Positron emission mammography in the diagnosis of breast cancer. Is maximum PEM uptake value a valuable threshold for malignant breast cancer detection?

AIM: To evaluate the diagnostic value (sensitivity, specificity) of positron emission mammography (PEM) in a single site non-interventional study using the maximum PEM uptake value (PUVmax). PATIENTS, METHODS: In a singlesite, non-interventional study, 108 patients (107 women, 1 man) with a total of 151 suspected lesions were scanned with a PEM Flex Solo II (Naviscan) at 90 min p.i. with 3.5 MBq 18F-FDG per kg of body weight. In this ROI(region of interest)-based analysis, maximum PEM uptake value (PUV) was determined in lesions, tumours (PUVmaxtumour), benign lesions (PUVmaxnormal breast) and also in healthy tissues on the contralateral side (PUVmaxcontralateral breast). These values were compared and contrasted. In addition, the ratios of PUVmaxtumour / PUVmaxcontralateral breast and PUVmaxnormal breast / PUVmaxcontralateral breast were compared. The image data were interpreted independently by two experienced nuclear medicine physicians and compared with histology in cases of suspected carcinoma. RESULTS: Based on a criteria of PUV>1.9, 31 out of 151 lesions in the patient cohort were found to be malignant (21%). A mean PUVmaxtumour of 3.78 ± 2.47 was identified in malignant tumours, while a mean PUVmaxnormal breast of 1.17 ± 0.37 was reported in the glandular tissue of the healthy breast, with the difference being statistically significant (p < 0.001). Similarly, the mean ratio between tumour and healthy glandular tissue in breast cancer patients (3.15 ± 1.58) was found to be significantly higher than the ratio for benign lesions (1.17 ± 0.41, p < 0.001). CONCLUSION: PEM is capable of differentiating breast tumours from benign lesions with 100% sensitivity along with a high specificity of 96%, when a threshold of PUVmax >1.9 is applied.

Tumour excision plus continuous tamoxifen compared with modified radical mastectomy in patients over 70 years of age with operable breast cancer.

Between 1985 and 1991, we randomly assigned 77 women over the age of 70 years with stage I-3a breast cancer to undergo a modified radical mastectomy or tumour excision followed by tamoxifen. Median follow-up was 45 months. Patients treated by tumour excision and tamoxifen had a significantly better survival (P = 0.04). The disease-free survival of the tumour excision and tamoxifen group was close to significantly better (P = 0.10). Only two patients in the tamoxifen group required an axillary dissection on follow-up for progressive nodal enlargement. Two patients underwent a local mastectomy for locally recurrent disease. We conclude that tumour excision followed by continuous tamoxifen is an acceptable, safe alternative to a modified radical mastectomy in patients over 70 years of age.

Breast cancer complicated by pleural effusion: patient characteristics and results of surgical management.

To evaluate the efficiency of pleurodesis (PD) in the management of symptomatic malignant pleural effusion (PE) in breast cancer, we reviewed 46 patients undergoing 49 PDs. When radiotherapy was part of the initial treatment, 41% of PEs were ipsilateral to the primary, if not, 85% of PEs were ipsilateral (P < 0.0075). Six percent of patients presented dyspneic with exertion, 32% during daily routine; 61% at rest. All except 1 were improved after PD; 74% had no dyspnea, 23% had exertional dyspnea. PD relieved chest pain in 4 and cough in 5 patients. With 31 Talc/Iodine PDs, 2 mortalities and 2 minor complications occurred. Of 17 tetracycline PDs, 1 was complicated by bronchopleural fistula and 1 failed. 1 Mustine PD was uncomplicated. Survival at 6, 12, and 24 months was 58%, 40%, and 13%, respectively. Primary local radiotherapy may prevent ipsilateral PE. Talc/Iodine and tetracycline PD reliably provide relief from the distressing symptoms of malignant PE.

[The cost of treatment operable breast cancer]. / Die koste van behandeling van opereerbare borskanker.

The cost of primary treatment of operable breast cancer was investigated in 25 patients. As a result, appropriate cost-saving measures were instituted. In 1988 the total costs paid by the patients amounted to R40 690. The actual cost calculated according to the Scale of Benefits would have amounted to R175 035. The average subsidy per patient amounted to R5 373. If the minimum number of special investigations before treatment on the 258 new patients registered in 1988 had been performed an amount of R60 000 would have been saved. If the number of inpatient days could have been reduced R284 832 would have been saved. Doctor's fees, theatre fees and the cost of medicine are fixed. Long-term savings are possible only if breast cancer can be diagnosed early, if inpatient days are limited, and if all doctors and students are selective in their requests for special investigations.

Aspects of work of women medical doctors in the Cape Province. A preliminary investigation.

Women form an increasingly important part of the medically trained workforce in South Africa. However, little is known about the professional issues and work-related problems affecting them. A survey was undertaken of all registered female medical practitioners practising in the Cape Province in order: (i) to ascertain their current pattern of work; (ii) to identify factors that influence this work pattern; and (iii) to identify factors that would help these women stay in the profession or re-enter it more easily after an absence. A questionnaire on biographical information, qualifications, employment (full-time/part-time), capacity in which employed, ease of keeping up to date, information about those participants not at present practising medicine, and changes in working conditions that would make it easier for those not practising to return to medical practice was posted to all eligible doctors. Of 774 copies posted, 480 were returned (62%). At the time of the survey, 90% of the respondents under 65 years of age were employed. The reason most often cited as to why respondents stopped practising was family commitments. The availability of part-time posts was most often mentioned as a working condition that would make return to work easier. Twice as many respondents found it difficult or very difficult to keep up with current practices than those who found it easy or very easy. There were 196 women (41%) who had been unemployed for more than 6 months; 44 ascribed this to the unavailability of posts. Women doctors need more flexible training schedules and conditions of employment. Part-time training and part-time career options should be extended.(ABSTRACT TRUNCATED AT 250 WORDS)

Phyllode tumours of the breast. A review of 21 cases.

Twenty-one cases of phyllode tumours of the breast (9 malignant, 4 borderline and 8 benign) were reviewed. Three patients with malignant tumours developed metastases, and all died. Eight patients developed local recurrence, 6 in the malignant and borderline groups and 2 in the benign group. The classification into malignant, borderline and benign groups is a reliable guide for use when deciding on the extent of surgery. Malignant and borderline tumours require local mastectomy, while tumour excision suffices for benign disease. The customary pathological separation of malignant phyllode tumours from primary sarcoma of the breast is questioned.

Analysis of prognostic factors in 568 patients treated for breast cancer by surgery.

The Tygerberg Breast Clinic serves a heterogeneous population, and it is therefore possible to analyse prognostic factors influencing survival and to identify any possible differences between these groups. From 1978 to 1985, 568 breast cancer patients (52% white and 48% colored) were treated surgically in Tygerberg Hospital. Stage for stage, all patients received identical treatment. Colored patients were seen at a younger age, with more advanced disease, had lower estrogen receptor values, and more nodes involved. Cox's regression analysis of age, receptor value, stage, nodal involvement, race, menopausal status, treatment, and study period in the evaluation of disease-free survival and overall survival confirmed stage and lymph node status as prognostic factors. Estrogen receptor status, menopausal status, age at presentation, treatment, study period, and race did not enter the regression, except in stage I, where race was a variable. A target group for directing educational intervention is identified.

Breast-conserving treatment for stage I and II cancer. Tumour excision, axillary dissection, peri-operative interstitial irradiation, with or without peri-operative chemotherapy, followed by breast irradiation--the Tygerberg Hospital experience.

Since 1984 breast-conserving treatment has been the treatment of choice for patients at Tygerberg Hospital with early breast cancer. Peri-operative interstitial brachytherapy in breast cancer is described in detail. In the 221 patients treated (225 breasts), 197 breasts received iridium implants and 26 patients received peri-operative chemotherapy (POPFAC). There were 6 recurrences in treated breasts, 3 within the booster area and 3 outside. There were 5 salvage mastectomies, and 1 patient was treated by excision and radiotherapy. Metastases developed in 27 patients. Two patients underwent mastectomy for severe radiation changes and 7 developed postoperative wound infection after POPFAC. Five patients, who had re-excisions and prolonged seroma formation, developed delayed wound infection after POPFAC. Five patients, who had re-excisions and prolonged seroma formation, developed delayed wound infection. The importance of mammography, patient selection, tumour-free margins and radiation dosage are discussed.