Risk of pneumothorax not increased by obstructive lung disease in percutaneous needle biopsy.

All computed tomography directed lung biopsies from 1987 to 1991 were retrospectively reviewed. Pneumothorax occurred in 33 of 93 (35 percent) patients; 16 of these patients or 17 percent overall required a chest tube. No correlation was found between the presence of obstructive lung disease and the incidence of pneumothorax. Patients with smaller lesions were more likely to incur a pneumothorax. No relation was found with central or peripheral location, patient's age, or the operator and the incidence of pneumothorax. Patients with a pneumothorax were more likely to require a chest tube if they had obstructive lung disease.

Identification of the major sources of error in estrogen receptor measurements for individual laboratories using both tissue and cytosol samples.

The major sources of error between laboratories performing estrogen receptor measurements in tissue samples were identified for 17 participating laboratories in a trial conducted by the Australasian Quality Assurance programme. Both tissue and cytosol samples were provided, and the In-House assays were compared with the ER-EIA kit (Abbott Laboratories, U.S.A.) as a reference assay. For both the In-House and Abbott assays, tissue samples resulted in a between laboratory CV of about 55% and a within laboratory CV of about 30%. In contrast to tissue samples, the between laboratory CV for cytosol samples was reduced to 41% for the In-House assays and to 33% for the Abbott assay, whereas the within laboratory CV was reduced to 10% for both types of assay. The different methods of tissue homogenization by themselves were not found to be sources of error, and protein extraction efficiency from tissue was strongly correlated with protein measurement (P less than 0.0005). The major sources of error due to protein measurement, cytosol preparation, In-House and Abbott assays were evaluated for individual laboratories. The results indicated absence of any major sources of error for four laboratories, while one, two and three or more sources were indicated for seven, three and three laboratories respectively. The conclusion that about half the participants need to improve their ER assays was confirmed by three independent reviews. Furthermore, the trial demonstrated that tissue samples are essential as quality assurance material for a realistic assessment of ER assays in biopsy specimens.

Evaluation of a new oestrogen receptor assay.

Replicate assays of oestrogen receptor (ER) concentration on 81 specimens of human breast carcinoma were performed to compare the ligand binding Sephadex separation method with a polystyrene bead linked anti-oestrogen receptor monoclonal antibody technique (enzyme immunoassay [EIA], Abbott Laboratories). Each specimen was homogenized and the cytosol divided into four fractions. Replicate assays by each method gave an estimate of reproducibility. The mean CV (coefficient of variation = standard deviation/mean) for the ligand binding method was 9.73% compared with a mean CV of 17.9% for the EIA method. In the clinically significant range of ER values, around the cut-off point between negative and positive assays, there was no difference in the precision of the two assays (Mann Whitney U-test). The correlation between methods gave a Pearson's Product Moment Correlation Coefficient (r value) of 0.822, significant at the P less than 0.001 level, indicating a close correlation between the two methods. The highest CVs for both methods were in the range of oestrogen receptor concentrations, below 10 fmol/mg cytosol protein. Using 10 fmol/mg cytosol protein as a cut-off between negative and positive assays, 9.87% of the specimens would be reclassified as either positive or negative by the new assay method. The new assay method is, therefore, acceptable for clinical use.

Androgen receptors in breast cancer.

Androgen receptor assays have been performed on 1371 specimens of histologically confirmed primary and recurrent breast cancer. Forty-two patients who had received tamoxifen as treatment for advanced disease were assessed for objective response. Another 42 patients who had received chemotherapy were similarly studied. Patients with androgen receptor-negative tumors had a significantly poorer response rate to hormone therapy than those with receptor-positive tumors (P less than 0.05). This clinical correlation is supported by survival data of 1181 patients with primary breast cancer which showed that patients with androgen receptor-negative tumors had a highly significant trend toward shorter overall survival than those with receptor-positive tumors (P less than 0.001). Androgen receptor data added significantly to the information provided by estrogen receptor data both in terms of response to hormone treatment and survival.

Progesterone receptors in breast cancer.

Sixty-six women who had received hormonal therapy for advanced disease were assessed for objective response to treatment. Another 51 patients who had received chemotherapy were similarly studied. Progesterone receptor was of no value as a predictor of patients unlikely to respond to hormone therapy, though it may have a role in predicting patients likely to respond favourably. The addition of progesterone receptor data to oestrogen receptor data may increase prediction of response in the ER+ range but clinicians should be cautious in their interpretation of progesterone receptor results in the ER- range. Progesterone receptor was of no value in predicting response to chemotherapy in this series. Analysis of survival data of 1731 women with primary breast cancer showed a highly significant trend toward longer survival in patients with progesterone receptor positive tumours than in those with receptor negative tumours (P less than 0.001). This trend was evident in both pre- and post-menopausal women. Even though the prognostic discrimination provided by progesterone receptor was correlated with that of oestrogen receptor, the addition of progesterone receptor data to oestrogen receptor data significantly improved prediction of survival (P less than 0.05).

Oestradiol receptor values in breast cancer and response of metastases to therapy.

Eighty-one women who had received hormonal therapy for advanced disease were assessed for objective response to treatment. Another 73 patients who had received chemotherapy were similarly studied. Patients with ER - tumours had a significantly poorer response rate to hormonal therapy than those with ER + tumours (P less than 0.05) and a significant trend toward an increasing rate of response occurred with increasing quantitative levels of receptor (P less than 0.01). This trend was even more significant when the assay had been performed on recurrent tumour (P less than 0.001), suggesting that this provides a more accurate index of response to hormonal treatment than assays performed on the primary lesion. These results suggest that whilst the quantitative receptor level used to discriminate between 'negative' or 'positive' assays is appropriate, this division is an over-simplification. Oestrogen receptor was not helpful in predicting response to chemotherapy.

The prognostic value of oestrogen receptors in breast cancer.

Survival data for 2006 women who had oestrogen receptor assay carried out on primary breast cancer tissue between 1976 and 1982 are presented. There was a significant trend to shorter survival in patients with low ER levels than in those with high ER levels (P less than 0.01). This trend was evident in both pre- and post-menopausal women. The point of maximum discrimination between prognostic groups occurred at 8 fm in premenopausal women and the four year survival rates of patients above and below this level were 84% and 48%, respectively. In post-menopausal women, maximum discrimination occurred at 90 fm, and the four year survival rates above and below this level were 82% and 64%, respectively.

Multiple or sequential oestrogen receptor assays in breast cancer.

Multiple oestrogen receptor assays have been performed on primary, locally recurrent, and metastatic breast cancer in 62 patients. A change in receptor status was found in seven of 25 late recurrences (28%). It was noted that the level of oestrogen receptor was higher in lymph nodes than the primary tumour, particularly at the time of initial surgery. Other factors which might contribute to differences in receptor levels include site of metastases, method of handling, heterogeneity of tumours, and subsequent treatment. Such differences have important implications in management.

Hormone-receptor assays in breast cancer. A five-year experience.

Over a five-year period, from 1976 to 1981, hormone-receptor assays were performed in breast cancer specimens from 1868 women and 10 men. Oestrogen, progesterone, and androgen receptor results were distributed from zero to high levels without any clear separation into identifiable groups, which suggests that the division of results into negative and positive is an arbitrary one. The number of positive results increased significantly during the course of the study, probably due to improved tissue handling and increasing experience with assays. Over-all results showed that 61% of primary breast cancers in women compared with only 49% of secondary cancers gave positive results for oestrogen receptor. The incidence of progesterone and androgen receptors was also higher in primary cancers than in secondary cancers. In women with primary cancers, 72% of cancers were women with primary cancers, 72% of cancers were oestrogen-receptor positive in women after menopause, whereas in those before menopause only 48% were positive. Oestrogen receptor was detected in nine out of 10 male breast cancers.