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PubMed1984

Usefulness of mammography in the diagnosis and management of breast disease in postmenopausal women.

We evaluated the clinical usefulness of mammography in postmenopausal women by conducting a "vertical" analysis using indexes of sensitivity and specificity, and a separate "horizontal" analysis assessing the relationship between the mammographic test result and the occurrence of specific clinical management decisions. The patients included 105 women with breast cancer, 104 women with fibrocystic breast disease, and 103 women with clinically benign breasts. Our study confirmed the generally accepted high values reported for the sensitivity and for the specificity of mammography as a test for breast cancer, while also helping to reconcile the widely varying indexes of test efficacy reported in some studies. We also observed that physicians' management decisions vary according to the mammographic interpretation, and include such distinctive clinical strategies as watchful expectancy (observe and follow), repeated mammograms, or breast biopsy. Future studies will need to determine reasons for specific management decisions, especially when they appear to contradict authoritative recommendations.

Breast Neoplasms↗
PubMedDate not supplied

Subclassification of benign breast disease by fine needle aspiration cytology. Comparison of cytologic and histologic findings in 265 palpable breast masses.

The cytologic and histologic features of 265 benign breast masses were analyzed in order to examine the ability of fine needle aspiration cytology to accurately subclassify benign breast lesions. Two hundred two of the masses were pure histologic examples of benign breast lesions (72 nonproliferative fibrocystic change, 27 proliferative fibrocystic change, 65 fibroadenoma, 12 abscess, 8 fat necrosis, 7 papilloma, 7 duct ectasia, 2 tubular adenoma, 1 sclerosing adenosis, 1 microglandular adenosis), and 63 masses were mixed lesions. Part I of the study consisted of retrospective comparison of the original cytologic diagnoses with the histologic diagnoses. A nonspecific descriptive diagnosis had been rendered in 135 of 265 (51%) cases, and these descriptive diagnoses corresponded to fibrocystic change in the majority of cases (70%). A specific benign cytologic diagnosis had been made in 130 of 265 (49%) cases, and overall the specific diagnosis was correct in 80% of cases. Part II of the study consisted of the semiquantitative scoring of the cytologic findings of the 202 pure examples of benign breast masses and statistical analysis of differences in the expression of cytologic features between the different types of lesions. Overall cellularity, amount of bipolar stripped nuclei, amount and architectural arrangement of epithelium, epithelial atypia/pleomorphism/nuclear overlapping and amount of apocrine metaplasia, foam cells and stroma were the cytologic parameters that were statistically significant (P < .05) in distinguishing between the cases of fibroadenoma, abscess, papilloma, fat necrosis, duct ectasia and fibrocystic change as a group. No cytologic parameter reached statistical significance in distinguishing between proliferative and nonproliferative fibrocystic change. We conclude that the majority of benign breast lesions yield characteristic cytologic findings that allow their subclassification when sufficiently sampled by fine needle aspiration. The distinction between proliferative and nonproliferative fibrocystic change is less reliable, and cytologic differences observed within this spectrum did not reach statistical significance.

Biopsy, Needle↗
PubMed1987

The effect of decreased caffeine consumption on benign proliferative breast disease: a randomized clinical trial.

A single-blind, randomized clinical trial of 56 female subjects was conducted to determine whether decreased consumption of caffeine decreases breast pain/tenderness or nodularity in patients with suspected benign proliferative breast disease. The subjects were randomly assigned to one of three groups--a control group (no dietary restrictions), a placebo group (cholesterol-free diet), and an experimental group (caffeine-free diet). At the initial examination, the subjects reported on the presence of breast pain, the degree to which pain affects daily activities, the frequency of pain, the degree of pain associated with breast examinations, and the degree of pain associated with close-fitting clothing. Subjects were then examined and the four quadrants of each breast were rated on a scale of 0 to 3 (0 = normal, fatty tissue, 1 = little seedy bumps or fine nodularity, 2 = discrete nodules or ropy tissue, 3 = confluent areas, hard or soft masses). Subjects in all three groups returned for 2- and 4-month follow-up examinations. Total nodularity scores, degree of pain/tenderness, and compliance with dietary restrictions were analyzed. The data showed that decreased caffeine consumption did not result in a significant reduction of palpable breast nodules or in a lessening of breast pain/tenderness.

Adult↗
PubMedDate not supplied

A clinico-radiological correlation of breast diseases during lactation and the significance of unilateral failure of lactation.

Over a period of three and a half years, 58 patients who for various reasons had both ultrasonography and mammography during lactation were analyzed to identify and correlate breast diseases, if any, with the clinical symptomatology. The clinical symptoms were breast pain, mass and/or unilateral failure of lactation. Twenty-one (21) out of 58 (36%) had abnormal findings. The commonest was galactocele (N = 9) which usually presented with breast pain and a mass. Unilateral failure of lactation and in particular refusal of the infant to suckle (infant rejection sign) was associated with breast lesions such as malignancy (N = 4), breast abscess (N = 2) and infected galactocele (N = 2). Mammographically, the affected breast showed a significantly reduced ductal pattern as well as significant pathology such as a mass. Symptomatic patient with bilateral successful lactation had benign breast lesions such as simple galactocele and fibroadenoma. Unilateral failure of lactation in a symptomatic breast may signal serious breast pathology during lactation and a thorough radiological evaluation including core biopsy of solid lesions and mammography is therefore suggested. Patients with breast pain and or mass but with bilateral normal lactation tend to have benign breast changes and ultrasound alone was adequate in evaluating these patients.

Adult↗
PubMed1996

Breast-duct endoscopy to study stages of cancerous breast disease.

BACKGROUND: In breast-cancer research, we lack reproducible non-invasive access to breast tissue. Breast cancer is thought to start in the lining of the milk duct or lobule. We have had no direct access to this area other than in tissue removed surgically or by fine-needle aspiration. Our objective was to explore an intraductal approach to studying breast cancer and precancerous changes by duct cannulation and endoscopy. METHODS: In this pilot study, women in a university hospital were asked to participate. Nine patients with previously diagnosed ductal carcinoma-in-situ (DCIS) or invasive breast cancer who were about to undergo mastectomy under general anaesthesia agreed. After the patient was asleep but before the operation, we spent 15 minutes cannulating their ducts, obtaining washings, and attempting endoscopy. The ducts that had been cannulated were marked by instillation of dye or other materials, the nipple was sutured shut, and the mastectomy proceeded as planned. The mastectomy specimen underwent extensive histopathological examination. FINDINGS: We were successful in intraductal cannulation and endoscopy in seven of the nine patients. In five of the nine, we obtained epithelial cells in the washings. In one the cells were consistent with proliferative disease, in three there was atypical epithelium, and in one there was frank DCIS. With several different contrast materials injected into separate duct orifices, DCIS was confined to a single duct system. INTERPRETATION: We found that the intraductal approach is feasible for the study of the early changes of breast cancer Technical difficulties include identification of the breast duct orifices, determining the distensibility of the duct, and developing a reliable technique to obtain washings.

Anesthesia, General↗
PubMed1989

Prolactin secretion and dehydroepiandrosterone sulphate plasma levels in women with benign breast disease.

The purpose of the present investigation was to verify possible positive correlations between prolactin secretion and dehydroepiandrosterone sulphate levels in plasma of women with benign breast disease. Prolactin secretion was evaluated in terms of basal levels, maximum peak, percent increase above baseline levels, total integrated area, response area after TRH stimulation. No correlation was found between the parameters of prolactin secretion and dehydroepiandrosterone sulphate levels.

Adult↗
PubMedDate not supplied

[Preoperative psychopharmacological correction in women with focal breast diseases].

The paper presents the results of a study dealing with the choice of an agent to correct the psychoemotional state in women with dyshormonal focal breast diseases (DFBD). The correction involved dimedrol, valerian extract, Novopassite, diazepam, phenazepam, amitryptiline, coaxil, grandaxine, alprozam (Xanax), or atarax. To assess the results, clinical, psychopathological, clinicopsychological, anamnestic, and experimental psychological studies were used. The use of alprozam and atarax yielded the best results of correcting the psychoemotional state in women with DFBD, by producing minimum adverse reactions.

Adult↗
PubMed1999

Breast disease in adolescents and young women.

Breast lesions, including mastalgia; benign proliferative changes; and benign masses, including fibroadenomas, are common in adolescents and young adult women. Breast cancer is rare in women less than 20 years old and uncommon in women less than 30 years old. Discrete masses in women less than 30 years old that do not feel suspicious on examination can be observed for 1 or 2 months. If they persist, than an FNA can differentiate those that are benign and can be observed versus those that need either an excisional biopsy or definitive surgery. Mammography has little role in the diagnosis of women less than 30 years old except in those individuals with highly suspicious lesions on examination.

Adolescent↗
PubMed2004

[Clinical evaluation of three methods of fine-needle aspiration, large-core needle biopsy and frozen section biopsy with focus staining for non-palpable breast disease].

BACKGROUND & OBJECTIVE: Early detection of breast cancer is crucial to improve the therapeutic effect and to increase the survival rate. However, it is difficult because breast cancer in early stage was usually occult, impalpable, and could not be detected by laboratory test. This study was designed to compare the effectiveness of three methods for diagnosis of non-palpable breast cancer. METHODS: Twenty-four patients with impalpable breast mass suggested by computer-aided stereotactic mammography were performed with three kinds of methods, including fine-needle aspiration cytology (FNAC), large-core needle biopsy (LCNB), and frozen section biopsy (FSB) with focus staining. The results were compared with postoperative pathology. RESULTS: Compared with postoperative pathology results, the diagnostic consistent rates of FNAC, LCNB and FSB with staining focus were 75%, 92%, and 100%, respectively (P< 0.05). CONCLUSION: Frozen section with focus staining guided by computer-aided stereotactic mammography was the effective diagnostic technique for non-palpable breast cancer.

Adult↗
PubMedDate not supplied

Mammary carcinoma with osteoclastlike giant cells cytologically mimicking benign breast disease. A case report.

BACKGROUND: Mammary carcinoma with osteoclastlike giant cells (OCLGCs) is a rare tumor. Few reports on the fine needle aspiration (FNA) findings are available. This case had cytologic findings overlapping with benign breast disease. CASE: A 50-year-old woman presented with multiple masses in her right breast and a 2-cm right axillary lymph node. Cytologic scrapings and FNA of the same breast mass showed large cohesive, two-dimensional epithelial cells with a uniform distribution of small, bland nuclei. Discohesion, single cells with features of malignancy, cytologic atypia and mitosis were lacking. Many OCLGCs were present. CONCLUSION: The cytologic features of this rare type of breast carcinoma need to become familiar to pathologists to avoid a false negative diagnosis.

Biopsy, Needle↗
PubMed1986

[Morphometric analysis of fibrocystic breast disease].

We used the automated microscopic image analysis (system "Robotron A 6471"; software AMBA/R) to study the ductal epithelium in biopsies from 88 patients with fibrocystic breast disease, including 52 with proliferative mastopathy. Significant differences were demonstrated using reproducible data and selective caryo- and histometric parameters which allowed the separation of ductal hyperplasia and ductal cell proliferation with atypia. In addition, multiparameter analysis indicated that cases with proliferative mastopathy III can be separated into two groups which have probably a different high risk with respect to carcinoma.

Adult↗
PubMedDate not supplied

Combined tamoxifen-lynestrenol treatment in benign breast disease.

In order to avoid secondary induction of estrogens caused by tamoxifen treatment, tamoxifen was associated with the progestative lynestrenol in 48 menstrual women with benign breast disease (adenoma or fibroadenoma, cystic, simple or complex dysplasia). In one variant tamoxifen dosage was 20 mg (2 tablets) daily taken orally from day 5 to day 25 of the menstrual cycle, associated with 10 mg (2 tablets) of lynestrenol daily, only during the last 15 days. In another variant the above mentioned drugs were given concomitantly from day 10 to 15 of the cycle (according to cycle length) for 10 days. The average duration of the treatment was 4 cycles. The results are analysed according to surface percentage reduction of the main and associated lesions within the same case. In all cases of simple dysplasia, in 78% of the cases with complex dysplasia and in 54% of the adenomas, the lesions decreased to less than half their initial size, and in some instances the lesions disappeared altogether and the breasts became normally soft. Breast pain was improved or disappeared altogether in 96% of the cases. Despite its positive results the associated treatment used should be applied only in certain cases, especially those diagnozed as complex dysplasia and only in those medical units that have adequate diagnosis and treatment follow-up facilities.

Adenofibroma↗
PubMed1991

Immunohistochemical analysis of estrogen and progesterone receptors in benign breast diseases.

Surgical specimens of 62 patients with fibrocystic disease, 39 with fibroadenoma and 11 with intraductal papilloma were evaluated with ER-ICA and PgR-ICA methods. Positive nuclear staining was only observed in the epithelial components. The myoepithelium, myofibroblasts, fibroblasts and the so called apocrine epithelium, however, did not contain steroid receptors. Some steroid receptor negative cases occurred among the atrophic and non-proliferating fibrocystic diseases. In the proliferating benign alterations, particularly in those considered preneoplastic, e.g. radial scar, ductal and lobular atypical epithelioses, such as carcinoma lobulare in situ and florid intraductal papilloma there was a positive staining for estrogen receptor and progesterone receptor in the epithelial cells. Authors' results seem to serve as a theoretical basis for the hormonal influence of precarcinomatous cases and to explain the success of antisteroid therapy in patients with fibrocystic disease.

Adenofibroma↗
PubMed1999

[Valoration of the epidermal growth factor receptor (EGFR) in benign breast disease and its relation with expression in malignant tumors classified by hormonal dependence].

The aim of this work is studying the behaviour of EGFR in benign breast pathologies and correlating it to its expression in CDI with hormonal dependency or independency using a radioligand technique. The EGFR expression was higher in FAD rather than in MFQ (mean +/- S.D.: 13.7 +/- 13.5; range: 1.0-55.3; median: 10.0 fmol/mg prot vs mean +/- S.D.: 4.0 +/- 3.5; range:1.0-11.4; median: 2.2 fmol/mg prot), with a result of a positive correlation in the first ones with RP (r = 0.4557) but not with RE. FAD present similar EGFR concentrations to those in CDI-hormonal independents (mean +/- S.D.: 10.7 +/- 12.6; range: 1.0-60.2; median: 6.75 fmol/mg prot), even though the way they are correlated with the content in RP leads us to the conclusion that they are both involved in the genesis and controled development of themselves. On the other hand, MFQ have got similar contents in EGFR to those of CDI hormono-dependents (mean +/- S.D.: 6.98 +/- 15.72; range: 1.0-118; median: 2.55 fmol/mg prot); this fact proves that the development of this pathology does not only depend on the growth factors but also on the hormonal environment which influences it.

Adolescent↗
PubMed1996

MCF10AT: a model for the evolution of cancer from proliferative breast disease.

A human cell line (MCF10A) originated from spontaneous immortalization of breast epithelial cells obtained from a patient with fibrocystic disease. MCF10A cells do not survive in vivo in immunodeficient mice. However, T24 c-Ha-ras oncogene-transfected MCF10A cells (MCF10AT) form small nodules in nude/beige mice that persist for at least 1 year and sporadically progress to carcinomas. By reestablishing cells in tissue culture from one of the carcinomas, a cell line designated MCF10AT1 was derived that forms simple ducts when transplanted in Matrigel into immunodeficient mice. With time in vivo, the epithelium becomes proliferative and a cribriform pattern develops within the xenografts. A significant number progress to lesions resembling atypical hyperplasia and carcinoma in situ in women, and approximately 25% progress to invasive carcinomas with various types of differentiation including glandular, squamous, and undifferentiated. Cells have been established in culture from lesions representing successive transplant generations. With each generation, cells are somewhat more likely to progress to high risk lesions resembling human proliferative breast disease. Although the incidence of invasive carcinoma remained fairly constant at 20 to 25%, the frequency of nodules showing proliferative breast disease rose from 23% in the first transplant generation to 56% in the fourth transplant generation.

Animals↗
PubMedDate not supplied

Breast disease: the radiologist's expanding role.

The role of the diagnostic radiologist in breast cancer has expanded during the eight-decade history of breast imaging. The radiologist's role now encompasses both breast cancer diagnosis and treatment. This article traces the expansion of the radiologist's role through the history of mammography. The current roles of the radiologist in breast cancer diagnosis are discussed, including screening mammography in the asymptomatic patient, problem-solving breast imaging, breast ultrasound, and galactography. The radiologist's roles in breast cancer treatment that are discussed include preoperative needle localization, percutaneous breast biopsy, and evaluation of the postoperative breast.

Biopsy, Needle↗