Biomedical subjects

R V Hutter

Publications and source records attributed to R V Hutter.

At least 55 records · Page 3Linked to original sources

PubMed1984

Pathological parameters useful in predicting prognosis for patients with breast cancer.

The pathologist has critically important responsibilities as a consultant in the management of patients with breast cancer. The clinical evaluation of the anatomic extent of cancer before treatment, the clinical-diagnostic stage, crudely estimates whether the cancer is localized to the breast, or whether there are regional or distant metastases. The pathologist establishes the diagnosis of cancer microscopically in a biopsy and reports the significant characteristics which can be used in the selection of therapy. The pathologist's additional gross and microscopic examinations after mastectomy, which more precisely document the anatomic extent of the cancer, are the basis of the postsurgical treatment-pathologic stage and provide additional information used to estimate prognosis and determine whether adjunctive therapy is needed. The pathology information used in staging includes the tumor size, histologic type, histologic grade, and presence or absence of axillary of other metastases. These and other pathological factors of significance which are discussed include the gross contour of the tumor as well as the presence or absence of necrosis, and any of the spectrum of cancers that we categorize as "minimal breast cancer" (in situ lobular carcinoma, intraductal carcinoma, invasive carcinoma smaller than 0.5 cm). Furthermore, the prognostic implications of the various histologic types are considered, as well as histologic and cytologic differentiation (grade), multicentricity, vascular invasion, cellular infiltration, and various other factors such as mucin or lipid production, steroid hormone receptors, and the nature of the tumor bed. The presence or absence of axillary lymph node metastases remains the single most significant variable in estimating prognosis for most breast cancers. In addition, combinations of the parameters noted above may have greater prognostic significance than any considered individually. Therefore, the pathologist, through the routine examination and documentation of breast biopsies and mastectomies, can provide important information which can be used to aid in the selection of treatment and in the estimation of prognosis.

Breast↗

PubMed1984

Epidemiology of minimal breast cancer among women screened in New York City.

A case-control study based on a screened population in New York City examined epidemiologic risk factor differences between minimal breast cancer (in situ and small invasive carcinomas) and all other breast carcinomas, referred to as clinical breast cancer. Histopathologic re-review of the original slides identified 113 minimal and 792 clinical breast cancers among 1,290 eligible cases; 2,173 randomly selected screenees served as controls. Among those who developed cancer, black women were twice as likely to develop minimal, as compared to clinical, breast cancer. Women who were less than 20 years of age at first live birth had more than double the probability of being diagnosed with minimal breast cancer, whereas women with first live birth at age 30 years or greater and nulliparous women were at 1.5 times the risk of clinical breast cancer. The relative proportion of minimal breast cancer increased with increasing number of children breast fed, being twofold among women who nursed 2 children or more. Unlike clinical breast cancer, minimal breast cancer was not associated with either family history of breast cancer or obesity. Meaningful histologic differences were not apparent between the case subgroups. Except possibly for obesity, these results could not be explained by any plausible diagnostic bias.

Adult↗

PubMed1981

Is cured early cancer truly cancer?

Is cured early cancer truly cancer? is a question that characterizes th dilemma created by pathologists who diagnose cancer while it is still microscopic. This question may be asked by those who hold the diagnosis of cancer valid if the individual patient succumbs, and may even accept a reduction in the mortality rate as a result of therapy; but the ultimate obviation of all deaths by therapeutic interdiction impugns the diagnosis. Both experimental and clinical data can help to explicate the rationale for the answer to the question. In experimental systems of neoplastically transformed cells, fully committed cancer cells are readily characterized biochemically, physiologically, and morphologically; and these cellular observations are the foundation for our understanding of the biology of cancer. We know that biologic neoplastic transformation can precede morphologic evidence of the change and that morphologic evidence of transformation does not always forbode inevitable lethal progression. Human in situ and minimal carcinoma are the earliest microscopic evidences of highly curable cancer. The spectrum considered also includes clinically indolent cancers which may be locally invasive but ordinarily have a low lethal potential, and those hopelessly disseminated cancers which spontaneously regress. Should these latter not be considered real cancers because they did not kill? The relative risk for fatal termination generally increases as the cancer becomes more clinically obvious. Although the minute microscopic cancers have a lethal potential, there is much still to be learned about the probability of their progression. The pathologist and therapist must ascertain and integrate all available data and make their best estimate of the clinical significance of the microscopic findings, giving due consideration to whether therapy is indicated, the extent of therapy required, the potential for physical and psychological disability, and cost. This information should be presented to and discussed with the patient, who must then decide, with the physician(s), what is best in these particular circumstances.

Cell Transformation, Neoplastic↗

PubMed1981

Indurative mastopathy: a benign sclerosing lesion of breast with elastosis which may simulate carcinoma.

Five cases of a benign sclerosing lesion of breast are described. The lesion is characterized by a stellate, indurated zone of sclerosis and elastosis in a region of benign ductal proliferation. Because of the stellate configuration and frequently retracted cut surface, the lesion may grossly resemble scirrhous carcinoma. Microscopically, there is often entrapment of benign but distorted ducts at the sclerotic margin, which may further cause confusion with cancer. Of special interest is the radiographic appearance, which may be indistinguishable from scirrhous carcinoma. The term "indurative mastopathy" is a descriptively valid designation for these lesions.

Adenocarcinoma, Scirrhous↗

PubMed1981

The surgical pathologist as a diagnostician and consultant.

The primary role of the surgical pathologist is to diagnose, and then to transmit this information effectively so that it can be used to guide patient management; therefore, the dual roles of the surgical pathologist as a diagnostician and consultant are inextricable. The diagnostic pathologist determines the nature, extent, and rate of disease processes as well as response to therapy or the effects of medication, on the basis of morphologic observations. This presentation reviews some historic aspects of the evolution of surgical pathology, and its projected status in the medical community. The paradoxical (mis)concept of the pathologist with his microscope and slide, in vacuo, devoid of pertinent clinical data, as a pristine expression of objectivity is discusses and compared with the real world in which veracity is a proper surrogate for blind objectivity. The molding of the scientific method with the art of clinical practice by the pathologist is also considered.

Breast Neoplasms↗

PubMed1980

The influence of pathologic factors on breast cancer management.

The pathologist routinely provides to the therapist data which are used in the management of breast cancer patients. Clinical as well as gross and microscopic examination provides information used for staging and treatment selection. Biologic neoplasia precedes the usual morphologic and cytologic changes that characterize precancer and in situ carcinoma to the pathologist. Minimal breast cancer, including in situ carcinoma and small (0.5 cm) infiltrating cancers, is now a recognized entity separable from clinical cancer, although therapy is not yet uniform. The pathologist can routinely report the gross size and contour of the cancer; microscopic evaluation of the primary cancer adds information on the histologic type, differentiation (histologic or cytologic grade), and such other data as blood vessel invasion and cellular infiltration. One of the most useful bits of information is the status of axillary lymph nodes: whether or not there are metastases, the number of nodes with metastases, and whether they are micrometastases or macrometastases that extend through the capsule and involve pericapsular vessels. All of these data can be recorded routinely and are useful in developing management criteria. The pathologist, as any other consultant, reports to the attending physician who then uses these data with all other pertinent facts to formulate an individualized therapeutic program.

Blood Vessels↗

PubMed1979

Video intercom: O.R. consultation and frozen section with screen display of gross and microscopic findings.

Seldom does the pathologist at Saint Barnabas Medical Center, Livingston, NJ, enter the operating room to consult with the operating surgeon. Instead, consultation takes place via an audio-intercommunication system supplemented by video. In this article, the authors explain how and when the system is used, the equipment needed, and the benefits to be derived by pathology residents.

Education, Medical↗

PubMed1977

Survival distribution in breast cancer.

It has been stated that breast cancer survival rates follow an exponential distribution. This would mean that the mortality rate is constant. Survival distribution was analyzed by the clinical life table method in one series of 10,752 patients and in another of 656 patients followed up to 8 and 18 years, respectively. Part of the larger series' table is (table: see text). Necessarily, clinical survival data are censored progressively. These kinds of data are analyzed best by examining the hazard function, which is the instantaneous death rate, or force of mortality. If an exponential distribution described survival in breast cancer correctly, the hazard function would be constant. These data clearly are not consistent with an exponential distribution, as the hazard function decreases. The survival distribution calculated from these data shows that the chance of dying of cancer decreases the longer a patient survives. This is more optimistic and consistent with clinical experience than is the exponential distribution.

Breast Neoplasms↗

PubMed1974