Comparative analysis of clinicopathological and mammographic findings between ductal carcinoma in situ with microinvasion and ductal carcinoma in situ / 中华放射学杂志

Objective:To comparative analyze mammographic and clinicopathological findings of ductal carcinoma in situ (DCIS) and DCIS with microinvasion (DCISM), and to investigate the predictive factors for DCISM.Methods:A total of 626 patients with DCISM and DCIS confirmed by surgery and pathology in the Affiliated Hospital of Qingdao University from January 2016 to July 2020 were collected and underwent preoperative mammography. The X-ray findings of DCISM and DCIS patients were classified and diagnosed according to the Breast Imaging Reporting and Data System (BI-RADS) criteria. The differences in clinicopathological and radiographic findings between DCISM and DCIS patients were analyzed using χ 2 test or Fisher exact test. The risk factors of DCISM were evaluated by using univariate and multivariate binary logistic regression analysis. Results:Among the 626 cases, 171 were diagnosed as DCISM, 455 were diagnosed as DCIS. Large diameter (≥2.7 cm), high nuclear grade, comedo type, axillary lymph node metastasis, high Ki67 proliferation index, negativity of estrogen receptor and progesterone receptor were found to be predictors of DCISM in the univariate analysis (all P<0.05). And large diameter (≥2.7 cm)(OR 2.229,95% CI 1.505-3.301, P<0.001), high nuclear grade(OR 1.711,95%CI 1.018-2.875, P=0.043) and axillary lymph node metastasis(OR 4.140,95% CI 1.342-12.773, P=0.013) were found to be independent predictors of DCISM in the multivariate analysis (all P<0.05). Mammographically, the lesion types, the presence and distribution of calcification were statistically significant between DCIS and DCISM patients (χ 2=17.42, 9.65, 9.10, P<0.05). Up to 17.6% (80/455) of DCIS were occult leisions, and DCISM showed more lesions with calcification in mass, asymmetry, and architectural distortion (49.1%, 84/171). Grouped calcifications were usually associated with DCIS (41.5%, 120/289), while regional calcification were commonly found in DCISM (35.9%, 47/131). Conclusions:Lesions with calcification and regional calcification were more likely associated with DCISM on mammography. Large diameter (≥2.7 cm), high nuclear grade and axillary lymph node metastasis were found to be independent predictors of DCISM.

Detecção precoce do câncer de mama em Unidades Básicas de Saúde / Detección precoz de cáncer de mama en unidades básicas de salud / Early detection of breast cancer in primary care center

Resumo Objetivo: Analisar as ações para detecção precoce do câncer de mama realizadas por enfermeiros da atenção primária, de acordo com as diferentes configurações de unidades básicas de saúde. Métodos: Estudo de corte transversal, desenvolvido em 38 unidades básicas de saúde. As unidades foram selecionadas mediante cálculo de amostra aleatória simples; os critérios de inclusão foram os enfermeiros de ambos os sexos, com tempo mínimo de um ano de atuação na unidade. As diferentes hipóteses cogitadas foram avaliadas por meio de análise bivariada na tabela de contingência, utilizando o teste de qui-quadrado ou teste exato de Fischer; todos os testes realizados levaram em consideração um α bidirecional de 0,05 e intervalo de confiança (IC) de 95%. Resultados: Dos 133 enfermeiros do estudo, 46,6% atuavam em unidades básicas da Estratégia Saúde da Família, 31,6% em unidades mistas e 21,8% em unidades tradicionais. Houve melhor desempenho para o modelo Estratégia Saúde da Família, com resultados estatisticamente significativos para as seguintes ações: investigação dos fatores de risco (p=<0,001); orientação da idade ideal para exame clínico das mamas e a importância de sua realização (p=0,002 e p=<0,001 respectivamente); reunião educativa sobre câncer de mama (p=<0,001); busca ativa de mulheres com laudo suspeito (p=0,002) e encaminhamento à unidade de referência (p=<0,001). Conclusão: As ações para a detecção precoce do câncer de mama realizadas pelos enfermeiros diferenciam-se em relação à configuração da Unidade Básica de Saúde, sendo que as do modelo Estratégia Saúde da Família se aproximam mais das recomendações do Ministério da Saúde.

Resumen Objetivo: Analizar las acciones para la detección precoz de cáncer de mama realizadas por enfermeros de atención primaria, de acuerdo con las diferentes configuraciones de las unidades básicas de salud. Métodos: Estudio de corte transversal, llevado a cabo en 38 unidades básicas de salud. Las unidades fueron seleccionadas mediante cálculo de muestra aleatoria simple. Los criterios de inclusión fueron enfermeros de ambos sexos, con un tiempo mínimo de un año de actuación en la unidad. Las diferentes hipótesis consideradas fueron evaluadas mediante el análisis bivariado en la tabla de contingencia, utilizando la prueba χ² de Pearson o prueba exacta de Fisher. Todas las pruebas realizadas tuvieron en consideración un α bidireccional de 0,05 e intervalo de confianza (IC) de 95 %. Resultados: De los 133 enfermeros del estudio, el 46,6 % actuaba en unidades básicas de Estrategia Salud de la Familia, el 31,6 % en unidades mixtas y el 21,8 % en unidades tradicionales. Se observó un mejor desempeño en el modelo Estrategia Salud de la Familia, con resultados estadísticamente significativos en las siguientes acciones: investigación de los factores de riesgo (p=<0,001), orientación sobre la edad ideal para examen clínico de las mamas y la importancia de su realización (p=0,002 y p=<0,001 respectivamente), reunión educativa sobre cáncer de mama (p=<0,001), búsqueda activa de mujeres con resultados sospechosos (p=0,002) y derivación a la unidad de referencia (p=<0,001). Conclusión: Las acciones para la detección precoz de cáncer de mama realizadas por los enfermeros se diferencian según la configuración de la unidad básica de salud, entre las cuales el modelo Estrategia Salud de la Familia está más cerca de las recomendaciones del Ministerio de Salud.

Abstract Objective: To analyze the actions for early detection of breast cancer performed by primary care nurses, according to the different configurations of primary care center. Method: Cross-sectional study, carried out in a total of 38 primary care center. The centers were selected by calculating a simple random sample; the inclusion criteria were nurses of both genders, with at least one year working in the health center. The different hypotheses considered were evaluated by a bivariate analysis in the contingency table, using the chi-square test or Fisher's exact test; all tests performed considered a bidirectional α of 0.05 and a 95% confidence interval (CI). Result: Out of the 133 nurses in the study, 46.6% worked in primary care center of the Family Health Strategy, 31.6% in mixed centers and 21.8% in traditional ones. There was a better performance for the Family Health Strategy model, with statistically significant results for the following actions: investigation of risk factors (p=<0.001); orientation of the ideal age for clinical breast examination and the importance of its performance (p=0.002 and p=<0.001 respectively); educational meeting on breast cancer (p=<0.001); active search for women with suspicious medical reports (p=0.002) and referral to the health center (p=<0.001). Conclusion: The actions for early detection of breast cancer performed by nurses differ in relation to the configuration of the Primary care center, and those from the Family Health Strategy model are closer to the recommendations of the Ministry of Health.

Application of localization needles under ultrasound-guidance for the nonpalpable breast calcification / 国际外科学杂志

Breast calcification is a specific sign of nonpalpable early breast cancer,the accurate localization and biopsy can obviously improve the diagnosis rate of early breast cancer,and imaging-guided needle localization is the premise of accurate biopsy of breast calcification.As the recommended guidance,mammography-guided localization and biopsy has certain limitations in localizing and biopsying breast calcification,however,high-resolution uhrasound makes it possible to localize the nonpalpable calcification in breast,and which has a certain advantage.

Tubular Carcinoma of the Breast: Clinicopathologic Features and Survival Outcome Compared with Ductal Carcinoma In Situ / 한국유방암학회지

PURPOSE: Tubular carcinoma (TC) of the breast is an uncommon histological subtype of invasive breast cancer with an excellent prognosis compared with standard invasive ductal carcinoma. Recent studies suggested a possible precursor role for low grade ductal carcinoma in situ (DCIS) in the development of TC. The goal of this analysis was to understand the clinicopathologic features and outcomes of TC by comparing TC with DCIS. METHODS: A retrospective review identified 70 patients with TC and 1,106 patients with DCIS between 1995 and 2011. Student t-test and Fisher exact test were used to compare the clinicopathologic characteristics of TC patients with those of DCIS patients. The Kaplan-Meier method and Cox regression analysis were used to determine disease-free survival (DFS) rates. RESULTS: Compared to DCIS, TC exhibited favorable clinicopathologic characteristics such as a lower nuclear grade (92.3%), higher expression of hormonal receptors (estrogen receptor-positive, 92.9%; progesterone receptor-positive, 87.0%), and less frequent overexpression of human epidermal growth receptor 2 (12.9%). DFS did not differ significantly between the TC and DCIS groups (5-year DFS, 100% vs. 96.7%; 10-year DFS, 92.3% vs. 93.3%; p=0.324), and cancer-specific deaths were not noted in either group. However, axillary lymph node involvement was observed in six (8.6%) of the 70 patients with TC. Three of these patients had small tumors (< or =1 cm). CONCLUSION: In our study cohort, TC was associated with an excellent prognosis and a low rate of lymph node metastasis. However, lymph nodes metastases were found even in patients with small tumors (< or =1 cm). Axillary staging must be considered for all patients with TC of the breast.

Ganglio centinela en cáncer de mama: experiencia 2000-2010 en el Instituto Nacional de Cancerología de Colombia / Sentinal lymph node in breast cancer: experience at the National Cancer Institute of Colombia 2000-2010

Objetivos: El presente estudio describe las características clínicas y epidemiológicas de las pacientes con cáncer de mama a quienes se les aplicó la técnica del ganglio centinela en el Servicio de Seno y Tejidos Blandos del Instituto Nacional de Cancerología (INC), en 10 años de experiencia. Métodos: Serie de casos de pacientes con diagnóstico de cáncer de mama temprano en estadios 0-IIB (T3N0M0), a quienes se les realizó la técnica. A partir de registros de los servicios de Patología, Medicina Nuclear y Cirugía de Seno y Tejidos Blandos del INC, se realizó la captura de datos aplicando un cuestionario previamente elaborado. Resultados: Se tomaron en cuenta 289 casos; las técnicas usadas incluyeron: radio coloides (Tecnecio 99) en 256 casos; colorante, en 5; y ambas técnicas, en los 28 restantes. El ganglio centinela fue identificado en 283 casos, con una tasa de detección del 98,0%. En carcinoma invasor, el tamaño tumoral promedio fue 2,2 cm (DE 1,1). En promedio, fueron resecados 1,5 ganglios (0,99 DE); de estos casos, 85 (30%) fueron metastásicos. Hubo 24 eventos adversos; el más común fue la formación de seroma. La media de seguimiento fue de 647 días (DE 693 días); el porcentaje de pacientes libres de enfermedad al seguimiento, del 94,4%; hubo recaída axilar en 1 paciente. Conclusiones: Según los autores de la experiencia descrita, la técnica de ganglio centinela es segura, pues permite una estadificación adecuada de la axila. Las características tumorales del ganglio centinela en la población objeto de estudio guardan similitud con las reportadas en la literatura mundial.

Objectives: This study describes the clinical and epidemiologic characteristics of breast cancer patients who were treated with sentinal node in breast service and soft tissue procedure at the National Cancer Institute during a 10-year period. Methods: Two hundred and eighty-nine (289) cases were included, and the techniques used were: radio colloids (Technetium 99) in 256 cases; dye in 5 cases; and both procedures in the remaining 28 cases. Sentinal lymph nodes were identified in 283 cases with a detection rate of 98.0%. In the case of invasive carcinoma, average tumor size was 2.2 cm (DE 1.1). On average, 1.5 ganglia (0.99) were resected; of these cases, 85 were metastatic (30%). There were 24 adverse events, the most frequent being seroma formation. Mean follow-up was 647 days (DE 693 days); percentage of disease-free patients during follow-up was 94.4%; axillary relapse occurred in 1 patient. Results: The procedure was performed on a series of patient cases with early breast cancer diagnosis in stages O-11B (T3NOMO). Data were compiled by utilizing a previously prepared questionnaire and on the basis of registries from the departments of pathology, nuclear medicine and breast and soft tissue surgeries at the National Cancer Institute. Conclusions: In our experience, the sentinal node procedure has proven to safely allow for the adequate stratification of the axilla. The tumoral characteristics of the sentinal lymph node in the population under study shared similarities with those reported in the international literature.

Detection of IL-2 and IL-6 in human breast tumor Bcap-37 cells treated by hematoporphyrin nonomethyl ether mediated photodynamic therapy / 肿瘤研究与临床

Objective To observe IL-2 and IL-6 changes in the breast tumor Bcap-37 cells reated by hematoporphyrin nonomethyl ether mediated photodynamic therapy (HMME-PDT).Methods Cells in logarithmic growth phase were collected among breast cancer cells cultured in conventional methods.According to blank control group or the experimental group (laser irradiation group,photosensitive agent group and HMME-PDT group),PDT in addition to HMME and HMME-PDT were conducted.The changes of IL-2,IL-6 were detected by radioimmunoassay.Results After HMME-PDT,IL-2 was increased as time passed.After 12,24 and 48 h,compared with IL-2 level in the control group,in laser irradiation group or photosensitive agent group,the levels of IL-2 in HMME-PDT group was significantly differences (P ＜ 0.05).But IL-6 levels decreased.The most obvious changes of IL-6 levels happened at 12h and 24h.There was significant differences between IL-6 in HMME-PDT group with the control group,laser irradiation group or photosensitive agent group (P ＜ 0.05).Conclusion HMME-PDT maybe have destruction effect by altering IL-2,IL-6 activity on breast tumor cells,which provides objective indicators for clinical patients to regulate immune function and auxiliary diagnosis.

Comparison of GP and Path Vysion FISH assays in measuring HER2 gene status in breast cancer / 中华检验医学杂志

Objective To evaluate clinical application of Jin Pujia GP HER2 probe kit in testing HER2 gene status of breast cancer through comparing it with PathVysion HER2 probe kit. Methods HER2 gene status were detected from 108 cases with invasive ductal breast cancer using GP and PathVysion HER2 probe kits by FISH. HER2 gene expression levels were measured by GP and PathVysion HER2 probe kits, and the sensitivity, the specificity and the accuracy of GP HER2 probe kit were evaluated. Results HER2 gene amplification positive rates detected by GP HER2 probe kit and PathVysion HER2 probe kit were 25.0%(27/108) and 26.9% (29/108), respectively. As compared with PathVysion HER2 probe kit, the sensitivity, the specificity and the accuracy of the GP HER2 kit were 89. 7% (26/29), 98.7% (78/79)and 96. 3% ( 104/108), respectively, whereas the PPV and NPV were 96. 3% (26/27) and 96. 3% (78/81), respectively. The GP HER2 probe kit had a sensitivity of 93.3% ( 14/15), a specificity of 100%(93/93) and an accuracy of 99. 1% (107/108) for detecting polysomy 17. Conclusion GP HER2 probe kit has high sensitivity and specificity for detecting HER2 gene status in breast cancer patients, and it has clinical application value.

Relationship between expression of Syk,VEGF-C and lymph node metastasis in breast carcinoma / 临床与实验病理学杂志

Purpose To investigate the relationship between the expression of Syk,VEGF-C and lymph node metastasis in breast carcinoma.Methods Immunohistochemical EnVision and SP methods were used to detect the expression of Syk,NFκB(p65)and VEGF-C in 55 cases of breast carcinoma.Results The positive rates of Syk, VEGF-C and NFκB(p65)in 55 cases of breast carcinoma were 50.9%,56.4% and 81.8%,respectively.Lower positive rate of Syk was obtained in the group of positive lymph-node metastasis than that in the group of non-lymph-node metastasis (P0.75).Higher positive rate of p65 nuclear expression was obtained in the group of positive lymph-node metastasis than that in the group of non-lymph-node metastasis (P＜0.025).The expression of Syk was negatively associated with VEGF-C (r=-0.620,P=0.000);the nuclear expression of p65 was associated with the low expression of Syk(r=0.448,P=0.002)and the high expression of VEGF-C (r=0.310,P=0.036).Conclusions In breast carcinoma, Syk may downregulate the expression of VEGF-C by inhibiting the activation of NFκB, which suppresses the lymph node metastasis of the cancer.

Correlação entre o exame clínico, a mamografia e a ultra-sonografia com o exame anatomopatológico na determinação do tamanho tumoral no câncer de mama / Correlation between clinical examination, mammography and ultrasonography with histopathological exam in the determination of tumor size in breast cancer

OBJETIVO: avaliar qual o melhor método entre o exame clínico (EC), a mamografia (MMG) e a ultra-sonografia (US) na determinação pré-operatória do tamanho tumoral no câncer de mama, tendo como referência o exame anatomopatológico. MÉTODOS: foram incluídas neste estudo 184 pacientes com lesões mamárias detectadas por MMG e US, palpáveis ou não, e que foram submetidas a ressecção cirúrgica do tumor, com diagnóstico histopatológico de câncer de mama. O maior diâmetro tumoral foi avaliado por EC, MMG e US por um mesmo examinador, e a medida obtida por cada método foi correlacionada com o diâmetro máximo obtido pelo exame anatomopatológico. A análise comparativa foi feita por meio do coeficiente de correlação de Pearson (r). RESULTADOS: o coeficiente de correlação de Pearson encontrado entre o exame anatomopatológico e o EC foi 0,8; entre o exame anatomopatológico e a MMG foi 0,7 e entre o exame anatomopatológico e a US foi 0,7 (p<0,05). Foram calculados também os coeficientes de correlação de Pearson entre os métodos avaliados, obtendo-se r=0,7 entre o EC e a MMG, r=0,8 entre o EC e a US e r=0,8 entre a MMG e a US (p<0,05). CONCLUSÕES: o EC, a MMG e a US apresentaram acentuada correlação com a medida anatomopatológica, além de forte correlação entre si, mostrando-se equivalentes como métodos na determinação pré-cirúrgica do tamanho do tumor mamário. No entanto, devido às limitações específicas de cada método, o EC, a MMG e a US devem ser considerados complementares entre si para obtenção de uma medida mais acurada do tumor no câncer de mama.

PURPOSE: to evaluate which method is the best to determine pre-surgically the size of breast cancer: clinical examination, mammography or ultrasonography, using as a reference the anatomopathological exam. METHODS: this study has included 184 patients with palpable-or-not breast lesions, detected by mammography and ultrasonography, that were submitted to surgical resection of the tumor, with histopathological diagnosis of breast cancer. The same examiner evaluated clinically the largest tumoral diameter, through clinical examination, mammography and ultrasonography, and the measurements obtained by each method were correlated with the maximum diameter obtained by the anatomopathological exam. The comparative analysis has been done by Pearson's correlation coefficient (r). RESULTS: Pearson's correlation coefficient between the anatomopathological and the clinical exams was 0.8; between the anatomopathological exam and the mammography, 0.7; and between anatomopathological exam and ultrasonography 0.7 (p<0.05). Pearson's correlation coefficients among the methods evaluated were also calculated and r=0.7 was obtained between clinical exam and mammography, r=0.8 between clinical examination and utrasonograhy, and r=0.8 between mammography and ultrasonography (p<0.05). CONCLUSIONS: clinical examination, mammography and ultrasonography have presented high correlation with the anatomopathological measures, besides high correlations among themselves, what seems to show that they may be used as equivalent methods in the pre-surgical evaluation of the breast tumoral size. Nevertheless, due to specific limitations of each method, clinical examination, mammography and ultrasonography should be seen as complementary to each other, in order to obtain a more accurate measurement of the breast cancer tumor.

Breast Cancer Early Detection Clinic lead in Department of Radiology: Early Experiences

PURPOSE: To describe the operation of our Breast Cancer Early Detection Clinic, lead by a radiologist. MATERIALS AND METHODS: From its opening in July 2000, until September 2001, patients who attended the Breast Cancer Early Detection Clinic at the Department of Radiology were referred mainly from the Health Promotion Center. Additional radiologic examinations were performed immediately, and according to the results, patients were either referred at once to a surgical clinic or a follow-up schedule was arranged for them there. The no-show rate, patient distribution, chief complaint, type and number of additional radiologic examinations, patient compliance rate, biopsy result, rate of cancer detection, and staging of cancers were determined. The merits and demerits of the clinic were also assessed. RESULTS: A total of 671 patients attended, with a no-show rate of 13.2%. Referrals from the Health Promation Centre accounted for 90.4% of patient visits. The most frequent complaint was a suspicious nodule at mammography. One additional radiologic examination was performed in 429 patients, two examinations in 70, and three or more examations in five. The most frequent type of examination was ultrasonography, followed by magnification compression view, mammography, and ultrasound-guided aspiration biopsy. An additional radiologic examination was recommended in 81.2% of patients and compliance rate was 96.7%. Primary breast cancer was diagnosed in 16 patients (2.1%), and was found to be stage 0 and 1 in 64.3% of these. No significant demerits were apparent. CONCLUSION: Radiologic examinations play a very important role in the detection of early-stage breast cancer, and the establishment of an early detection clinic lead by a radiologist is a very effective and recommendable approach to screening.

Cigarette Smoking, Alcohol Consumption, and Breast Cancer in Korea / 한국역학회지

A hospital-based case-control study was conducted to assess the relationship between cigarette smoking, alcohol consumption, and the risk of bgreast cancer in Korea. Histologically confirmed incident cases of breast cancer(n=146) were selected from the inpatients at the Department of Surgery, Seoul National University Hospital and Borame Hospital during 1994 to 1997. Women ithout self-reported past history of any malignandies were regarded as controls and selected at the same hospitals during the same period(n-153). Information on life-styles including cigarette smoking, alcohol drinking, and reproductive history were obtained by direct interview using standardixed questionnaire. Each case was matched with one control by 5-year age category(n=146). Adjusted odds ratios and 90% confidence intervals were estimated by unconditional linear logistic regression model. For smokers, age at first smoking was significantly associated with the breat cancer risk(adjusted OR=14.1, 90% CI=1.24-364.2). Particularly noteworthy was an increasing tendency of the breast cancer risk with the duration of alcohol consumtion in years aong alcohol drinkers(ptrend<0.1). These findings suggest that cigarette smoking at an earlier age and alcohol intake might contribute to the risk factor of breast cancer in Korean women. Further investigation on the association between genetic polymorphism of xenobiotic metabolism enxymes of environmental carcinogens and breast cancer should be needed.