Is risk of axillary lymph node metastasis associated with proximity of breast cancer to the skin?

INTRODUCTION: Risk of axillary lymph node metastasis, the most important predictor of disease-free and overall survival in breast cancer patients, is estimated primarily from histologic features of the primary cancer including tumor size, histologic type and grade, and hormone receptor expression. Based upon a clinical impression, and research showing that palpable cancers are more likely to be node positive, we hypothesized that primary breast cancers more proximal to the skin of the breast are more likely to be positive for axillary lymph node metastasis. METHODS: This is a retrospective medical record review of 209 women with stage T1 or T2 (

Impact of computer-aided detection in a regional screening mammography program.

OBJECTIVE: This study was conducted to prospectively assess the effect of computer-aided detection (CAD) on screening outcomes in a regional mammography program. MATERIALS AND METHODS: Between January 1, 1998, and December 31, 2000, 27,274 consecutive screenings were performed. Radiologists' performance before CAD (n = 7,872) and with CAD (n = 19,402) was determined by annual audits. All positive biopsy results were reviewed; histopathology was reviewed and confirmed. Outcomes (recall, biopsy, and cancer detection rates) with CAD (1999, 2000) were compared with historical control data (1998). RESULTS: With CAD, increases were seen in recall rate (8.1%, from 7.7% to 8.3%), biopsy rate (6.7%, from 1.4% to 1.5%), and cancer detection rate (16.1%, from 3.7 per 1,000 to 4.3 per 1,000). Detection rate of invasive cancers of 1.0 cm or less increased 164% (from 0.508 to 1.34 per 1,000 screens; p = 0.069). Detection rate of in situ cancers declined 6.7% (from 1.27 to 1.19 per 1,000; p = 0.849). In multivariable analysis of invasive cancers, early stage (stage I) was strongly associated with detection by CAD (odds ratio = 4.13, p = 0.025). Mean age at screening detection of cancer was 5.3 years younger in the CAD group than in the pre-CAD group (p = 0.060). CONCLUSION: Increased detection rate, younger age at diagnosis, and significantly earlier stage of invasive cancer detection are consistent with a positive screening impact of CAD. Audit results were positive but generally not statistically significant due to sample size limitations. Our findings support the hypothesis that screening with CAD significantly improves detection of the specific cancer morphologies that CAD algorithms were designed to detect.

Breast cancer care: changing community standards.

A community hospital-based program was developed to improve breast cancer care in the community. A consensus was developed for what should be optimal care; a database was established to document the care being delivered in the community; and the data were analyzed to document changes in practice patterns over time. The major clinical benefits to patients included a significant improvement in needle biopsy rates, decreased utilization of second operative procedures, increased breast conservation surgery, conformity to guidelines for adjuvant chemotherapy administration, and a sizable increase in discovery of small breast cancers by screening mammography.

Ubiquinol cytochrome c reductase (UQCRFS1) gene amplification in primary breast cancer core biopsy samples.

OBJECTIVES: The ubiquinol cytochrome c reductase UQCRFS1 is a key subunit of the cytochrome bc1 complex (complex III) of the mitochondrial respiratory chain. The purpose of this study is to evaluate the significance of the ubiquinol cytochrome c reductase UQCRFS1 gene amplification in primary breast cancers. METHODS: Samples were obtained from image-guided core needle biopsies (CNB) in 40 patients with nontreated breast cancers. To examine UQCRFS1 gene amplification, we employed fluorescent in situ hybridization using BACs RP11-46I12 that harbors UQCRFS1 gene, RP11-110J19 that overlaps to RP11-46I12, and CA125 as a control gene. The amplification data were evaluated blindly of histopathological factors. RESULTS: Amplification of UQCRFS1 gene was found in 5 of 39 specimens (12.8%). The specimens with amplified UQCRFS1 gene were associated with high grade of cancer cells (P = 0.005). CONCLUSIONS: These results suggest that the UQCRFS1 gene appears to be involved in development of more aggressive phenotype of breast cancer.

The use of FISH on breast core needle samples for the presurgical assessment of HER-2 oncogene status.

HER-2 status has been used in breast carcinoma as a prognostic marker to predict drug response and to select patients for trastuzumab treatment. Since immunohistochemistry (IHC) is thought to be less reliable, HER-2 testing with FISH is preferred. The analysis of HER-2 is usually performed on formalin-fixed paraffin tissue sections obtained from surgery. The use of paraffin sections is very time consuming and labor intensive. The objectives of this study were to (1) develop a simple and quick FISH protocol using touch imprints of breast core needle biopsies, eliminating the deparaffinization and pretreatment; and (2) make the HER-2 status available at the presurgical multidisciplinary treatment planning conference. A total of 50 core samples of breast carcinoma were obtained from image-guided core needle biopsy. Both FISH and IHC data were available for 46 cases. Forty-four of 46 cases (95.7%) were consistent. Two IHC 2+ cases were nonamplified (ratios of 0.99 and 1.09). It is expected that, in the near future, additional molecular markers will be used before surgery when the overall treatment plan is being developed. We conclude that HER-2 gene analysis by FISH on breast touch imprints is easily done and is a useful and reliable technique.