p63/MT1-MMP axis is required for in situ to invasive transition in basal-like breast cancer.

The transition of ductal carcinoma in situ (DCIS) to invasive breast carcinoma requires tumor cells to cross the basement membrane (BM). However, mechanisms underlying BM transmigration are poorly understood. Here, we report that expression of membrane-type 1 (MT1)-matrix metalloproteinase (MMP), a key component of the BM invasion program, increases during breast cancer progression at the in situ to invasive breast carcinoma transition. In the intraductal xenograft model, MT1-MMP is required for BM transmigration of MCF10DCIS.com breast adenocarcinoma cells and is overexpressed in cell clusters overlying focal BM disruptions and at the invasive tumor front. Mirrored upregulation of p63 and MT1-MMP is observed at the edge of MCF10DCIS.com xenograft tumors and p63 is required for induction of MT1-MMP-dependent invasive program in response to microenvironmental signals. Immunohistochemistry and analysis of public database reveal that p63 and MT1-MMP are upregulated in human basal-like breast tumors suggesting that p63/MT1-MMP axis contributes to progression of basal-like breast cancers with elevated p63 and MT1-MMP levels.

Pure and mixed mucinous carcinoma of the breast: fine needle aspiration cytology findings and review of the literature.

OBJECTIVE: Mucinous (colloid) breast carcinoma accounts for 1-6% of all breast cancer. It comprises pure mucinous tumours and mixed infiltrating ductal carcinomas with a mucinous component. As this latter mixed form has a worse prognosis than pure colloid carcinoma, making this diagnosis on fine needle aspiration cytology (FNAC) might influence the choice of treatment. METHODS: We report a consecutive series of 22 cases consisting of 17 mixed and five pure mucinous carcinomas diagnosed by cytology and verified on histopathology. Patients underwent FNAC at the one-stop clinic of our institution during a 7-year period of time. Cytological findings were evaluated by a semi-quantitative method and included percentage of smear surface occupied by mucin, shape of cell groupings, size and outline of tumour nuclei as well as presence or absence of nucleolus. RESULTS: Three of five pure mucinous carcinomas displayed at least two of the following features: abundant mucin, small nuclei and/or regular nuclear outlines. Sparse mucin, large nuclei, irregular nuclear outlines or the presence of nucleoli were found in 7 out of 17 mixed mucinous carcinomas but not in pure tumours. CONCLUSION: Cytopathological identification of patients with pure mucinous carcinomas may be performed in a limited number of cases.

Measuring oral health self perceptions as part of a concise patient survey.

AIM: To investigate the measurement of oral health self perceptions, as part of a concise patient survey, and to consider the potential value of including this aspect in survey instruments. METHOD: In 2011, the data collected from 42,794 patients attending 276 practices participating in a voluntary accreditation programme patient survey were reviewed, with a particular emphasis on three oral health impact questions (OHIQs) included in the instrument. These three questions were about comfort (pain), function and dental appearance. RESULTS: Patient self perceptions of oral health varied with age. For each of the three OHIQs the percentage of patients reporting 'ideal' health fell with age to some extent, although for each of the OHIQs the percentage of patients reporting 'unacceptable' health remained below 3% and varied little with age. Statistically significant variations from the mean scores for these OHIQs were observed for some of the participating practices, which would not be explained by age variations in their patient sample alone. CONCLUSION: Patient surveys are a useful opportunity to elicit collective feedback from patients on self perceived oral health. When results are benchmarked they can inform practices, particularly when reviewed together with additional relevant data, of opportunities to develop clinical services to produce still higher standards of oral health and wellbeing for their patients.

The development of a concise questionnaire designed to measure perceived outcomes on the issues of greatest importance to patients.

AIM: To develop a concise patient feedback audit instrument designed to inform practice development on those issues of greatest importance to patients. METHODS: A literature review was used to establish the issues which were of greatest importance to patients. Ten core questions were then designed with the help of an experienced survey and polling organisation. A challenging grading of patient responses was utilised in an attempt to differentiate perceived performance within a practice on the different aspects and between practices. A feasibility study was conducted using the interactive voice response mode with seven volunteer practices in 2009. The instrument was then used in the later part of 2010 by 61 practices mostly in paper-based format. Practices received feedback which is primarily based on a bar chart plotting their percentage of top grades received against a national reference sample (NRS) compiled from the results of other participating practices. A statistical analysis was conducted to establish the level at which an individual practice result becomes statistically significant against the NRS. RESULTS: The 61 participating practices each received an average of 121 responses (total 7,381 responses). Seventy-four percent of responses across all ten questions received the top grade, 'ideal'. Statistical analysis indicated that at the level of 121 responses, a score of around 4-9% difference to the National Reference Sample, depending on the specific question, was statistically significant. CONCLUSION: In keeping with international experience with dental patient feedback surveys this audit suggests high levels of patient satisfaction with their dental service. Nevertheless, by focusing results on the proportion of highest grades received, this instrument is capable of indicating when perceived performance falls significantly below the average. It can therefore inform practice development.