Axillary lymphadenectomy for intraductal carcinoma of the breast.

During a ten year period, 175 axillary lymph node dissections were done as part of the treatment for intraductal carcinoma of the breast; 98 patients were treated with modified radical mastectomy and 77 were treated by mammary preservation, consisting of excision of the lesion, axillary dissection and radiation therapy. One of 175 axillary node dissections yielded positive nodes. Axillary dissection for intraductal carcinoma of the breast is unlikely to yield involved nodes and is not indicated for use in most instances. It should be reserved for lesions demonstrating microinvasion.

Intraductal carcinoma of the breast (208 cases). Clinical factors influencing treatment choice.

Two hundred eight cases of intraductal breast carcinoma (DCIS) were selectively treated; 97 with mastectomy, 96 with radiation therapy, and 15 using excisional biopsy only. Mastectomy patients tended to have larger tumors, involved biopsy margins, palpable and often multifocal tumors. Breast preservation patients tended to have smaller, often occult, tumors with clear surgical margins. Before 1983, mastectomy was more common; during and after 1983, breast preservation was more common. Comedocarcinomas were the most frequent tumors. They were the largest, had the highest percentage of microinvasion (20%), and had the highest recurrence rate (8%). Noncomedo DCIS had a recurrence rate of 1%, one of 103 tumors. The recurrence rate for comedocarcinomas treated with radiation therapy was nearly three times higher than for those treated with mastectomy (11% versus 4%). One of 164 (0.6%) axillary lymph node dissections yielded positive nodes. Nine patients have recurred: two in the mastectomy group and seven in the breast conservation group (P less than 0.1). Eight of nine recurrences were the comedo subtype (P less than 0.05). Three patients developed metastatic disease, two of whom have died. Axillary dissection for intraductal carcinoma of the breast is unlikely to yield involved nodes and is not indicated for most cases. It should be reserved for lesions revealing microinvasion. Conservative therapy for comedocarcinoma must be viewed with caution.

Nonpalpable breast lesions: diagnosis with slightly overpenetrated screen-film mammography and hook wire-directed biopsy in 1,014 cases.

Slightly overpenetrated screen-film mammography and hook wire-directed localization were used in 1,014 breast biopsies performed for nonpalpable, mammographically detected breast abnormalities. One lymphoma and 205 breast cancers (20%) were found; 115 breast cancers (56%) were noninvasive, and 90 (44%) were invasive. Mastectomy was performed in 69 breast cancers (34%); 136 (66%) were treated conservatively, 28 with biopsy only and 108 with lumpectomy, node dissection, and radiation therapy. All patients with noninvasive breast cancers treated with axillary dissection had uninvolved lymph nodes. Of the 90 invasive breast cancers, six (7%) had metastases to axillary nodes, which, to the authors' knowledge, is lower than percentages reported in other studies of wire-directed breast biopsies. The authors believe that the slightly overpenetrated technique is a valuable adjunct to screen-film mammography.

Improved resolution of soft x-ray contact images using laser-produced plasmas.

Soft x-ray contact images have been obtained of diatom skeletons using laser-generated plasmas of low energy (2 J IR). These images have a resolution of less than 60 nm, which is superior to that reported previously for biological specimens, using this technique.

Breast cancer in women after augmentation mammoplasty.

More than 1 million American women have undergone augmentation mammoplasty; 100,000 (10%) will develop or already have developed breast cancer. Between March 1981 and August 1986, 20 patients with previous augmentation mammoplasty were treated for breast carcinoma. All patients had unilateral infiltrating carcinomas and presented with a palpable mass. None of the cancers were occult (discovered mammographically). Thirteen patients (65%) had metastases to axillary lymph nodes. During the same period, 733 nonaugmented patients with breast cancer were treated: 207 (28%) had involved axillary nodes, 194 (26%) had in situ lesions, and 154 cancers (21%) were occult. Augmentation mammoplasty with sillicone-gel-filled implants reduces the ability of mammography, our best diagnostic tool, to visualize breast parenchyma. When compared with our own nonaugmented breast cancer population, augmented patients with breast cancer presented with more advanced disease; they had a higher percentage of invasive lesions and positive axillary nodes, resulting in a worsened prognosis.

Axillary lymph node dissection for intraductal breast carcinoma--is it indicated?

One hundred patients with intraductal breast carcinoma (DCIS) were treated with either mastectomy (49 patients) or radiation therapy (51 patients). All patients underwent axillary lymph node dissection (average number of nodes removed, 16) as part of their treatment. No patient had any positive axillary lymph nodes. There has been one recurrence in each treatment group (median follow-up, 27 months) and no deaths. Intraductal breast carcinoma has little potential for metastasis to axillary lymph nodes.

Quantitative imaging and microanalysis with a scanning soft x-ray microscope.

A scanning soft x-ray microscope has been developed that uses synchrotron radiation focused by a Fresnel zone plate to form a submicron beamspot on the specimen. Transmitted x-rays are detected and used to form a quantitative map of specimen absorptivity. Applications of the instrument to the imaging of whole wet cells and to the mapping of calcium in sections of bone are presented, with a resolution of 300 nm and an elemental sensitivity of 2 micrograms cm-2.

Hooked-wire-directed breast biopsy and overpenetrated mammography.

Six hundred fifty-three biopsies were performed for clinically occult, mammographically detected breast abnormalities. One hundred forty-seven cancers (22.5%) were found. Eighty-nine of those cancers (60.5%) were noninvasive. None of the in situ lesions had involved axillary lymph nodes. Of the 58 invasive cancers, only six (10.3%) had metastases to axillary nodes. Fifty-four patients (36.7%) were treated by mastectomy while 93 patients (63.3%) were treated conservatively, 20 by biopsy only, and 73 by lumpectomy, axillary node dissection, and radiation therapy. Only four patients (0.7%) had significant complications.

Nondestructive single-shot soft x-ray lithography and contact microscopy using a laser-produced plasma source.

A toroidal relay optic has been used to overcome the problem of damage caused by debris that has limited previous attempts at soft x-ray lithography and contact microscopy using laser-produced plasma sources. Not only is the specimen preserved, but it is now possible to have a vacuum retaining soft x-ray transparent Si(3)N(4) window as a permanent part of the apparatus, greatly simplifying specimen handling. The exposure times are ~2 ns.