Breast cytology. Statistical analysis and cytohistologic correlations.

OBJECTIVE: To analyze the sensitivity, specificity, positive and negative predictive values and the efficacy of fine needle aspiration (FNA) in our material, to investigate the influence of the histologic type and stage of carcinoma on the quality of the aspirates and on the detection rates of mammary carcinoma, and to investigate the rate of inadequate samples and the accuracy of cytologic diagnoses, with an emphasis on the rate of false positive diagnoses in benign mammary lesions. STUDY DESIGN: The results of 1,472 FNAs of the breast obtained over three years were subjected to a retrospective analysis. RESULTS: The cytologic diagnoses were benign in 1,003 cases (68.1%), suspicious in 49 (3.3%) and malignant in 181 (12.3%); 239 (16.2%) of the aspirates were inadequate. In 393 (26.6%) of the cases and in 85% of cytologically malignant smears, the aspirate was compared with histologic examination. The rate of false negative FNAs was 9.0%. The proportion of inadequate cases was clearly related to stage (pT): it was 9.5% in pT1, 5.0% in pT2 and 0% in pT3. Among invasive carcinomas the sensitivity was 89.9%, specificity 99.3% and overall accuracy 88.5%. Among the cases diagnosed cytologically as benign, 182 were compared with biopsies. Of these, 79.9% were true negative, 0.5% (1 case) was false positive, and 15.4% had insufficient cells for evaluation. CONCLUSION: FNA cytology has improved decision making and the selection of patients for biopsy of mammary lesions and has contributed to saving time in the clinical management of breast lumps. In no case did FNA lead to inadequate clinical measures or other disadvantages to patients. Thus, FNA cytology is an indispensible diagnostic tool in the management of breast lesions.

No tumor-specific expression levels of protein kinase C isoenzymes and of c-fos in human breast cancer cell cultures.

Epithelial cells derived from 46 human breast tissue samples of patients suffering from breast cancer have been cultivated. Twenty-five of these cell cultures stemmed from normal and 21 from tumor tissues. Moderate to large variations of protein levels of three protein kinase C (PKC) isoenzymes (alpha, delta and epsilon) were found among the various cell cultures. The cell cultures also exhibited very heterogeneous basal as well as inducible levels of c-fos mRNA. However, none of these variations could be correlated with the character of the original tissue nor with any clinical parameter of the respective patient. Our results suggest that altered levels of PKC isoenzymes or of the protooncogene c-fos per se cannot serve as an indication for a transformed behavior of the epithelial cell fraction of human breast tissue.

[Sarcoma of the breast: what is the contribution of immunohistochemistry and flow cytometry?]. / Sarkome der Mamma: Was bringen Immunhistochemie und Flowzytometrie?

Only 0.2-1% of all mammary malignancies are sarcomas of the breast. This study includes 4 cases: 2 osteosarcomas, 1 fibrosarcoma, and 1 malignant undifferentiated stromal sarcoma. The therapy was mastectomy in 3 cases with dissection of axillary lymph nodes and simple mastectomy in one case. One patient demonstrated local recurrence and died. The remaining 3 patients developed neither metastases nor local recurrence. They are still alive after a follow-up period of between 18 months and 17 years. As first-line treatment, wide local excision or simple mastectomy is recommended. Dissection of the axillary lymphatics, adjuvant radiotherapy, or chemotherapy have no established value in the treatment of breast sarcoma. In our 4 cases, flow-cytometric analysis does not always agree with the biological properties of the tumour and the clinical behaviour, in contrast to the results obtained in respect of carcinomas.

[Rare breast tumors]. / Seltene Mammatumoren.

The cystosarcoma phylloides, like the sarcoma, represents 0.3 to 0.9% of all tumors of the breast. The clinical features include two different developments, one phase with increase and the other without. After removal of tumors, there are frequent recurrences. The unique therapy is for that reason to remove the lump with a margin in healthy tissue. The sarcoma of the breast represents only 0.2 to 1% of all mammary malignancies. This study reports four cases, including two osteosarcomas, one fibro- and one malignant fibrous sarcoma. The treatment of choice was mastectomy in three cases with dissection of axillary lymph nodes. The remaining patient was treated by simple mastectomy only. One patient demonstrated local recurrence and died. The remaining three patients developed neither metastases nor local recurrence. They are still alive with periods of observation between 18 months and 17 years. As first-line treatment wide local excision or simple mastectomy is recommended. Dissection of the axillary lymphatics, adjuvant radiotherapy or chemotherapy have no proven value in the treatment of breast sarcoma.

[Clinical diagnosis of breast cancer]. / Klinische Diagnostik des Mammakarzinoms.

Every clinical breast examination requires a careful history and the inspection and palpation of the breast. The inspection enables us to recognize remarkable external variations of the breast, and with the manual examination it is possible to palpate nodes and indurations. Very important for an early detection of a carcinoma of the breast is self-examination. Finally, also the diagnostic of the secretion of the ducts of the mammary gland is part of a clinical examination of the breast.

[Breast cancer in medical history]. / Der Brustkrebs im medizinisch-historischen Rückblick.

Hippocrates, in his days, was already aware of 'karkinos' or 'karkinoma' for tumors, above all the breast. The etiology of the carcinoma of the breast was seen in the fluids of the body. The humoralistic theory persisted till the second half of the 19th century, although considerable progress in the ability of diagnoses and operating techniques had meanwhile been made. In the 19th century a classification of breast cancer was developed and the first statistical analysis presented. Although anesthesia was introduced in 1846 and antisepsis somewhat later, surgical techniques could not be improved until the 20th century, when radiotherapy and hormonal treatment were discovered. Despite all efforts made since antiquity to cure breast cancer, the medical community today is not much further than were the doctors facing the dangers of infectious disease prior to the discovery of antibiotics.

Therapy of vulvar carcinoma.

83 vulvar carcinoma patients were originally treated in the period between 1970 and 1990. 82 patients presented with squamous cell carcinoma. 70% of the patients were in Stage I or II. It was originally possible to operate on 74 of the 83 patients. A simple or partial vulvectomy was applied 17 times. A bilateral inguinal lymph node excision additionally took place in 6 cases. 51 patients were subjected to radical vulvectomy with inguinofemoral lymph node excision. In 13 cases, pelvic lymph node extirpation was also performed. A posterior pelvic exenteration was performed in 6 cases presenting extensive carcinoma involvement of the vulva. In the remaining 9 patients, either it was not possible to operate, or a nonradical operation could be performed. The primary morbidity, consisting of wound healing disturbances and infections, amounted to 50% in our group. We observed lymphedema in 47% of the cases, although it was clinically important in only 10%. We did not have any primary surgical mortality. The 5-year survival rate was 82% in our patients without inguinofemoral lymph node involvement and only 40% in lymph node metastatic cases. The absolute 5-year cure rate was 66%, or 69% corrected. To be able to give increased preference to less invasive methods an improved prevention and clarification procedure for physicians and patients is necessary.

[Quality assurance. A review with special reference to surgical gynecology]. / Qualitätssicherung. Eine Ubersicht unter spezieller Berücksichtigung der operativen Gynäkologie.

The aim of quality assurance should be to ameliorate the medical treatment. Also it is automatically part of the medical profession. This paper defines the terms quality assurance and quality. Concepts existing in the USA and in Germany are partly just formed in Switzerland or work at the ASF (Arbeitsgemeinschaft Schweizerischer Frauenkliniken) successfully since 10 years. The quality assurance in hospitals and in the health system should be reached throughout Switzerland.

[Sarcoma of the breast]. / Sarkome der Mamma.

Sarcoma of the breast represents only 0.2-1% of all mammary malignancies. This study reports 5 such cases, including 2 osteosarcomas, 1 fibro-, 1 lipo-, and 1 malignant fibrous sarcoma. The treatment used was mastectomy in 3 cases with excision of axillary lymph nodes. The remaining 2 patients were treated by simple mastectomy whereby 1 of these received a immediate reconstruction with a prosthesis. 1 patient demonstrated local recurrence and died. The remaining 4 patients did not develop neither metastases nor local recurrence and are still alive after an observing period between 12 months up to 17 years. Today, first-line treatment is wide local excision or simple mastectomy. Excision of the axillary lymphatics, adjuvant radiotherapy, and chemotherapy have been disappointing in the treatment of breast sarcoma.

[Does breast self-examination affect the stage of breast carcinoma?]. / Beeinflusst die Selbstkontrolle der Brust das Stadium des Mammakarzinoms?

The regular self-examination of the breast is one of the possibilities to detect breast cancer early. Our aim was to test the sensitivity of the method on rural, poorly informed patients. Almost one fourth of the 90 cancer patients belonged to the self-examination group. 52% of these women had a stage-I tumor. 58% of the women who didn't examine themselves entered hospital with stage-III or stage-IV tumor. In the self-examination group, in 71% of the lymph nodes were negative. This cohort showed also a better result concerning tumor extension. The average size was 1.9 cm compared to 3.8 cm in the 'non-analyser group'. We summarize that women controlling themselves have a better prognosis. Therefore, self-examination, combined with mammography and clinical control, is one of the best methods for early detection of mammary-cancer.

[Open uterine rupture of the pregnant uterus bicornis--a case report]. / Offene Uterusruptur bei gravidem Uterus bicornis--Ein Fallbericht.

A report is made on a pregnancy of a 33-year old II-gravida/I-para patient, terminating with the rupture of the uterus bicornis unicollis in the 18th week of pregnancy. The cause of this rupture was believed to be pathological disturbance of the attachment of the placenta. The early detection of uterine anomalies with ultrasonic investigation, reviewing the literature, is discussed.