Is apocrine differentiation in breast carcinoma of prognostic significance?

Apocrine differentiation in human breast cancers has been assessed using immunohistochemistry to detect zinc alpha 2 glycoprotein and the findings related to standard prognostic factors, disease free interval (DFI) and survival in 145 women with early breast cancer. Breast tumour samples from women with a minimum follow-up of 5 years were assessed. Routinely fixed and processed tissue was used throughout. Sixty-six (45%) tumours did not stain with the antibody. Fifty-two (36%) exhibited positive apocrine staining while for 27 (19%) only a few cells were reactive. The presence of apocrine differentiation was unrelated to lymph node status, menstrual status, tumour grade or size, oestrogen receptor (E2R) or progesterone receptor status. However, patients whose tumours exhibited apocrine staining had a shorter disease-free interval (DFI) (P = 0.03) and survival (P = 0.03). A Cox's multiple regression analysis of the data found that the presence of staining added significantly (P = 0.047) to the predictive value of node status (P = 0.0001), menstrual status (P = 0.0001), tumour size (P = 0.0026) and E2R status (P = 0.0014) for patient survival. The other seven prognostic factors tested did not reach significance and were rejected from the model. Apocrine differentiation in breast cancer appears to be an independent predictor of poor prognosis tumours.

The efficacy of delayed radiotherapy for locoregionally recurrent postmastectomy breast cancer.

Using the results from a randomized controlled trial of patients with operable breast cancer (aimed at assessing the need for immediate postmastectomy radiotherapy in patients with no histological evidence of nodal involvement on subpectoral node biopsy), it has been possible to study the effectiveness of salvage radiotherapy for recurrences in the group of patients who had not received postoperative radiotherapy. While only 1 of 43 patients (2.3%) showed progressive disease, there was a further in-field relapse in 16 of the remaining 42 patients (38%). Four of these patients were salvaged by systemic therapy. Ultimately, therefore, there was failure of delayed radiotherapy for locoregional control in 30% of patients. (However, the overall locoregional control in both arms of the trial was identical).

Guidelines for selective radiological assessment of inversion ankle injuries.

A prospective study was performed to establish definitive guidelines for selective use of radiography in the assessment of inversion ankle injuries. Five hundred patients were included, representing 3.2% of the workload of the department during the study period. There were 379 soft tissue injuries, 56 malleolar fractures, 40 avulsion fractures, 21 fractures at the base of the fifth metatarsal, and four calcaneal fractures. Multiple logistic regression identified distal fibular tenderness, age, and ability to bear weight as the most important clinical variables in predicting important fractures (p less than 0.001). A policy of requesting x ray examination of only those patients with distal fibular tenderness or inability to bear weight or aged over 60, with a further proviso that no foot radiographs should be obtained, would produce a 60% reduction in ankle radiography in this centre without detriment to patient care.