ABSTRACT
Histological axillary node involvement [ANI] evaluated by axillary dissection remains the most accurate predictive factor for patients with invasive breast cancer. Axillary node involvement implies the necessity of systemic adjuvant treatment and locoregional irradiation. Is to detect the relative frequency of node positivity in relation to histopathology through studying a large mastectomy series. This study included 3747 mastectomy specimens performed al NCI Cairo in the period 1993-2003. In each case we assesed the age at time of diagnosis. pathologic tumor size and number, histologic subtype [including grade], tumor location, number of lymph nodes dissected and number of positive nodes [burden of node positivity]. Females constituted 96.8% of cases, 60.7% of them were premenopausal. The mean age was 47.1 +/- 10.5 years. Tumor size ranged from 0.5 to 20 cm. The global ANI rate in the entire cohort was 70.6%. In univariate analysis. five variables were significantly correlated to ANI, these were laterality, multiplicity, tumor size, histologic subtype and grade, while multiplicity, tumor size, histologic subtype and grade correlated significantly with metastatic burden, Multivariate analysis showed that older women [40-60 and> 60 years] have at least half the risk of developing LN metastasis compared to those < 40 years with the odds of 0.51[0.35-0.73] and 0.31[0.18-0.55], respectively. Tumor size >2cm put the women with breast cancer at 3 [if 2-5cm] to 9 [if> 5cm] folds of developing lymph node [LN] metastasis. Tumor size> 5 cm increases the likelihood of higher metastatic burden [> 3 +ve nodes] with odds of 1.5 [1.24-1.9]. Unfavorable histology also, increases the liklihood of more positive nodes to the double when compared to favourable histology. The results of this study reflected the unfortunate presentation of breast cancer patients. In addition, some factors could be used as useful guidlines in the management of those patients. These factors include age, tumor size and histologic type of the tumor
Subject(s)
Humans , Male , Female , Neoplasm Metastasis , Mastectomy , Lymph Nodes , Histology , AxillaABSTRACT
The aim of the present study was to explore by immunohistochemical methods, on lymph node and infiltrated bone marrow bioposies. the potential value of MIB-l proliferation rate. p53 overexpression and Mast cell tryptase [MCT] as possible prognostic fators for large cell lymphomas on 69 adult patients for whom paraffin blocks, clinical data and survival information were available. In the reviewed series, large cell lymphoma included: 84.1% large B-cell lymphoma. 11.6% peripheral T-cell lymphoma and 4.3% anaplastic large cell lymphoma. MIB-1 labeling was quantitated by image analysis and cases were classified as either of low or high proliferation rate taking MIB-l count of 50% as a cutoff value. For p53, nuclear immunoreactivity equal to or more than 20% were considered overexpression or positive. As for MCT, presence of> 5 mast cells/hpf was recorded as high count while counts <5 mast cells/hpf were considered low counts. In the L.N. biopsies examined the mean MIB-l labeling rate was 48.5%. p53 positive tumors contributed 33.3% of cases while high MCT counts were detected in 43.5% of cases. High MIB-l rate, p53 positivity and MCT counts showed a statistically significant relation to high lPl and were associated ".ith poor response to therapy and unfavorable 2-year overall survival and hence were considered risk factors. Additionally, high MCT count was found to show a strong relation with T-cell phenotype and extranodal forms. Bone marrow biopsies were examined to detect infiltrated cases. B.M. infiltration was detected in 15 cases whose levels of MIB-l and p53were in accordance to the corresponding L.N. values.MCT counts in B.M. biopsies were within the high count group but were lower than corresponding L.N. values and were strongly related to T-cell phenotype. It is concluded that MIB- 1. p53 and MCT are valuable prognostic factors which could serve as a guideline for treatment by identifying unfavorable cases for more intensive therapy