Image-guided core biopsy in patients with breast disease.

Ultrasonographically-guided core biopsy has been used as an adjunct to triple assessment when fine-needle aspiration cytology was inadequate or equivocal, if the overall assessment of the patient was uncertain, or if it was deemed the preferred diagnostic option. Some 143 of 2603 patients had a guided core biopsy, 125 to establish the diagnosis and 18 to obtain histology in cytologically proven malignancy. A diagnosis of malignancy was established in 43 of the 125 patients who had a diagnostic core biopsy. Some 45 patients with benign disease were either discharged or returned to follow-up on the basis of the core biopsy. The remaining 37 patients required surgical biopsy, of whom 13 had malignant and 24 benign disease. The overall positive predictive value for malignancy was 98 per cent. Experience with ultrasonographically-guided core biopsy shows that it can reduce the need for surgical biopsy in both benign and malignant conditions of the breast.

High bile duct strictures.

The diagnosis and surgical treatment of carcinoma of the common hepatic duct present diffucult problems. Accurate preoperative localization of the obstructive lesion is essential and slim needle transhepatic percutaneous cholangiography is the investigation of choice. Worth while palliation may be achieved if biliary-enteric flow can be reestablished by introducing a plastic stenton through the obstructive lesion in the bile duct. Three patients are reviewed who survive 36, 31 and 26 months after this operation. A further patient died of metastases after 5 months.

The effect of Corynebacterium parvum on the proliferation of monocyte precursors in the bone marrow of mice.

The anti-tumour activity of C. parvum is thought to be mediated via the monocyte/macrophage system (Scott, 1974). These cells originate from rapidly dividing precursors in the bone marrow and it might be at this level that C. parvum exerts its action. To test this hypothesis bone marrow T0 Swiss mice has been cultured according to the method of Bradley and Metcalf (1966), which gives an index of the number of proliferating macrophage precursor cells at the time of sacrifice. Experiments were set up at various times following a single i.p. injection of 700 microgram of an anti-tumour strain of C. parvum (CN 6134-Wellcome Research Laboratories). Controls received 700 microgram of either C. diphtheriae CN 2000 or C. parvum CN 5888, a strain with no anti-tumour activity. Macrophage colony counts in those mice receiving "active" C. parvum were significantly higher than those in controls at intervals from 2 h to 3 weeks post-treatment. This time course parallels certain immunological properties of C. parvum and suggests a possible mode of action.

Clinical experience in the use of C. parvum in the treatment of locally advanced carcinoma of the breast.

Twenty-one patients with locally advanced breast cancer which had failed to respond to conventional therapy have been treated by infusion of C. parvum (strain CN 6134, Wellcome Research Laboratories) in 5% Dextrose. Thirteen patients had a single dose of 15 mg. C. parvum over 4 h and 8 patients received 5 daily infusions of 4 mg C. parvum over 1 h. In 3 patients there was some evidence of tumour regression. Pyrexia, often associated with rigors, headaches, vomiting and variations in blood pressure occurred in most patients receiving either schedule, although the severity of the side effects decreased daily in those receiving 5 treatments. One patient became comatose within 24 h of treatment and died two weeks later. Progressive swelling of the arm on the side of the tumour and inflammation of the primary lesion were prominent in those receiving 5 daily treatments. These results show that caution must be exercised in the clinical use of C. parvum and the search for an ideal schedule should continue.

The effect of intravenous infusion of Corynebacterium parvum on an immune profile of women with breast cancer.

An immunological profile has been measured in 21 patients with advanced breast cancer who were treated with C. parvum (Wellcome strain CN6134). Thirteen patients received a single i.v. dose of 15 mg of C. parvum and 8 received 4 mg i.v. on 5 successive days. The "profile" was recorded before and 7-10 days after treatment and included measurement of total white count, absolute lymphocyte and monocyte counts, PHA response, B and T cell percentages. DNCB and Mantoux skin tests, immunoglobulin classes G, A, M and E and spleen size. Most patients showed a rise in white count, due largely to a polymorph leucocytosis, but there was no consistent change in any of the immunological variables recorded. IgG levels increased significantly following the single injection but not after the 5-day course; suggesting the possibility of acquired immunological tolerance. These results fail to demonstrate a consistent effect of C. parvum on either T-lymphocyte dependent function or on the spleen size, properties well documented in the experimental animal.