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Biomedical subjects

A P Forrest

Publications and source records attributed to A P Forrest.

At least 73 records · Page 4Linked to original sources
PubMed1986

A human tumour model.

An approach to the management of patients with large (greater than 4 cm) operable breast cancers is described. The conventional sequence of mastectomy followed by systemic therapy is reversed, allowing accurate measurements of response to individual forms of endocrine therapy or chemotherapy. Such a method not only permits individual selection of appropriate systemic therapy, but also allows clinical response to be related to histological and biochemical tumour parameters. A response was observed in eleven of twenty-three patients to endocrine treatment and in twelve of thirteen to combination chemotherapy. In five of the latter the response was histologically complete.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Comparative pathology of prevalent and incident cancers detected by breast screening. Edinburgh Breast Screening Project.

In the Edinburgh Breast Screening Project 210 cancers were detected from commencement in 1979 up to December, 1984. By this time the full initial cohort had completed at least 3 visits and a proportion had attended for up to 5 visits, so pathological characteristics for prevalent and incident cancers could be compared. The main differences are in distribution of histological type of cancer, detection of occult invasive disease, and lymph-node positivity among incident tumours. Only the first of these was statistically significant. This evaluation shows that cancer detection by screening in Edinburgh conforms with screening theory, in which detection of good prognosis tumours is favoured at the prevalence screens, and faster growing, aggressive tumours are found at the incidence screens. Qualitative histopathology may provide a better measure than standard quantitative judgments of size and lymph node status to compare the varieties of cancer detected by screening programmes and to understand the biology of the disease.

Aged↗
PubMed1986

Beneficial response to pituitary ablation following aminoglutethimide.

Twenty-five postmenopausal women with advanced carcinoma of the breast, who were treated initially with aminoglutethimide alone (14 patients) or combined with tamoxifen (11 patients) had, on relapse or failure of treatment, a pituitary ablation performed. Initial therapy had produced a complete response in one patient, a partial response in 7, disease stasis in 6 but was without benefit in 8 patients. A further three patients were intolerant of aminoglutethimide therapy. Ten of these 25 patients benefited from subsequent pituitary ablation (1 complete response, 4 partial responses and 5 disease stasis), both local and distant sites of disease being influenced by this further therapy. Experience is also reported of 10 patients with advanced breast cancer who were treated initially by pituitary ablation and then subsequently received aminoglutethimide therapy. None responded. It is concluded that pituitary ablation should be considered for patients with progressive disease following aminoglutethimide therapy, irrespective of the therapeutic response to aminoglutethimide.

Adult↗
PubMed1986

Specimen radiology of excised breast lesions.

The value of specimen radiology in the surgical management of palpable breast lesions was assessed in 100 consecutive patients undergoing excision of a palpable breast lump. Only 41 per cent of palpable breast lesions were demonstrable as a radiological abnormality on the excised specimen. The greatest sensitivity was found for lesions which proved to be malignant. Only 27 of 88 benign palpable breast lesions were radiologically visible in the specimen. Surprisingly, only 8 of 13 fibroadenomas were identified as discrete opacities. No residual breast lump was detected on clinical examination in patients reviewed postoperatively, including those patients who had a demonstrable preoperative mammographic abnormality and a negative specimen radiograph. We conclude that specimen radiology does not contribute to the surgical management of palpable breast lesions.

Biopsy↗
PubMed1986

Advances in the management of carcinoma of the breast.

It is clear from this review that, although we may still be a long way from the eventual cure of carcinoma of the breast, we have advanced from the days of a unified approach to the disease by standard local radical treatment. Of great importance is the understanding that one person (the surgeon) can no longer treat the disease alone, but that he or she should be a member of a multi-disciplinary team in which surgical skills make a unique and significant contribution. We are fortunate in Edinburgh to have such a team, and I am grateful to my colleagues for their cooperation and help.

Adult↗
PubMed1985

Prediction of recurrence after mastectomy for operable breast cancer.

A patient's risk of early recurrence after mastectomy for breast cancer has been estimated by using a combination of four prognostic factors. A computer program, designed to calculate the exact probability of recurrence within 2 years of mastectomy, was accurate when tested on 240 patients. A simple scoring system could identify patients at lower and greater risk than any single factor alone.

Breast Neoplasms↗
PubMed1985

The efficacy of lower axillary sampling in obtaining lymph node status in breast cancer: a controlled randomized trial.

Four hundred and seventeen patients with operable breast cancer treated by simple mastectomy were randomly allocated to have node sampling or total axillary clearance. There was no significant difference in the incidence of node positivity. One hundred and thirty-five patients had node sampling and were randomized at the completion of this procedure to have axillary clearance or to have no further surgery. All node positive patients who went on to have a clearance had positive samples, confirming the accuracy of the sampling technique.

Breast Neoplasms↗
PubMed1985

Long-term survivors after breast cancer.

A retrospective analysis of two groups of patients, one surviving 16-20 years and the other dying within 10 years after diagnosis and treatment of primary breast cancer has been undertaken to determine whether there were particular clinical or histological features associated with long-term survival. The striking histological difference between the tumours of the two groups of patients was the prevalence of tumours of 'special' invasive types (cribriform, tubular, lobular and medullary) in the long-term survivors. Micro-invasive and non-invasive carcinomas were also more common in the survivors. The tumours of the surviving group which were not of a 'special' type more commonly had a better histological grade than those tumours of patients dying early from breast cancer. In the overall group elastosis was present in significantly more tumours of the survivors whereas tumour necrosis, vascular and lymphatic invasion were all significantly more common in the short-term survival group. Although there was a significantly increased incidence of earlier stage tumours in the long-term survivors, the histological distinctions between the two groups were independent of the differences in clinical features.

Adult↗
PubMed1985

Fibro-adenoma of the breast.

A retrospective study of 134 patients with a clinical diagnosis of fibro-adenoma of the breast indicated that histological confirmation of this diagnosis is made in only 50 per cent. The majority of the others have a diagnosis of benign mammary dysplasia. Eight patients had an unsuspected carcinoma, all but one being above the mean age for the fibro-adenoma group. The natural history of fibro-adenoma is not known precisely. In view of the high sensitivity of fine needle aspiration cytology in the diagnosis of malignant disease, we believe that there is justification to carry out a prospective study to determine this. In this study women with a clinical diagnosis of fibro-adenoma will be carefully observed provided they are less than 35 years of age and fine-needle aspiration cytology reveals no malignant cells.

Adenofibroma↗
PubMed1985

Are the lesions of duct ectasia sterile?

A prospective study was established to determine whether, using suitable transport media, bacteria could be isolated from the lesions of mammary duct ectasia. The results indicate that both aerobic and anaerobic organisms are present in a high proportion of patients with nipple discharge associated with this condition and in all patients who develop peri-areolar sepsis (abscess and mammillary fistulae) as part of the syndrome. The lesions of duct ectasia are therefore not sterile and the possibility exists that bacteria have a role in the aetiology and pathogenesis of this condition.

Abscess↗
PubMed1985

Operative aid to combined synchronous mastectomy and latissimus dorsi breast reconstruction.

A special frame is described which has been designed to hold the upper trunk and arm of patients firmly in the lateral position during the operation of combined synchronous mastectomy and latissimus dorsi breast reconstruction. The frame has prevented movement at the shoulder joint and distraction on the brachial plexus which resulted in brachial plexus palsy in two out of 15 patients in whom the operation was performed with a conventional arm support.

Breast↗
PubMed1984

Fine needle aspiration cytology, in relationships to clinical examination and mammography in the diagnosis of a solid breast mass.

The accuracy of clinical examination, mammography and fine needle aspiration cytology in identifying malignancy has been assessed in 1655 breast masses from two time periods. Clinical examination and mammography remained consistent at identifying malignancy but 9 per cent of all breast carcinomas were considered benign by both techniques (sensitivity 91 per cent). Fine needle aspiration cytology, when performed by multiple aspirators in the first study period, had a sensitivity of only 66 per cent for malignancy. During the second period of study, when all aspirates were performed by a single aspirator, sensitivity rose to 99 per cent. The two patients with false negative cytology in this latter period had both clinical and mammographic evidence of malignancy. No patient with malignant cytology was subsequently shown to have benign disease. It is concluded that a combination of clinical examination and mammography, with fine needle aspiration cytology performed by committed individuals with aptitude for the technique and interpreted by experienced pathologists, can identify all patients with breast cancer before surgery.

Adult↗
PubMed1984

The Edinburgh randomised trial of screening for breast cancer: description of method.

Edinburgh was selected as one of the centres in the UK Seven-year Trial of Breast Screening of women aged 45-65 which began in 1979. Subsequently, our study was extended to a randomised trial with its own control population within the city. Half the practices were randomly allocated for screening, giving a cluster sampling of women. The total number in the trial is 65,000. Women with previously diagnosed breast cancer are excluded. Women allocated for screening are invited to the clinic and screened according to the procedures specified in the U.K. protocol, having clinical examination every year and mammography on alternate years. The two modalities of screening are assessed independently and the role of nurses is being evaluated. Breast cancer incidence is monitored by pathology register and the local cancer registry office and deaths from the General Register office. Long-term follow-up will be obtained through flagging at NHS Central Register. To determine the value of screening, standard statistical methods will be used to compare breast cancer mortality rates in the whole of the screening population with that of the controls. This trial has a power of 83% of detecting a reduction in mortality of 35% after 7 years of follow-up and a power of 95% of detecting a similar reduction at 10 years (alpha = 0.05, one-sided test).

Breast Neoplasms↗