Direct measurement of sound velocity in various specimens of breast tissue

RATIONALE AND OBJECTIVES

Previous studies using ultrasound CT or clinical amplitude/velocity reconstruction imaging ultrasound may indicate that cancers differ from normal breast tissue by increased sound velocity. However, only limited experience with direct measurements of sound velocity exists. This study aimed to investigate sound velocity measured directly in a variety of breast specimens.

METHODS

Sound velocity was measured directly by forceps in fresh breast specimens chosen to contain one type of tissue only. Eighty specimens (31 cancers, 18 benign changes of glandular/fibrous tissue, 22 fatty tissues, 5 fibroadenomas, 2 compound tissues, 1 phylloides tumor, and 1 inflammation) were analyzed.

RESULTS

Ultrasound velocities in carcinoma, benign changes, fibroadenoma, inflammation, and the phylloides tumor were very similar, with almost complete overlap. In contrary, the ultrasound velocity of fatty tissue was significantly lower. Compound tissues containing fat had an intermediate sound velocity.

CONCLUSIONS

Sound velocity may add complementary information to echogenicity (B-scan). Because fat lobules exhibit low ultrasound velocity and carcinomas do not, a locally exact combination of ultrasound velocity information and reflexivity information should allow improved breast cancer detection by ultrasound.

Relaxin-like factor (RLF) is differentially expressed in the normal and neoplastic human mammary gland

BACKGROUND

Expression of relaxin-like factor (RLF), a member of the relaxin family, was studied in normal, benign, and malignant neoplastic human breast tissue.

METHODS

Reverse transcription polymerase chain reaction (RT-PCR) and nonradioactive in situ hybridization were employed to detect RLF transcripts. RLF epitopes were detected with a rabbit polyclonal antiserum generated against the putative receptor binding domain of human RLF. The RLF antiserum was characterized by Western blot analysis on human testicular and placental tissues, recombinant glutathione S-transferase-RLF fusion protein, and baculovirus-derived recombinant marmoset-RLF and marmoset-relaxin.

RESULTS

RT-PCR analysis revealed RLF amplicons in a cDNA library of normal human breast tissue and in malignant neoplastic breast tissue. RLF hybridization signals were localized exclusively in the tubuloalveolar and ductal breast epithelium but were absent in stromal cells. Benign breast disease displayed weaker RLF hybridization signals compared with normal tubuloalveolar breast tissue. Malignant transformation of breast epithelial tissues resulted in down-regulation of RLF gene expression. The weakest expression of RLF mRNA was observed in lymph node metastases of corresponding primary ductal carcinomas. Immunoreactive RLF was exclusively expressed in breast epithelial cells. Despite strong RLF hybridization signals, the tubuloalveolar epithelial cells of normal breast tissue displayed only very weak immunoreactive RLF. Benign breast disease showed clearly detectable levels of both RLF mRNA and immunoreactive protein. In contrast, epithelial cells in breast carcinoma and lymph node metastases displayed strong expression of immunoreactive RLF, although expression of RLF transcripts was weak.

CONCLUSIONS

Results demonstrated that transcriptional and posttranscriptional mechanisms affected human RLF gene expression in normal and neoplastic epithelial breast cells.

Ectopic lobular breast cancer of the vulva

BACKGROUND

Primary breast cancer of the vulvar region is a rare tumor entity. Only 12 cases have been published so far in the literature.

PATIENT AND METHODS

We report on a case of a 60-year old woman with an invasive lobular breast cancer localized to the vulva. The woman with elevated CA 15-3 and CEA markers underwent local wide excision of the tumor and bilateral inguinal lymphonodectomy, adjuvant anthracycline containing chemotherapy and locoregional irradiation including both inguinal regions and subsequent endocrine therapy with tamoxifen.

RESULTS

The resected specimen showed an estrogen receptor-positive diffuse infiltrating lobular breast cancer of the vulva with metastases in both groins. Original tissue of the breast adjacent to the malignant vulvar transformation was lacking. Imaging of the breast was lacking any pathology. Our patient has been followed up for 20 months without any signs of progressive disease.

CONCLUSION

Due to the rare occurrence, we are not able to give general guidelines for the treatment of ectopic breast cancer. However, adjustment of treatment to the therapeutic recommendations for orthotopic breast cancer seems reasonable and effective.

Significance of endovaginal ultrasonography in assessing tamoxifen-associated changes of the endometrium. A prospective study

BACKGROUND

A prospective study was conducted investigating the value of endovaginal ultrasound in the assessment of tamoxifen-associated changes of the endometrium in patients with breast cancer.

METHODS

Seventy postmenopausal patients with breast cancer treated with anti-estrogens for at least 6 months were entered. Those with bleeding disorders and/or an endometrial thickness of > or =10 mm found on ultrasonography underwent hysteroscopy and dilatation and curettage (D&C) for further histological evaluation. In 22 patients, positive ultrasound findings could be compared with histopathology.

RESULTS

82% of the 22 patients with positive sonographic findings had a glandular-cystic hyperplasia or a glandular-cystic polyp. No adenomatous hyperplasia or endometrial cancer was observed in our series.

CONCLUSION

Vaginal ultrasound represents a useful diagnostic tool to detect tamoxifen-associated changes of the endometrium. A threshold of 10 mm endometrial thickness appears suitable to identify endometrial abnormalities while reducing the rate of false-positive findings to an acceptable level. However, the role of vaginal ultrasound in screening for endometrial cancer or premalignant lesions remains uncertain.

[Estrogen and progesterone receptors of primary breast carcinoma and their axillary lymph node metastases--immunohistochemical investigations of routine formalin-fixed paraffin-embedded tissue]

OBJECTIVE

The estrogen- (ER) and progesterone receptors (PR) of 27 pre- and 33 postmenopausal primary breast carcinomas with 320 axillary lymphonodal metastases were investigated in formalin-fixed paraffin-embedded tissue.

MATERIAL AND METHODS

Special interest was devoted to the comparison of the receptor equipment between the axillary lymphonodal metastases and the appertained primary carcinoma. ER-antibody D5 and PR-antibody NCL-PGR were used for investigation.

RESULTS

ER-positive carcinomas of premenopausal women and ER-respectively PR-positive carcinomas of postmenopausal women corresponded significantly more frequent to receptor-positive lymphonodal metastases. Carcinomas with receptor-positive metastases were mostly ER-positive and PR-negative. About all receptor-positive metastases had the same combination of receptors. In cases of high numbers of lymphonodal metastases these were in general more often receptor-negative. Respectively, the receptor-positive metastases numbered lower than the receptor-negative. Immunohistochemical receptor-negative primary carcinomas can inherit receptor-positive lymphonodal metastases.

CONCLUSIONS

Immunohistochemical investigations render it possible to determine ERs and PRs not only in primary carcinomas but in lymphonodal metastases, too. Eventually the prognostic factors "ER" and "PR" will be used more often in the determination of therapeutic decisions.

[Direct in-vitro measurement of ultrasound velocity in carcinomas, mastopathic tissue, fatty tissue and fibroadenomas of the female breast]

PURPOSE

The study aimed to investigate ultrasound velocity (SV) in carcinomas, fibrocystic changes, fibroadenomas and fatty tissue of the female breast by means of direct in-vitro measurements. We intended to test whether or not differences in SV exist between the various types of tissue and whether the SV is a useful criterion to differentiate the different tissues.

METHOD

SV was measured by comparing transmission time of the ultrasound beam through the specimen and through water. Altogether 40 specimens (12 cancer, 14 fibrocystic changes = FCD, 10 fatty tissues, 3 fibroadenomas, and 1 mixed tissue) were analysed.

RESULTS

Velocity differed significantly between fat (1478.5 +/- 6.5 m/s) and tumor (1523.1 +/- 5.9 m/s) (p approximately 10(-11)) and between fat and FCD (1526.0 +/- 9.0 m/s) (p approximately 10(-12)). No significant differences and much overlap were seen between the ultrasound velocities of tumors and FCD. Ultrasound velocity in fibroadenomas (1533.2 +/- 3.8 m/s) was comparable with that in carcinomas and FCD.

CONCLUSIONS

We conclude that ultrasound velocity may add complementary information to echogenicity (B-scan). Thus, a locally exact correlation of echogenicity and sound velocity might allow for an improved tissue characterization.

MR-guided percutaneous excisional and incisional biopsy of breast lesions

The aim of this study was the realisation and clinical application of MR-guided vacuum biopsy for percutaneous excisional and incisional biopsy of enhancing breast lesions. A breast biopsy system and procedure have been developed which allow precise and safe access to breast lesions in any location and use of vacuum biopsy (VB) under MR guidance. Fifty-one patients with 55 MR-detected lesions were examined. Verification of these diagnoses included re-excision histology of all 14 malignancies and for benign lesions retrospective correlation of histology and imaging, assessment of complete or partial removal of the enhancing area directly after VB (40 of 40 lesions) and follow-up MRI (33 of 40 lesions), which in contrast to conventional needle biopsy can be used as proof of representative removal. Fifty-four of 55 procedures (including 15 lesions </= 5 mm and another 26 lesions of 5-10 mm size) were successful. One failure was caused by incorrect use of the VB gun. Vacuum biopsy yielded 14 malignancies and 40 benign lesions. With the available verification techniques all diagnoses proved correct. Percutaneous VB became possible under MR guidance. With minimal invasion it allowed increased certainty and accuracy even for very small lesions.

Relaxin-like factor expression in a human ovarian Sertoli-Leydig cell tumor

Relaxin-like factor (RLF), a new member of the insulin-like growth factor family, is a reliable marker for normal Leydig cells in the human postpubertal testis (1). Expression of the RLF gene appears to be developmentally regulated, given that only during puberty is RLF expression up-regulated. We recently demonstrated down-regulation of the human RLF gene in testicular Leydig cell tumors indicating dedifferentiation of the Leydig cells within the tumor (2). Ovarian Sertoli-Leydig cell tumors (SLCTs), histologically typed as androblastomas, are rare, potentially malignant sex-cord stromal tumors exhibiting testicular-like structure and differentiation of various degrees. In the present study, we investigated the expression of RLF, 17alpha-hydroxylase, 3beta-hydroxysteroid dehydrogenase (3beta-HSD), Ki-67, and cytokeratin 18 in a human ovarian SLCT of low differentiation.

Demyelination and axonal degeneration in corpus callosum assessed by analysis of transcallosally mediated inhibition in multiple sclerosis

OBJECTIVE

Following focal transcranial magnetic cortex stimulation (fTMS), inhibition of voluntary EMG activity in the ipsilateral first dorsal interosseus (FDI) muscle was studied, in order to assess the functional integrity of the corpus callosum in patients with multiple sclerosis (MS).

METHODS AND RESULTS

Thirty-four patients suffering from definite MS and 12 healthy, age-matched normal subjects were examined. In mid-sagittal slices, 29 patients showed lesions within the truncus corporis callosi in T2-weighted MRI. In 20 patients, all areas (anterior, middle and posterior parts), in one both the anterior and posterior part, in 3 exclusively the anterior, in 4 the middle and in one the posterior area were affected. In 5 patients, lesions of corpus callosum were lacking. In normal subjects, fTMS elicited a transient inhibition (TI) of preactivated (50% of maximal force) isometric voluntary ipsilateral FDI muscle activity. Mean onset latencies of TI were 35.5+/-5.4 ms in right and 36.1+/-4.2 ms in left FDI. Mean duration of TI amounted to 23.0+/-8.4 ms for right and 24.6+/-8.4 ms for left FDI. In the MS group, TI latencies were significantly increased in 23 and TI durations in 16 cases, whereas a lack of TI was found in 5 patients bilaterally and in 6 unilaterally. In patients, mean onset latencies of TI were 40.4+/-13.8 ms in right and 43.3+/-14.4 ms in left FDI, TI duration amounted to 30.5+/-17.4 ms for right and 31.0+/-25.2 ms for left FDI. Increase of onset latencies and durations of TI were positively correlated with the summed area of lesions of corpus callosum in representative mid-sagittal MRI slices. Significant correlations between TI onset latencies and duration on the one hand, and central motor conduction latencies along corticospinal tracts (CML) on the other hand, were not found.

CONCLUSION

The present investigation indicates that measurement of TI elicited by fTMS seems to be a sensitive method for an assessment of demyelination and axonal degeneration within corpus callosum in MS patients.

Borrelia burgdorferi central nervous system infection presenting as an organic schizophrenialike disorder

BACKGROUND

We report on a 42-year-old female patient who presented with a schizophreniform disorder and complete relief of symptoms after specific therapy.

METHODS

Cerebrospinal fluid and magnetic resonance imaging findings led to the diagnosis of Lyme disease.

RESULTS

To our knowledge this is the first reported case with an exclusive psychiatric manifestation of Lyme disease.

CONCLUSIONS

In case of first manifestation of psychotic disorder, although neurological symptoms are lacking, Lyme disease should be considered and be excluded by cerebrospinal fluid analysis.

[New methods for minimal invasive assessment of uncertain mammography and MRI tomography findings]

Results of 3 minimal invasive techniques for breast biopsy of clinically occult lesion are presented. 1. Mammographically guided Site-Select biopsies allow removal of tissue in one piece using a large diameter core biopsy instrument (similar to the ABBI-principle). However the overlying subcutaneous tissue is saved. No technical problems occurred in 13/13 diagnostic biopsies. Complete removal was, however, only possible in 2/4 tumors < 1 cm due to tissue shift during insertion of the instrument. 2. Mammographically guided vacuum biopsy also allows contiguous removal of areas of 1.2-1.8 cm diameter, while blood is suctioned out, as well. 3 stereotaxic miscalculations were immediately recognized. Diagnostic accuracy in 405 biopsies so far is 100%. The examination was very well tolerated by the patients. 3. By means of a specially developed biopsy coil and vacuum biopsy percutaneous in- or excisional biopsy of enhancing lesions visible by MRI alone has been realized by us for the first time. 24/25 diagnoses are definitely representative--as proven by lack of enhancement after biopsy. One diagnosis, which was uncertain due to overlying blood, is being followed. Minimal invasive methods may open up new perspectives.

Arylhydrocarbon receptor expression in the human endometrium

OBJECTIVE

To determine the expression and localization of the arylhydrocarbon (dioxin) receptor in human endometrium throughout the normal menstrual cycle.

DESIGN

Retrospective immunohistochemical and in situ hybridization study.

SETTING

Academic research unit.

PATIENT(S)

Premenopausal women (n = 86), aged 25 to 45 years, with histologically normal endometrium undergoing curettage or hysterectomy.

INTERVENTION(S)

Endometrial samples were collected from days 3 to 26 of the cycle by superficial scrapings of the uterine cavity or by hysterectomy.

MAIN OUTCOME MEASURE(S)

Expression of arylhydrocarbon receptor mRNA and protein.

RESULT(S)

Arylhydrocarbon receptor was expressed in 43% of the endometria studied and was correlated with the day of the cycle. The maximum of immunopositive endometria was found around the time of ovulation. Immunostaining decreased with increasing age of the patients. The receptor protein was localized exclusively in the apical part of the cytoplasm in the epithelial cells of the endometrial glands. In women positive for arylhydrocarbon receptor, arylhydrocarbon receptor mRNA was expressed in the cytoplasm of endometrial epithelial cells.

CONCLUSION(S)

Our results describe the expression of the arylhydrocarbon receptor in human endometrium and indicate a possible involvement of this transcription factor in endometrial function in women during the reproductive phase.

Retrospective analysis for evaluation of the value of contrast-enhanced MRI in patients treated with breast conservative therapy

PURPOSE

The aim of this study was to assess the value of contrast-enhanced (c.-e.) MRI in the follow-up of patients with conservatively treated breast cancer since detection and exclusion of malignancy may interfere significantly with posttherapeutic changes within the treated breast.

MATERIAL AND METHODS

A total of 207 patients with a history of limited surgery and radiation therapy underwent MR imaging, 40 patients were examined 0-12 months and 167 patients were examined later than 12 months after radiotherapy. Suspicious or indeterminate findings were suggested by clinical examination or conventional imaging in 80 studies. In 127 women, MRI was performed within breast tissue that was difficult to assess due to scarring or dense breast tissue.

RESULTS

Recurrent carcinoma was confirmed in 27 patients by surgical biopsy. All 27 carcinomas, except for one with a slow signal increase, demonstrated early rise of signal intensity on dynamic T1-weighted contrast enhanced images. During the first year after therapy, the diagnostic accuracy could not be improved by additional use of c.-e. MRI. Differentiation between posttherapeutic changes and recurrent carcinoma was frequently not possible because of strong and sometimes early and ill-circumscribed enhancement. Later than 12 months after therapy enhancement decreased significantly, thus the false positive calls could be reduced from 49 (conventional imaging) to 12 (conventional imaging plus MRI). A total of 12 of 26 recurrences and multifocality in 4/5 cases were diagnosed by MR imaging alone at this time interval.

CONCLUSION

In the first year after therapy, c.-e. MRI is only indicated in selected cases. The results later than 12 months emphasize that c.-e. MRI may contribute significant additional information. It allows better distinction of posttherapeutic fibrosis from recurrent carcinoma and proved to be able to detect recurrent disease more sensitive and at an earlier stage.

Minimally invasive stereotaxic vacuum core breast biopsy

The purpose of our study was the assessment of the diagnostic value of vacuum core biopsy, which promises high accuracy by minimally invasive percutaneous excision of 1-2 cm3 of tissue. The materials used were a digital stereotaxic biopsy table (Fischer Imaging) and a Mammotome-gun (Biopsys). A total of 236 patients with 261 predominantly indeterminate lesions (indeterminate: 230; suspicious: 26; malignant: 5) underwent vacuum core biopsy (VCB). Verification was as follows: (a) demonstration of complete or partial removal of the lesion or replacement of the lesion by a small hematoma by comparison of the pre- and post-VCB mammogram; (b) reexcision of 45 malignant and 6 borderline lesions; (c) radiologic-histologic correlation; and (d) 6-month-follow-up mammograms in 129 cases. Two VCBs were not possible because very fine microcalcifications could not be visualized. Two puncture errors occurred which, however, were immediately recognized and VCB was repeated. Based on the above verification a 100 % accuracy was achieved. No relevant side effects occurred. Except for 2 cases mammographically hardly any scarring was visible. Based on the excellent accuracy and excellent tolerance of the procedure VCB appears to be the future method of choice for the workup of those indeterminate mammographically detected lesions that up to now have still required surgical biopsy.

[Preoperative axilla sonography in breast tumor suspected of malignancy--a diagnostic advantage?]

PURPOSE

To assess the value of preoperative axillary sonography possibly malignant for breast tumours.

METHOD

We performed preoperative axillary sonography on 89 patients with suspicious breast tumours. In 78 cases, among which there were 74 invasive carcinomas, the surgery that followed included an axillary lymph node dissection and a comparison with the histology was possible.

RESULTS

The sonographic detection of axillary lymph node metastases has a sensitivity of 90% and a specificity of 91.7% in relation to all tumour stages and a sensitivity of 100% and specificity of 89.6% in relation to T1 tumours. In our analysis, therefore, it is vastly superior to a clinical examination of the axilla.

CONCLUSION

Ultrasonography is an accurate imaging method for the diagnosis of axillary lymph node metastases. Broadening this analysis to include more patients will validate this conclusion. The results of our preliminary study suggest that this diagnostic method could help reduce unnecessary radical surgery in the treatment of breast cancer.

[Vacuum punch biopsy under digital stereotaxic control, a new procedure in percutaneous diagnostic incision and excision biopsy of mammographic findings: initial experience]

PURPOSE

To evaluate a digital, stereotactically controlled vacuum punch biopsy method.

MATERIAL AND METHOD

In 60/61 female patients a vacuum punch biopsy (14 G) was performed under digital stereotactic control; by means of a single biopsy 1-2 cm3 of tissue was obtained. In one patient the examination could not be carried out because of insufficient microcalcification. Excision biopsies were performed because of doubtful microcalcification (24), focal lesions (35) or abnormal tissue architecture (1).

RESULTS

48 of the biopsies proved benign, 2 showed dysplasias, 5 in situ and 5 invasive carcinomas. In all cases the histological and radiological diagnoses were in agreement. The possibility of a non-presentative biopsy could be excluded with a high degree of certainty because of the accurate localisation and the coherent tissue samples; this produced significant increase in diagnostic certainty. Subsequent haematomas seen mammographically (58/60) are smaller (1-1.5 cm) than for conventional percutaneous punch biopsies because of the effect of suction. The examination was well tolerated (there were no significant haematomas and no infection). Problems consisted of one case of bleeding (due to little experience) and one incorrect localisation which was immediately recognised.

DISCUSSION

If the high degree of accuracy, which is expected, can be confirmed, the procedure would appear suitable for replacing diagnostic operative biopsies of non-characteristic mammographic finding.

[Value of contrast medium magnetic resonance tomography of the breast in breast reconstruction with implant]

Early recognition of recurrence and work-up of clinically indeterminate lesions may be impaired after reconstruction with silicone implants due to superimposition of the implant or to scarring. This study was undertaken to evaluate the use of contrast-enhanced MRI in patients with silicone implant after breast cancer. Contrast-enhanced MRI was offered to 169 patients. Comparative two- to three-view mammography was also performed in 169 patients, as well as comparative sonography in 144 patients. Conventional imaging and clinical examination detected only 8/13 recurrences, whereas 12/13 were detected by MRI. One recurrence had been visible as a strongly enhancing 2-mm dot in a previous examination (2 years before), but was not called. It was therefore counted as false negative. In addition, multicentricity was detected by MRI alone in two of three cases. MRI correctly diagnosed scar tissue in all cases with indeterminate findings. However, due to false-positive calls caused by enhancing granulomas specificity could not be improved. Contrast-enhanced MRI allowed decisive additional information in our study group and improved the sensitivity significantly (concerning all diagnoses). Contrast-enhanced MRI is recommended in patients with diagnostic problems or high risk of recurrence after silicone implants.

[Vacuum punch biopsy of the breast with a stereotaxic guide. A new procedure for percutaneous diagnostic biopsy based on 120 cases]

PURPOSE

To test the capabilities of vacuum core biopsy (VCB) in the diagnosis of mammographically indeterminate lesions.

MATERIALS AND METHODS

120 patients (131 lesions) were examined using VCB with 14G or 11G vacuum core.

RESULTS

VCB was mostly performed because of indeterminate microcalcifications (67 cases) or soft tissue densities/architectural distortion (64 cases). 112 benign changes, 14 DCIS and 5 invasive carcinomas were found. Excellent accuracy was achieved (presently 100%), since complete excision of small lesions/areas (< or = 1 cm) or partial excision of larger lesions was possible. No relevant hematomas or infections occurred. Patients tolerated the painless procedure very well.

DISCUSSION

This report confirms our previous experiences. This method promises to replace diagnostic open biopsy of indeterminate or suspicious nonpalpable lesions.

[Relatives of psychotic patients: effect of group discussions and group education]

Forty relatives of young psychotic patients participated in psychoeducative groups for eight sessions and filled in questionnaires at the first and the last session. They were questioned about user satisfaction, degree of strain, knowledge, attitude and behaviour in relation to mental illness, and the emotional climate in the family. The emotional climate in the family was investigated by means of the Family Questionnaire and divided in subscales, measuring criticism and over-involvement. The relatives had experienced strain in relation to the patient's behaviour. Aggression, unpredictability, dependence/helplessness were factors which the relatives felt most straining. The relatives' burden of care had consequences in economy, private life and working life. The relatives complained of lack of continuity in the treatment of the patient. Information about the condition, diagnosis and prognosis of the patient was criticized for being unsatisfactory, too vague or too scarce. After the psychoeducative group sessions, both criticism and over-involvement tended to fall (non-significant). The relatives were very satisfied with the group sessions. It is concluded that psychoeducative group sessions with relatives of psychotic patients are effective in influencing the emotional climate in the families in a desirable way. Better cooperation between psychiatric department/community mental health care centre, patient and relative can increase compliance with medical treatment and increase the relatives' ability to handle problems related to the patient's disease.

[Steroid receptors in the gestagen treatment of endometriosis]

In 35 patients with laparoscopically proved endometriosis we determined the cytosolic estrogen and progesterone receptor content in endometrial samples before and after a 3-month course of progestagen treatment (DCC method). Dienogest was given in 20 cases, norethisterone in an other group of 15 patients. Compared with a normal group the receptor content was clearly higher in endometriosis patients. It correlated closely to the histological findings dated according to Noyes. In more than 60% of the pretherapeutic cycles there were some signs of disturbed differentiation. After 3 month of therapy the binding capacity of steroid receptors significantly decreased, particularly in norethisterone patients. Both clinical results and receptor conditions correspond to previous investigations concerning the competition behaviour, having confirmed different binding affinity to the receptor for the two gestagens here tested.

[Microinvasive stage Ia cancer of the uterine cervix--results of a multicenter clinic based analysis]

A retrospective multicentre study to investigate diagnosis, treatment and end results of treatment of cervical cancer stage Ia, was carried out in 6 departments of gynaecological oncology. After reclassification by a reference pathologist, among the 936 cervical cancer cases primarily diagnosed and treated as stage Ia between 1970 and 1980, only 530 (56.6%) met the criteria of microinvasive cancer stage Ia. Misclassifications concerned all participating centres with statistically significant differences amongst them. Overdiagnosis (reference diagnosis only CIN I-III, 42.5%) was more frequent than underdiagnosis (reference diagnosis stage Ib--0.9%). In comparison to 1970-74, in the period 1975-80 a significant increase of cases detected asymptomatically (86.5%) was observed. The percentage of cases primarily diagnosed by cone biopsy, also increased significantly and amounted to 71.2%. Patients with cervical cancer stage Ia were most frequently treated by surgery alone (93.2%). Radiotherapy alone did not play any important role (5.7%). There were only a few cases treated by combined surgery and radiotherapy (5.7%) with a decreasing trend over time. Women under the age of 45 years were significantly more frequently treated by the conservative method (cone biopsy, simple hysterectomy) than older ones, without any significant relation between depth of invasion and radicality of treatment. A total of 19 (14 local, 5 lymph node) recurrences were diagnosed between 9 and 110 months after primary treatment. Local recurrences could be observed more frequently after limited than extended treatment. There was no significant relation between depth of invasion and frequency of recurrences, but the latter were significantly increased in cases with histologically proven invasion of blood or lymph vessels.(ABSTRACT TRUNCATED AT 250 WORDS)