Pain experienced by patients during minimal-invasive ultrasound-guided breast biopsy: vacuum-assisted vs core-needle procedure.

AIMS: To evaluate comparatively the pain associated with ultrasound-guided core-needle (CN) and vacuum-assisted (VA) biopsy for non-palpable breast lesions. METHODS: 723 women undergoing ultrasound-guided breast biopsy for BIRADS IV and V lesions according to the same standardised protocol were prospectively studied. 14-gauge CN biopsy with an automated gun was performed in 321 patients. In 402 women biopsy was made using 11-gauge VA hand-held probe. Immediately after the procedure patients were interviewed about the pain experienced during the biopsy and were asked to indicate at the pain intensity on a eleven-point scale: from 0 (none) to 10 (extreme, worst possible pain). RESULTS: The median rate of pain experienced by women during biopsy was 4 (range 2-7). There were no significant differences between CN and VA groups with regard to age, body mass index, menopausal status, history of parity, hormone replacement therapy, menopausal status, breast parenchymal pattern (according to Wolfe's classification), family history of breast cancer, lesion size and number of samples. CN biopsy with an automated gun was significantly more painful (P < 0.01) than procedure with VA hand-held device as evaluated by patients: median 6 (4-7) vs 3 (2-5), respectively. CONCLUSIONS: Despite using the larger needle VA procedure results in less pain experienced by women in comparison to CN biopsy with automated gun. Reduced patient discomfort should be one of the reasons for the preferential use of VA biopsy in the assessment of non-palpable breast masses.

The impact of pre- or postoperative radiochemotherapy on complication following anterior resection with en bloc excision of female genitalia for T4 rectal cancer.

OBJECTIVE: The aim of the study was to assess the mortality and morbidity following extended anterior resection with excision of internal female genitalia combined with pre- or postoperative chemoradiotherapy in women with extensive rectal cancer. METHOD: The study included a consecutive series of 21 women with T4 adenocarcinoma of the rectum infiltrating the reproductive organs treated with curative intent between 1997 and 2003. All patients had an extended anterior sphincter preserving resection of the rectum (total mesorectal excision) and hysterectomy with or without posterior vaginal wall excision. In all patients, surgery was combined with adjuvant radiochemotherapy. Ten patients received preoperative radiotherapy (50.4 Gy) concurrently with two courses of chemotherapy [fluorouracil with folinic acid (FA)] followed by surgery within 6-8 weeks and subsequently four courses of postoperative chemotherapy. Eleven received postoperative chemoradiotherapy (50.4 Gy plus fluorouracil with FA). RESULTS: There was no postoperative mortality. Postoperative complications were observed in 57% patients (early in 14% and late in 52%). These included: anterior resection syndrome with anorectal dysfunction in 52% (requiring proximal diversion in 5%), urinary complications in 24% (complete incontinence requiring a permanent catheter in 5%). In addition, postoperative acute bleeding requiring relaparotomy, delayed wound healing caused by superficial infection, anastomotic leakage, prolonged bowel paralysis, benign rectovaginal fistula and anastomotic stricture occurred (5% each). The risk of postoperative morbidity (52%) was similar for patients with or without preoperative radiochemotherapy. CONCLUSION: Despite this aggressive therapeutic approach, most postoperative complications were transient or could be treated. Preoperative radiochemotherapy did not increase the risk of morbidity.

Breast cancer expression of E-cadherin does not differ between patients with positive and negative oncological history.

PURPOSE: The question of whether or not non-sporadic breast malignancies have different immunohistochemical features than sporadic malignancies has not been investigated previously. Consequently, the purpose of this study was to compare the expression of E-cadherin (EC) in breast cancer patients with positive and negative oncologic histories. MATERIAL AND METHODS: The study included 98 breast cancer patients divided into two groups: 1) without the personal or familial history of previous malignancies, and 2) with the personal history of previous malignancies and/or with the data on cancer episodes in first- and/or second-degree relatives. RESULTS: There were no significant differences in the expression of EC between breast malignancies of the two groups. Moreover, statistical relationships were not observed between the positive or negative oncologic history, the age, and the menopausal status of patients, or histological tumor grade. CONCLUSIONS: Although the results of our series revealed no significant differences in the expression of EC between assumed sporadic and assumed non-sporadic malignancies, there is a need for further comparative studies on the immunohistochemistry of both the breast carcinoma types in order to find the other biological markers that could suggest or exclude cancer susceptibility in a given patient. Nevertheless, the results of our study suggest that EC immunohistochemistry cannot be used as a surrogate marker for screening for hereditary breast cancer.

Multivariate analysis of oestrogen receptor alpha, pS2, metallothionein and CD24 expression in invasive breast cancers.

Determination of oestrogen receptor alpha (ER) represents at present the most important predictive factor in breast cancers. Data of ours and of other authors suggest that promising predictive/prognostic factors may also include pS2, metallothionein (MT) and CD24. Present study aimed at determining prognostic and predictive value of immunohistochemical determination of ER, pS2, MT, and CD24 expression in sections originating from 104 patients with breast cancer. An univariate and multivariate analysis was performed. Both univariate and multivariate analyses demonstrated that cytoplasmic-membranous expression of CD24 (CD24c-m) represents a strong unfavourable prognostic factor in the entire group and in most of the subgroups of patients. In several subgroups of the patients also a prognostic value was demonstrated of elevated expression of pS2 and of membranous expression of CD24. Our studies demonstrated that all patients with good prognostic factors (higher ER and pS2 expressions, lower MT expression, CD24c-m negativity) survived total period of observation (103 months). The study documented that cytoplasmic-membranous expression of CD24 represented an extremely strong unfavourable prognostic factor in breast cancer. Examination of the entire panel of the studied proteins permitted to select a group of patients of an exceptionally good prognosis.

Elevated metallothionein (MT) expression in invasive ductal breast cancers predicts tamoxifen resistance.

Elevated expression of the low molecular weight metallothionein (MT) proteins can be found typically in breast cancer cases with less favourable prognosis. The MT gene has been described to be potentially down-regulated by estrogen receptor alpha. The present study is aimed at examining the predictive value of MT expression for results of tamoxifen treatment in breast cancer in relation to steroid receptor status. Sixty patients with primary invasive ductal breast cancers with post-operative tamoxifen treatment were enrolled in the study. In paraffin sections of the studied tumours immmunohistochemical reactions were performed using antibodies directed against MT, estrogen receptors (ER) and progesterone receptors (PgR). Results of the immunohistochemical reactions and of clinical observations were analysed using multivariate progression analysis based on the Cox proportional hazard model. Elevated MT expression was demonstrated to be typical for cases with documented relapse of the disease (P<0.001) or terminated by death (P=0.03). Decreased ER expression was found to be typical for cases of a higher grade (P=0.02) and cases terminated by death (P=0.006). The multivariate analysis showed that elevated MT expression was characteristic for cases with shorter overall survival time (P=0.04). The data showed that MT carried an independent, and also independent from ER status, unfavourable predictive value as far as results of tamoxifen treatment were concerned.

Prognostic significance of metallothionein expression in correlation with Ki-67 expression in adenocarcinomas of large intestine.

The study aimed at determining levels of metallothionein (MT) and Ki-67 antigen expression in adenocarcinomas of large intestine and examining relation of the expression levels with various clinical and pathological variables. The studies were performed on 81 cases of large intestine adenocarcinoma. Using immunocytochemistry, expressions of MT (positive reaction in 73 cases) and of Ki-67 (positive reaction in 79 cases) antigen were examined and the obtained results were compared with, i.a., grade (G) of the tumour and depth to which intestinal wall was infiltrated by individual tumours. Patient survival analysis was also performed, as correlated to expression levels of the two antigens. The obtained results permitted to disclose that the lower was grade of histological differentiation (G2, G3), the more pronounced was expression of MT and Ki-67. Also, the deeper was neoplastic infiltration of intestinal wall, the more pronounced was MT and Ki-67 expression. Despite the relatively strong correlation between MT expression and Ki-67 expression (r=0.536; p<0.05), only Ki-67 antigen expression in large intestine adenocarcinomas was inversely correlated to survival of the patients. Ki-67 proved to be a better prognostic marker, as compared to MT, in large intestine adenocarcinomas.

Lactoferrin-induced up-regulation of zeta (zeta) chain expression in peripheral blood T lymphocytes from cervical cancer patients.

Alteration of T-cell-associated signal transduction molecules has recently been implicated in immune suppression in tumour-bearing hosts. Here we report the immunoregulatory effects of human lactoferrin (LF) on zeta-chain expression in peripheral blood T lymphocytes from cervical cancer patients and healthy donors. By quantitative flow cytometry analysis, we demonstrated that the mean zeta-chain expression was significantly higher in freshly-isolated T lymphocytes from healthy donors (69%), compared with the patients (38%). Following 3-day culture under standard conditions, zeta-chain expression in T lymphocytes from the patients increased significantly, whereas it dropped in the cells from healthy donors. Anti-CD3 MoAb as well as LF, significantly increased expression of zeta-chain in T cells both from patients and control subjects. The addition of LF to the anti-CD3 MoAb cell cultures resulted in an even higher stimulation of the zeta-chain expression. The results suggest that, in patients with cervical cancer, zeta-chain defects could be corrected by the therapeutic application of LF.

Immunocytochemical evaluation of metallothionein (MT) expression in myoepithelial cells of ductal mammary carcinoma and its relation to survival time: analysis of 7-year course of the disease.

Myoepithelial cells participate in the development of mammary glands and have been suggested to play a role in the biology of mammary cancer. Recent studies demonstrated in the cells expression and overexpression of metallothionein (MT): a low molecular weight, cystein-rich protein which participates, i.a., in the multidrug resistance to cvtostatic drugs. The present study was aimed at examining the relation between results of immunocytochemical (ICC) detection of MT expression in myoepithelial cells, present in structures of a ductal mammary carcinoma, and survival of the patients. In sections originating from 43 patients with ductal mammary carcinoma ICC reactions were performed to detect MT and to confirm the presence of myoepithelial cells (using antibodies to smooth muscle actin). Survival of the patients was also determined in the course of 7-year observations. Statistical analysis using the Coxe's model did not detect relations between MT expression intensity, in the myoepithelium on one hand and patient survival on the other (chi2=0.003 p=0.96).

Expression of metallothionein in synovial sarcoma cells.

Other authors have demonstrated earlier that cells of normal synovium contain metallothionein. The protein was also detected in several other normal cell types and in tumors derived from the cells. Metallothionein content is thought to reflect proliferative activity of neoplastic cells. Therefore, it was decided to demonstrate metallothionein expression in various types of synovial sarcoma. The present study aimed to determine metallothionein cellular expression by immunocytochemical techniques in nine cases of biphasic, six cases of monophasic (spindle cell), and five cases of poorly differentiated synovial sarcoma, and to compare the expression with those of vimentin and cytokeratin 19. Metallothionein expression was demonstrated in epithelioid cells in all cases of biphasic type sarcoma and in spindle cells in all cases of monophasic type tumors. In poorly differentiated tumors, metallothionein expression was detected in four of five cases (80%). Expression of cytokeratin 19 was typical for epithelioid cells and expression of vimentin for spindle cells of synovial sarcoma. A much less pronounced expression of the proteins was observed in poorly differentiated tumors. The results indicate that metallothionein expression may prove useful in differential diagnosis and for defining prognosis in cases of synovial sarcomas.

Analysis of estrogen receptor (ER) and estrogen-dependent pS2 protein expression in cells of mammary ductal carcinoma.

Not every case of mammary carcinoma with expression of estrogen receptors (ER) responds by remission to anti-estrogen treatment. Possible causes of the phenomenon may involve abnormalities of the receptor or defects in mechanisms of signal transmission. One of the ways in which function of the receptor may be detected involves examination of expression of the antigens which appear as a consequence of estrogen stimulation, e.g., expression of pS2 protein. The present study was aimed at comparing ER and pS2 expression in cells of mammary carcinoma, and hence, at finding out whether the presence of ER is equivalent to the sensitivity to estrogen action. In paraffin sections of ductal mammary carcinoma samples obtained from 56 patients, immunocytochemical reactions were performed using monoclonal antibodies against ER and pS2. The results documented positive correlation between the presence of ER and the presence of pS2 in cells of mammary carcinoma (Spearman's rank correlation: r=0.43, p <0.001). Thus, the intensity of pS2 expression was directly related to the expression of ER and the latter was found to be functional.

Prognostic value of immunocytochemical estimation of estrogen receptor (ER) and of pS2 estrogen-dependent protein in cells of mammary ductal carcinoma. Analysis of five-year course of the disease.

The pS2 protein belongs to the so called estrogen-dependent proteins, which appear in cells as a result of estrogen stimulation. The present study was aimed at determining prognostic value of estrogen receptor (ER) and pS2 protein expression in mammary cancer cells. The immunocytochemical reactions were performed in paraffin sections of tissue samples from 62 patients with ductal mammary carcinoma using monoclonal antibodies against ER and pS2. The analysis included also survival time of the patients, determined during the five-year observations. The studies documented a correlation between survival time and the level of ER expression (p=0.014) and absence of correlations between survival time and pS2 expression (p=0.55). The results indicate that evaluation of ER expression in mammary cancer cells may assist in defining prognosis of the patients while parallel estimation of pS2 expression in the cells is useless in this respect.

Factors influencing period of time between negative second-look laparotomy and ovarian carcinoma recurrence. Multicenter study in Poland.

OBJECTIVE: The aim of our study was to evaluate factors such as primary clinical stage, presence of ascites, serum CA 125 antigen level, histological type of ovarian cancer, cell differentiation and number of chemotherapy cycles influencing the time of recurrence after negative second-look operations. MATERIAL AND METHODS: Having observed complete clinical remission in 356 patients with ovarian cancer, second-look laparotomy was performed. In 180 patients complete pathologic remission was detected and in 73 recurrence was observed. Correlation analysis between time of recurrence and the above-mentioned prognostic factors was carried out by means of the Mann-Whitney and Kruskal-Wallis tests. RESULTS: The time from the second-look operation till diagnosis of relapse ranged from 7 to 36 months (average 21 months). The statistical analysis showed a correlation between the presence of ascites, increased serum CA 125 antigen level, the administration of six chemotherapy courses and the time of recurrence. In all those cases relapse occurred earlier than in patients without ascites, with normal CA 125 antigen levels and after ten courses of chemotherapy. CONCLUSION: Our findings suggest that the stage of clinical advancement and histologic grading do not influence the time of recurrence. The presence of ascites, increased serum CA 125 antigen level and the administration of fewer chemotherapy courses (6 versus 10) after primary surgery affects the earlier relapse of disease.

[Stromal sarcoma of the uterus in an 18-year old girl]. / Miesak podscieliskowy trzonu macicy u 18-letniej dziewczyny.

The authors describe diagnostic difficulties connected with proper estimation of stromal sarcoma biological activities, which developed in uterus corpus in 18 year old girl previously treated with hormones, because of irregular painful menses. Macroscopic and microscopic investigations of postoperative specimen allowed to set final diagnosis: stromal sarcoma with intermediate grade of malignancy, which showed an aggressive growth in the surrounding tissue and demonstrated moderate, focal polymorphism and different amounts of the mitoses in different areas.

[Stromal sarcoma of the uterine body in an 18-year old girl]. / Miesak podscieliskowy trzonu macicy u 18-letniej dziewczyny.

The authors describe diagnostic difficulties connected with proper estimation of stromal sarcoma biological activities, which developed in uterus corpus in 18 years old girl previously treated with hormones, because of irregular painful menses. Macroscopic and microscopic investigations of postoperative specimen allowed to set final diagnosis: stromal sarcoma with intermediate grade of malignancy, which showed an aggressive growth in the surrounding tissue and demonstrated moderate, focal polymorphism and different amounts of the mitoses in different areas.

Serum soluble interleukin 2 receptor alpha and soluble CD8 levels in patients with gynecological malignancies undergoing radiotherapy.

The phenotype peripheral blood lymphocytes, soluble interleukin 2 receptor alpha (sIL-2R alpha) and soluble CD8 (sCD8) were studied in 30 patients with gynecological malignancies before and after ratiotherapy. The absolute count of CD3+, CD4+, CD8+, CD19+ and CD25+ lymphocytes before treatment was within normal range. The levels of serum sIL-2R alpha and sCD8 were significantly increased before treatment compared to normal controls. After treatment the absolute number of CD3+, CD4+ and CD19+ lymphocyte subsets significantly decreased. The levels of sIL-2 alpha and sCD8 corrected according to absolute lymphocyte count reached normal range. The decrease of tumor mass correlated with the serum levels of sIL-2R alpha and sCD8. Further studies are needed to evaluate the usefulness of these tests in the prognosis and treatment of these diseases. Our study suggests that sIL-2R alpha and sCD8 in our patients probably has not been originating from the proteolytic cleavage of membrane bound receptors from peripheral blood mononuclear cells (PBMC). It can be speculated that sIL-2R alpha and sCD8 originated in these patients from activated tumor-infiltrating lymphocytes or may arise from separate alternatively spliced mRNAs coding for soluble vs. membrane forms.

[CA-125 antigen in patients with cancer of the uterine body]. / Antygen CA 125 u chorych na nowotwory zlosliwe trzonu macicy.

In 72 patients with malignant neoplasms of uterine body the serum concentration was determined of CA 125 antigen. In 38 cases serum samples were taken before oncological treatment and in 34 cases after the first stage of treatment. It was found that CA 125 concentration was significantly higher in patients before the treatment, with higher values in more advanced cases and in poorly differentiated tumours. The sensitivity of the CA 125 test was however low in the studied material (19.4%) at cut-off threshold 35 IU/ml, and routine determination of this antigen in serum to be without diagnostic value in uterine body malignancy.

Evaluation of diagnostic usefulness of CEA, hCG and SCC antigens in cervical cancer patients.

Pretreatment serum levels of CEA, hCG and SCC antigens were estimated in 130 patients suffering from 0-III FIGO cervix cancer. The mean serum concentrations and the percentages of samples exceeding the cut-off limits were the highest in advanced disease stages and in highly differentiated forms of cancer. Very high specificity of SCC antigen for uterine cervix cancer was established. The simultaneous estimation of three antigens under study did not give more usable clinical information than the estimation of SCC antigen alone.