Mammographic and ultrasonographic findings in bilateral breast cancer: a comparative study.

To compare the results of mammographic and US examinations in unilateral and bilateral breast cancers in routine clinical work, the files of all patients with 825 preoperative mammograms and 525 preoperative US examinations operated on for primary breast cancer in the Oulu University Hospital from 1983 through 1993 were retrospectively reviewed. The only statistically significant difference noted in the mammographic findings was the false-negative rates in unilateral, bilateral and metachronous second breast cancers (6.8, 16.3 and 23.3 %, respectively). The differences were mainly due to the lower sensitivity of mammography in the detection of palpable bilateral breast cancers. The false-negative rate of US was also significantly higher in bilateral breast cancers (23 %) than in unilateral cancers (11 %), and significantly higher for nonpalpable than palpable cancers in both the bilateral and the unilateral groups. The mammographic failure rates and the difference between these two groups were most pronounced during the early study period, which underscores the importance of experience and dedicated imaging technique. The smaller tumour size at the time of diagnosis and probably the loss of the opposite breast for comparison have contributed to the higher false-negative rates in bilateral breast cancer.

Determinants of positive histologic margins and residual tumor after lumpectomy for early breast cancer: a prospective study with special reference to touch preparation cytology.

BACKGROUND AND OBJECTIVES: Removal of the entire tumor by breast-conserving surgery is important, but the determinants of adequate excision have not been established. METHODS: A prospective study of 55 consecutive lumpectomies for early breast cancer was performed to study the correlation between touch preparation cytology and histologic margins and the determinants of positive histologic margins and residual disease after the initial excision. RESULTS: The correlation between touch preparation cytology and histologic margins was poor: sensitivity and specificity were 37.5% and 85.1%, respectively. The histologic margins were positive in 8 cases (14.5%) and were related to the presence of intraductal carcinoma and to the large pathologic size of the index tumor. Re-excision specimen of the tumor bed (34 of 55 cases) contained residual cancer in seven cases (20.6%). Multifocal and nonpalpable index tumors predicted residual cancer. Residual disease was found in 37.5% of the cases (3 of 8) with positive and in 15.4% of the cases (4 of 26) with negative histologic margins. CONCLUSIONS: Touch preparation cytology cannot be recommended as a method of assessing lumpectomy margins for early breast cancer. Histologic margins are misleading in predicting residual cancer in re-excision specimens. To minimize the risk of residual cancer, wide excision or mastectomy should be considered in the management of multifocal and nonpalpable tumors.

Nonpalpable breast lesions: pathologic correlation of ultrasonographically guided fine-needle aspiration biopsy.

To evaluate the usefulness of ultrasonographically guided fine-needle aspiration biopsy in routine clinical use, we evaluated retrospectively all of the 781 nonpalpable breast lesions operated on in the Oulu University Hospital during the period 1986 to 1993. There were 86 patients with 90 nonpalpable breast lesions, of which samples were taken by ultrasonographically guided fine-needle aspiration biopsy. Open wire-guided surgical biopsy was obtained in all cases for a histologic diagnosis. Two false-negative results and one insufficient cytologic sample occurred in the 26 malignancies and one false-positive result and two insufficient cytologic samples were found in the 73 benign breast lesions, giving sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy values of 84%, 93%, 94%, 95%, and 90%, respectively. The calculations include the insufficient samples. We conclude that ultrasonographically guided fine-needle aspiration biopsy is a method comparable to mammographic and stereotactic fine-needle aspiration biopsy methods.

Rat testicular interstitial fluid contains mediators of vasopermeability.

An intradermal injection of testicular interstitial fluid (IF) produced a marked increase in vasopermeability in a dose-dependent manner. Likewise bovine follicular fluid caused a smaller but significant response. The effect of IF was associated with accumulation of polymorphonuclear leucocytes (PMNs) inside the dermal venules and with their adherence to the venular endothelium. A minor but significant response was noticed after injecting anterior chamber fluid, but there was no response after an injection of amniotic fluid or serum intracutaneously. Destroying the Leydig cells with ethane dimethanesulphonate did not change the vasopermeability-increasing effect of IF, but after denaturation of IF proteins the effect was diminished by about 50%. Intravenous administration of hCG did not increase the ability of IF to cause the effect. These results suggest that rat testicular interstitial fluid contains mediators of vasopermeability, probably specific for the testis and also follicular fluid. The vasopermeability effect of IF does not seem to depend on the collecting time or on Leydig cells and is at least partly mediated by PMNs which are seen in the dermal venules shortly after an injection of IF.