Molecular detection of the mammaglobin expression in the peripheral blood of Thai breast cancer patients.

Mammaglobin (hMAM) is expressed exclusively in the mammary glands of adult woman and mammary tumour cell lines. Thus, we examined hMAM expression as a market for the detection of carcinoma cells in the peripheral blood of patients with breast cancer in Thailand. In addition, we studied the correlation between hMAM expression in circulation mammary carcinoma cells and clinicopathological prognostic factors of breast cancer. Blood sample obtained from two hundred breast cancer patients at various stages of their disease and from sixty females without breast cancer (thirty healty individuals and thirty patients with various malignancies other than breast cancer) were screened for hMAM mRNA by a nested reverse transcriptase polymerase chain reaction (RT-PCR) assay. We found significant differences between patients with breast cancer and those with other malignancies or healthy controls. None of the samples from the peripheral blood of sixty females without breast cancer was positive, whereas sixty four (32%) of the two hundred sample from breast cancer patients tested positive for hMAM mRNA. While our hMAM nested RT-PCR approach has 100% specificity, its sensitivity is only 32%. The presence or absence of hMAM expression in these breast cancer patients was not associated with clinicopathological prognostic factors including stage, oestrogen and progesterone status, lymph node metastases, histological type, tumour size, differentiation, lymphatic invasion, vascular invasion, menopausal status or age. We summarized that the hMAM nested RT-PCR assay may be an effective tool for the detection of circulating mammary carcinoma cells of breast cancer patients. Nevertheless, the clinical relevance hMAM RT-PCR based tumour cell detections should be further evaluated in prospective studies.

Risk of breast cancer in post-menopausal women using hormone replacement therapy.

OBJECTIVE: To study the relationship of hormone replacement therapy (HRT) in post-menopausal women and risk of breast cancer. PATIENTS AND METHOD: The authors conducted a case-control study comparing the proportion of HRT used between breast cancer and non-breast-cancer women. Cases were breast cancer patients who had natural menopause (excluded hysterectomy) and aged > or = 50-years-old from the Siriraj Breast Cancer database (1983-1996). Controls were post-menopausal volunteers aged 50 year or older who visited Siriraj Hospital for other purposes such as elderly clinics, health check, etc. After informed consent, well-trained surgeons examined the women in the control group to exclude any potential breast cancer. Patient characteristics and risk factors were collected. RESULTS: Of 1,913 patients in the database, 623 were included as the cases. Data from 679 volunteers were collected for controls from May to December 1999. Among 1,302 of the study population 58 women had ever used HRT (4.5%), which distributed to 3.2 per cent (20/623) in cases and 5.6 per cent (38/679) in controls. From univariate analysis, age, age at menopause, number of children, habitat, education, contraceptive pills, familial history of breast cancer and HRT usage were associated with breast cancer (p-value<0.05). After multivariate forward stepwise logistic regression analysis, there was no association between HRT use and breast cancer (adjusted odds ratio (OR) = 0.61, 95% CI = 0.31-1.20). In subgroups analysis, women who had older age, higher education level, history of taking contraceptive pills, or positive familial history of breast cancer in second degree relatives had a decreased risk of breast cancer, while those living outside Bangkok had an increased risk. CONCLUSION: Hormonal replacement therapy in post-menopausal women was not associated with increased risk of breast cancer.

Ability of clinical nodal staging to predict histologic nodal status in breast cancer patients.

Axillary lymph node metastasis is the most important prognostic factor for breast cancer. Pathologic examination of axillary lymph node dissection specimens is the gold standard for determining if the tumour has metastasized. Clinical nodal staging may help the physician to plan for management and to decide what advice to give the breast cancer patients. We studied the metastasis predictive ability of clinical lymph node staging, and tried to identify subgroups that were more reliable for clinical staging. Patients and Methods: We did a cross-sectional study by collecting the data of patients who had their breast cancers treated at Siriraj Hospital from 1983 to 1993. The lymph node status from preoperative physical examination was compared to the pathologic result of axillary lymph node dissections. Results: Of 1,355 breast cancer patients, 4 patients were stage 0, 224 were stage I, 891 were stage II, 161 were stage III, and 40 patients were stage IV (with 35 missing). Mean diameter of the cancer was 3.6 cm. The average age at diagnosis was 48.5 years. Fifty one percent (697 patients) had at least one palpable node from preoperative physical examination, and 50% of cases (678 patients) had pathologic axillary lymph node positive for metastasis. When compared to pathologic examination, the accuracy of clinical lymph node staging was 70.6%, with 70% sensitivity and 71% specificity. The accuracy was increased in patients with small (T1) or large primary tumor (T3,4) subgroups. Conclusion: Physical examination of axillary lymph node could be used as a guide for predicting metastasis of breast cancer, but with 25-30% of uncertainty.

Surgical treatment of phyllodes tumour of the breast in Siriraj Hospital.

The authors studied retrospectively the surgical treatment of phyllodes tumour of the breast patients between 1989-1994 in the Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University. 24 patients were found. Their ages ranged from 18-60 years (mean 40 years). 17 patients were single and 7 patients were married. The pathological diagnoses of the growths were 15 benigns, 6 borderline malignants and 3 malignants. The size clinically were 1.5 to 30 cm (mean 10.7 cm.) and pathologically were 2 to 48 cm. (mean 10.98 cm.). 7 patients (29.17%) suffered recurrence of the growths. The time that the breast masses were detected before coming to the hospital ranged from 1 to 36 months (mean 7 months). The follow-up period ranged from 4 to 71 months (mean 17 months). The latest surgical procedures were 12 excisions, 7 simple mastectomies 2 subcutaneous mastectomies, 2 modified radical mastectomies, and 1 extended radical mastectomy.

Bloody and serosanguineous nipple discharge.

Spontaneous bloody and serosanguineous nipple discharge is not only a relatively uncommon condition but also an alarming experience for women who suffer it. The objective of this study is to find the underlying causes, clinical pattern and proper management for the individual patient. From 1986 to June 1993 at the Department of Surgery, Siriraj Hospital, 32 cases were identified from the surgical records. All were female who had nonlactational, solitary, unilateral and spontaneous bloody or serosanguineous nipple discharge. Their ages ranged from 16 to 76 years with a mean age of 42 years. 11 of the 32 cases also had an associated definite breast mass and 2 had a subareolar induration. All but one were surgically treated by microdochectomy, segmental resection, excisional biopsy of the mass, and frozen section with mastectomy in 18, 6, 5 and 2 cases respectively. Intraductal papilloma or papillomatosis was the leading underlying cause followed by invasive ductal carcinoma which was found in 9 cases or 28% of the series. The malignant patents tended to be older and almost always had an associated breast mass on physical examination (8 in 9 cases). The risk of malignancy for the associated definite breast mass was statistically significant. Therefore, to eradicate the bleeding and establish a pathological diagnosis, all patients should be treated surgically regardless of the results of investigations. And those who have an associated definite breast mass should be considered to have a malignant growth until proved otherwise.