Usefulness of Frozen Section Examination of Core Needle Biopsy in the Breast Carcinoma

BACKGROUND: Core needle biopsy (CNB) is widely used as the initial sampling method for breast cancer. And because frozen section (FS) diagnosis is rapid and reliable, we studied the diagnostic agreement between the diagnosis of FS of CNB and final diagnosis after surgery to evaluate the diagnostic accuracy of the FS of CNB. METHODS: Of 409 patients who were preoperatively diagnosed by FS of CNB and who underwent final surgery from 1996 through 2000, 24 cases were found to be ductal carcinoma in situ (DCIS) and 385 cases invasive carcinoma (IC). The diagnoses of FS of CNB were compared with final diagnoses. RESULTS: The diagnostic accuracy of carcinoma is 63.6% for DCIS and 86.9% for invasive carcinoma. Five cases (1.2%) could not be diagnosed because of material insufficiency for diagnosis. Twenty two cases (5.4%) were diagnosed as benign on FS, among which 20 (90.9%) were misdiagnosed by sampling error. Twenty seven cases (6.7%) were deferred on FS, 4 of these cases were DCIS, 5 were invasive lobular carcinoma (ILC), the rest displayed low nuclear grades or marked freezing artifacts. CONCLUSIONS: The diagnostic accuracy of FS of CNB is very high except for cases of ILC and low grade DCIS. Considering the advantage of rapid evaluation, more definitive diagnosis, familiarity by pathologists and availability of ancillary study, FS of CNB is very useful method as the preoperative evaluation.

Expression of p53 Protein and Ki-67 in Atypical Ductal Hyperplasia, Ductal Carcinoma in Situ, and Microinvasive Ductal Carcinoma of the Breast

Mutation of the p53 gene is one of the most common genetic alterations in invasive breast carcinoma. However, it is unclear that the mutation usually occurs in noninvasive breast lesions. It might be expected that there is a correlation between histologic progression of breast lesions and proliferative rate. We investigated the expression of p53 protein and Ki-67 labelling index (LI) using immunohistochemistry in 16 ductal carcinoma in situ with microinvasion (DCIS-Mi), 56 DCIS, 15 atypical ductal hyperplasia (ADH), and 7 intraductal hyperplasia (IDH). Expression of p53 protein was detected in 33.9% of DCIS and 56.3% of DCIS-Mi and was confined exclusively in Van Nuys DCIS group 2 and 3. In ADH and IDH, no expression of p53 protein was found. There was no significant correlation between Van Nuys DCIS groups and Ki-67 LI. In conclusion, p53 mutation may be involved in the neoplastic progression from ADH to DCIS and is directly related to high nuclear grade and associated necrosis of DCIS.

Telomerase Activity in Human Breast Tumors

BACKGROUND: Telomerase is a ribonucleoprotein enzyme that synthesizes telomeric DNA onto the ends of chromosomes, thereby preventing the replication-dependent shortening of those ends. Telomerase activity is detected in a wide range of cancers of various tissues, and its expression may be a critical step in tumor progression. Our objective was to determine if detection of telomerase activity may be an indicator for diagnosis of breast cancer and if any association exists between telomerase activity and prognostic factors of breast cancer. METHODS: Using a polymerase chain reaction-based telomerase activity assay, we examined telomerase activity in 30 breast cancer specimens (2 ductal carcinoma in situ, 28 invasive ductal carcinoma), 25 benign lesions (14 fibroadenomas, 11 fibrocystic diseases), and 24 normal breast tissues (13 adjacent to malignancy, 11 adjacent to benign lesion). RESULTS: Among surgically resected samples, telomerase activity was detected in 23 (77%) of 30 breast cancers. While telomerase activity was not detected in any of the 11 specimens of fibrocystic disease and the 11 normal tissues adjacent to benign lesion, surprisingly low levels of telomerase activity were detected in 5 (36%) of the 14 fibroadenomas and 1 (7%) of the 13 normal tissues adjacent to malignancy. There was no significant difference in expression of telomerase among prognostic factors of breast cancer. CONCLUSIONS: In summary, telomerase activity may be useful in the diagnosis of breast cancer. We found no correlation between telomerase activity and stage, tumor size, or LN status. Mechanisms of telomerase expression are still under investigation; therefore, the significance of telomerase expression in malignant tumors and their progression remains to be determined.

Analysis of 200 Cases of Midtrimesteric Amniocentesis / 대한산부인과학회잡지

OBJECTIVE: We analyzed 200 cases of prenatal amniocentesis and compared them with other reported studies. Thus we propose the necessity of metanalysis for prenatal amniocentesis. METHOD: We analyzed 200 cases that have undergone amniocentesis at Masan Samsung hospital from January 1996 to December 1997. The results of our study was compared with other reported studies of amniocentesis by indication and maternal age. The proportion of age-class and indication are compared between previous study subjects and our 200 cases. RESULTS: Triple marker abnormality was the most common indication of amniocentesis(51%) and the most common age distribution was 25-29 years (43.5%). Chromosomal aberration was diagnosed in 20 cases (10%) of which the numerical aberration was 9 cases (4.5%) and the structural aberration was 11 cases (5.5%). 5 cases (2.5%) out of ll cases of the structural aberration were normal variant. There were 7 cases (trisomy 21) of autosomal aberration and 2 cases (Turner syndrome) of sex chromosome aberration. Arnong the structural aberration, there was only one reported case of 46, t(7:10) reciprocal translocation. There were no cases of fetal death except for a little self limited preterm labor. There were no neonatal complications. In the comparison of indication and maternal age with other studies, abnormal triple test was the most common indication of amniocentesis. The number of young pregnant women under 35 years old who underwent genetic amniocentesis was increased year by year. CONCLUSION: Triple maker screening test and genetic amniocentesis become popular method of antenatal diagnosis in Korea. Now, it is the proper time to establish standard indication of prenatal amniocentesis in this country by systemic and objective statistic examination. So we address the need for metanalysis in our country as comparing with other studies.

Telomerase Activity in Human Breast Tumors / 한국유방암학회지

Telomerase is a ribonucleoprotein enzyme that synthesizes telomeric DNA onto the ends of chromosomes. thereby preventing the replication-dependent shortening of these ends. Telomerase activity is detected in a wide range of cancers of various tissues, and its expression may be a critical step in tumor progression. Our objective was to determine if detection of telomerase activity may be an indicator for diagnosis of breast cancer and any association between telomerase activity and prognostic factors of breast cancer. Using a polymerase chain reaction-based telomerase activity assay, we examined telomerase activity in 30 breast cancer specimens (2 ductal carcinoma in situ, 28 invasive ductal carcinoma), 25 benign lesions (14 fibroadenomas, 11 fibrocystic diseases) and 24 normal breast tissues (13 adjacent to malignancy, 11 adjacent to benign lesion). Among surgically resected samples, telomerase activity was detected in 23 (77%) of 30 breast cancers. While telomerase activity was not detected in any of 11 specimens of fibrocystic disease and 11 adjacent normal tissues to benign lesion, surprisingly low levels of telomerase activity were detected in 5 (36%) of 14 fiboadenomas and 1 (7%) of 13 adjacent normal tissues to malignancy. There was no significant difference in expression of telomerase among prognostic factors of breast cancer. In summary, telomerase activity in breast cancer may be useful in diagnosis of breast cancer. We found no correlation between telomerase activity and stage, tumor size or LN status. Mechanisms of telomerase expression are still under investigation; therefore, the significance of telomerase expression in malignant tumors and their progression remains to be determined.

Needle Localization Biopsy of 546 Nonpalpable Breast Lesions

A retrospective review of 546 consecutive female patients who had undergone mammographically controlled needle localizations was performed to assess the effectiveness of the technique and to analyze the number and the characteristics of the criteria malignancies found in this group. Localization biopsy was recommended if one or more of the following criteria were present: evidence of a mass, microcalcifications, parenchymal distortion, and/or spiculation. Of those 546 patients who had undergone specimen mammography after needle localization biopsy, a lesion was detected on 544 cases and missed in 2 cases(0.3%). Fifty-five cancers were detected(10.1%) Histologically, the cancers included 23 invasive and 32 in-situ tumors. The predominant histologic cell type was ductal in origin with only three having lobular characteristics. Postoperative pathologic findings of the lymph nodes showed 3 of the 55 were positive for metastases. In summary, the technique of preoperative needle localization in this series had a 99.7% success rate. The cancer detection rates for a 'mass with a microcalcification', a 'microcalcification', and a 'mass' were 17.0, 14.0, and 5.1% respectively. As a conclusion, needle localization biopsy is a safe and effective method for definitely diagnosing nonpalpable breast lesions.

Needle Localization Biopsy of 546 Nonpalpable Breast Lesions

A retrospective review of 546 consecutive female patients who had undergone mammographically controlled needle localizations was performed to assess the effectiveness of the technique and to analyze the number and the characteristics of the criteria malignancies found in this group. Localization biopsy was recommended if one or more of the following criteria were present: evidence of a mass, microcalcifications, parenchymal distortion, and/or spiculation. Of those 546 patients who had undergone specimen mammography after needle localization biopsy, a lesion was detected on 544 cases and missed in 2 cases(0.3%). Fifty-five cancers were detected(10.1%) Histologically, the cancers included 23 invasive and 32 in-situ tumors. The predominant histologic cell type was ductal in origin with only three having lobular characteristics. Postoperative pathologic findings of the lymph nodes showed 3 of the 55 were positive for metastases. In summary, the technique of preoperative needle localization in this series had a 99.7% success rate. The cancer detection rates for a 'mass with a microcalcification', a 'microcalcification', and a 'mass' were 17.0, 14.0, and 5.1% respectively. As a conclusion, needle localization biopsy is a safe and effective method for definitely diagnosing nonpalpable breast lesions.

The Association Between Unexplained Second-Trimester Maternal Serum Alpha-Fetoprotein or Human Chorionic Gonadotropin Elevations and Perinatal Complications / 대한산부인과학회잡지

Our purpose was to study the correlation between elevated maternal serum alpha-fetoprotein(MSAFP) or human chorionic gonadotropin(HCG) levels and pregnancy-induced hypertension (PIH), preeclampsia, preterm delivery. MSAFP and HCG levels were measured in stored second-trimester(14~22 weeks) serum obtained from 510 women. The criteria for patients with unexplained MSAFP elevations were a MSAFP level 2.5 or greater multiples of the median(MoM) and HCG elevations were a HCG level 2.0 or greater multiples of the median(MoM) excluding multiple pregnancy, fetal malformation or death on ultra-sonography and molar pregnancy. In contrast, patients with MSAFP levels 0.5 to < 2.5 MoM, HCG levels < 2.0 MoM were served as controls. Women with elevated HCG levels had more significant association with PIH than control group(22.2 % versus 3.4 % ; p < .005). Elevated MSAFP was significantly associated with preeclampsia(7.7 % versus 1.1 % ; p < .05). But no significant differences were observed in the incidence of preterm delivery. We suggested elevated second-trimester MSAFP or HCG levels appear to be correlated with high risk for PIH and preeclampsia. So, These patients require careful monitoring with adequate obstetric managements.