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P I Pressman

Publications and source records attributed to P I Pressman.

18 recordsLinked to original sources
PubMed1999

Tubular carcinoma of the breast: sensitivity of diagnostic techniques and correlation with histopathology.

OBJECTIVE: Our objective was to assess our experience in diagnosing pure tubular carcinoma of the breast and to correlate the radiologic and histopathologic features. MATERIALS AND METHODS: A retrospective review of 932 consecutive cases of proven breast cancer diagnosed between 1990 and 1997 revealed 78 cases (8.4%) of tubular carcinoma in 69 patients. Clinical, imaging, cytologic, and histologic findings were analyzed. RESULTS: Mammography revealed tubular carcinoma in 68 (87%) of the 78 cases. Sonography showed tubular carcinoma in all 38 cases in which it was used; nine of these lesions were mammographically occult. These nine lesions were slightly, but not significantly (p < .05), smaller than the 29 lesions that had also been detected on mammography. Large core needle biopsy was performed in 22 patients (sensitivity, 91%). At biopsy, diagnoses were malignant (n = 16 [73%]), suspicious (n = 4 [18%]), atypia (n = 1 [4.5%]), and benign (n = 1 [4.5%]). Fine-needle aspiration biopsy was used to evaluate 36 cases of tubular carcinoma (sensitivity, 50%); cytologic diagnoses were malignant (n = 15 [42%]), suspicious (n = 3 [8%]), atypia (n = 10 [28%]), and benign (n = 8 [22%]). Only 15 (19%) of the 78 tubular carcinomas were palpable. Other tumors were detected within the excised tissue in 47 of the patients (68%); of these other types of lesions, ductal carcinoma in situ was found most often. CONCLUSION: Most cases of tubular carcinoma can be revealed by mammography; for mammographically occult tubular carcinoma, sonography can be performed. The rate of accuracy for determining the presence of tubular carcinoma is higher with large core needle biopsy than with fine-needle aspiration biopsy. Finally, when tubular carcinoma is diagnosed, other histologic types of carcinoma often occur in the same breast.

Adenocarcinoma↗
PubMed1998

Surgical treatment and lymphedema.

BACKGROUND: Lymphedema is a serious and disabling complication of the treatment of breast carcinoma. This is related directly to the removal of axillary lymph nodes. Because lymph node status is the single most important predictor of outcome, it is necessary to obtain accurate information. Whereas breast conservation has become the preferred approach for treating early breast carcinoma, the accompanying axillary dissection continues to cause morbidity. METHODS: The history of the operations for breast carcinoma is reviewed, and the anatomy, techniques, and complications of axillary lymphadenectomy are described. Data to support the necessity for accurate axillary staging is presented, and results of noninvasive axillary staging approaches are discussed. The technique and value of sentinel node biopsy are presented. RESULTS: Axillary lymphadenectomy is required where lymph node metastases are present to accomplish local control, improve survival, and provide information for staging to plan adjunctive therapy. Noninvasive techniques do not yet provide high enough sensitivity to assess the status of the axilla. The sentinel lymph node biopsy is a technique that can identify those patients who require axillary lymphadenectomy. CONCLUSIONS: Screening mammography has been responsible for down-staging the size of detected breast carcinomas, so that the axillary dissection may be omitted in small carcinomas of favorable histologic type. For carcinomas in which the probability of axillary metastases exists, by using the sentinel lymph node biopsy, axillary dissections can be avoided when results are negative, and the risk of lymphedema can be reduced.

Axilla↗
PubMed1996

Stereotactic fine-needle aspiration biopsy for the evaluation of nonpalpable breast lesions: report of an experience based on 2,988 cases.

BACKGROUND: The increasing use of mammography has led to a significant increase in the detection of clinically occult lesions, the majority of which prove to be benign. SFNB has been suggested as a means of expediting a diagnosis for lesions that are malignant while limiting surgical biopsies for those that are benign. METHODS: Clinically occult mammographic lesions were assessed by SFNB in 2,988 patients. Definitive histologic diagnoses were made on surgical specimens in all instances in which the cytologic diagnosis was malignant, suspicious, or atypical. Patients with benign cytology were either followed with interval mammograms or underwent surgical biopsy. RESULTS: Two hundred ninety-one of the 295 lesions (99%) diagnosed as cancer via SFNB were confirmed by histopathology. Twenty-two of the 22 lesions (100%) that were diagnosed as suspicious were diagnosed on histopathology as malignant. Forty-three of the 70 lesions (61%) with cytologic atypia were diagnosed on histopathology to be malignant. CONCLUSIONS: SFNB is an accurate means of diagnosing carcinoma, but must be followed by surgical biopsy when the cytology shows atypia. For lesions diagnosed as benign by SFNB, close interval mammography is essential.

Adult↗
PubMed1993

Distinction between postsurgical changes and carcinoma by means of stereotaxic fine-needle aspiration biopsy after reduction mammaplasty.

Stereotaxic fine-needle aspiration biopsy (SFNAB) was performed to evaluate suspicious mammographic findings (31 stellate lesions, 20 regions of grouped calcifications, two nodules, and one area of prominent trabecular markings) in 54 patients who had undergone reduction mammaplasty. SFNAB findings were correlated with findings in histologic specimens whenever possible; the cytologic samples were classified as malignant, atypical, or benign. In 22 lesions, the abnormalities on mammograms were considered highly suspicious for malignancy. In the 32 others, the degree of suspicion was lower, but these lesions had a change in appearance since acquisition of the first postoperative mammogram. SFNAB enabled diagnosis of adenocarcinoma in five women. Patients who have undergone mastectomy with reconstruction of one breast and mammaplasty in the other are at higher risk for development of contralateral breast cancer, as are all patients who have had such cancer. SFNAB is reliable for evaluation of suspicious mammographic abnormalities that develop after mammaplasty and findings that change after acquisition of the first postoperative mammogram.

Adult↗
PubMed1992

Indications for breast conservation in early stage breast cancer.

Breast conservation, utilizing limited excisional breast surgery and axillary lymphadenectomy followed by radiation therapy can achieve excellent local/regional control and survival in many breast cancer patients. With average sized tumors, where larger volume resections are performed the results can equal that of the modified radical mastectomy. However, smaller tumors do very well with breast removal so it is a challenge to demonstrate that the long-term results of breast conservation in earlier stage disease are equivalent to mastectomy. Small or occult tumors do not always indicate localized disease and suitability for breast conservation depends on a combination of factors: tumor size and ratio of tumor to breast volume, cell type, location of tumor, obtaining clear margins, the mammographic picture, multicentricity, and the probability of axillary lymph node involvement. It is important to select patients for conservation where an equivalent survival can be expected. Recurrence in the radiated breast usually is diagnosed and treated at a more advanced stage than the disease which was initially treated conservatively. It is difficult to manage and carries a poorer prognosis.

Breast Neoplasms↗
PubMed1986

Selective biopsy of the opposite breast.

The bilaterality of breast cancer detected by performing a contralateral biopsy has been reported to be 14%. Since the majority of cancers detected were noninfiltrating, a mastectomy was not always performed because of either the advanced stage of the presenting carcinoma or the age of the patient. This study was undertaken to determine the yield of contralateral cancers in younger patients with a better prognosis. Patients younger than 65 years with clinical Stage I and II initial breast cancers were selected for biopsy of the opposite breast between September 1978 and December 1984. Of 651 consecutive patients treated for breast cancer, 610 had an initial breast cancer and 258 (42%) met the criteria. Forty-three contralateral primary breast cancers were detected, for an incidence of 16.7%. In 11 of these 43 patients there was suspicion that a malignancy might be present; these were all infiltrating carcinomas. In 32 patients a truly random biopsy was performed, and the yield was 14.2%. Four (12.5%) of these were infiltrating cancers, and 28 (87.5%) were in situ carcinomas. By selecting patients for biopsy of the opposite breast, a 16.7% incidence of cancers can be detected. Since these patients were younger than 65 years and have a good prognosis in terms of their initial breast cancer, biopsy of the opposite breast is a worthwhile procedure and should be performed with the hope of improving these patients' ultimate outcome.

Biopsy↗
PubMed1976

Technique of adrenalectomy for metastatic cancer of the breast.

The transabdominal approach to adrenalectomy offers many advantages in the patient with metastatic cancer of the breast who is likely to respond to an ablative operation. Information derived in the course of laparotomy is important in planning for adjunctive chemotherapy, and oophorectomy can be carried out through the same incision when indicated. The vena cava can be plicated in patients who are considered to be at riak for thromboembolic phenomenom.

Adrenalectomy↗
PubMedDate not supplied

Lymphedema: current issues in research and management.

Lymphedema is a common and troublesome problem that can develop following breast cancer treatment. As with other quality-of-life and nonlethal conditions, it receives less research funding and attention than do many other areas of study. In 1998, an invited workshop sponsored by the American Cancer Society reviewed and evaluated the current state of knowledge about lymphedema. Recommendations and research initiatives proposed by the 60 international participants are presented in the conclusion section of the article, following a summary of current knowledge of the anatomy, physiology, detection, and current treatment of lymphedema. The etiology of lymphedema is multifaceted; all of the factors that contribute to the condition and the nature of their interaction have not yet been identified. To compound the problem, methods of assessing the degree of arm and hand swelling vary and are not agreed upon, and reliable methods of assessing the functional impact of lymphedema have not yet been developed. In the absence of a cure for lymphedema, precautions and prevention are emphasized. Current treatments include elevation, elastic garments, pneumatic compression pumps, and complete decongestive therapy; surgical and medical techniques remain controversial. Elements and details of these treatments are described.

American Cancer Society↗