The evaluation and treatment implications of isolated pulmonary nodules in patients with a recent history of breast cancer.

BACKGROUND: Breast cancer patients with pulmonary lesions are often assumed to have metastatic disease and treated palliatively. We evaluated the proportion of these patients who actually have primary lung tumor (PLT) and assessed their outcome. METHODS: We performed a 10-year retrospective review of the cancer registry in a community hospital system. RESULTS: Among 54 breast cancer patients with pulmonary nodules, biopsy was pursued in 30. Although metastatic breast cancer (MBC) was presumed in 24, biopsy showed MBC in 9 patients and PLT in 21. The two groups differed in age, stage, breast tumor size, nodal involvement, and estrogen receptor (ER) positivity. However, no variable excluded the possibility of PLT. Of those with PLT, 11 had early-stage lung disease; 9 underwent curative resection. CONCLUSIONS: Women with breast cancer and 1 or more pulmonary lesions without evidence of other metastatic disease require work-up of pulmonary lesions. Aggressive evaluation can afford treatment of lung cancer and impact survival.

Risk counseling and management in patients with lobular carcinoma in situ.

BACKGROUND: The understanding of lobular carcinoma in situ (LCIS) has evolved since it was first described. LCIS once was thought to be a premalignant condition, but now it is considered a marker for increased risk for developing invasive breast cancer. We evaluated patient perception of risk, counseling, and subsequent management. METHODS: A community cancer registry of 3,605 cases of breast cancer was reviewed. Fifty-five (1.5%) patients with LCIS as their sole diagnosis were identified and these patients were sent a questionnaire. RESULTS: Forty of 55 patients completed the questionnaire for a 73% response rate. The patients' perception of lifetime risk for invasive cancer was variable. Surgeons performed the majority of counseling. Fourteen patients (35%) were placed on a selective estrogen-receptor modulator. Eleven patients (28%) had bilateral mastectomy. Three patients had unilateral mastectomy. Screening recommendations included an annual mammography (64%), a professional examination (64%), and a monthly self-breast examination (75%). CONCLUSION: A patient's perception of risk for invasive breast cancer after a diagnosis of LCIS is widely variable. Patients will adhere to suggested screening recommendations. Surgeons are performing the majority of counseling and must stay abreast on current recommendations.

Accuracy of intraoperative touch imprint cytologic analysis of sentinel lymph nodes in breast cancer.

BACKGROUND: Eliminating full axillary dissection (AD) in the face of negative sentinel lymph nodes (SLN) has become increasingly popular. We sought to evaluate the accuracy of intraoperative touch imprint cytology in detecting clinically significant metastatic involvement of the SLN. METHODS: Retrospective review of intraoperative cytology and final hematoxylin-eosin stain evaluation of sentinel nodes examined in a community hospital from 1997 to 2002. RESULTS: During that period 1,585 patients underwent axillary dissection; 380 had SLN identification with 142 patients undergoing intraoperative cytologic evaluation of 446 SLNs. Fourteen patients with negative intraoperative cytology had involvement of a SLN on final hematoxylin-eosin examination, for a sensitivity of 75%, specificity of 100%, negative predictive value of 95%, and a false negative rate of 4.9%. In all but 1 case the metastasis was microscopic and measured 2 mm or less. Seven patients went on to completion axillary dissection (50%) with no additional nodal involvement found. CONCLUSIONS: Intraoperative touch imprint cytology is accurate in predicting clinically significant SLN pathology. Although the false negative rate in this series was 4.9%, in all but 1 case it represented micrometastatic disease that may not necessarily require completion axillary dissection.