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B Zafrani

Publications and source records attributed to B Zafrani.

At least 37 records · Page 2Linked to original sources
PubMed1998

Stereotactic fine-needle aspiration cytology of nonpalpable breast lesions: Institut Curie's experience of 243 histologically correlated cases.

BACKGROUND: The early diagnosis of nonpalpable breast lesions is a medical challenge because of the low specificity of different radiologic modalities. Fine-needle aspiration cytology (FNAC) assisted by a stereotactic guidance is an adjunctive diagnostic approach in the management of these lesions. The primary purpose of this article was to assess the diagnostic accuracy of FNAC in patients with nonpalpable breast lesions. METHODS: Three hundred and seventy-one lesions from 357 patients (all female) underwent FNAC using the stereotactically guided technique. Of these cases, 243 lesions from 238 patients subsequently were acquired by surgical excisional biopsies and formed the basis of this study. Statistical analyses of the cytologic and the histologic diagnoses of these cases were performed. RESULTS: Histologically, 107 lesions (44%) were benign and 136 lesions (56%) were malignant. Of the 136 malignant lesions, cytology was concordant in 73 lesions (53.7%), suspicious in 15 lesions (11.0%), false-negative in 12 lesions (8.8%) (benign), and unsatisfactory in 36 lesions (26.5%). Among the 107 benign lesions, cytology was concordant with histology in 75 lesions (70.1%), whereas 4 lesions (3.7%) and 28 lesions (26.2%) were cytologically suspicious and unsatisfactory, respectively. No false-positive cytologies were found in the current series. CONCLUSIONS: The current prospective study indicates that mammography combined with FNAC provides an accurate and practical diagnostic approach for the majority of nonpalpable lesions. Patients with unsatisfactory and false-negative lesions should undergo excisional biopsy.

Adult↗
PubMed1998

Ultrasound-guided fine-needle aspiration cytology of nonpalpable breast lesions: Institut Curie's experience with 198 histologically correlated cases.

BACKGROUND: The value of ultrasound-guided fine-needle aspiration cytology (FNAC) in the diagnosis of nonpalpable breast lesions remains a subject of debate. To determine the accuracy of this procedure in these lesions, a comparative analysis with open surgical biopsy in 188 patients was performed. METHODS: Six hundred and fifty-four nonpalpable breast lesions detected by ultrasound in 585 patients were subjected to FNAC. Of these, 198 lesions (30.3%) from 188 patients were surgically excised. RESULTS: Histologically, 105 lesions (53%) were malignant and 93 (47%) were benign. Among carcinomas, 65 cases (61.9%) were concordant, whereas 21 cases (20%) were suspicious, 12 cases (11.4%) were false-negative (benign), and 7 cases (6.7%) were unsatisfactory for diagnosis. Among benign lesions, 80 cases (86%) were concordant, whereas 5 cases (5.4%) were suspicious, and 8 cases (8.6%) were unsatisfactory. No false-positive diagnoses were made. The sensitivity of the FNAC method was 87.8%, the specificity was 94.5%, and the positive predictive value was 94.6%. CONCLUSIONS: These results indicate that, with the exception of random microcalcified lesions, ultrasound-guided FNAC is a valuable and reliable technique in the diagnosis of nonpalpable breast lesions.

Adult↗
PubMed1998

No significant predictive value of c-erbB-2 or p53 expression regarding sensitivity to primary chemotherapy or radiotherapy in breast cancer.

To document whether c-erbB-2 over-expression or p53 accumulation in tumour cells was predictive of response to chemo- or radiotherapy, we analyzed a population of patients with breast cancer assigned to neo-adjuvant therapy (median follow-up: 54 months). T2/T3-N0N1b-M0 tumours (329 cases) were treated either by FAC chemotherapy or by radiotherapy before surgery, and the clinical response was classified as complete or incomplete. Expression of c-erbB-2 and p53 was retrospectively evaluated by immunohistochemistry. Proliferation rate was assessed by means of MIB-1 antibody and by S-phase fraction. A complete response to chemotherapy was observed in 38/167 patients (23%). Complete response rate was 20% in c-erbB-2-negative tumours, and rose to 31% in tumours with c-erbB-2 over-expression, but this trend was not statistically significant. There was no correlation between p53 staining and response to treatment, whereas chemosensitivity was found correlated with histological grade and S-phase. A complete response to radiotherapy was observed in 64 of the 156 evaluable patients (41%). Complete response rate was 41% in c-erbB-2- or p53-negative tumours, 54% in tumours with c-erb-B-2 over-expression, and 44% in tumours with p53 accumulation. There was no correlation between response to radiotherapy and histological grade or proliferative rate. No prognostic value was found for c-erbB-2 or p53 expression, whereas the 5-year survival rate was 85% for patients presenting a tumour with a low proliferating index (MIB-1 < 10%), and 68% for patients presenting a tumour with a high proliferative index. In multivariate analysis, node status (RR = 2), MIB-1 immunostaining (RR = 2), and tumour size (RR = 1.8) were found to be associated with survival. These results indicate that c-erbB-2 or p53 expression is not significantly associated with tumour response to neo-adjuvant chemo/radiotherapy in our series of breast cancers.

Breast Neoplasms↗
PubMed1998

Homogeneously staining regions in 223 breast carcinomas: cytogenetic and clinicopathological correlations.

A correlation analysis was performed on 223 breast carcinomas to assess the relationships between gene amplification, karyotypic and clinicopathological features. Homogeneously staining region (HSR) is the most frequent form of amplification found in breast cancer. HSR-containing tumours accounted for 60% of the cases. Although up to 40% of tumours with slightly altered karyotype contained HSRs, an excess of HSRs was found within the tumours whose karyotype showed the highest rates of rearranged chromosomes. HSRs were also found to be particularly frequent in small tumours of high histological grade and with a low expression of progesterone receptors. An excess of HSRs seems to be observed in younger patients, however, significant correlation could be demonstrated only for patients below 55 years and below 60 years, compared with older ones. With a 120-month follow-up for 152 patients, a significant association between the presence of HSRs and a shortened overall survival was observed. Altogether, the presence of HSRs appears to be a good indicator of poor prognosis. Further studies are needed to determine whether amplification of specific genes or cell ability to amplify is the most important parameter for tumour progression.

Adolescent↗
PubMed1998

Human papillomavirus genotype as a major determinant of the course of cervical cancer.

PURPOSE: To determine whether the prognosis of invasive cancers of the uterine cervix is related to the type of human papillomavirus (HPV) associated with the tumor. PATIENTS AND METHODS: Two hundred ninety-seven patients with invasive cervical cancer were prospectively registered from 1986 to 1994. HPV typing was performed on DNA extracted from frozen tumor specimens by means of Southern blot hybridization (SBH) and polymerase chain reaction (PCR) techniques. The median follow-up was 38 months. RESULTS: HPV sequences were detected in 246 patients (83%): 150 patients had HPV16, 31 patients had HPV18, and 14 patients had one of the intermediate-oncogenic-risk HPV types (HPV31, 33, 35, 52, 58). In 51 patients, HPV type remained undetermined, and in 51 patients, no viral sequences were found. No significant associations were observed between virologic data and tumor stage or node status. The 5-year disease-free survival (DFS) rate was 100% for patients with intermediate-risk HPV-associated tumors, 58% for patients with HPV16-positive tumors, and 38% for patients with HPV18-positive tumors (P = .02). In multivariate analysis, patients with HPV18-associated tumors had a relative risk (RR) of death 2.4 times greater (95% confidence interval [CI], 1.29-4.59) than that for patients with HPV16, and 4.4 times greater (95% CI, 3.48-5.32) than that for patients with a tumor associated with a viral type different from HPV16/18. CONCLUSION: The prognosis for invasive cancers of the uterine cervix is dependent on the oncogenic potential of the associated HPV type. HPV typing may provide a prognostic indicator for individual patients and is of potential use in defining specific therapies against HPV-harboring tumor cells.

Adult↗
PubMed1998

Increased expression of prolactin receptor gene assessed by quantitative polymerase chain reaction in human breast tumors versus normal breast tissues.

The role of PRL in human breast tumorigenesis is not well understood. One of the limitations is the difficulty of accurately measuring PRL receptors (PRLR) in human tissues. We established a quantitative PCR method (Q-PCR) in T-47D human breast cancer cells and applied it to 29 patients, 25 of whom presented with either cancer or fibroadenoma. Four patients underwent a mammoplasty, and normal epithelial cells were cultured before Q-PCR. In T-47D cells, 31 x 10(6) messenger RNA molecules were detected per microgram of total RNA. In all patients, expression of the PRLR gene was detected, varying from 1500 to 1 x 10(6) molecules/microgram of RNA in normal tissues and from 4500 to 34.7 x 10(6) molecules/microgram of RNA in tumors. PRLR expression was always greater in tumor than in normal contiguous tissue and similar in cultured mammary epithelial cells and normal breast tissues. Estradiol and progesterone receptor-negative tumors expressed low levels of PRLR transcripts, similar to normal breast tissue from menopausal women. Immunocytochemical analysis of PRLR confirmed stronger staining in almost all tumor samples compared with normal tissues. A messenger RNA encoding locally produced human PRL was also identified by RT-PCR in every sample tested. Our results confirm PRLR gene expression in all tissues studied, and moreover, indicate that this expression is increased in human breast tumors vs. normal contiguous tissues.

Adult↗
PubMed1998

[Diagnostic difficulties and limits in breast histopathology in core biopsies (breast microbiopsies)].

Core biopsy is increasingly used for the diagnosis and management of breast lesions. As a result, pathologists are being confronted with new difficulties pertaining to (1) the histological diagnosis on micro specimens (2) the correlation between core biopsy histological findings and mammographic findings, (3) the diagnostic significance of atypical hyperplasia on core biopsies, (4) the impact of tissue displacement on surgical specimens after needling procedures, and (5) the disagreement that can appear between the diagnostic on surgical specimen and on core biopsy.

Biopsy↗
PubMed1998

Consistency achieved by 23 European pathologists in categorizing ductal carcinoma in situ of the breast using five classifications. European Commission Working Group on Breast Screening Pathology.

The increased detection of ductal carcinoma in situ (DCIS) by mammographic screening, the greater use of breast-conserving surgery, and the recognition that certain histological subtypes are associated with a greater risk of local recurrence has led to the formulation of several new classifications of DCIS in recent years. There are, however, no data concerning the degree of consistency with which these schemes can be applied by reasonable numbers of pathologists. Thirty-three cases of DCIS were thus examined by a working group of 23 European pathologists who categorized them using five recently published classifications: (1) that of the European Pathologists' Working Group based on differentiation (a combination of nuclear grade and cell polarization) with categories of poorly, intermediately, and well differentiated; (2) one based entirely on nuclear grade with categories of high, intermediate, and low, currently in use in the UK national and EC-funded breast screening programs; (3) the same classification in which only two categories, high nuclear grade and other, were used; (4) the Van Nuys system in which lesions are divided into high grade, non-high grade with necrosis and non-high grade without necrosis; and (5) a two-category classification based entirely on the presence or absence of comedo necrosis. Of the three systems with three categories, Van Nuys gave the highest overall kappa statistic of 0.42. Others gave similar values of 0.37 and 0.35 showing that assessing cell polarization in addition to nuclear grade neither improves nor worsens consistency. In all three systems, the middle category was associated with the lowest value for kappa. Of the two systems with two categories, that based on nuclear grade gave the highest overall kappa of 0.46 and that based on comedo necrosis the lowest of 0.34. The most robust histological features were thus high- and low-grade nuclei and necrosis as long as the latter did not involve the recognition of a comedo growth pattern. These values probably represent the maximum achievable, at least by reasonable numbers of pathologists in everyday practice. They are better than those previously reported for classification based entirely on architecture, but further improvement is needed.

Breast Neoplasms↗
PubMed1996

Sclerosing lymphocytic lobulitis in the male breast.

Sclerosing lymphocytic lobulitis is an inflammatory disorder of the breast that is well recognised in women. It has only been reported previously in two men; two further men with the condition are described here. Both presented with a breast mass, and one was an insulin dependent diabetic. Biopsy specimens from both patients showed circumscribed perivascular and, to a lesser extent, periductal collections of B and T lymphocytes. Sclerosing lymphocytic lobulitis in the female breast shows predominantly perilobular inflammation. The predominantly perivascular distribution in men is consistent with the relative paucity of epithelium in the male breast. Interlobular fibrosis with epithelioid fibroblasts was also present.

Biopsy↗
PubMed1996

[Intraductal cancer of the breast in women under age 35 years].

The incidence of intraductal carcinomas (IDC) of the breast is increasing. However, few cases have been reported in young women. Based on a series of 13,168 women treated for breast cancer at the Institut Curie over a 12-year period, this article analyses the prevalence, clinical presentation, prognosis and treatment of IDC in patients younger than 35 years. Of this series of 13,168 cancers, 882 occurred in women under the age of 35 years (6.7%). Sixteen of these cases (2%) were strictly intraductal lesions and therefore constituted the study population. The frequency of IDC in women under the age of 35 years was identical to that of IDC in the general population of this study. The circumstances of discovery were: palpable tumour in seven cases (44%), mammographic discovery in four cases (25%), nipple discharge in five cases (31%). Histological examination revealed a well-differentiated IDC in two cases, moderately differentiated in seven cases and poorly differentiated in five cases (two cases not specified). Conservative treatment by lumpectomy and irradiation was performed in nine patients, and another seven patients were treated by mastectomy and low axillary lymph node dissection. The mean follow-up was 83 months (range: 5 to 156 months). A single patient has relapsed: an isolated invasive mammary recurrence, 6 years after conservative treatment. This patient in now in complete remission after mastectomy. All patients are therefore alive, with no evidence of disease, at 83 months. In the group of women younger than 35, the frequency of IDC appeared to be identical to that observed in the general population. Their prognosis after treatment is excellent, and identical to that of IDC in older women. Conservative treatment is justified in localized forms, but mastectomy with immediate reconstruction must be performed in the presence of extensive disease.

Adolescent↗
PubMed1996

[Recommendations for the immunohistochemical evaluation of hormone receptors on paraffin sections of breast cancer. Study Group on Hormone Receptors using Immunohistochemistry FNCLCC/AFAQAP. National Federation of Centres to Combat Cancer/French Association for Quality Assurance in Pathology].

These recommendations regard the immunohistochemical evaluation of estrogen and progesterone receptors in paraffin sections of breast cancers. All the components of the procedure are dealt with: fixation, antigen retrieval, antibodies, controls, analysis and interpretation of immunostaining, report and quality assurance parameters. The purpose of these guidelines is to serve as a basis for standardization of techniques and results and to improve quality control.

Breast Neoplasms↗
PubMed1996

Frequent association of human papillomavirus 16 and 18 DNA with anal squamous cell and basaloid carcinoma.

Human papillomaviruses (HPVs) play a major role in the development of genital neoplasia. Their role in anal carcinogenesis is less clear, and the rate of HPV genome detected in invasive anal carcinoma varies considerably in the different reports. Moreover, the relationship of HPV to basaloid carcinoma, claimed to represent a histologic type different from the common squamous cell carcinoma, is still controversial. By use of both polymerase chain reaction and Southern blot hybridization on DNA extracted from frozen tissue specimens, we looked for HPV sequences in 12 cases of squamous cell carcinoma, in 9 cases of basaloid invasive carcinoma, in 1 case of carcinoma in situ, and in 1 case of Paget's disease of the anal canal. We have looked for correlations between virologic data and histologic types of tumors, and analyzed the clinical characteristics of HPV-positive and HPV-negative lesions. In our series, 20 (74%) of 27 cases of invasive anal carcinoma were positive for HPV DNA by Southern blot hybridization and/or polymerase chain reaction. HPV 16 DNA was found in 17 cases, HPV 18 in 2 cases, and in 1 case, the type of the HPV sequences detected remained undetermined (HPV X). Histovirologic correlations showed that 12 of 18 squamous cell carcinomas were associated with HPV 16 and that 8 of 9 cases of basaloid carcinoma were HPV positive; 5 case corresponded to HPV 16, 2 cases to HPV 18, and 1 case to HPV X. The carcinoma in situ case and the Paget's disease case were negative. An analysis of these data within the framework of the literature indicates that approximately 75% of cases of invasive anal carcinoma can actually be considered associated with HPV sequences. Basaloid carcinoma is also frequently associated with HPV genomes and is more likely to represent a histologic variant of squamous cell carcinoma than a separate entity. No clinical characteristics related to the HPV status of the tumors were observed in our series. Epidemiologic data on cervical, anal, and vulvar neoplasia are compared and their relation to the oncogenic properties of HPV in these different tissues are discussed.

Adult↗
PubMed1995

Ductal carcinoma in situ: MR imaging-histopathologic correlation.

PURPOSE: To correlate histopathologic and magnetic resonance (MR) imaging findings of ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: Thirty-six women with DCIS underwent preoperative contrast material-enhanced subtraction dynamic MR imaging. Concomitant early contrast enhancement in the breast parenchyma with normal vessels was considered a positive finding. The size and shape of early enhancement were correlated with the size and density packing of ducts involved by DCIS. Tumor angiogenesis in the stroma that surrounded the ducts was evaluated with immunoperoxidase staining. RESULTS: Early contrast enhancement was demonstrated in 34 patients with DCIS but not in two patients with comedo-type DCIS. Tumor angiogenesis was demonstrated in the stroma. The size and morphology of contrast-enhanced lesions significantly correlated with the size (P = .0085) and density packing of ducts involved by DCIS (P = .012). CONCLUSION: Contrast enhancement on dynamic MR images of DCIS may be due to the presence of tumor angiogenesis in the stroma.

Breast↗
PubMed1995

[Metaplastic breast cancer with chondroid differentiation. Report of three cases].

The authors report three cases of breast carcinoma with chondroid metaplasia. These three tumors were characterized by direct transition between the carcinomatous and the mesenchymal component. Immunohistochemical study revealed epithelial antigens within the mesenchymal appearing component. Pitfalls in the diagnosis and in the classification of metaplastic carcinomas are reviewed.

Adult↗