[The attitude before subclinical breast lesions on mammography]. / Atitudinea fata de leziunile mamare infraclinice descoperite mamografic.

Mammographic screening and improvement of mammography resolution have resulted in the increasingly frequent identification of small-size mammary lesions that have no clinical expression. If in Western countries, approximately one quarter of breast cancers are discovered when clinically occult, in Romania such cases are rare and, most of the times, discovered merely by chance. Infraclinical mammary lesions identified by mammography pose problems concerning the appropriate response. The paper assesses the various diagnosis and therapy choices as well as the localization techniques to be employed in order to establish the best approach. We describe twelve cases of infraclinical mammary lesions identified by mammography. In two of this cases fine needle aspiration biopsy with cytological examination was used, and in one case we performed core biopsy and histological examination. In those cases, lesion localization has been performed using stereotactic X-ray devices. In nine cases, we performed excisional biopsy with histologic assessment. In four of those cases, the lesions proved to be malignant. Preoperative localization was performed with hookwires placed in the proximity of the lesion under mammographic control. In five of those cases, lesion coordinates have been determined by stereotaxy. Using this technique, we removed, in all cases, the clinical lesions identified by mammography. We believe surgical excision to be the best approach in such lesions. Total removal of the lesion enables a thorough histopathological examination resulting in more accurate diagnosis. Curative surgery is also possible within the same surgical procedure. Unless preoperative localization is performed the surgeon is in the position to excise an image that has no clinical expression. Under this circumstances surgical removal is performed blind, as the lesion is hard to be found even intraoperatory. Preoperative localization provides guidance to the surgeon, ensures removal of the lesion that has been identified by mammography and helps avoids unnecessary mammary resection.

Interleukin-2 alterations in the immune status of patients with mammary neoplasm.

Immune control is achieved by the balance between tumour reduction mechanisms and the "immunological creeping" phenomenon. The purpose of this study was to look into the alterations of the immune effector component in the case of mammary tumours. The study included 42 cases of women with a clinical diagnosis of mammary tumour, initially referred for surgery, with a mean age of 45.07 (18-65 years of age). Neither radiotherapy nor chemotherapy had been given to the patients before surgery. Histopathological examination performed intraoperatively as well as later, under paraffin, revealed 12 cases of malign tumours. The control group consisted of 18 women (blood donors), apparently healthy, with a mean age of 41 (30-49 years of age). In both groups, the immune status was assessed by means of: lymphocyte counts, T-lymphocyte counts (TL), rosetting, lymphocyte blastic transformation test (BLT) under the action of polyclonal mitogens, immunoglobulin dosing and Interleukin-2 (IL-2) determination in lymphocyte cultures stimulated with mitogens. The conclusion of our results has been that even in the less advanced stages of mammary cancer, there occur alterations of the immune response represented by: A decrease in the total number of lymphocytes, especially through a decrease of the TL number; A decrease of the lymphocyte blastic transformation index on stimulation with PHA; A decrease of IL-2 concentration in cultures stimulated with mitogens through the impairment of the TL CD4+ (TL Helper) function. The decrease of IL-2 production capacity influences the transmission of the immune message to the cytotoxic TL and thus impairs the cytotoxic effector component whose role is to remove tumoral cells. Evidence of IL-2 involvement in the immunodeficiency of mammary cancer patients could prove useful for diagnosis purposes and could plead in favour of the therapeutic potential of this interleukin.