Contribution of ploidy and cell kinetics from fine-needle aspirates for the diagnosis of breast lesions: study of 606 consecutive cases

Transcription and alternative splicing of telomerase reverse transcriptase in benign and malignant breast tumours and in adjacent mammary glandular tissues: implications for telomerase activity

Telomerase activity was determined in 15 breast cancers, 24 benign breast lesions, and 36 breast tissues adjacent to benign or malignant tumours. A positive TRAP (telomeric repeat amplification protocol) signal was detected in 67% of carcinomas and 29% of benign tumours. In five of ten cases, non-invaded breast tissues adjacent to telomerase-positive carcinomas also displayed telomerase activity. Conversely, in peritumoural specimens adjacent to benign lesions, telomerase activity was never detected. To investigate the regulatory mechanisms of telomerase activity in breast tissues, the expression of telomerase subunits was assessed, as well as the presence of alternatively spliced variants of human telomerase reverse transcriptase (hTERT). The presence of the hTERT full-length transcript appeared necessary for telomerase activity in breast carcinomas. Specifically, all telomerase-positive carcinomas expressed the hTERT full-length message, together with different combinations of alternatively spliced variants, whereas in telomerase-negative cancers, the hTERT full-length transcript was not detectable, or its abundance was markedly lower than that of alternatively spliced variants. Results obtained in benign tumours and normal tissues surrounding carcinomas instead showed that the presence of hTERT full-length transcript was not sufficient to determine telomerase activity. These findings suggest that in non-neoplastic tissues there are other mechanisms that suppress telomerase activity downstream from hTERT transcription and mRNA splicing and that such mechanisms have been lost during neoplastic transformation.

Flow cytometry in breast cancer: prognostic and surgical indications of the sparing of axillary lymph node dissection

The lymph node status is still regarded as the most important prognostic factor in breast cancer. However, the utility of axillary lymph node dissection in clinically node-negative patients with breast cancer as a therapeutic approach rather than a pathologic staging procedure has been recently discussed. DNA index (DI) and S-phase fraction (SPF), evaluated by flow cytometric analysis, are two prognostic factors used especially in the assessment of the adjuvant therapy in stage N0 tumors. By studying a large number of cases, the authors aimed to assess the potential role of flow cytometry in predicting lymph node status. Two hundred eleven patients with breast cancer were included. Each tumor specimen was freshly analyzed by flow cytometry to assess DI and SPF. The authors also evaluated TNM status of patients, estrogen- and progesterone-receptor (ER and Pgr) status, and histologic grades. A group of patients with negative axillary lymph nodes was identified by means of association of tumor size of 2 cm or less, DI of 1, and SPF less than 7%. The ER and PgR status as well as histologic grade were significantly more favorable in this group of patients. These findings indicate that association of DI, SPF value, and tumor size may be predictive of axillary lymph node status in breast cancer.