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J Pickren

Publications and source records attributed to J Pickren.

9 recordsLinked to original sources
PubMed1985

Immunostaining for carcinoembryonic antigen does not discriminate for early recurrence in breast cancer. The ECOG experience.

Carcinoembryonic antigen (CEA) immunohistochemistry was evaluated by 11 surgical pathologists with sections from 147 postmenopausal women with node-positive breast cancer. Carcinoembryonic antigen staining in breast cancer tissues has been correlated with a worse prognosis. This association was studied with a clinically characterized population of Eastern Cooperative Oncology Group (ECOG) patients using precisely the peroxidase-antiperoxidase methodology which had been employed in another published study. In 50% of the cases, the study pathologists were uncertain whether CEA was or was not present in the cancers. Various groupings of the pathologists' interpretation were compared with the observed disease-free intervals in the patients. These analyses suggested no association of perceived CEA staining with the biological course of the cancers. Two reference pathologists who examined the sections in a similar way also gave non-prognostic interpretations. There is no convincing evidence that pathologists can reliably interpret the CEA content in the same breast cancer tissue sections. There is no observed correlation between immunohistochemical evidence of CEA in a breast cancer tissue section and the biological behavior of that cancer.

Aged↗
PubMed1985

Interobserver reproducibility of histopathological features in stage II breast cancer. An ECOG study.

Eleven surgical pathologists studied microscopic sections from 45 mastectomy specimens of node positive breast cancer patients who had been entered into ECOG clinical trials. Inter-observer reproducibility for histoprognostic features was examined as a prerequisite before a subsequent evaluation of their possible clinical applicability could be undertaken. Histological type, nuclear grade, tubular formation, and lymphoid reactions were studied in the cancerous tissues. Lymph nodal responses (follicular and pulp prominence, sinus histiocytosis) were also examined in a manner that stimulated slide review in routine surgical pathology practice. Numerous two-way comparisons of the pathologists' findings resulted in low levels of agreement (usually much less than 90%). The degree of inter-observer reliability is clinically unacceptable using customary slide review analysis. New ways of examining breast cancer tissues need to be explored in the search for prognostic features which can be applied to the clinical management of breast cancer patients.

Breast Neoplasms↗
PubMed1983

Management of brain metastases from breast cancer by combination chemotherapy.

Since most patients with brain metastases from breast cancer have disseminated disease elsewhere and a dismal prognosis when treated by whole brain irradiation alone, we investigated the use of systemic chemotherapy in 66 such patients. Fifty-two percent (34 of 66 patients) demonstrated an objective response to this therapy which was similar to the results obtained in patients treated for extracranial metastases. Eighteen patients who subsequently had recurrence of brain metastases were successfully retreated with secondary chemotherapy. The median duration of remission in 34 responders was ten months. The median survival, from the time of chemotherapy for brain metastases, was 13.1 months in 34 responders (range 5-74+) vs. 3.0 months in 32 non-responders (P less than 0.001). These findings suggest that systemic chemotherapy is effective in the treatment of patients with brain metastases from breast cancer by inducing remission and prolonging survival.

Adult↗
PubMed1982

Interobserver variation in the identification of breast carcinoma in intramammary lymphatics.

Nine surgical pathologists participated in a microscopic review of 35 cases of pT1-2 N0 M0 breast carcinoma. The pathologists outlined strict criteria for the identification of intramammary lymphatics and blood vessels and for the identification of cancerous emboli in these vascular channels. Each mastectomy case was studied by three different pathologists. All three concurred on the presence or absence of intralymphatic cancer in 12 of the 35 cases. Observers agreed on the absence of blood vessel invasion in 30 of the 35 cases. There was no consistent bias on the part of a single reviewer, either alone or with another pathologist, in identifying the emboli. We conclude that the identification of intralymphatic cancerous emboli in mastectomy specimens is not a reliably reproducible prognostic finding on which recommendation of systemic chemotherapy in stage I breast carcinoma patients can be based.

Breast Neoplasms↗