ABSTRACT
PURPOSE: The anti-malignin antibody serum (AMAS) test (Oncolab, Boston, MA) has been reported as 97% sensitive and 95% specific for malignancies. To objectively assess accuracy of this test for discrimination of breast cancer, we studied a series of women undergoing core breast biopsy. SUBJECTS AND METHODS: Seventy-one core-needle breast biopsies were classified as malignant, suspicious, or benign by two independent pathologists blinded to AMAS results. Corresponding sera were read as AMAS positive, negative, or borderline by criteria used by Oncolab and also using criteria derived from receiver-operator curves based on values for slow (S-tag), fast (F-tag), and their difference (Net-tag) antibody reported by Oncolab. We calculated sensitivity and specificity and analyzed distributions by Fisher's exact test. RESULTS: Biopsies were read as 42 (59%) benign, 12 (17%) suspicious, and 17 (24%) malignant. By Oncolab criteria, sensitivity (59%) and specificity (62%) were maximized by pooling suspicious with malignant and AMAS borderline with positive (P = 0.098). Receiver-operator curves showed best sensitivity (62%) and specificity (69%) for the criterion AMAS positive if Net-Tag > 135 microg/mL or S-Tag > 220 microg/mL (P = 0.015). CONCLUSIONS: The AMAS test discriminates suspicious and malignant from benign lesions, but sensitivity is insufficient to identify patients to be spared biopsy and false-positive rates are too high for population screening.
Subject(s)
Biomarkers, Tumor/isolation & purification , Breast Neoplasms/pathology , Neoplasm Proteins , Adult , Aged , Aged, 80 and over , Antibodies, Anti-Idiotypic/blood , Biopsy, Needle , Breast Neoplasms/blood , Breast Neoplasms/diagnosis , False Positive Reactions , Female , Humans , Middle Aged , Neoplasm Proteins/blood , Neoplasm Proteins/immunology , ROC Curve , Sensitivity and SpecificityABSTRACT
BACKGROUND: The optimal technique and timing for the implantation of a recently developed breast brachytherapy balloon catheter (MammoSite; Proxima Therapeutics, Alpharetta, Georgia) have not been well defined. We hypothesized that placing this postoperatively, utilizing percutaneous ultrasound-guided placement, would be preferable. METHODS: Patients who met eligibility requirements for breast brachytherapy were implanted with the MammoSite device utilizing percutaneous ultrasound-guided technique. Additionally, to study optimal timing, a historical cohort of patients operated upon for breast cancer by two of the authors were analyzed to compare the intraoperative and postoperative candidacy for MammoSite placement. RESULTS: Twenty-one of 23 patients successfully completed brachytherapy after implantation, with only 2 (9%) requiring catheter removal secondary to unfavorable balloon positioning. There were no serious complications. Of 343 historical patients with breast cancer, 137 were intraoperative candidates for brachytherapy, but final postoperative histology disqualified 40 (29%). CONCLUSIONS: Implantation of the MammoSite brachytherapy device is optimally performed postoperatively, after the final pathology is defined, utilizing ultrasound-guided percutaneous technique.
