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Biomedical subjects

J L Peterse

Publications and source records attributed to J L Peterse.

At least 109 records · Page 6Linked to original sources
PubMed1993

Feasibility study of FEC-chemotherapy with dose-intensive epirubicin as initial treatment in high-risk breast cancer.

BACKGROUND: The prognosis of patients with stage III B breast carcinoma with metastasis to the apical axillary lymph nodes is poor despite adequate local control achieved by surgery and/or radiation therapy. This study evaluated the feasibility of a dose-intensive up-front chemotherapy regimen in this subgroup of patients. PATIENTS AND METHODS: A preoperative chemotherapy regimen consisting of 3 courses of fluorouracil 500 mg/m2, dose-intensive epidoxorubicin 120 mg/m2 and cyclophosphamide 500 mg/m2 (DIE-FEC), was administered at 21-day intervals without hematopoietic growth factors to 31 patients with apex-positive disease. All patients were below 60 years of age and none had had prior chemotherapy or radiotherapy. RESULTS: Seven patients achieved clinical complete responses (23%), and 21 achieved clinical partial responses (68%); three patients had stable disease (10%), one of whom had only ductal carcinoma in situ at histopathologic evaluation, which suggested an additional response to therapy. The major toxicity was moderate bone marrow suppression with a median WBC nadir of 1650/microliters (range 500-4600). Other toxic effects were mild. CONCLUSION: DIE-FEC is well-tolerated and highly effective as up-front chemotherapy in relatively young patients with high-risk breast cancer, with a 90% (CI 74%-98%) clinical objective response rate.

Adult↗
PubMed1993

Reliability of fine needle aspiration cytology for distinguishing between carcinoma, lymphoma and sarcoma; the influence of clinical information.

To investigate interobserver variation of fine needle aspiration (FNA) cytological diagnosis with respect to distinguishing between carcinoma, sarcoma and lymphoma, a set of 80 randomly sampled slides was randomized twice and read 'blindly' by five cytopathologists. In the first round the slides were read without any information, and in the second round clinical information was provided. Histology was used as a reference standard. In the first round, the positive predictive values for the cytological diagnosis of carcinoma, sarcoma and lymphoma were 93%, 94% and 86% respectively. In the second round the positive predictive values for the cytological diagnoses of carcinoma, sarcoma and lymphoma were 95%, 99% and 99%, respectively. Interobserver variability, tested with weighted kappa scores (range 0.73-0.92) between histological and cytological diagnosis, was low. The most accurate FNA cytologic classification was obtained when the clinical context was known.

Biopsy, Needle↗
PubMed1992

Amplification of genes within the chromosome 11q13 region is indicative of poor prognosis in patients with operable breast cancer.

Amplification of the chromosome 11q13 region, which harbors the BCL1 region and the PRAD1, EMS1, HSTF1, and INT2 genes, was found in 36 (16%) of a series of 226 breast carcinomas. In the 153 patients with stage I-IIIa disease who had received no therapy prior to surgery and who were treated with curative intent, 11q13 amplification was associated with the presence of lymph node metastases (P less than 0.002). The presence of an 11q13 amplification was associated with a significantly shorter relapse-free survival (P less than 0.002) and a higher breast cancer-specific mortality (P less than 0.003). Stepwise multivariate analysis showed that, in addition to lymph node status, 11q13 amplification was the best predictor for short survival. Stratified log-rank analysis indicated that, within the group of lymph node-positive breast cancer patients, 11q13 amplification identifies a subgroup at high risk.

Breast Neoplasms↗
PubMed1992

Polyploidy in pleomorphic adenomas with cytological atypia.

Occasionally, in fine-needle aspirates of pleomorphic salivary gland adenomas, considerable cytonuclear atypia is present, which may give rise to a false-positive diagnosis. In this study DNA cytophotometry was performed on Feulgen restained smears prepared from material obtained by needle aspirates of normal salivary glands (n = 4), pleomorphic adenomas with (n = 5) and without (n = 4) atypia and a carcinoma in a pleomorphic adenoma. The results showed a clear diploid DNA histogram in the specimens of normal salivary gland and pleomorphic adenomas without atypia. In contrast, in the pleomorphic adenomas with atypia a distinct polyploid pattern was present in three out of the five DNA histograms with DNA values in 2c, 4c and 8c ranges. In two of these cases a 16c peak was also present and in the two remaining cases tetraploidy was demonstrated. In the carcinoma a main stemline at 4c was found. This report once more emphasizes the possible atypia which may be present in FNA of pleomorphic adenomas of the salivary gland. The atypia is due to polyploidy in a histologically benign tumour.

Adenoma, Pleomorphic↗
PubMed1992

Recurrence after breast ablation for ductal carcinoma in situ.

Three patients are described having locally recurrent invasive breast cancer after breast ablation for ductal carcinoma in situ (DCIS). All had initially extensive type ductal carcinoma in situ without evidence of invasion in adequately sampled microscopical studies. One patient developed a scar recurrence and lung metastases 2 years after surgery; one patient showed a scar recurrence 3 years after operation and one patient had a recurrence in the chest wall 27 years after surgery. Although generally stated that ablative therapy offers a 100% cure in case of DCIS, these cases illustrate that local recurrence may occur. Possible causes and preventions are discussed.

Aged↗
PubMed1992

Breast cancer: a study into the value of a historical group as comparative material for new methods of treatment.

A large group of consecutive patients were studied who had been treated for a primary breast carcinoma by a radical mastectomy at the Netherlands Cancer Institute, during the period of 1960-1974. One of the objectives of that retrospective study was to record the results of treatment of a historical group of patients in such a way that they could presumably serve as a reference for new methods of treatment of breast cancer. To verify the validity of this presumption, the present study compares the treatment results of patients from the EORTC trial 10801, which addresses the value of breast conserving procedures, with that of matched controls from the historical group mentioned above. Matching was carried out with respect to the following prognostic factors: age, tumor size, localization, (number of) positive axillary nodes and grade of malignancy. Analysis of the results strongly suggests that the prognosis for the patients from the historical group is worse than for both groups of patients from the trial 10801. Therefore, this study again confirms that a historical group is not suitable as comparative material for new ways of treatment of breast cancer, and that prospective randomized studies are required to test new treatment schedules.

Breast Neoplasms↗
PubMed1991

Breast-conserving therapy of ductal carcinoma in situ: frequency of local recurrence after wide excision with and without additional radiotherapy, a retrospective study of 42 cases.

Clinicopathologic features were retrospectively studied in 42 patients with ductal carcinoma in situ (DCIS), who underwent breast-conserving therapy at the Netherlands Cancer Institute from 1974 to 1987. During follow-up (13 to 128 months, average 73 months) five of the 14 patients treated with an excision alone recurred locally. Recurrence occurred in only one out of 28 patients who received additional radiotherapy. Secondary mastectomy was performed in five patients with recurrence, all are alive with no evidence of disease (average follow-up 21 months). One patient developed disseminated disease. Breast-conserving therapy might be considered in selected cases of DCIS with a limited extent, when a complete excision can be accomplished. Additional radiotherapy may reduce the risk of recurrence. Because most series in literature are small, retrospective, selected and with a short follow-up randomized prospective trials have to demonstrate what subset of patients with DCIS can safely be treated with breast-conserving therapy. Therefore, participation in these studies, is of the utmost importance.

Adult↗
PubMed1991

Breast-conserving therapy for invasive carcinoma: diagnosis of local recurrence.

The way in which local recurrence after breast conserving treatment for invasive carcinoma became apparent, is reported in 44 patients. All patients were followed by regular physical examination and annual mammography. In 36 patients first suspicion of local recurrence was heralded by clinical signs and symptoms, presented between two scheduled routine visits in 12 patients, and at the time of a routine visit in 14 patients. Routine physical examination by surgeon or radiotherapist revealed local recurrence in 10 patients. Local recurrence was detected only by mammography in eight patients. Mammography confirmed the clinical suspicion in seven patients. The remaining 23 patients with clinical overt recurrence showed no signs of recurrent tumour on the mammographs performed after first clinical suspicion. Fine needle aspiration (FNA) cytology confirmed the clinical suspicion in 35 of the 38 tested patients. In our experience, regular physical examination is the mainstay for the detection of local recurrence after breast conserving therapy. Mammography was of limited value but proved more valuable for the early detection of recurrent tumour outside the primary tumour area. Fine needle aspiration cytology is a helpful tool in confirming the diagnosis of local recurrence.

Adult↗
PubMed1989

Atypia in fine-needle aspiration cytology of the breast: a histologic follow-up study of 301 cases.

A gray area of uncertainty exists in fine-needle aspiration (FNA) cytology of the breast in which common criteria to distinguish benign from malignant lesions overlap. Aims of this study were to define this area and to evaluate statistically cytomorphologic criteria in a semiquantitative analysis. In a test set of specimens from well-differentiated carcinomas and benign proliferative lesions, signs of malignancy were cell dissociation, arrangement in small clusters, nuclei greater than 16 microns, anisonucleosis, irregular nuclear borders, nucleoli, and necrosis. Features in favor of benignancy were large monolayers, nuclei less than 16 microns without variation in size, smooth nuclear borders, and bipolar nuclei in the monolayers. Originally the term "atypia" had been applied to 956 (12%) of all FNAs of the breast performed at our institute from 1974 to 1985. Using these criteria in a review of all 301 cases in which histologic follow-up and cellular smears were available, much better results were obtained than originally; specificity increased from 80% to 95%, and sensitivity increased from 60% to 90%. The number of overdiagnoses decreased from 24 to seven, and underdiagnoses decreased from 57 to nine. In this selected series, the area of uncertainty was restricted to 16% of the cases; the number of these cases that proved to be malignant and benign was equal. In such cases of indistinct cytomorphologic criteria, a surgical biopsy is indicated for histologic studies.

Biopsy, Needle↗
PubMed1988

Neu-protein overexpression in breast cancer. Association with comedo-type ductal carcinoma in situ and limited prognostic value in stage II breast cancer.

Amplification of the neu proto-oncogene in breast cancer has been reported to correlate with the presence of lymph-node metastases and with a poor prognosis. We describe a method for the immunohistochemical detection of overexpression of neu protein on formalin-fixed paraffin-embedded tissue, with the use of two different monoclonal antibodies. In a group of tumors with a known neu-gene copy number, intense membrane staining of tumor cells was present in all tumors with neu-gene amplification. Of 189 tumors from patients with Stage II breast cancer, 27 (14 percent) had neu-membrane staining. Neu overexpression was associated with larger tumor size (P = 0.006) but not with lymph-node involvement. Neu-protein expression in lymph-node metastases was the same as its expression in primary tumors. Among the patients with neu overexpression (median follow-up, 37 months), disease-free survival was not significantly shorter; overall survival was reduced significantly in these patients (P = 0.042), but this reduction did not remain significant after adjustment for tumor size. Of 45 ductal carcinomas in situ, 19 (42 percent) had neu-membrane staining. These 19 were all of the large-cell, comedo growth type. None of 16 ductal carcinomas in situ of small-cell, papillary, or cribriform growth type had neu overexpression. We conclude that neu overexpression may be an early step in the development of a distinct histologic type of carcinoma of the breast, but we could find no association of overexpression with lymph-node status or tumor recurrence.

Antibodies, Monoclonal↗
PubMed1988

The impact of tumor size and histology on local control after breast-conserving therapy.

To investigate possible contraindications for breast-conserving therapy (BCT) a retrospective clinicopathological study was carried out in 585 patients treated conservatively in The Netherlands Cancer Institute from 1979 to 1984. The local recurrence rate in the breast was 2% at 6 years and was similar in stages I and II breast cancer. Invasive cancer with extensive ductal carcinoma in situ (DCIS) component appeared to be the only main prognostic factor when local failure in the breast was considered. A multivariate analysis revealed that tumor size, microscopically incomplete excision of the primary tumor and age did not have a significant influence on local control alone, when this was corrected for extensive DCIS. When breast and axillary recurrences were taken together, age and extensive DCIS component appeared to be two independent prognostic factors according to a multivariate analysis. Especially patients younger than 40 years with an extensive DCIS component had a higher locoregional recurrence rate.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

CSF cytology versus immunocytochemistry in meningeal carcinomatosis.

CSF immunocytochemistry with monoclonal antibodies was compared with conventional cytology to determine its sensitivity in detecting malignant cells in patients with meningeal carcinomatosis. One hundred and eighteen samples were investigated. Cytology was tumour positive in 83 samples and immunocytochemistry in 85. Dissimilar results between the two diagnostic methods were noted in 12 specimens, invariably occurring in samples with a low cell count and obtained from treated patients. Combined use of the two methods led to a 9% increase of sensitivity in detecting malignant cells compared with cytology alone. It is concluded that immunocytochemistry is of minor help in the problem of false-negative cytology in meningeal carcinomatosis.

Adenocarcinoma↗