Selected immunohistochemical prognostic factors in endometrial cancer.

OBJECTIVE: The objectives of this study were to assess the immunohistochemical expression of p53, bcl-2, c-erbB-2, Ki-67, estrogen (ER) and progesterone (PR) receptors, matrix metalloproteinase-7 and -26 (MMP-7 and MMP-26) in endometrial cancer patients and to assess the relation between steroid receptor positivity and other markers. DESIGN: Experimental prospective study. SETTING: Department of Obstetrics and Gynecology, Department of Genetics, Department of Pathology, Palacký University Medical School and University Hospital Olomouc. METHODS: We studied 144 cases of primary untreated endometrial carcinoma in which the p53, bcl-2, c-erbB-2, Ki-67, ER, PR, MMP-7, and MMP-26 antigens were investigated with the use of immunohistochemical methods. We evaluated the correlations among immunohistochemical staining and the age, International Federation of Gynecology and Obstetrics stage, grading, depth of invasion, and metastatic spread to lymph nodes. RESULTS: Mean age was 65.7 years (range, 34-90 years). p53, bcl-2, c-erbB-2, Ki-67, ER, and PR were positive in 35 (24.3%), 100 (69.4%), 41 (28.4%), 65 (45.1%), 115 (79.8%), and 127 (88.1%) cases, respectively. Matrix metalloproteinases were evaluated in a group of 70 patients, wherein MMP-7 was positive in 33 patients (47.1%) and MMP-26 was positive in 40 patients (57.1%). The expression of MMP-7 decreased with higher patient age. p53 and Ki-67 overexpression was found to be related to poor differentiation. Immunostaining for bcl-2 correlated with the positivity of steroid receptors status, whereas immunostaining for c-erbB-2 correlated inversely with ER-positive group of cases. CONCLUSIONS: The overexpression of p53 and Ki-67 seems to indicate a more malignant phenotype, whereas bcl-2 expression in dependence of steroid receptor positivity could contribute to the identification of high-risk tumors.

The value of dynamic contrast enhanced breast MRI in mammographically detected BI-RADS 5 microcalcifications.

AIMS: To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (MRI) in the diagnosis of BI-RADS-5 type of microcalcifications of the breast, to compare the size of the microcalcification lesions using mammography (MG) and MRI, and to determine the value of MRI in surgery for microcalcifications. The study also determines the morphology of microcalcification lesions, assesses kinetic curves and compare MRI features of ductal carcinoma in situ (DCIS) for different histopathological grades. METHODS: Our group consisted of 32 patients with mammographically detected BI-RADS 5 microcalcifications. The MRI was done in this group of women which was later followed by stereotactic vaccum-assisted biopsy (SVAB). Surgery was performed on all patients with a biopsy that resulted in a diagnosis of breast cancer or atypical ductal hyperplasia (ADH). RESULTS: Of our group of 32 patients, there were 35 mammograhically detected microcalcification lesions, 32 DCIS, one ADH and two benign findings according to the final histology. The microcalcification lesions were larger using MRI than in MG in 10 women. We diagnosed DCIS multifocality in 6 women and bilateral carcinoma in one woman. As with kinetic curve assessment, we found in 67 % of DCIS a rapid rise, 27 % a moderate and in 6 % a slow initial rise. With the pattern of enhancement in the delayed phase, we found in 30 % of DCIS a washout pattern, 67 % a plateau and in 3 % a persistent pattern. Noted difference between high and low grade DCIS was confirmed. CONCLUSIONS: MRI sensitivity in the detection of DCIS was 94 % in our group of patients and was the sole evidence for detection of multifocality and bilateral incidence of carcinoma. In 26 % of women the outcome of MRI was the most important for converting breast conserving surgery to mastectomy.

Technetium-99m-MIBI scintimammography by planar and SPECT imaging in the diagnosis of breast carcinoma and axillary lymph node involvement.

BACKGROUND: We compared SPECT and planar (99m)Tc-MIBI scintimammography (SMM) in the detection of primary breast cancer and metastatic axillary lymph node involvement, and the scintigraphic results with the histopathological/cytological findings. MATERIAL AND METHODS: 303 consecutive patients with 308 suspicious or indeterminate lesions observed in mammographies were entered in this study. After an intravenous injection of 740 MBq of (99m)Tc-MIBI, anterior supine, right and left lateral planar images in a prone position and a SPECT study were acquired. RESULTS: 85 malignant and 223 benign breast lesions were confirmed by histopathology/cytology. The overall sensitivity in the detection of breast cancer was 92% (78/85) for SPECT and 82% (70/85) for planar imaging (p = NS), respectively; overall specificity was 91% (204/223) for SPECT and 91% (202/223) for planar scans (p = NS), respectively. Metastatic axillary lymph node involvement was seen in 35 patients; per-axilla overall sensitivity was 66% (23/35) for SPECT and 54% (19/35) for planar images (NS), respectively; overall specificity was 76% (38/50) and 86% (43/50), respectively (NS). CONCLUSIONS: Our results confirm the high diagnostic accuracy of (99m)Tc-MIBI scintimammography in the diagnosis of breast cancer, and show SPECT to be slightly more sensitive than planar imaging, especially in detecting malignant breast lesions. We found the sensitivity of both imaging modalities to be quite low in the detection of metastatic axillary lymph node involvement. SPECT provides additional information to planar SMM with respect to the localization of (99m)Tc-MIBI uptake and tumour extent and improves diagnostic certainty. Our experience suggests that SPECT combined with planar SMM should be used more widely.