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PubMed2001

[Magnetic resonance imaging in the diagnosis of breast diseases].

Authors report about the role of contrast medium enhanced magnetic resonance imaging in diagnosis of breast diseases, and experiences with this method. The aim of the study was to determine the diagnostic accuracy of the method. The results was correlated with the histopathological findings, and compared to the diagnostic accuracy of the conventional X-ray mammography in breast lesions. X-ray and MR-mammography were evaluated in 220 patients (238 breasts) scheduled for breast surgery. The breasts were examined with T1-weighted transversal images using contrast medium enhanced semidynamic technique with 3D fast low angle shot (FLASH) sequence. Each breast was given a routine examination with 3 mammographic views. Contrast enhanced MR-mammography is a highly sensitive method for the detection of breast cancer, it has a higher diagnostic accuracy (84.5%), than conventional X-ray mammography (82.4%). When MRI and conventional X-ray mammography were used together, very high sensitivity but a lower diagnostic accuracy (81.5%) was achieved. MRI was effective in revealing mammographically equivocal or occult lesions and multifocal tumors even in dense breasts, but it was less reliable for some invasive lobular cancers, non-invasive ductal carcinomas, fibroadenomas and hyperplastic breast changes. Presently accepted indications for MRI of the breast are: (1) patients with breast implants--to demonstrate prothesis complications and tumor relapses; (2) postoperative imaging in patients after tumorectomy and radiation therapy--in these cases MRI allows differentiation between tumor relapses and extensive scars; (3) proven axillary lymph node metastasis from an unknown primary carcinoma; (4) preoperative MR imaging in cases suspected or verified carcinomas within dense breasts to exclude multicentricity/multifocality; (5) follow-up in chemotherapy of breast cancer; (6) patients with high-risk constellation.

Breast↗

PubMed1985

Older women's attitudes towards breast disease, self examination, and screening facilities: implications for communication.

Qualitative research techniques were used in two studies in Edinburgh to explore older women's attitudes and motivations towards breast disease, self examination, and screening, with a view to identifying appropriate strategies for communication. The results indicated that knowledge of breast disease and screening facilities was poor and that many psychological and emotional issues inhibited self examination. Increasing information about self examination and clinics is unlikely to influence uptake unless it is presented together with emotional support rather than through conventional mass media channels. Such support may best be provided by setting breast screening within general health screening rather than emphasising the single disease.

Adult↗

PubMed1983

Risk factors relevant to cystic breast disease: a case-control study.

A total of 188 women aged 40-54 with cystic breast disease and 2213 asymptomatic controls were questioned in Edinburgh between 1974 and 1978 concerning marital, reproductive, and menstrual status, history of oral contraception use, history of previous breast complaints, and a family history of breast cancer. Women with a history of breast biopsy were at an increased risk of the disease and those past the menopause were at a decreased risk. These results agree with previous findings that the disease is most prevalent among premenopausal women and suggest that benign cystic disease of the breast does not share a common aetiology with breast cancer in the age range 40-54.

Adult↗

PubMed2003

Proliferative breast disease: epidemiologic aspects, and cytologic diagnosis.

PURPOSE: The aim of the present study is to describe the prevalence of proliferative breast lesions in cases of benign and malignant tumors of the breast as well as to assess the contribution of rapid intraoperative imprint cytology in the diagnosis of proliferative breast disease. METHODS: Frozen section and intraoperative imprint cytology were performed on breast tissue biopsies from 486 breast cancer patients who underwent primary surgical treatment. Imprints were stained either by the Papanicolaou (Pap) or the May Grünwald-Giemsa (MGG) or the Hematoxylin eosin (HE) technique. Cytologic diagnoses were compared to the histopathologic ones from paraffin sections. RESULTS: Sclerosing adenosis was the most common finding in benign breast biopsies while in breast cancer the prevalence of the lesion was reduced by half. On the other hand, atypical hyperplasias in malignant biopsies were almost twice as many as in benign ones. Imprint cytology presented high sensitivity and specificity (99% and 96% respectively) in distinguishing benign proliferative from malignant lesions as a whole, but regarding atypical hyperplasias the specificity was significantly reduced (76% vs 96%). CONCLUSION: Clarification of cytologic diagnostic criteria and expertise in cytologic interpretation could show off intraoperative imprint cytology as a useful and inexpensive diagnostic tool providing the surgeon with prompt and accurate information regarding the nature of breast lesions.

Breast Diseases↗

PubMed1985

Serum steroid binding proteins and the bioavailability of estradiol in relation to breast diseases.

Serum concentrations of sex hormone binding globulin (SHBG), corticosteroid binding globulin (CBG), and albumin were found to be normal in women with breast cancer (Ca), with benign breast disease (BBD), or with a family history of breast cancer (FHCa). Comparisons between serum steroid binding capacities and immunoassayable SHBG and CBG concentrations did not reveal abnormal forms of either protein. The serum distribution of estradiol (E2) was also determined, and women with Ca were found to have a significantly (P less than .025) higher mean percentage of non-protein-bound E2 than matched controls, but the difference was very small. In general, women with Ca also had proportionately more (P less than .05) albumin-bound E2 and less (P less than .05) SHBG-bound E2 in their sera than the controls, but the serum distributions of E2 in the BBD and FHCa subjects were the same as in controls. The dissociation rates of 5 alpha-dihydrotestosterone and E2 from SHBG in serum appear to increase with time in frozen serum samples, and this factor may effect measurements of the distribution of these steroids in serum.

Aged↗

PubMedDate not supplied

A cooperative approach to decision support in the differential diagnosis of breast disease.

The problem of differential diagnosis in breast histopathology is described and areas in need of decision support identified. It is argued that the conventional role played by decision support systems, i.e. that of the 'autonomous problem-solver', is unacceptable in this domain and that support must be given to the actual cognitive functions of potential system users. Decision-making processes of pathologists are examined with particular reference to Rector's category of 'broad experts'. Pathologists possess a rich set of general diagnostic concepts for their domain, but their knowledge of detailed aspects of differential diagnosis may contain gaps and errors. A cooperative model of decision support, which utilizes the strengths and complements the weaknesses of pathologists' problem-solving skills, is described and the operation of this model within a functioning system illustrated.

Artificial Intelligence↗

PubMed1976

Fine-needle aspiration cytopathology in breast disease.

The cytopathology of benign and malignant breast lesions is described and correlated with the histopathology. Problems in diagnosis and the advantages of fine-needle aspiration are discussed. The diagnostic accuracy is approximately 93% with this technique.

Adenofibroma↗

PubMedDate not supplied

Serum prolactin levels in women with gross cystic breast disease.

Serum prolactin (PRL) concentrations at baseline and after TRH stimulation were determined in 15 healthy women and in 51 premenopausal patients suffering from Gross Cystic Breast Disease. All women were in the luteal phase of the menstrual cycle and patients were divided into three groups according to cyst type at presentation. Basal hormone levels were within the normal range in the control group and in the three cystic breast disease groups. The maximum PRL response to TRH stimulation was significantly higher (p < 0.001) in patients with type I cysts (low Na+/K+ intracystic ratio and apocrine epithelium) than in patients with type II cysts (high Na+/K+ intracystic ratio and flattened epithelium), type III cysts (intermediate Na+/K+ intracystic ratio and mixed epithelium) and in normal women. Serum PRL concentrations corresponding to samples obtained 60 and 90 minutes after stimulation remained higher in the first group of patients. These results led us to consider the existence of an altered central regulation of PRL secretion in patients with type I cysts at presentation.

Adult↗

PubMed1987

Fine needle aspiration cytology in breast disease management--a 4 year experience.

At the Queen Victoria Medical Centre between 1981 and 1984, 2920 fine needle aspirates of the breast were examined with an overall diagnostic accuracy of 97% and a sensitivity of 80%. This high diagnostic accuracy combined with the ease and complication-free nature of the procedure has meant that fine needle aspiration (FNA) has become an important part of the investigation and management of breast disease within the breast service of the Queen Victoria Medical Centre.

Australia↗

PubMed1990

Breast cancer among women from Gothenburg with regard to age, mortality and coexisting benign breast disease or leiomyoma uteri.

The entire female population of Gothenburg, aged 20 years or above as of November, 1969 (n = 162,449), was studied for virtually all inpatient hospital admissions in 1970-1979 with breast cancer (n = 2,411). After the vital status as of December, 1984 had been traced, cases of fetal (n = 1,502) and of nonfatal (n = 909) breast cancer were separated. A search for coexisting benign breast disease and leiomyoma uteri yielded significant recordings of disease association exclusively with nonfatal breast cancer.

Adult↗

PubMed1979

Caffeine, cyclic nucleotides, and breast disease.

Methylxanthine consumption is associated with the development of fibrocystic disease of the breast. Methylxanthine abstention is associated with resolution of signs and symptoms of fibrocystic disease. Abstinence from methylxanthine consumption decreased breast biopsies and the need for major breast surgery because of benign disease. Methylxanthine consumption is associated with elevated cyclic adenosine monophosphate (AMP) and cyclic guanosine monophosphate (GMP) values in fibrocystic dsiease over those obtained in normal breast tissue.

Adenosine Monophosphate↗

PubMed1991

[Oral contraception and benign breast diseases: point of view of the epidemiologist].

The study of the association between oral contraceptives (OC) and benign breast disease (BBD) is of great interest for the epidemiologist, because of the impact that this association may have on the risk of breast cancer. In fact, three factors have to be analysed simultaneously: OC use, the occurrence of BBD and the occurrence of breast cancer. This analysis is complex because two out of the three factors are not univocal in their definition (various composition and doses for pills, numerous histologic types of BBD). Moreover, a fourth parameter is to take into account: the time factor. This last factor intervenes in the chronological order of events (OC before or after BBD), and for the use of different types of pills (duration of use, age at the start of OC use before or after the first full-term pregnancy, etc). Although all the relationships between these different factors are still insufficiently known at the present time, certain points are acquired: 1) OC use decreases the risk of BBD (particularly when pills contain high doses of progestogens); 2) a history of BBD increases the risk of breast cancer (particularly when BBD is a fibrocystic mastosis with cellular atypia); 3) in spite of the decrease in the risk of BBD associated with OC use, OC use does not decrease the risk of breast cancer. For a long time, this third proposition appeared as paradoxal. In 1986, Stadel and Schlesselman tried to estimate the terms of this paradoxe. Their estimations allowed to show that the risk of breast cancer associated with OC use, for women with a history of BBD, was overestimated in all previous reports. Indeed, the decrease of the occurrence of BBD due to OC use, which was associated with an important reduction in the number of breast cancer cases, was not taken into account in the estimation of this risk. Other epidemiological investigations with a greater number of subjects are needed to further analyse complex relationships between OC use, BBD and breast cancer.

Breast Diseases↗

PubMed1976

On the significance of nipple discharge in the diagnosis of breast disease.

Nipple discharge, especially the blood-stained type, is regarded as an important symptom in breast disease. In many reports the high incidence of malignancy is stressed and an active surgical approach has often been recommended. In this series of 80 women with nipple discharge the type of secretion and the result of exfoliative cytology were evaluated. Three women had cancer but the nipple discharge was important for the diagnosis in only one case. Six women had papilloma and in all the nipple discharge was essential for the diagnosis. Fibroadenosis and duct ectasia were the most common diagnoses. The blood-stained secretion was due to fibroadenosis in about half of the cases. No cancer was found in 46 women with a serous secretion. When a tumour is present nipple discharge is of little importance for the diagnosis and treatment. In the absence of a tumour and when exfoliative cytology gives no suspicion of cancer and no atypical cells or papillomatous clusters are present, an expectant attitude towards surgery seems satisfactory. With such an approach many surgical biopsies prove unnecessary, but a prerequisite is an organized follow-up.

Adolescent↗

PubMed1993

Immunocytochemical identification of cell types in benign and malignant breast diseases: variations in cell markers accompany the malignant state.

We performed immunocytochemical staining of benign, in situ, and malignant breast disease to identify antigens related to the presence of the major parenchymal cell types of the normal breast. Markers for the epithelial cells, antiserum to epithelial membrane antigen, and three monoclonal antibodies (MAb) to milk-fat globule membranes stained most of the inner cells in benign breast lesions, carcinoma in situ, and invasive carcinomas, but the peripheral cells in benign lesions, as well as in carcinoma in situ, were unstained. MAb to epithelium-specific keratin 18 stained the majority of inner cells in benign breast lesions but comparatively fewer such cells in carcinoma in situ and invasive carcinoma. Markers for the myoepithelial cells, antisera, and MAb to smooth muscle actin and vimentin stained most of the peripheral cells in benign breast lesions and in carcinoma in situ but failed to stain virtually any neoplastic cells in invasive carcinomas. Markers for the basement membrane adjacent to the myoepithelial cells, antiserum, and MAb to laminin and Type IV collagen delineated an intact basement membrane around benign lesions and carcinoma in situ, and fragmented structures in 5-10% of invasive carcinomas; the remaining carcinomas were largely unstained. Markers for both myoepithelial and epithelial cells, keratin MAb PKK2 and LP34, stained most of the inner cells in benign lesions but usually only relatively few malignant cells in carcinoma in situ and invasive carcinomas. Markers for the secretory alveolar cell, MAb to beta- and kappa-casein, stained a few isolated cells in benign lesions, many more inner cells in two such lesions in pregnant females, and none in invasive carcinomas. In conclusion, the myoepithelial cell and, under suitable hormonal conditions, the secretory alveolar cell, are retained in most benign lesions, but they are largely lost in invasive carcinomas.

Adolescent↗

PubMed1995

One-stop diagnosis for symptomatic breast disease.

A consultant-led one-stop diagnostic service has been available at a busy symptomatic breast clinic each week at St Bartholomew's Hospital for 18 months. Women can be investigated appropriately using mammography, ultrasonography and cytology with immediate reporting. The aim is to achieve a diagnosis and management plan for each patient at the initial outpatient visit. A prospective audit of four consecutive clinics was undertaken to assess the impact of this service on clinical practice. Fifty patients out of 134 new and 386 follow-up clinic attenders had one-stop investigations. As a result of immediate reporting, 48 (96%) patients had a management decision made at the first outpatient visit, 9 (18%) were offered surgery, and 18 (36%) were discharged with a benign diagnosis and no dominant mass. Four symptomatic cancers were detected and evaluated on a one-stop basis, constituting 8% of the workload of this clinic. The mean wait from designated appointment until surgical consultation was 37.7 min (range -68-171 min) and that for investigation until subsequent clinical review was 56.9 min (range -4-191 min). Thirty-six (72%) one-stop patients had a total wait of less than 2 h and 95% were seen in under 3 h. It is felt that the one-stop clinic allows optimum patient management, minimises anxiety associated with symptomatic breast disease, and maximises utilisation of hospital outpatient resources.

Adult↗

PubMed1987

Psychological interactions for women with breast disease.

At the outset, the concept of team care was suggested not as a panacea but perhaps as a better approach to acquiring help in areas of expertise not held by the physician. There are tools to help ascertain psychosocial information from patients, and there are agencies that would be willing to conduct psychosocial work-ups for physicians and teach these significant psychosocial concepts. There are many innovative and creative group practices that now employ their own behavioral personnel to assist in a humanistic evaluation of the patient. Recently, Boyd demonstrated through her research projects how one might want to consider approaching women with patient education and treatment of breast disease. The inventory she uses to ascertain both mental and physical characteristics that might place a woman at risk for breast disease is superb and highly recommended. Another paradigm to consider would be Bartlett's "Behavioral Diagnosis," a practical approach to patient education. These are but two of countless others one might want to consider. And finally, the "Cancer Inventory of Problem Situations" can also be a very useful tool. This is only a cursory view of the complexities one encounters when attempting to understand women, how and why they behave the way they do, how they respond to the health care system, what some of their influences are, and what we must all do together to help them help themselves and us, to provide them with a longer, more productive, rewarding and healthy life span. We have addressed patient education and how physicians might want to embark upon a sound enlightenment program for their patients by enhancing their communication skills and paying strict attention to the patient's psychosocial history as well as their own psychosocial orientation.

Breast Diseases↗

PubMed1988

Hormonal profile in benign breast disease. Endocrine status of cyclical mastalgia patients.

Plasma levels of prolactin, before and after TRH stimulation, progesterone, estradiol, sex-hormone-binding-globulin, androstenedione, testosterone and dehydroepiandrosterone-sulphate were determined in a group of women with benign breast disease and in control group, in order to correlate a possible hormonal disorder to breast pathology. The hormonal pattern in the patients with benign breast disease was characterized by an increased responsiveness of lactotrophes to TRH stimulation and by higher levels of sex hormone binding globulin, probably sustained by an underlying hyperestrogenism.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Estrogen replacement therapy and fibrocystic breast disease.

In a hospital-based case-control study conducted in New Haven, Connecticut, women experiencing estrogen replacement therapy were found to be at twice the risk of nonusers for histologically confirmed fibrocystic breast disease (odds ratio = 2; 95 percent confidence limits = 1-3.9) if their menopause was natural. No excess risk was found for women experiencing a surgical menopause. The highest risk for fibrocystic disease was observed for women with more than three years of estrogen replacement therapy. When therapy occurred was not significantly related to the risk of disease once duration of use was controlled for. These results suggest an etiologic role of estrogen replacement therapy in the development or promotion of fibrocystic breast disease.

Adult↗