Local/regional therapy of primary breast cancer: a contemporary multimodal approach.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to H Safaii.
Explore the source record for details and available documents.
The use of mammography to screen patients for the presence of early breast cancer results in the detection of nonpalpable lesions. As screening becomes more widespread, the number of needle localizations performed will continue to increase. This procedure requires involvement of the radiologist, surgeon, and pathologist. Close cooperation between these disciplines will ensure optimal patient care.
Explore the source record for details and available documents.
The approach to these lesions is being reexamined in light of results with conservative surgery for invasive breast cancers. According to available data, the invasive potential of in situ lesions varies. Mammographic and pathologic findings may differentiate patients who will benefit from lumpectomy (with or without radiotherapy) from those requiring mastectomy.
Between 1982 and 1985, 108 women with AJC Stage I and II invasive mammary carcinoma were treated to 115 breasts with conservative surgery and irradiation. The irradiation dose was adjusted to the histopathological normal tissue margin around the carcinoma in the tumor excision specimens. Margins were arbitrarily determined negative, close, and positive with normal tissue margins in the inked tumor excision specimens of greater than 5 mm, 2-5 mm, and less than 2 mm, respectively. Negative, close, and positive tumor margin patients were treated to radiation doses of 60, 65, and 70 Gy, respectively. The boost in excess of 50 Gy was directed to the tumor bearing quadrant of the breast using interstitial Ir-192 implants for doses greater than or equal to 70 Gy. The draining lymphatics were irradiated to 50 Gy except in patients with tumor in the lateral half of the breast and no axillary lymph node metastases. Histopathological evaluation of re-excision specimens revealed the difficulty of obtaining negative margins for tumors greater than 2 cm. By our criteria, 54% of the patients had a positive resection margin. None of the patients experienced a local recurrence at 60 months median follow-up. Three patients failed regionally, two in un-irradiated lymph node areas, one in the skin of the contralateral breast; five patients failed systemically. Overall and disease-free survival for Stages T1/N0, T1/N1, T2/N0 was 100 and 95%, respectively, and for T2/N1, 90 and 80%, respectively. The cosmesis was excellent in 66% of the patients with minimal treatment related complications. Carefully planned standardized irradiation with assessment of resection margins yields both excellent local control rates and cosmetic results.
The records of 21 consecutive patients referred for breast-conservation treatment of early-stage mammary carcinoma contained insufficient histopathologic documentation of adequate resection margins after tumor excision at other hospitals. All patients underwent postbiopsy mammography before reexcision of the tumor bed. In 12 of the 21 cases, there was pathologic evidence of macroscopic or microscopic residual tumor. In seven of the 12 cases, there was no clinical or mammographic evidence to suggest residual carcinoma. The findings indicate that mammography is insufficient to evaluate the completeness of tumor excision in the absence of histopathologic documentation.
Forty consecutive cases of nonpalpable breast carcinoma presenting on the mammogram as microcalcifications without an associated mass were reviewed. The precise relationship between the mammographic microcalcification and the histologic carcinoma was determined in each case. In 25 cases (63%), the mammographic calcium was confined to the tumor, and in 13 cases (33%), the calcification was present both within the tumor and contiguous to the tumor margin. In two cases (5%), the calcium was not contained within the tumor but was located next to it. In one of these cases, the calcium was within 4 mm of the malignant neoplasm and in the other it was within 13 mm. No difference was seen between the appearance of the calcifications located within the tumor and the appearance of calcification next to the tumor. Precise histologic analysis revealed that microcalcifications that had prompted biopsy were confined to the tumor in 63%, within and contiguous to the tumor in 32%, and within 13 mm of the tumor in 5%.
The cytomorphologic features in cervical biopsies and smears associated with human papilloma virus antigen (Ag) expression as demonstrated by immunoperoxidase staining techniques are presented. There was good concordance between cytology and biopsy results with respect to immunoperoxidase staining for human papilloma virus Ag. Cytomorphologic scoring of low-grade lesions (cervical intraepithelial neoplasias, grades O and I) showed atypical mitoses, macronucleated koilocytes, superficial cell keratohyaline granules, and multinucleation to be more frequent in Ag+ biopsy specimens. Chronic inflammation was more evident in Ag- biopsy specimens (P less than 0.05). Parakeratosis was more frequent in Ag+ cytologic specimens. Koilocytosis was not a reliable indicator of Ag expression in either preparation. Human papilloma virus (HPV) Ag testing by immunoperoxidase techniques appears to be a useful adjunct for screening low-grade atypias of the cervix.
Explore the source record for details and available documents.
Two hundred eighty-six fine needle aspiration biopsies were reviewed. The sensitivity for the diagnosis of malignancy was 90 percent for lymph node specimens, 93 percent for skin and soft tissue masses, and 74 percent for breast cancer. The overall accuracy of the technique was 82 percent for breast lesions, and 90 to 92 percent for soft tissue and lymph node lesions. Traditional open biopsy in an outpatient setting for these tumors is twice as costly as fine needle aspiration biopsy. Further refinement in the use of the cytocentrifuge and immunohistochemical techniques will result in fewer inadequate fine needle aspiration specimens and an increase in the diagnostic information available with this technique. Fine needle aspiration is recommended as the first biopsy technique of choice for localized solid tumors.
Extrarenal Wilms' tumor is a rare entity usually seen as a mass in the retroperitoneal area. It may surround and distort otherwise normal kidneys and ureters. Like many other abdominal masses, its true nature remains uncertain until microscopic examination has been performed after surgery. The tumors appear to behave clinically like intrarenal Wilms' tumors, though in the cases reviewed there was a relatively higher incidence in older patients. The prognosis of extrarenal Wilms' tumor is difficult to evaluate due to the small numbers of cases reported and the differing tumor therapy used. However, those cases treated most recently appear to have a good response to therapy.
Because the rate of malignancies in young women exposed in utero to diethylstilbesterol (DES) is low, appropriate population screening methods have not been established. A case is presented that is believed to represent the first reported instance of a DES-exposed daughter who developed clear cell adenocarcinoma of the vagina after initially negative examinations. The patient was followed with Papanicolaou smears, pelvic examinations, and colposcopy every 6 months for 2 years prior to the discovery of malignancy. Initially negative, Papanicolaou smears successfully predicted the presence of an early adenocarcinoma. Palpation aided by colposcopy allowed directed biopsy of the small asymptomatic lesion. This case underscores the necessity for frequent vaginal cytologic smears and pelvic examinations at intervals no greater than 6 months. Colposcopy is indicated to direct biopsies when an abnormal cytologic smears is reported or when abnormal bleeding or discharge occurs. Biopsy of any palpable lesion is mandatory.
Explore the source record for details and available documents.
A combined immunocytochemical and quantitative serum and tissue study was performed on a group of endodermal sinus (yolk sac) tumors, localizing and measuring both alpha1-antitrypsin (AAT) and alpha-fetoprotein (AFP) in tumor tissue and patient sera. Utilizing indirect immunofluorescent and triple-sandwich immunoperoxidase methods, both proteins were demonstrated within intra- and extracellular periodic acid-Schiff-positive hyaline globules characteristic of the tumor, as well as within the cytoplasm of tumor epithelial cells lining endodermal sinuses, where AAT deposition predominated. Tumor tissue extracts confirmed the presence of significant quantities of both proteins, and pretreatment serum elevations of both showed a parallel decline during therapy. In this study, AAT is characterized as a tumor protein marker for the first time, and a parallelism between AAT and AFP is demonstrated in both serum and tumor tissue. These findings represent additional supportive evidence for the yolk sac origin of endodermal sinus tumors in man.