados como benignos en el examen histológico después de investigación adicional, 9/10 (90%) fueron fibroadenomas y 1/10 (10%) fue una lesión benigna no mejor especificada. El ratio del SUVmáx de la lesión en comparación con el hígado o con el pool vascular es significativamente mayor en las lesiones malignas que en las benignas. Conclusiones. Nuestro estudio multicéntrico demuestra que, aunque son poco frecuentes, las CIM muestran un alto porcentaje de malignidad, por lo tanto las CIM necesitan investigación adicional (AU)

The role of endoscopic ultrasound (EUS) in relation to other imaging modalities in the differential diagnosis between mass forming chronic pancreatitis, autoimmune pancreatitis and ductal pancreatic adenocarcinoma / Papel de la endoscopia en relación con otras modalidades de imagen en el diagnóstico diferencial entre pancreatitis crónica en forma de masa, pancreatitis autoinmune y adenocarcinoma pancreático

Differential diagnosis of solid pancreatic lesions remains as an important clinical challenge, mainly for the differentiation between mass forming chronic pancreatitis, autoimmune pancreatitis and pancreatic adenocarcinoma. Endoscopic ultrasound (EUS), computed tomography (CT) and magnetic resonance imaging (MRI) can all provide valuable and complementary information in this setting. Among them, EUS has the unique ability to obtain specimens for histopathological diagnosis and can therefore play a crucial role in the evaluation patients with inconclusive findings on initial examinations. Nowadays, new developed techniques associated to EUS, like elastography and contrast enhancement, have shown promising results for the differential diagnosis of these pancreatic lesions(AU)

Yield of selective magnetic resonance imaging in preoperative workup of newly diagnosed breast cancer patients planned for breast conserving surgery.

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.

Disnea y tos persistente como primera manifestación de la recaída a distancia / Dyspnea and persistent cough as first signs of distant recurrence disease

La incidencia de metástasis endobronquiales secundarias a tumores sólidos es baja. Los tumores primarios que con más frecuencia producen metástasis endobronquiales son la mama, el colon y los tumores renales. Normalmente se presentan como una manifestación tardía de la enfermedad con un pronóstico malo y por su forma inespecífica de presentación precisan diagnóstico diferencial con los tumores pulmonares primarios (AU)

Endobronchial metastases secondary to extrapulmonary solid malignant tumours are rare. The most frequent primary tumours associated with endobronchial involvement are breast, colon and renal cell carcinoma. Endobronchial metastases usually appear later with a poorer prognosis and require differential diagnosis from a primary lung cancer (AU)

La telorrea como manifestación del carcinoma intraductal de mama / Nipple discharge as a manifestation of ductal carcinoma in situ

Antecedentes. La secreción por pezón es un método diagnóstico inocuo y accesible que, en la práctica, se considera de baja sensibilidad y especificidad diagnóstica. Caso. Mujer de 45 años con telorragia derecha y escozor que como único dato en pruebas radiológicas presenta dilatación de 1mm. de un conducto retroareolar. En una de las exploraciones, se consigue muestra de secreción a la expresión que muestra un fondo con hematíes y algunos agregados de células epiteliales, con ligera superposición celular, contorno abollonado y otras veces liso. Las células muestran aumento de relación N/C, hipercromasia, contorno nuclear irregular e imágenes de canibalismo. Con la sospecha de lesión papilar se realiza biopsia excisional que evidencia un carcinoma intraductal de grado medio con necrosis de tipo comedo. Conclusión. Aunque el carcinoma ductal de mama, ya sea intraductal o infiltrante se expresa sólo raramente con telorrea, ante grupos epiteliales con atipia citológica no hay que olvidar esta posibilidad además de lesiones papilares (AU)

Introduction. Nipple discharge is an innocuous and accessible diagnostic method that, in practice, is considered to have low sensitivity and specificity. Case. A 45-year-old woman presented with bloody right nipple discharge and burning sensation. Imaging tests revealed a 1-mm dilatation as the only finding of interest. In one of the examinations, a sample of the secretion was obtained that showed a bloody background and some clusters of epithelial cells, with slight cellular overlapping, and contour that was smooth in parts and dented in others. The cells showed an increase in the nucleus/cytoplasm ratio, hyperchromatic nuclei, irregular nuclear membrane and images of cannibalism. Because a papillary lesion was suspected, excisional biopsy was performed, revealing intermediate-grade ductal carcinoma in situ with comedo-like necrosis. Conclusion. Though the ductal carcinoma of the breast, whether in situ or invasive, is rare expresses nipple discharge, if there are epithelial clusters with cytologic atypia we have not forget this possibility besides papillary lesions (AU)

Análisis de recurrencias axilares tras biopsia selectiva del ganglio centinela en cáncer de mama inicial / Axillary recurrences after sentinel lymph node biopsy in initial breast cancer

Objetivo. Analizar los resultados de la aplicación de la biopsia selectiva del ganglio centinela en cáncer de mama en nuestro medio, mediante el análisis de recurrencias axilares en pacientes con Ganglio Centinela (GC) negativo sin vaciamiento axilar convencional, tras seguimiento clínico posterior. Material y métodos. Se han incluido un total de 218 pacientes a quienes se aplicó la BSGC tras diagnóstico de cáncer de mama en estadio inicial (T1-2N0) con vaciamiento axilar convencional únicamente si GC positivo. Se aplicó en todos los casos protocolo de 2 días para detección del GC tras inyección de 99mTc- Nanocoloide. Resultados. La media de seguimiento clínico posterior fue de 27 meses. Se extirparon un total de 413 GC con una media de 1,89/paciente (1–5). En un 33,9% se detectó infiltración [59,45% macrometástasis, 22,97% micrometástasis y 17,5% células tumorales aisladas (CTA)], siendo negativo el resto de ganglios extirpados en el vaciamiento axilar convencional en el 60% de los casos. En nuestra serie de pacientes se detectó un único caso de falso negativo de GC por bloqueo linfático masivo, identificándose intraoperatoriamente una adenopatía no captante adyacente al GC, sin detectarse ningún caso de recidiva axilar durante un seguimiento clínico medio de 27 meses. Conclusión. La ausencia de recidivas axilares en nuestra serie de pacientes con GC negativo sin vaciamiento axilar convencional indica el adecuado control local que la biopsia selectiva del ganglio centinela ofrece en el cáncer de mama en estadios iniciales(AU)

Objective. The aim of our study was to analyze the application of the Selective Sentinel Lymph Node Biopsy (SLNB) in early Breast Cancer of our population, through the analysis of axillary recurrences in patients with false negative sentinel node procedures without complete axillary lymphadenectomy, after a subsequent clinical follow-up. Material and methods. A total of 218 early Breast Cancer patients who underwent SLNB after being diagnosed of early breast cancer (T1-2N0) with complete axillary dissection only when the SLNB was positive in the histopathological analysis. In every case, a 2-day protocol was used to localize the sentinel node after injection of 99mTc-Nanocolloid. Results. The mean subsequent clinical follow-up was 27 months. A total of 413 sentinel nodes were removed with a median of 1.89/p (range 1–5). Infiltration was detected in 33.9% of patients (59.45% macrometastasis, 22.97% micrometastasis and 17.5% Isolated Tumor Cells (ITC)) and negative for the other nodes excised after conventional lymphadenectomy in 60% of cases. In our population, there was only one case of false negative (FN) SLN due to massive lymphatic blockage, and an abnormal lymph node without uptake adjacent to the SLN was identified intraoperatively. No case of axillary recurrence was detected during an average follow-up of 27 months. Conclusion. The absence of axillary recurrences in our population with negative SLNB without complete axillary dissection demonstrates the appropriate local control offered by this procedure in early Breast Cancer(AU)

Expresión de p63 y citoqueratina 5/6 en los diferentes tipos moleculares del carcinoma de mama / p63 and citokeratin 5/6 expression in different molecular subtypes of breast carcinoma

Antecedentes. El cáncer de mama es un grupo heterogéneo de tumores. Los estudios de microarrays de ADN han llevado a la clasificación del carcinoma invasor de mama en diferentes clases moleculares. El objetivo de este estudio fue determinar la expresión de p63 y citoqueratina 5/6 en carcinomas ductales invasores y su relación con las diferentes clases moleculares, en especial con el subgrupo de tipo basal. Métodos. Se realizó estudio inmunohistoquímico con los anticuerpos p63 y CK5/6 en 200 muestras de carcinoma ductal invasor sin otra especificación. En cada caso se había determinado previamente el estado de los receptores de estrógeno y progesterona (RE, RP), y de HER2. De acuerdo a estos datos, los tumores se clasificaron como luminal A, luminal B, HER2+ y tipo basal (triple negativo). Resultados. Se observó expresión de p63 en 5 casos de HER2+ y 19 casos de tumores del tipo basal (23,2%), se demostró una fuerte relación entre la expresión de CK5/6 y los tumores de tipo basal (59,8%, p<0,0001), pero también se expresó en un caso luminal A, 3 luminal B y 8 HER2+. Conclusiones. No todos los casos triple negativo son de tipo basal. Es necesario estandarizar la clasificación molecular basada en inmunohistoquímica, así como el panel de anticuerpos a utilizar, en especial para la identificación del tipo basal(AU)

Background. Breast cancer is a heterogeneous group of tumors. DNA microarray profiling studies have led to the classification of invasive breast carcinoma called molecular classes. AIMS: To study the expression of p63 and cytokeratin (CK) 5/6 in invasive ductal carcinomas and their relationship to the different molecular classes, especially the basal like subgroup. Methods. Immunohistochemistry with the antibodies p63 and CK5/6 was performed in 200 samples of invasive ductal carcinomas with no other specification. Each case had previous results of estrogen and progesterone receptor (ER, PR), and HER2. According to these data they were classified as luminal A, luminal B, HER2+ and basal like (triple negative). Results. p63 was expressed in 5 cases of HER2+ and 19 cases of basal like tumours (19.5%). There was a strong relationship between CK5/6 expression and basal like tumours (68.9%, p<0.0001), but it was also expressed in one luminal A, three luminal B and eight HER2+ cases. Conclusions. Not every triple negative tumors express basal markers. It is necesary to standarize the molecular classification of breast cancer and the panel of markers to use in its caracterization, especially for the basal like(AU)

Angiomas capilares lobulares diseminados / Disseminated Lobular Capillary Hemangiomas

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Carcinoma ductal del utrículo prostático. Caso clínico y revisión de la literatura / Prostatic utricle ductal carcinoma. Case report and bibliographic review

Objetivo: Se presenta un caso de adenocarcinoma ductal prostático, anteriormente conocido como carcinoma endometrioide y se revisa la literatura. Métodos: Paciente de 75 años que acude a la consulta por sintomatología de obstrucción urinaria, PSA de 8,1 ng/ml., sin otra clínica acompañante. El tacto rectal y la ecografía abdominopélvica evidencian una próstata pequeña y pétrea. Se realiza resección transuretral desobstructiva y la anatomía patológica revela carcinoma ductal del utrículo prostático. Resultados: A los 9 años del diagnóstico no presenta signos de diseminación. Conclusiones: De hallazgo casual en el estudio anatomo-patológico, el adenocarcinoma ductal del utrículo prostático es una rara neoformación, cuya incidencia entre todos los carcinomas prostáticos ha sido citada entre 0,2-0,8%, si bien resulta interesante hacer una revisión sobre el tema para fomentar su estudio. Se revisan la clínica, diagnóstico y tratamiento de dicho carcinoma (AU)

Objective: A case of ductal carcinoma of the prostatic utricle is described, previously known as endometrial carcinoma, and literature is reviewed. Methods: 75 years old patient who consults for lower urinary tract obstructive symptoms, with a PSA of 8.1 ng/ml., without more symptoms. Digital rectal examination and ultrasound showed a small and stony prostate. Deobstructive transurethral resection of the prostate was performed and the biopsy revealed ductal carcinoma of the utricle. Results: Nine years after diagnosis signs of dissemination are not present. Conclusions: As incidental finding in the biopsy, ductal carcinoma of the utricle is a rare tumor, the incidence of which among all prostatic carcinomas has been cited as 0.2-0.8%. We report a review about this topic for improving its knowledge. Symptoms, pathological findings and treatment of this carcinoma have been reviewed (AU)

Ganglio intramamario metastásico como primera manifestación del cáncer de mama / Metastatic intramammary lymph node as the first manifestation of breast cancer

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Espiradenomas múltiples con distribución lineal / Multiple linear spiradenoma with a linear distribution

Presentamos el caso de una mujer de 32 años que acudió a nuestra consulta con múltiples nódulos en el brazo izquierdo y mama homolateral de 15 años de evolución. Estas lesiones tenían una coloración azulada y eran dolorosas. Pocos años atrás le habían extirpado en el brazo izquierdo otras tres lesiones similares con el diagnóstico histopatológico de espiradenoma. Todos los nódulos estaban dispuestos siguiendo un trayecto lineal y bajo una lesión maculopapulosa eritematosa que clínicamente parecía corresponder a un nevo epidérmico. Los casos de espiradenomas múltiples son muy raros y más aún los espiradenomas múltiples que adoptan una disposición lineal

We report the case of a 32-year old woman who presented with multiple nodules in the left arm and breast that had been present for 15 years. These nodules had a bluish colour and were occasionally painful. She had gone under excision of three other nodules on the left arm with the histopathological diagnosis of spiradenoma. All of the nodules were disposed in a linear arrangement and underneath a maculo-papular erythematous lesion which clinically seemed to be an epidermal nevus. The case described in the literature of multiple spiradenomas are vey rare and multiple linear spiradenomas are even rarer

Carcinoma de mama metastático en ganglios axilares con linfoma no Hodgkin. Presentación de un caso / Concurrent metastatic breast carcinoma and malignant lymphoma in lymph nodes. Report of a case

La larga supervivencia de pacientes diagnosticados de neoplasia maligna tras exitosos tratamientos ha incrementado la aparición de segundas neoplasias. Presentamos un caso de una mujer de 74 años con un carcinoma ductal infiltrante de mama. Todos los ganglios linfáticos axilares estaban ampliamente afectados por linfoma no Hodgkin, y 2 ganglios linfáticos mostraron metástasis de carcinoma. El interés de nuestro caso radica en la coexistencia de ambos tumores en los ganglios linfáticos axilares

The long survival of patients diagnosed with malignant neoplasm after successful treatments has increased the incidence of second neoplasms. We report a case of a 74-year-old woman with an invasive ductal breast carcinoma. All axillary lymph nodes were extensively affected by non-Hodgkin’s lymphoma, and two lymph nodes demonstrated metastatic carcinoma. The interest of our case resides in the coexistence of both tumors in the axillary lymph nodes

Correlation between VEGF expression and angiogenesis in breast carcinoma.

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.

Prognostic significance of angiogenesis evaluated by CD105 expression compared to CD31 in 905 breast carcinomas: correlation with long-term patient outcome.

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.

Minichromosome maintenance protein 2 is a strong independent prognostic marker in breast cancer.

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.

Missed breast carcinoma: pitfalls and pearls.

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.