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  • 1
    Electronic Resource
    Electronic Resource
    Ratio of Positive to Total Number of Sentinel Nodes Predicts Nonsentinel Node Status in Breast Cancer Patients (2005)
    Oxford, UK : Blackwell Publishing, Ltd.
    The @breast journal 11 (2005), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract:  Selective sentinel lymphadenectomy (SSL) has replaced axillary lymph node dissection (ALND) for many patients with early breast cancer and negative sentinel lymph nodes (SLNs). Yet many patients with a positive SLN are undergoing unnecessary ALND, as no further disease is found in the axilla. The aim of our study was to determine factors associated with additional positive lymph nodes in the axilla in patients who have a positive SLN. This was a retrospective study of patients undergoing SSL with ALND as part of their treatment for breast cancer at a single institution from November 1997 to August 2003. Only patients with one or more positive SLNs were selected for this study. There were 86 patients who fit our study criteria. Of these, 38% had further positive lymph nodes upon ALND. More than one positive SLN and a ratio of positive SLNs to total SLNs of greater than 0.5 were found to be predictors for additional axillary nodal involvement in both univariate and multivariate analyses. The number of positive SLNs and the ratio of positive SLNs to total SLNs is an indication of total tumor burden in the sentinel nodes and may be a reflection of the propensity of the tumor for further lymphatic invasion in the axillary basin. 
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1075-122X.2005.21633.x
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  • 2
    Electronic Resource
    Electronic Resource
    Failure to Harvest Sentinel Lymph Nodes Identified by Preoperative Lymphoscintigraphy in Breast Cancer Patients (2003)
    Oxford, UK : Blackwell Science Inc
    The @breast journal 9 (2003), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: Selective sentinel lymphadenectomy dissection has been demonstrated to have high predictive value for axillary staging in breast cancer patients. Preoperative lymphoscintigraphy can localize and facilitate the harvesting of sentinel lymph nodes (SNLs) with a high success rate. The failure rate of selective sentinel lymphodenectomy ranges between 2% and 8%. Details of the failures were seldom addressed. This study analyzes the causes of failure to harvest SLNs in spite of positive preoperative lymphoscintigraphy. From November 1997 through November 2000, 201 female patients with histologically confirmed and operable breast carcinoma underwent selective sentinel lymphadenectomy at the University of California, San Francisco (UCSF) Carol Franc Buck Breast Care Center. Among these patients, 183 (91%) received preoperative lymphoscintigraphy to identify axillary lymph nodes. The causes of failure to harvest the SLNs in this group of patients despite successful preoperative lymphoscintigraphy were analyzed. In our series, the failure rate of SLN identification was 7.0% (14/201). The failure rate for our first year was 11.1% (6/54), second year 9.1% (7/77), and third year 1.4% (1/70). The incidence of failure in spite of positive preoperative lymphoscintigraphy was 3.5% (6/170). The shine-through effect of the primary injection site and failure to visualize a blue lymph node were the main reasons for technical failure. Most of these cases occurred during our learning curve of the procedure. The possibility of failure to get the SLN should be explained to patients before surgery. Axillary lymph node dissection (ALND) should be done if selective SLN dissection is not successful. 
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-4741.2003.09205.x
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  • 3
    Electronic Resource
    Electronic Resource
    Primary Tumor Characteristics Predict Sentinel Lymph Node Macrometastasis in Breast Cancer (2005)
    Oxford, UK : Blackwell Publishing, Ltd.
    The @breast journal 11 (2005), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract:  Selective sentinel lymphadenectomy (SSL) is rapidly becoming the standard of care in the surgical management of patients with early breast cancer. Sentinel lymph node macrometastasis has been well documented in the literature to have a higher risk of nonsentinel node tumor involvement when compared to micrometastasis. The aim of our study was to determine the primary tumor characteristics associated with sentinel node macrometastasis that will allow us to preoperatively determine this subgroup of patients at risk. This study was a retrospective review of 644 patients who underwent successful SSL as part of their surgical treatment of breast cancer at the University of California San Francisco Carol Franc Buck Breast Care Center from November 1997 to August 2003. All patients underwent preoperative lymphoscintigraphy followed by wide excision or mastectomy and sentinel lymphadenectomy with or without axillary lymph node dissection. One hundred twenty-two patients had positive sentinel nodes on histology. Micrometastasis was present in 43 of these patients and macrometastasis in the remaining 79. Statistical analysis showed that a tumor size greater than 15 mm, poor tubule formation by the tumor cells, and lymphovascular invasion were significantly associated with sentinel node macrometastasis. A high mitotic count showed a trend but was not significant in our study. Patients with a tumor size greater than 15 mm, poor tubule formation, and lymphovascular invasion are at risk of having sentinel node macrometastasis. These patients can be identified preoperatively based on imaging and biopsy criteria, allowing the option of selective intraoperative pathologic evaluation of the sentinel node and immediate completion axillary dissection as necessary. 
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1075-122X.2005.00043.x
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  • 4
    Electronic Resource
    Electronic Resource
    Contrast-Enhanced Magnetic Resonance Imaging to Assess Tumor Histopathology and Angiogenesis in Breast Carcinoma (1999)
    Boston, MA, USA : Blackwell Science Inc
    The @breast journal 5 (1999), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Contrast-enhanced magnetic resonance imaging (cMRI) is a potentially powerful new tool in the early diagnosis and staging of patients with breast carcinoma. Rapid contrast enhancement is suggestive of carcinoma and likely related to high tumor vascularity. We have developed a new cMRI technique that combines anatomic and kinetic information to help characterize breast carcinomas. Signal enhancement ratio (SER) patterns (which quantitate the kinetics of contrast enhancement using a three time point high-resolution method) were correlated in tumors from 32 patients with histopathology and tumor angiogenesis as measured by intratumoral microvessel density (iMVD). Early signal enhancement with rapid washout of intravenous contrast (i.e., corresponding to high SER values) correlated with high tumor vascularity. We found that TARGET MRI with SER analysis has potential as a tool for characterizing breast carcinoma in vivo. It enables anatomic visualization of tumor and appears to add biologic information as well, such as level of tumor angiogenesis. ▪
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-4741.1999.005001013.x
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  • 5
    Electronic Resource
    Electronic Resource
    Internal Mammary Sentinel Lymph Node Mapping for Invasive Breast Cancer: Implications for Staging and Treatment (2005)
    Oxford, UK : Blackwell Science Inc
    The @breast journal 11 (2005), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract:  The optimal staging and treatment of the internal mammary nodes (IMNs) among patients with invasive breast cancer (IBC) is controversial. Although medial tumors have been reported to more commonly drain to IMNs, other variables predictive for IMN drainage may help identify those patients who may benefit from further IMN assessment. Factors associated with IMN drainage were analyzed among 141 patients who underwent lymphatic mapping and selective sentinel lymphadenectomy using intradermal injection (ID) or peritumoral (PT) injection. Fourteen of 83 patients (17%) receiving PT injections had IMN drainage, compared to none among the 58 patients who underwent ID injection alone (p = 0.0004). There were no differences in patient or tumor variables detected between the two groups. Among patients receiving PT injections, no factors examined were significantly associated with IMN drainage on univariate analysis. Using the multivariate logistic regression model, palpable disease was the most important factor associated with IMN drainage (risk ratio [RR] = 6.02; 95% confidence interval [CI] 0.64–56.34; p = 0.05). In addition, lymphatic/vascular invasion (LVI) and age less than 50 years were associated with IMN drainage (RR = 6.17; 95% CI 1.02–37.50; p = 0.09 and RR = 2.94; 95% CI 0.82–10.49; p = 0.09, respectively). IMN drainage occurred in a significant proportion of patients after PT injection, but not ID injection. In the final model, palpable disease was the most important factor associated with IMN drainage; LVI and age less than 50 years were of borderline significance. These factors may aid in the selection of patients who might benefit from further staging or treatment of the IMNs. 
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1075-122X.2005.21527.x
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  • 6
    Electronic Resource
    Electronic Resource
    Mechanism of hemin inhibition of erythroid cytoplasmic DNA polymerase (1975)
    s.l. : American Chemical Society
    Biochemistry 14 (1975), S. 796-799 
    Details
    ISSN: 1520-4995
    Source: ACS Legacy Archives
    Topics: Biology , Chemistry and Pharmacology
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1021/bi00675a023
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  • 7
    Electronic Resource
    Electronic Resource
    Current National Health Insurance Coverage Policies for Breast and Ovarian Cancer Prophylactic Surgery (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 325-332 
    Details
    ISSN: 1534-4681
    Keywords: Prophylactic surgery ; BRCA1 ; BRCA2 ; Breast cancer ; Ovarian cancer ; Health insurance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The efficacy of prophylactic mastectomy and oophorectomy in reducing breast and ovarian carcinoma has recently been reported in high-risk women. Because cost has become central to medical decision-making, this study was designed to evaluate currently existing coverage policies for these procedures. Methods: A confidential detailed cross-sectional nationwide survey of 481 edical directors from the American Association of Health Plans, Medicare, and Medicaid was conducted. Results: Of the 150 respondents, 65% (n 5 97) had 100,000 or more enrolled members and 35% (n 5 53) had fewer than 100,000 enrolled members. Only 44% of private plans have specific policies for coverage of prophylactic mastectomy for a strong family history of breast cancer and 38% of plans for a BRCA mutation. Only 20% of total responding plans had a policy for coverage of prophylactic oophorectomy under any clinical circumstance. Governmental carriers were significantly less likely to have any policy for prophylactic surgery (range, 2%–12%) compared with nongovernmental plans (range, 24%–44%; P,.001). No significant regional differences for coverage policies were identified (P.05). Conclusions: Significant variations currently exist for health insurance coverage of prophylactic mastectomy and oophorectomy. As genetic testing becomes widespread, more uniform policies should be established to enable appropriate high-risk candidates equal access and coverage for these procedures.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0325-1
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  • 8
    Electronic Resource
    Electronic Resource
    Vaccination with the extracellular domain of p185 neu prevents mammary tumor development in neu transgenic mice (1999)
    Springer
    Cancer immunology immunotherapy 47 (1999), S. 337-342 
    Details
    ISSN: 1432-0851
    Keywords: Key words Breast cancer vaccine ; HER2/neu ; Tumor immunotherapy ; Transgenic mice
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The HER2/neu oncogene product, p185HER2/ neu , is overexpressed on the surface of many human breast cancers. Strains of transgenic mice have been developed that express the rat neu oncogene in mammary epithelial cells and develop spontaneous mammary tumors that overexpress p185 neu . This model provides an ideal system for testing interventions to prevent tumor development. In this study, we immunized neu-transgenic mice with a vaccine consisting of the extracellular domain of p185 neu (NeuECD). Immunized mice developed Neu-specific humoral immune responses, as measured by circulating anti-Neu antibodies in their sera, and cellular immune responses, as measured by lymphocyte proliferation to NeuECD in vitro. In addition, the subsequent development of mammary tumors was significantly lower in immunized mice than in controls and vaccine treatment was associated with a significant increase in median survival.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002620050539
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