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  • 1
    Electronic Resource
    Electronic Resource
    Mammographic Screening: A Surgeon's Perspective (1997)
    Oxford, UK : Blackwell Publishing Ltd
    The @breast journal 3 (1997), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: Prospective randomized trials demonstrate breast cancer mortality reduction in patients offered mammographic screening, conclusively for ages 50–69 and (with longer follow-up) likely for ages 40–49. The 25–30% degree of mortality reduction observed is particularly striking in view of the number of confounding variables in each trial, most of which would act to diminish the observed benefit. Few studies have examined the impact over time of more frequent mammography usage on women found to have breast cancer. During the period in which mammography came into general usage, how did means of cancer diagnosis change, and what was the impact of mammography on stage of disease?1096 patients were treated in the author's practice for intraductal (DCIS) and invasive breast cancer between 1979 and 1993. Grouped into 5-year treatment intervals, and stratified by age and primary means of diagnosis, trends in tumor size, axillary node status, and tumor histopathology were compared.Over time, patients were increasingly likely 1) to have had mammography previously, 2) to have had their cancers diagnosed mammographically, 3) to have T1a/b (0.1–1.0 cm) tumors, 4) to be axillary node negative, and 5) to have DCIS pathologically. These trends were observed for patients both younger and older than age 50. There was no trend toward earlier-stage disease among patients either self- or physician-diagnosed, supporting the impression that the 15-year trend in this practice toward earlier diagnosis is entirely due to an increased usage of mammography. Mammography every 1–2 years is indicated in all women 40 and older, and every effort should be made to promote mammography among the substantial number of women who have still never had one.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1524-4741.1997.tb00203.x
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  • 2
    Electronic Resource
    Electronic Resource
    Sentinel Lymph Node Drainage in Multicentric Breast Cancers (2002)
    Boston, MA, USA : Blackwell Science Inc
    The @breast journal 8 (2002), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Axillary lymph node status is the most important prognostic marker in patients with breast cancer; the presence of axillary metastases impacts prognosis as well as subsequent systemic therapy. Axillary lymph node dissection (ALND) is associated with significant morbidity and psychological distress; the introduction of sentinel lymph node (SLN) biopsy with lymphatic mapping affords the ability to identify those patients most likely to benefit from ALND, sparing node-negative patients. The lymphatic drainage of the breast is poorly understood, and the situation is further complicated by the lack of standardization of the SLN biopsy technique among institutions. Multicentricity has generally been considered to be a contraindication to SLN biopsy due to concerns about potential inaccuracies. Here we report five cases of patients with multicentric breast cancers (two tumors in two distinct quadrants). In each case, injection of one site with technetium-labeled sulfur colloid and the second site with isosulfan blue dye resulted in successful identification of at least one node that was both hot and blue within the axilla. These observations suggest that the lymphatic drainage of the entire breast coincides with drainage of the tumor bed, regardless of the quadrant. However, further studies are needed to validate the accuracy of SLN biopsy in multicentric breast cancers.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-4741.2002.08605.x
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  • 3
    Electronic Resource
    Electronic Resource
    ErbB-2 protein in sera and tumors of breast cancer patients (1998)
    Springer
    Breast cancer research and treatment 49 (1998), S. 261-270 
    Details
    ISSN: 1573-7217
    Keywords: erbB-2 protein ; serum ; tumor ; age ; nulliparity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We compared levels of erbB-2 oncoprotein among three groups: Group I included 60 asymptomatic women; Group II had 51 women with benign breast biopsies; and Group III had 67 women with node-negative breast cancer. Serological levels of erbB-2 protein were measured in all participants; tumor levels were measured for Groups II and III. Forty-three percent of usable tumors (25/58), including three of seven lobular tumors, were erbB-2 positive. Tumor and blood oncoprotein levels were unrelated. Blood levels, however, were positively related to tumor volume, but only when the tumor had both a ductal carcinoma in situ (DCIS) component and an invasive component, suggesting a role for erbB-2 protein in progression of DCIS to invasive carcinoma. In Groups I and II serological levels of erbB-2 protein were directly related to age, and inversely related to having had a live birth. Therefore, a model that determined the threshold levels of serological erbB-2 positivity in Group III included age and nulliparity as independent variables. Only three of the 67 women (4.5%) in Group III were positive for serological erbB-2. In a multivariate model, with serological erbB-2 as the dependent variable, and in which the independent variables included Study Group, there was a statistical trend for younger women, in which Group III had the highest serological levels of erbB-2, followed by Group II, and then Group I. In women who were over the age of 50 years the trend was reversed; i.e., levels of erbB-2 tended to be lowest in Group III, followed by Group II, and finally Group I.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1006033214721
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  • 4
    Electronic Resource
    Electronic Resource
    Intradermal Radiocolloid and Intraparenchymal Blue Dye Injection Optimize Sentinel Node Identification in Breast Cancer Patients (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 450-454 
    Details
    ISSN: 1534-4681
    Keywords: Breast cancer surgery ; Sentinel node biopsy.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Radiotracer and blue dye mapping of sentinel lymph nodes (SLN) have been advocated as accurate methods to stage the clinically negative axilla in breast cancer patients. The technical aspects of SLN biopsy are not fully characterized. In this study we compare the results of intraparenchymal (IP) and intradermal (ID) injection of Tc-99m sulfur colloid, to establish an optimal method for SLN localization. Methods: 200 consecutive patients had SLN biopsy performed by a single surgeon. Of these, 100 (Group I) had IP injection and 100 (Group II) had ID injection of Tc-99m sulfur colloid. All patients had IP injection of blue dye as well. Endpoints included (1) successful SLN localization by lymphoscintigraphy, (2) successful SLN localization at surgery, and (3) blue dye–isotope concordance (uptake of dye and isotope by the same SLN). Results: Isotope SLN localization was successful in 78% of Group I and 97% of group II patients (P 〈 .001). When isotope was combined with blue dye, SLN were found in 92% of group I and 100% of Group II (P 〈 .01). In cases where both dye and isotope were found in the axilla, dye mapped the same SLN as radiotracer in 97% of Group I and 95% of Group II patients. Conclusions: The dermal and parenchymal lymphatics of the breast drain to the same SLN in most patients. Because ID injection is easier to perform and more effective, this technique may simplify and optimize SLN localization.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0450-4
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  • 5
    Electronic Resource
    Electronic Resource
    Is Routine Intraoperative Frozen-Section Examination of Sentinel Lymph Nodes in Breast Cancer Worthwhile? (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 651-655 
    Details
    ISSN: 1534-4681
    Keywords: Sentinel lymph nodes ; Frozen section ; Macrometastases ; Micrometastases
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Routine intraoperative frozen section (FS) of sentinel lymph nodes (SLN) can detect metastatic disease, allowing immediate axillary dissection and avoiding the need for reoperation. Routine FS is also costly, increases operative time, and is subject to false-negative results. We examined the benefit of routine intraoperative FS among the first 1000 patients at Memorial Sloan Kettering Cancer Center who had SLN biopsy for breast cancer. Methods: We performed SLN biopsy with intraoperative FS in 890 consecutive breast cancer patients, none of whom had a back-up axillary dissection planned in advance. Serial sections and immunohistochemical staining for cytokeratins were performed on all SLN that proved negative on FS. The sensitivity of FS was determined as a function of (1) tumor size and (2) volume of metastatic disease in the SLN, and the benefit of FS was defined as the avoidance of a reoperative axillary dissection. Results: The sensitivity of FS ranged from 40% for patients with T1a to 76% for patients with T2 cancers. The volume of SLN metastasis was highly correlated with tumor size, and FS was far more effective in detecting macrometastatic disease (sensitivity 92%) than micrometastases (sensitivity 17%). The benefit of FS in avoiding reoperative axillary dissection ranged from 4% for T1a (6 of 143) to 38% for T2 (45 of 119) cancers. Conclusions: In breast cancer patients having SLN biopsy, the failure of routine intraoperative FS is largely the failure to detect micrometastatic disease. The benefit of routine intraoperative FS increases with tumor size. Routine FS may not be indicated in patients with the smallest invasive cancers.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0651-3
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  • 6
    Electronic Resource
    Electronic Resource
    Sentinel Lymph Node Biopsy: Is It Indicated in Patients With High-Risk Ductal Carcinoma-In-Situ and Ductal Carcinoma-In-Situ With Microinvasion? (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 636-642 
    Details
    ISSN: 1534-4681
    Keywords: Breast carcinoma ; Ductal carcinoma-in-situ ; Microinvasion ; Sentinel lymph node biopsy ; Intraductal carcinoma ; Micrometastases
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Axillary lymph node status is the strongest prognostic indicator of survival for women with breast cancer. The purpose of this study was to determine the incidence of sentinel node metastases in patients with high-risk ductal carcinoma-in-situ (DCIS) and DCIS with microinvasion (DCISM). Methods: From November 1997 to November 1999, all patients who underwent sentinel node biopsy for high-risk DCIS (n = 76) or DCISM (n = 31) were enrolled prospectively in our database. Patients with DCIS were considered high risk and were selected for sentinel lymph node biopsy if there was concern that an invasive component would be identified in the specimen obtained during the definitive surgery. Patients underwent intraoperative mapping that used both blue dye and radionuclide. Excised sentinel nodes were serially sectioned and were examined by hematoxylin and eosin and by immunohistochemistry. Results: Of 76 patients with high-risk DCIS, 9 (12%) had positive sentinel nodes; 7 of 9 patients were positive for micrometastases only. Of 31 patients with DCISM, 3 (10%) had positive sentinel nodes; 2 of 3 were positive for micrometastases only. Six of nine patients with DCIS and three of three with DCISM and positive sentinel nodes had completion axillary dissection; one patient with DCIS had an additional positive node detected by conventional histological analysis. Conclusions: This study documents a high incidence of lymph node micrometastases as detected by sentinel node biopsy in patients with high-risk DCIS and DCISM. Although the biological significance of breast cancer micrometastases remains unclear at this time, these findings suggest that sentinel node biopsy should be considered in patients with high-risk DCIS and DCISM.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0636-2
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  • 7
    Electronic Resource
    Electronic Resource
    Internal mammary node status: A major prognosticator in axillary node-negative breast cancer (1995)
    Springer
    Annals of surgical oncology 2 (1995), S. 32-37 
    Details
    ISSN: 1534-4681
    Keywords: Breast cancer ; Metastasis, internal mammary and axillary ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The internal mammary lymph nodes (IMN) have received little attention in recent years, yet are a well-documented site of metastasis and a major prognostic factor in early-stage breast cancer. Methods/Results: Ten-year follow-up of the final 195 patients treated by extended radical mastectomy (ERM) in this practice (selected largely on the basis of medial tumor location, and comprising 15% of all patients treated from 1965 to 1978) found IMN + in 24% of all cases: 36% of AX + versus 18% of AX -patients (p=0.0023). In a multivariate analysis, the disease-free survival impact of IMN + (p=0.004) was second only to axillary node involvement (p〈0.0005), and surpassed tumor size (p=0.077). IMN + was equally frequent for tumors less than, or greater than, 2 cm (24%), and was not significantly related to patient age. Among AX - patients, there was a twofold greater risk of recurrence or death at 10 years for IMN + than for IMN -. Among T1N0 patients, 19.6% were IMN +. Conclusions: Failure to consider IMN status in the steadily enlarging cohort of T1N0 breast cancers may result in the undertreatment of a significant proportion of stage I patients. Systemic adjuvant therapy should be considered for T1N0 patients with central or medial tumors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303699
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