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  • 1
    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
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  • 2
    Electronic Resource
    Electronic Resource
    New York, N.Y. : Wiley-Blackwell
    Journal of Cellular Biochemistry 53 (1993), S. 254-255 
    ISSN: 0730-2312
    Keywords: Life and Medical Sciences ; Cell & Developmental Biology
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Biology , Chemistry and Pharmacology , Medicine
    Notes: One of the most critical issues regarding management of early breast cancer is the proper detection and correct estimation of its malignant potential. In recent years, primarily through mammography, the frequency of ductal carcinoma in situ (DCIS) in malignant breast biopsies has increased several fold, from ∼5% to over 20%. At present, DCIS classification is based exclusively on descriptive parameters and several attempts have been made to obtain uniform classification among pathologists. This goal has been elusive and further attempts both in North America and Europe have been made to better distinguish between DCIS lesions. However, even if this can be achieved to a satisfactory degree, the malignant potential of a DCIS lesion, either comedo or non-comedo, cannot be assessed without quantitative evaluation of these lesions. It may be possible to assess the malignant potential by estimating a variety of parameters, such as the presence of oncogenes or their products, presence of receptors, etc. To date, some of these have been shown either to be necessary or sufficient conditions for obtaining invasive cancer.We have recently shown that the nuclear features of diagnostic cells, as well as nuclear features of the surrounding normal appearing cells, can be used for objective lesion classification and estimation of the malignant potential of DCIS lesions. A high resolution image cytometer (Cyto-SavantTM, Xillix Technologies Corp.) has been developed. This device can be used for automated measurements of large numbers of cell nuclei stained stoichiometrically for DNA. Nuclear features such as size, shape, DNA amount, and foremost, the texture features describing the distribution of the DNA are extracted. The Cyto-SavantTM system has been trained to recognize the relevant cells in smears from fine needle aspirates or cytospins of cells extracted from tissue blocks using standard procedures. Several thousand cell nuclei per slide can be analyzed using only a few minutes of the pathologist's time. Combining qualitative assessment with quantitative data greatly improves the diagnosis of DCIS lesions and may provide prognostic and treatment monitoring information as well. The system will be discussed in detail and experimental data shown for several cases.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    New York, N.Y. : Wiley-Blackwell
    Journal of Cellular Biochemistry 53 (1993), S. 107-113 
    ISSN: 0730-2312
    Keywords: Early breast cancer ; image cytometry ; malignant potential ; nuclear features ; Life and Medical Sciences ; Cell & Developmental Biology
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Biology , Chemistry and Pharmacology , Medicine
    Notes: We have been testing two independent hypotheses which postulate that the malignant potential of early breast cancer can be objectively assessed by measuring nuclear features of the diagnostic-malignant cells (hypothesis I) and/or normal-appearing epithelial cells found in the vicinity of the carcinoma (hypothesis II). In preliminary experiments, we tested some of these hypotheses using historical samples and a high resolution image cytometry apparatus. Tissue sections were stained with our stoichiometric stain and over 60 nuclear features, primarily texture features describing the DNA distribution in the nuclei, were employed in the multivariate analyses. Data derived from measurements of ductal carcinoma in situ (DCIS) with and without the invasive component indicated that the malignant potential of these lesions can be estimated with a sensitivity and specificity of at least 80%. The analysis of the tissue surrounding an invasive breast carcinoma showed that the existing malignancy can be predicted solely from the measurements of normal nuclei (normal-appearing breast lobules) in more than 85% of patients. This result indicates that the analysis of benign tissues also could give prognostically valid information.These results can be greatly improved using larger sample sizes and other improvements, including technical improvements of the cytometry device. We believe that this approach can be developed into a practical diagnostic and prognostic tool for better management of early breast cancer.
    Additional Material: 5 Ill.
    Type of Medium: Electronic Resource
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