Expression of GCDFP-15 in breast carcinomas. Relationship to pathologic and clinical factors.

A retrospective immunoperoxidase staining study for a glycoprotein isolated from human breast gross cystic disease fluid (GCDFP-15) in 562 primary breast carcinomas in 539 patients was conducted to correlate its immunohistochemistry with pathologic and clinical factors. Overall, 55% of the carcinomas studied stained positively for GCDFP-15. In certain histologic subtypes, the percentage of carcinomas that stained positively was greater: those subtypes with apocrine histologic features (75%), intraductal carcinoma (70%), and infiltrating lobular carcinoma with signet-ring cell differentiation (90%). In contrast, only 5% of medullary carcinomas exhibited positive staining. Only 23% of breast carcinomas without apocrine features stained positively for GCDFP-15. Carcinomas that stained positively were more likely to have involved axillary lymph nodes (P less than 0.054). The staining was independent of nuclear grade, mitotic index, tumor size, and estrogen receptor status. Positive staining was related to a history of gross cystic disease but not to age, parity, menopausal status, or age at first birth. A positive stain was not related to risk of recurrence or survival.

Lumpectomy for mammary carcinoma. A retrospective analysis of 40 presumptive candidates from a surgical series.

This presumptive study concerns the value of lumpectomy as a curative procedure for minimal breast carcinoma, defined as an operable cancer no larger than 2 cm in diameter, with no palpable axillary lymph nodes, and, in peripherally located lesions, no Paget's disease. From 199 surgically treated mammary cancer patients, 40 cases met the minimal criteria. Thirty-eight of the minimal breast carcinoma patients had a radical mastectomy and two had a supraradical procedure. The pathology findings and survival data were analyzed in these minimal carcinoma cases, and it was calculated that lumpectomy alone would have left cancer cells in 48% of the patients because of regional lymph node involvement by cancer, extension of cells from a peripheral cancer to the nipple ducts, or presence of a second carcinoma in the breast. However, the estimated 30-year cure rate in these radical surgically treated patients was 86%.

A personal experience with Halsted's radical mastectomy.

This is a summary of Haagensen's experience with radical mastectomy over a 51-year period at the Columbia Presbyterian Medical Center. His prospective, experimental study includes 1036 patients with a follow-up of 47 years. These data are unequalled for any single method of treatment for breast carcinoma.

Coexisting lobular neoplasia and carcinoma of the breast.

In a review of 3040 cases of carcinoma of the breast of all types in the files of the Laboratory of Surgical Pathology at Columbia for the years 1960 to 1980, 267 cases were found in which the lobular neoplasia lesion coexisted with one of the usual forms of breast carcinoma. These patients had a separate and distinct, and of course malignant, clinicopathologic entity which is distinguished from benign lobular neoplasia occurring alone. Comparing these findings in lobular neoplasia coexisting with one of the usual forms of carcinoma with our findings in lobular neoplasia occurring alone, it was found that the patients with the latter lesion were younger. Three of the nine microscopic features studied in both forms of lobular proliferation were considerably more frequent in lobular neoplasia coexisting with carcinoma: (1) loss of cohesion of the cells filling up the lobules; (2) macroacini; and (3) a maximal amount of lobular neoplasia. The great majority of the forms of carcinoma that were found coexisting with lobular neoplasia were well differentiated, small cell, intraductal, and tubular, and metastasized less often than carcinomas usually do. Carcinoma developed in the second breast three times more frequently in patients with lobular neoplasia preceding or coexisting with unilateral carcinoma than it did in patients without lobular neoplasia.

Tubular carcinoma of the breast. Clinical pathologic correlations based on 100 cases.

One hundred tubular carcinomas were reviewed, analyzed and compared with previously reported studies in the literature. Our cases were subdivided into five groups, according to the proportion of the carcinoma which was tubular. In the case of pure or almost pure tubular carcinomas (76% or more), tumor size was small, no metastases were found, no recurrences developed, and there were no deaths attributable to the carcinoma. As the proportion of the carcinoma which was tubular decreased, the size and biologic aggressiveness of the tumor increased; this it is likely that tubular carcinoma may represent an early form of carcinoma. A right-sided preponderance was found of the "pure tubular" carcinomas; and lesions of the central sector of the breast were rare in all five groups. The incidence of bilateral cancer was greater than that expected for breast cancer in general and included three patients with bilateral tubular carcinomas. On the basis of our findings, we suggest that lesions which are composed 90% or more of tubular carcinoma may be treated by simple mastectomy, and that axillary dissection is not necessary. For all carcinomas with a lower proportion of tubular elements, at least total mastectomy and axillary dissection are indicated, although the safest treatment probably is radical mastectomy.

An improved technique for the study of lymph nodes in surgical specimens.

The importance of the meticulous study by pathologists of the lymph nodes in surgical specimens is emphasized. Most pathologists identify only a small proportion of the lymph nodes in these specimens and valuable prognostic information is lost. Data illustrating the evolution in the Columbia Laboratory of surgical pathology of methods used to study surgical lymph node specimens over a 44-year period (1935--1979) are reviewed. An improved method of clearing the specimens of axillary dissections in radical mastectomy finds more lymph nodes and more metastases, and greatly shortens the time required for clearing. The importance of identifying metastases in the interpectoral nodes is emphasized. In a special study with our new clearing technique metastases were found in the interpectoral nodes in 19% of the radical mastectomy specimens. These nodes are not removed in the modified operation, which does not include resection of the pectoral muscles. The opportunity to cure a substantial proportion of patients is thus lost.

Lobular neoplasia (so-called lobular carcinoma in situ) of the breast.

In a review and reclassification of 5,560 benign epithelial lesions of the breast entered in the files of the Laboratory of Surgical Pathology at Columbia, we found 211 examples of the type of lobular proliferation occurring alone without co-existing infiltrating carcinoma, which we prefer to call lobular neoplasia, but which is generally referred to as noninfiltrating lobular carcinoma in situ. We regard this lesion as a separate distinctive pathological-clinical entity. These 211 cases are studied from a number of parameters, including the ages of the patients, the breast affected, the length of the follow-up, the interval between the initial diagnosis and the frank carcinoma which eventually developed in 17.1 percent of the patients. The relationship of microscopic qualitative and quantitative variations in the lobular neoplasia to subsequent carcinoma was studied; the variations were not found to have any value in predicting subsequent carcinoma. This study is unique in that we have data as to the frequency of a family history of carcinoma in a mother or sister, and also as to the occurrence of gross cystic disease in our patients with lobular neoplasia. We have determined the ratio between the observed and expected numbers of patients developing carcinoma in the several possible combinations of these three factors which predispose to carcinoma. We report that the predisposition is cumulative: in patients in whom all three predisposing factors were present the ratio of observed to expected risk of carcinoma was 13:8. We do not recommend mastectomy for lobular neoplasia, but only systematic follow-up by palpation of the patients' breasts every four months.