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Biomedical subjects

G F Schwartz

Publications and source records attributed to G F Schwartz.

At least 37 records · Page 2Linked to original sources
PubMed1994

Stability of malignant breast microcalcifications.

PURPOSE: To determine the frequency of stability in malignant microcalcifications and its relationship to specific histologic diagnoses. MATERIALS AND METHODS: During a 34-month period, microcalcifications were proved malignant in 182 patients referred for needle-guided biopsy. In 105 patients, the mammograms were compared with one or more than one previous mammogram. These patients were classified on the basis of interval change in two groups: those with stable and those with increasing or new microcalcifications. The histologic diagnoses were reviewed. RESULTS: Microcalcifications were stable for 8-63 months (mean, 25.4 months) in 26 patients (24.8%), only three (12%) of whom had invasive ductal carcinoma, which was found in 29 (37%) of the 79 patients with increasing or new microcalcifications. CONCLUSION: The odds for presence of invasive ductal carcinoma are statistically significantly lower (P < .025) among patients with stable microcalcifications than among those with increasing or new microcalcifications. Stability of indeterminate or suspicious microcalcifications is unreliable for exclusion of a diagnosis of malignancy.

Breast Neoplasms↗
PubMed1994

Perioperative implantation of iridium-192 as the boost technique for stage I and II breast cancer: results of a 10-year study of 655 patients.

PURPOSE: To assess the efficacy of perioperative implantation of iridium-192 for stage I and II breast cancer. MATERIALS AND METHODS: The authors retrospectively reviewed findings from 655 patients with stage I and II cancer treated with conservative surgery and Ir-192 implantation between 1982 and 1992. Hollow plastic tubes were placed in the tumor bed as a single- or double-plane implant at lumpectomy. Ribbons with Ir-192 seeds were inserted into the tubes 4-6 hours later. The Ir-192 was left in place for approximately 50 hours. External-beam irradiation was given to the whole breast 10-14 days later. RESULTS: Follow-up ranged from 2 to 146 months. The local control at 10 years for stage I and II disease was 93% and 87%, respectively. The 10-year actuarial survival rate was 92% +/- 1 for stage I disease and 72% +/- 4 for stage II disease. The rate of survival with no evidence of disease for stage I and II disease combined was 82% +/- 1 at 5 years and 75% +/- 3 at 10 years. CONCLUSION: Perioperative implantation produced excellent local control equal to that with electron-beam therapy.

Brachytherapy↗
PubMed1994

Management of clinically occult (nonpalpable) breast lesions.

In the past generation, mammography has become a major, if not the best available, diagnostic tool for the earlier detection of breast cancer. We have certainly come far from hard-to-imagine anecdotes of the early 1970s that "if I can't feel it, it's not there!" Although current controversy questions the earliest age at which screening mammography truly lowers the death rate from breast cancer, that mammography does detect breast cancer years before it might be discovered as a mass in the breast cannot be challenged. Mammographic techniques have improved so that smaller and smaller areas of suspicion may be identified, and mammographers have gained greater judgment in the interpretation of these minute radiographic abnormalities. This has inevitably led to an increase in procedures designed to explain them. The incurred costs, both emotional and economic, of positive mammographic "calls" are considerable. Whether practicing medicine as patients' advocates or, as unfortunately currently seems to be of equal importance, exercising politically correct and cost-effective mandates, the management of nonpalpable breast lesions certainly bears witness to the correlation of cognitive and procedural skills and cooperation between physicians, as well as the technical achievements of contemporary medicine.

Biopsy↗
PubMed1994

The role of excision and surveillance alone in subclinical DCIS of the breast.

Mammography has led to the earlier detection of nonpalpable, subclinical DCIS, either as nonpalpable calcifications or as an incidental finding in a biopsy. Concurrently, the inevitable progression of DCIS to invasive carcinoma has been questioned, so that traditional treatment of this disease has been challenged. Local excision alone for carefully selected patients with DCIS can result in a recurrence rate as low as 15%. Candidates for treatment by surveillance alone after local excision are those patients with a limited area of DCIS on mammography, detected as an area of calcifications 6 cm2 (2.0 to 2.5 cm diameter) or less. Subgroups of DCIS, such as the comedo form, may be more likely to recur. The ultimate objective is to identify the population of patients with subclinical DCIS who are unlikely to suffer recurrence of disease after local excision alone, sparing them from either mastectomy or irradiation.

Breast Neoplasms↗
PubMed1993

Clinical applications of serum and tissue markers in malignant disease: breast cancer as the paradigm.

Within the past few years, the measurement of serum and tissue markers, especially the latter, has assumed a more significant role influencing clinical decisions about treatment and follow-up of patients with malignant disease. Breast cancer is a useful paradigm to illustrate the types and importance of these various markers. Tissue markers, including nuclear grade, steroid hormone receptors, DNA index, ploidy, expression of oncogenes or tumor-suppressor genes, epidermal growth factors, cathepsin D, proliferating cell nuclear antigen (PCNA), Ki-67, p32, and others, may influence choices of initial treatment as well as adjuvant chemotherapy and (or) hormone administration. The serial measurement of serum markers, those currently available and those on the horizon, for example, may offer a way to monitor patients at risk for recurrent cancer. Although the current role of these markers may be controversial, as information about them is collected and refined, in the future perhaps a panel of such studies could be incorporated into forthcoming clinical staging systems for carcinoma of the breast and other malignancies to define both treatment and outcome.

Biomarkers, Tumor↗
PubMed1992

Subclinical ductal carcinoma in situ of the breast. Treatment by local excision and surveillance alone.

BACKGROUND: Mammography has led to earlier detection of subclinical ductal carcinoma in situ (DCIS) of the breast either as nonpalpable calcifications or as an incidental finding in a biopsy performed for another reason. Many women in whom DCIS was detected early may not be destined to have an invasive carcinoma. How should subclinical DCIS be treated if that is the case? What is the role of excision and surveillance only as an alternative to mastectomy or irradiation? METHODS: All patients with DCIS detected as nonpalpable calcifications or as an incidental finding were eligible for this study. Diagnosis was confirmed, and the histologic subtype was determined. Results of postbiopsy mammography confirmed excision of calcifications; wide local reexcision and assessment of margins was also performed in most patients. The maximum diameter of calcifications considered suitable for this treatment was 25 mm. RESULTS: Between 1978 and 1990, 70 women (72 breasts) were entered into this study (mean follow-up time, 49 months; median follow-up time, 47 months). Of this group, 66% were detected as calcifications and 33% were detected as incidental findings. The recurrence rate was 15.3%. All but one of the patients who experienced a recurrence had the comedo type of DCIS as the initial lesion. Each of the recurrences was of the comedo type. All but one recurrence was at the same site as the primary lesion. None of the patients with DCIS as an incidental finding experienced a recurrence. CONCLUSIONS: Excision and surveillance is a reasonable alternative to mastectomy or irradiation for selected women with DCIS that presents as nonpalpable calcifications or as an incidental finding.

Adult↗
PubMed1992

Surgical and medical management of patients with narrow anterior chamber angles: comparative results.

We retrospectively reviewed case records of 70 patients (114 eyes) to assess long-term outcome of surgical and medical treatment of narrow anterior chamber angles. Fifty eyes had undergone a peripheral iridectomy, incisional or laser; 64 had been treated medically, without surgery. The two groups were not strictly comparable. (It is assumed but not proven that, since iridectomy was considered necessary in one group and not in the other, the surgically-treated patients were more seriously diseased.) Comparing clinical data obtained at the first visit with data obtained at the last visit, the eyes receiving iridectomies, as compared with those receiving medical treatment alone, showed a greater number of improved anterior chamber configurations (74% vs 28%), had a lower incidence of peripheral anterior synechiae (2% vs 10%), and required fewer glaucoma medications (30% fewer vs 10% fewer). The percentage of eyes with increased intraocular pressure was similar in both groups (36% vs 28%), as was the percentage of those with decreased visual field (17% vs 21%) and decreased visual acuity (66% vs 60%). No significant complications occurred in the eyes receiving laser iridectomies; however, one of the incisionally-treated eyes lost nine Snellen lines of vision.

Anterior Chamber↗
PubMed1991

Strategic acquisitions by academic medical centers: the Jefferson experience as operational paradigm.

As capital investments in the health care industry have changed in popularity, mergers and acquisitions of and by hospitals have created supersystems of health care that are based on the assumption that economies of scale offer greater protection from a variety of forces. The acquisition of West Park (Jefferson Park) Hospital by Thomas Jefferson University and the infusion of Jefferson management into Methodist Hospital have provided the institution with unique opportunities to broaden its population base for acute care admissions and to permit greater diversification within the entire health care market.

Academic Medical Centers↗
PubMed1991

Management of patients with nonpalpable breast lesions.

Ever-increasing use of mammography brings with it a growing number of breast biopsies. The authors describe the five radiologic findings that mandate a surgical consultation. About 30% of their biopsies for nonpalpable breast lesions prove to be invasive or in situ carcinomas. When a mammogram is ambiguous, the authors recommend a repeat mammogram in 6 months. They use needle-localization, and feel that dye marking is superfluous. The films, duly marked by the radiologist, should accompany the patient to the OR. The biopsy is an outpatient procedure, and only local anesthesia, sometimes with IV sedation, is required. It is not necessary to remove the skin over the biopsy site, nor all of the tissue traversed by the needle localizer. The authors describe their surgical procedure for biopsy, state that x-ray of the specimen is mandatory, and that frozen sections are not desirable. Their procedure takes longer, but it's better, they say.

Biopsy, Needle↗
PubMed1989

Heterogeneity of intraductal carcinoma of the breast.

Fifty-one women (29 to 75 years of age) with 55 cancers (ductal carcinoma in situ [DCIS] or ductal carcinoma in situ with microinvasion [DCISM] were studied by comparing biopsy specimens with mastectomy specimens. Presentation, histologic type, nuclear grade, microscopic duct counts, multicentricity, and microinvasion were correlated. Forty-seven percent of the cancers (26 of 55) were detected by mammography, 18% (ten of 55) were incidental to benign disease, and 35% (19 of 55) were palpable or exhibited nipple abnormality. Incidental tumors were all DCIS, averaged seven ducts, and showed no residual tumor during mastectomy. Mammographic lesions averaged 117 ducts (31% [eight of 26] were DCISM and 42% [11 of 26] were multicentric). Most comedocarcinomas that showed a high incidence of microinvasion were in this group. Clinical lesions averaged 110 ducts (42% [eight of 19] were DCISM and 68% [13 of 19] were multicentric). Three had nodal metastases. Mammographic and clinical tumors in the quantitative range of the incidental group (50 ducts) showed significant differences from it for all variables studied. Histologic and quantitative study of these tumors is necessary to best guide treatment. Incidental tumors, however, may only need observation.

Adult↗
PubMed1989

Nonpalpable in situ ductal carcinoma of the breast. Predictors of multicentricity and microinvasion and implications for treatment.

Fifty breasts with nonpalpable ductal carcinoma in situ (DCIS) were examined for the presence of microinvasion, multicentricity, and number of involved ducts to see if the biopsy specimen could have predicted the findings in the remainder of the breast. When DCIS was an incidental finding, fewer ducts were involved and no evidence of either microinvasion or multicentricity was found. Solid and cribriform DCIS were rarely multicentric or microinvasive; micropapillary DCIS was often multicentric, rarely microinvasive; comedocarcinoma was more likely to be both microinvasive and multicentric. Ductal carcinoma in situ as an incidental finding may be treated by excision alone; papillary and micropapillary DCIS are best treated by therapy aimed at the entire breast, although axillary dissection may not be required. Therapy for comedocarcinomas should include the entire breast and the axillary nodes.

Adult↗
PubMed1988

Ultrasonographic localization of non-palpable breast masses.

Preoperative ultrasound was used as an alternative to x-ray mammography to localize 92 breast lesions encountered in 82 patients. Recommendation for biopsy was made based upon the ultrasonographic finding of a nonpalpable mass or an area of architectural distortion, or in the presence of equivocal physical findings if sonomammography demonstrated a solid or anechoic mass. Sonomammography was performed in the operating room, just prior to anticipated biopsy, using a hand-held, high resolution scanner. When the suspicious area was imaged, and its precise location noted, the breast was then prepped and draped in the usual manner, and biopsy performed. If the suspicious area could not be easily localized after the incision was made and the breast explored, the transducer was "gowned" and used directly in the wound to help find the lesion. This technique has proven effective and accurate. In selected patients, ultrasound may be used instead of, and as well as, x-ray needle localization for the precise excision of non-palpable breast masses and areas of parenchymal distortion. Microcalcifications must still be addressed by x-ray mammography and needle localization with specimen radiography.

Adult↗
PubMed1988

Ultrasound for guidance of breast mass removal.

Hand-held sonomammography was used intraoperatively to localize 52 masses in 45 women in an out patient operating suite. All but five women had a positive X-ray mammogram. The ultrasound mammogram was able to identify all lesions. In 42 women studied by a preoperative ultrasound examination before the operating room procedure, all the masses were successfully identified. Precise localization was successfully performed in the operating room before sterile preparation in less than 10 minutes. Relocalization after incision in the sterile operating field was necessary in two cases. This technique requires no ionizing radiation and expedites outpatient surgical removal of the lesion. Of the 52 masses, there were 32 fibroadenomas, three carcinomas, three cysts, six cases of focal fibrous mastitis, and eight patients with focal fibrocystic disease. In patients with positive sonograms for nonpalpable masses, ultrasound localization is a fast, accurate alternative to X-ray needle placement.

Adenofibroma↗
PubMed1988

Significance and staging of nonpalpable carcinomas of the breast.

Current staging protocols for carcinoma of the breast do not contain precise definitions for cancers detected as suspicious mammographic findings only. We have examined the distribution of malignant lesions and the frequency of metastasis to the axillary nodes and multicentricity in 1,059 women who have undergone 1,132 biopsies of the breast for nonpalpable lesions in order to determine if nonpalpable carcinomas should be categorized and staged separately from those detected in the traditional manner. Of these 1,132 biopsies, 29.1 per cent (330) were malignant, including 190 invasive ductal carcinomas, 13 invasive lobular carcinomas, 81 in situ ductal carcinomas, 25 microinvasive ductal carcinomas, 20 instances of lobular carcinoma in situ and one instance of malignant carcinoid. None of the women with noninvasive or microinvasive carcinomas had axillary metastasis; however, of 167 women with invasive ductal or lobular carcinoma who underwent axillary dissection, 32.9 per cent had at least one positive axillary node. In those women in whom the invasive carcinomas presented as clustered calcifications, the likelihood of axillary metastasis was the same as in the women who had nonpalpable masses. The significant frequency of axillary metastasis in women with clinically occult cancers challenges the use of the term "minimal" to describe any invasive cancer, regardless of size. Although noninvasive and microinvasive ductal cancers may continue to be considered as "minimal," invasive cancers, regardless of presentation, should be staged according to their measured size on the mammograms that detect them.

Adult↗
PubMed1988

Ultrasonography: an alternative to x-ray-guided needle localization of nonpalpable breast masses.

Preoperative ultrasonography was used as an alternative to x-ray mammography to localize 92 breast lesions encountered in 82 patients. Recommendation for biopsy was made on the basis of the ultrasonographic finding of a nonpalpable mass or an area of architectural distortion, or in the presence of equivocal physical findings if sonomammography demonstrated a solid or an anechoic mass. Sonomammography was performed in the operating room, just before anticipated biopsy, with a hand-held high-resolution scanner. When the suspicious area was imaged and its precise location noted, the breast was then prepared and draped in the usual manner, and a biopsy was performed. If the suspicious area could not be easily localized after the incision was made and the breast explored, the transducer was "gowned" and used directly in the wound to help find the lesion. This technique has proven effective and accurate. In selected patients ultrasonography may be used as well as, or instead of, x-ray needle localization for the precise excision of nonpalpable breast lesions, excluding calcifications.

Adult↗
PubMed1987

Neoadjuvant chemotherapy before definitive treatment for stage III carcinoma of the breast.

One hundred women with American Joint Committee (AJC) stage III (T2, N2; T3, N0/1/2; T4, N0/1/2) carcinoma of the breast were treated with combination chemotherapy following biopsy to confirm the diagnosis and determine hormone receptor status before any other treatment of the local disease (so-called neoadjuvant chemotherapy). Response was assessed after three cycles of treatment, and responders were treated until the tumor and/or axillary nodes failed to show further regression. Definitive surgery was then performed, usually radical mastectomy. Chemotherapy was resumed following surgery for a total of 12 cycles. Ninety patients are assessable, and 70% have responded to chemotherapy. Outcomes of both responders and nonresponders were analyzed. Radical mastectomy without postoperative radiotherapy seems to be the preferable surgical treatment for the responders. Median follow-up of the assessable patients was 27 months; projected five-year disease-free survival of the responders is greater than 65%, and projected overall five-year survival of this group is greater than 85%. Because the follow-up of these patients suggests a marked improvement in outcome compared with similar patients treated traditionally with mastectomy or radiotherapy followed by adjuvant chemotherapy, we advocate more widespread use of combination chemotherapy before definitive treatment for stage III carcinomas of the breast.

Adult↗
PubMed1987

Clinically occult breast lesions: localization and significance.

From early 1974 through September 1985, 927 needle-guided breast biopsies were performed for clinically occult breast lesions. Two hundred and seventy (29%) of these lesions were malignant. This frequency of malignancy was comparable to a 20% frequency in biopsy samples obtained because of clinical (palpable) findings. Of 142 patients with nonpalpable invasive lesions who underwent axillary dissection, 42 (30%) had histologically confirmed axillary metastases. Although these invasive lesions may be clinically occult, they are not inconsequential and demand appropriate treatment. For those patients in this series undergoing mastectomy, the frequency of multicentric cancer in the same breast was 39%. The past 10 years have witnessed a trend in surgical management away from the standard radical or modified radical mastectomy toward limited surgery and radiation therapy for so-called early breast cancer. When planning treatment for these occult lesions, one must consider their biological potential to metastasize as well as their propensity for multicentricity.

Adult↗