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Santos ROMD, Assis MD, Dias MBK, Tomazelli JG. [Risk of false-positive result in mammography screening in Brazil]. CAD SAUDE PUBLICA 2023; 39:e00117922. [PMID: 37255192 PMCID: PMC10641911 DOI: 10.1590/0102-311xpt117922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 06/01/2023] Open
Abstract
False-positive results on mammography screening are common, putting a burden on both women and the health care system. This study aimed to estimate the risk of false-positive results in Brazilian mammography screening based on data from the Brazilian Unified National Health System (SUS) information systems. A retrospective cohort study was conducted with women aged 40-69 years, who underwent mammography screening and breast histopathological examination at SUS from 2017 to 2019. The rate of false-positive results was estimated based on the prevalence of altered BI-RADS results on mammography screening and the proportion of benign results on breast histopathological examination. Of the 10,671 women with histopathological examination at SUS, 46.2% had a benign result, and this proportion was significantly higher in women aged 40-49 years compared to women aged 50-69 years. The estimate of false-positive results was 8.18 cases per 100 women aged 40-49 years and 6.06 per 100 women aged 50-69 years. This information is useful for public managers in evaluating mammography screening programs, as well as for health care providers to guide women on the implications of mammography screening.
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Affiliation(s)
| | - Mônica de Assis
- Coordenação de Prevenção e Vigilância, Instituto Nacional de Câncer, Rio de Janeiro, Brasil
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2
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Hirschfeld M, Ge I, Rücker G, Waldschmidt J, Mayer S, Jäger M, Voigt M, Kammerer B, Nöthling C, Berner K, Weiss D, Asberger J, Erbes T. Mutually distinguishing microRNA signatures of breast, ovarian and endometrial cancers in vitro. Mol Med Rep 2020; 22:4048-4060. [PMID: 33000259 DOI: 10.3892/mmr.2020.11466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/06/2020] [Indexed: 11/05/2022] Open
Abstract
Early diagnosis and therapy in the first stages of a malignant disease is the most crucial factor for successful cancer treatment and recovery. Currently, there is a high demand for novel diagnostic tools that indicate neoplasms in the first or pre‑malignant stages. MicroRNAs (miRNA or miR) are small non‑coding RNAs that may act as oncogenes and downregulate tumor‑suppressor genes. The detection and mutual discrimination of the three common female malignant neoplasia types breast (BC), ovarian (OC) and endometrial cancer (EC) could be enabled by identification of tumor entity‑specific miRNA expression differences. In the present study, the relative expression levels of 25 BC, EC and OC‑related miRNAs were assessed by reverse transcription‑quantitative PCR and determined using the 2‑ΔΔCq method for normalization against the mean of four housekeeping genes. Expression levels of all miRNAs were analyzed by regression against cell line as a factor. An expression level‑based discrimination between BC and OC cell types was obtained for a subgroup of ten different miRNA types. miR‑30 family genes, as well as three other miRNAs, were found to be uniformly upregulated in OC cells compared with BC cells. BC and EC cells could be distinguished by the expression profiles of six specific miRNAs. In addition, four miRNAs were differentially expressed between EC and OC cells. In conclusion, miRNAs were identified as a potential novel tool to detect and mutually discriminate between BC, OC and EC. Based on a subset of 25 clinically relevant human miRNA types, the present study could significantly discriminate between these three female cancer types by means of their expression levels. For further verification and validation of miRNA‑based biomarker expression signatures that enable valuable tumor detection and characterization in routine screening or potential therapy monitoring, additional and extended in vitro analyses, followed by translational studies utilizing patients' tissue and liquid biopsy materials, are required.
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Affiliation(s)
- Marc Hirschfeld
- Department of Gynecology and Obstetrics, Faculty of Medicine and Medical Center, University of Freiburg, D‑79106 Freiburg, Germany
| | - Isabel Ge
- Department of Gynecology and Obstetrics, Faculty of Medicine and Medical Center, University of Freiburg, D‑79106 Freiburg, Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, D‑79104 Freiburg, Germany
| | - Julia Waldschmidt
- Department of Gynecology and Obstetrics, Faculty of Medicine and Medical Center, University of Freiburg, D‑79106 Freiburg, Germany
| | - Sebastian Mayer
- Department of Gynecology and Obstetrics, Faculty of Medicine and Medical Center, University of Freiburg, D‑79106 Freiburg, Germany
| | - Markus Jäger
- Department of Gynecology and Obstetrics, Faculty of Medicine and Medical Center, University of Freiburg, D‑79106 Freiburg, Germany
| | - Matthias Voigt
- Praxis of Plastic and Aesthetic Surgery and Evangelian Deaconry Hospital, D‑79110 Freiburg, Germany
| | - Bernd Kammerer
- Center for Biological Systems Analysis, University of Freiburg, D‑79104 Freiburg, Germany
| | - Claudia Nöthling
- Department of Gynecology and Obstetrics, Faculty of Medicine and Medical Center, University of Freiburg, D‑79106 Freiburg, Germany
| | - Kai Berner
- Department of Gynecology and Obstetrics, Faculty of Medicine and Medical Center, University of Freiburg, D‑79106 Freiburg, Germany
| | - Daniela Weiss
- Department of Gynecology and Obstetrics, Faculty of Medicine and Medical Center, University of Freiburg, D‑79106 Freiburg, Germany
| | - Jasmin Asberger
- Department of Gynecology and Obstetrics, Faculty of Medicine and Medical Center, University of Freiburg, D‑79106 Freiburg, Germany
| | - Thalia Erbes
- Department of Gynecology and Obstetrics, Faculty of Medicine and Medical Center, University of Freiburg, D‑79106 Freiburg, Germany
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3
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Wan ZB, Gao HY, Wei L, Zhang AQ, Zhang JY, Wang Y, Wang DD, Zhang Y. Expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki-67 in ductal carcinoma in situ (DCIS) and DCIS with microinvasion. Medicine (Baltimore) 2018; 97:e13055. [PMID: 30383678 PMCID: PMC6221707 DOI: 10.1097/md.0000000000013055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) represents a heterogeneous disease in its histologic appearance and biological potential. Some women treated for DCIS subsequently develop invasive breast cancer. DCIS with microinvasion is considered as the interim stage in the progression from DCIS to invasive breast cancer. Analysis of the differences between DCIS and DCIS with microinvasion may aid in understanding the characteristic of DCIS with microinvasion and identifying biological factors determining progression of DCIS to invasive disease.Retrospective analysis of 219 cases between 2012 and 2018 was performed in our institution. The pathological results and axillary lymph nodes status were collected. Analysis of the expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 in pure DCIS (164 cases), and DCIS with microinvasion (55 cases) using immunohistochemistry.DCIS with microinvasion had a higher nuclear grade (P < .001) and was more likely to have sentinel lymph node biopsy (SLNB) positivity (P = .039) than DCIS. Expression of ER, PR were significantly higher in DCIS compared with DCIS with microinvasion (P < .001, P < .001). While the expression of HER-2 in DCIS with microinvasion (56.4%) was significantly higher than in DCIS (36.6%, P = .01). Furthermore, DCIS with microinvasion was significantly more likely to have aggressive subtype (Triple-negative and HER2-enriched tumors, P = .005).Our results indicated that DCIS with microinvasion was different from pure DCIS in clinicopathologic characteristics and molecular alterations. It displayed a more aggressive biological nature than pure DCIS. It may be a distinct entity.
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Affiliation(s)
- Zhi-Bin Wan
- Department of Pathology, Guangdong Women and Children Hospital of Guangzhou Medical University
| | - Hong-Yi Gao
- Department of Pathology, Guangdong Women and Children Hospital
| | - Lian Wei
- School of Public Health, Guangzhou Medical University
| | - An-Qin Zhang
- Breast Disease Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Jiang-Yu Zhang
- Department of Pathology, Guangdong Women and Children Hospital
| | - Yi Wang
- Department of Pathology, Guangdong Women and Children Hospital
| | - Dong-Dong Wang
- Department of Pathology, Guangdong Women and Children Hospital
| | - Yan Zhang
- Department of Pathology, Guangdong Women and Children Hospital
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4
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Wunderle M, Olmes G, Nabieva N, Häberle L, Jud SM, Hein A, Rauh C, Hack CC, Erber R, Ekici AB, Hoyer J, Vasileiou G, Kraus C, Reis A, Hartmann A, Schulz-Wendtland R, Lux MP, Beckmann MW, Fasching PA. Risk, Prediction and Prevention of Hereditary Breast Cancer - Large-Scale Genomic Studies in Times of Big and Smart Data. Geburtshilfe Frauenheilkd 2018; 78:481-492. [PMID: 29880983 PMCID: PMC5986564 DOI: 10.1055/a-0603-4350] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 12/24/2022] Open
Abstract
Over the last two decades genetic testing for mutations in
BRCA1
and
BRCA2
has become standard of care for women and men who are at familial risk for breast or ovarian cancer. Currently, genetic testing more often also includes so-called panel genes, which are assumed to be moderate-risk genes for breast cancer. Recently, new large-scale studies provided more information about the risk estimation of those genes. The utilization of information on panel genes with regard to their association with the individual breast cancer risk might become part of future clinical practice. Furthermore, large efforts have been made to understand the influence of common genetic variants with a low impact on breast cancer risk. For this purpose, almost 450 000 individuals have been genotyped for almost 500 000 genetic variants in the OncoArray project. Based on first results it can be assumed that – together with previously identified common variants – more than 170 breast cancer risk single nucleotide polymorphisms can explain up to 18% of familial breast cancer risk. The knowledge about genetic and non-genetic risk factors and its implementation in clinical practice could especially be of use for individualized prevention. This includes an individualized risk prediction as well as the individualized selection of screening methods regarding imaging and possible lifestyle interventions. The aim of this review is to summarize the most recent developments in this area and to provide an overview on breast cancer risk genes, risk prediction models and their utilization for the individual patient.
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Affiliation(s)
- Marius Wunderle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Gregor Olmes
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Naiba Nabieva
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Claudia Rauh
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ramona Erber
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Juliane Hoyer
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Georgia Vasileiou
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Cornelia Kraus
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - André Reis
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Institute of Diagnostic Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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5
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Puharić Z, Žulec M, Ceronja I, Parun AŠ. High Participation Rate in Mammography Screening: Experience from Croatia. Cent Eur J Public Health 2018; 25:303-306. [PMID: 29346854 DOI: 10.21101/cejph.a4684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of the study was to analyse the results of three cycles of mammography screening (MS) in the Croatian National Programme (CNP) for Early Breast Cancer Detection for women aged 50–69 years in the Bjelovar-Bilogora County (BBC) from 2006–2014. METHODS Data on women aged 50–69 screened during a 9-year period were obtained from the Croatian Cancer Registry and Institute of Public Health reports. Participation rate and performance indicators were examined. RESULTS The total of 57,428 women were invited to mammography screening in BBC during a 9-year period and 31,402 mammograms in total were performed. The response rate of 84% in BBC was consistently higher than the national average of about 60% reported in 2007, 2013 and 2014. CONCLUSION The National Programme in BBC has been carried out continuously for nine years with a higher response rate compared with the national average, as a result of additional efforts of the Croatian Institute of Public Health team, as well as good cooperation among all programme stakeholders. It was concluded that to achieve better results in the response of women to screening and consequently reduced mortality from breast cancer is possible through tailored health promotion activities.
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Affiliation(s)
- Zrinka Puharić
- Study of Nursing, Technical College in Bjelovar, Bjelovar, Croatia
| | - Mirna Žulec
- Study of Nursing, Technical College in Bjelovar, Bjelovar, Croatia
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6
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Wilm J, Schüler-Toprak S, Ortmann O. Krebsfrüherkennung des Zervix- und des Mammakarzinoms. DER PATHOLOGE 2016; 37:477-89. [DOI: 10.1007/s00292-016-0228-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Schulz-Wendtland R, Fasching PA, Bani MR, Lux MP, Jud S, Rauh C, Bayer C, Wachter DL, Hartmann A, Beckmann MW, Uder M, Loehberg CR. Touch Imprint Cytology and Stereotactically-Guided Core Needle Biopsy of Suspicious Breast Lesions: 15-Year Follow-up. Geburtshilfe Frauenheilkd 2016; 76:59-64. [PMID: 26855442 DOI: 10.1055/s-0041-110395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Introduction: Stereotactically-guided core needle biopsies (CNB) of breast tumours allow histological examination of the tumour without surgery. Touch imprint cytology (TIC) of CNB promises to be useful in providing same-day diagnosis for counselling purposes and for planning future surgery. Having addressed the issue of accuracy of immediate microscopic evaluation of TIC, we wanted to re-examine the usefulness of this procedure in light of the present health care climate of cost containment by incorporating the surgical 15-year follow-up data and outcome. Patients and Methods: From January until December 1996 we performed TIC in core needle biopsies of 173 breast tumours in 169 patients, consisting of 122 malignant and 51 benign tumours. Histology of core needle biopsies was proven by surgical histology in all malignant and in 5 benign tumours. Surgical breast biopsy was not performed in 46 patients with 46 benign lesions, as the histological result from the core needle biopsy and the result of the TIC were in agreement with the suspected diagnosis from the complementary breast diagnostics. A 15-year follow-up of these patients followed in 2013 and follow-up data was collected from 40 women. Results: In the 15-year follow-up of the 40 benign lesions primarily confirmed using CNB and TIC, a diagnostic sensitivity, specificity, positive and negative predictive value and accuracy of 100 % was found. Conclusion: TIC and stereotactically guided CNB showed excellent long-term follow-up in patients with benign breast lesions. The use of TIC to complement CNB can therefore provide immediate cytological diagnosis of breast lesions.
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Affiliation(s)
- R Schulz-Wendtland
- Department of Gyn. Radiology, Institute of Diagnostic Radiology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - M R Bani
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - M P Lux
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - S Jud
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - C Rauh
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - C Bayer
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - D L Wachter
- Institute of Pathology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - A Hartmann
- Institute of Pathology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - M Uder
- Institute of Diagnostic Radiology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - C R Loehberg
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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8
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Grischke EM, Röhm C, Hahn M, Helms G, Brucker S, Wallwiener D. ICG Fluorescence Technique for the Detection of Sentinel Lymph Nodes in Breast Cancer: Results of a Prospective Open-label Clinical Trial. Geburtshilfe Frauenheilkd 2015; 75:935-940. [PMID: 26500370 PMCID: PMC4596694 DOI: 10.1055/s-0035-1557905] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022] Open
Abstract
Introduction: Detection of sentinel lymph nodes (SLN) is the standard procedure to evaluate axillary lymph node status in breast cancer. In addition to known and established procedures such as the blue dye method and scintigraphy, this study investigated the efficacy of a method based on use of the fluorescent dye indocyanine green (ICG). Patients and Method: A total of 126 women with breast cancer histologically verified by punch biopsy were studied during surgical removal of SLN. In addition to SLN marking with technetium and scintigraphy, intra-individual comparison was done using indocyanine green (ICG) for marking instead of the standard blue dye. Results: Scintigraphy had a detection rate of 96 %; the detection rate with ICG was just under 89 %. A body mass index (BMI) > 40 was found to be a limiting factor for the fluorescent method. Investigation into potential toxicities associated with the use of the fluorescent dye ICG revealed no systemic or even local side effects. The fluorescent method was found to be significantly less expensive than the scintigraphy method. Conclusion: The ICG fluorescence technique for the detection of SLN was found to be a valid and feasible method in clinical practice when compared directly with the blue dye method and scintigraphy.
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Affiliation(s)
| | - C. Röhm
- Universitäts-Frauenklinik Tübingen, Tübingen
| | - M. Hahn
- Universitäts-Frauenklinik Tübingen, Tübingen
| | - G. Helms
- Universitäts-Frauenklinik Tübingen, Tübingen
| | - S. Brucker
- Universitäts-Frauenklinik Tübingen, Tübingen
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9
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Schulz-Wendtland R, Dankerl P, Dilbat G, Bani M, Fasching PA, Heusinger K, Lux MP, Loehberg CR, Jud SM, Rauh C, Bayer CM, Beckmann MW, Wachter DL, Uder M, Meier-Meitinger M, Brehm B. Comparison of Sonography versus Digital Breast Tomosynthesis to Locate Intramammary Marker Clips. Geburtshilfe Frauenheilkd 2015; 75:72-76. [PMID: 25684789 DOI: 10.1055/s-0034-1396164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/08/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022] Open
Abstract
Introduction: This study aimed to compare the accuracy of sonography versus digital breast tomosynthesis to locate intramammary marker clips placed under ultrasound guidance. Patients and Methods: Fifty patients with suspicion of breast cancer (lesion diameter less than 2 cm [cT1]) had ultrasound-guided core needle biopsy with placement of a marker clip in the center of the tumor. Intramammary marker clips were subsequently located with both sonography and digital breast tomosynthesis. Results: Sonography detected no dislocation of intrammammary marker clips in 42 of 50 patients (84 %); dislocation was reported in 8 patients (16 %) with a maximum dislocation of 7 mm along the x-, y- or z-axis. Digital breast tomosynthesis showed accurate placement without dislocation of the intramammary marker clip in 48 patients (96 %); 2 patients (4 %) had a maximum clip dislocation of 3 mm along the x-, y- or z-axis (p < 0.05). Conclusion: The use of digital breast tomosynthesis could improve the accuracy when locating intramammary marker clips compared to sonography and could, in future, be used to complement or even completely replace sonography.
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Affiliation(s)
- R Schulz-Wendtland
- Gynäkologische Radiologie, Radiologisches Institut + Universitätsklinikum Erlangen, Erlangen
| | - P Dankerl
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen
| | - G Dilbat
- Radiologie, Radiologie Roth, Roth
| | - M Bani
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - P A Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - K Heusinger
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M P Lux
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - C R Loehberg
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - S M Jud
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - C Rauh
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - C M Bayer
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - D L Wachter
- Pathologisches Institut, Universitätsklinikum Erlangen, Erlangen
| | - M Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen
| | - M Meier-Meitinger
- Gynäkologische Radiologie, Radiologisches Institut + Universitätsklinikum Erlangen, Erlangen
| | - B Brehm
- Gynäkologische Radiologie, Radiologisches Institut + Universitätsklinikum Erlangen, Erlangen
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10
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Sänger N, Engels K, Graf A, Ruckhäberle E, Effenberger KE, Fehm T, Holtrich U, Becker S, Karn T. Molecular Markers as Prognostic Factors in DCIS and Small Invasive Breast Cancers. Geburtshilfe Frauenheilkd 2014; 74:1016-1022. [PMID: 25484376 DOI: 10.1055/s-0034-1383033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 08/11/2014] [Accepted: 08/18/2014] [Indexed: 12/12/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) accounts for up to half of screen-detected breast cancers and thus constitutes a major public health problem. Despite effective current treatment many patients with DCIS are either over- or undertreated because of the paucity of precise models to predict recurrence or progression. The combination of clinical and molecular factors as already applied for invasive disease may help to build such models also for DCIS. We compared 53 DCIS (36.6 %) and 92 (63.4 %) invasive breast cancer cases and found no significant differences in age, receptor status of ER, PR, and HER2, and the use of radiotherapy. Interestingly, the proportion of disseminated tumor cells (DTC) did also not significantly differ between DCIS and invasive cases (p = 0.57). A negative PR status was associated with the detection of DTCs (p = 0.026). We then compared relationships of clinical parameters and biomarkers with patients' prognosis in 43 DCIS and 40 small invasive tumors ≤ 5 mm (T1a). ER negativity was associated with shorter relapse free survival in the complete cohort (p = 0.004) and showed a trend in both subgroups (p = 0.053 for DCIS and p = 0.046 for T1a, respectively). In conclusion, we found markedly similar properties of both DCIS and small invasive breast cancers with respect to the distribution of several parameters as well as to the prognostic value of biomarkers. DCIS with a luminal phenotype seem to be characterized by a favourable prognosis.
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Affiliation(s)
- N Sänger
- Dept. of Gynecology and Obstetrics, Goethe University Frankfurt, Frankfurt
| | - K Engels
- Zentrum für Pathologie, Zytologie und Molekularpathologie, Neuss
| | - A Graf
- Dept. of Gynecology and Obstetrics, Goethe University Frankfurt, Frankfurt
| | - E Ruckhäberle
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf
| | | | - T Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf
| | - U Holtrich
- Dept. of Gynecology and Obstetrics, Goethe University Frankfurt, Frankfurt
| | - S Becker
- Dept. of Gynecology and Obstetrics, Goethe University Frankfurt, Frankfurt
| | - T Karn
- Dept. of Gynecology and Obstetrics, Goethe University Frankfurt, Frankfurt
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11
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Winzer KJ, Unger S, Bick U, Dieckmann F, Fallenberg E. Use of an Additional Diagnostic Work-up Following a Treatment Recommendation from the Preoperative Conference of the Mammography Screening Units. Geburtshilfe Frauenheilkd 2014; 74:370-375. [PMID: 25076794 DOI: 10.1055/s-0033-1360322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 12/25/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022] Open
Abstract
Objective: If a focus of suspicion is classified as being B 3-5 by a punch biopsy as part of a mammography screening, a recommendation for further action to be taken will be given in the preoperative conference of the screening unit. As part of this investigation, these treatment recommendations were compared with the final therapeutic approach taken at a certified breast centre. Furthermore, it was investigated whether and which additional examinations were performed on patients, depending on compliance with the recommended treatment. Material and Method: The data from 272 breast cancer patients from the years 2007, 2008 and 2009 was analysed. The patients took part in the screening programmes of four screening units in the German mammography screening programme, in one federal state. In addition, the data from each patient from one screening unit was analysed in two further federal states. Results: In total, the most recently conducted intervention deviated from the treatment recommendation from the preoperative conference in the screening unit in 77 out of 272 patients (28.3 %). Of these, there were 50 recommendations for open biopsy which ultimately resulted in breast-conserving surgery, which is not to be evaluated as an error, as the bioptic result was supplemented by the open biopsy. Additional examinations were performed in patients with deviating treatment recommendation in 39 cases (50.6 %) and in patients without deviating treatment recommendation in 66 cases (34.0 %). The additional examinations carried out included additional punch biopsies (most frequent) and MRI scans, but also additional ultrasounds or a mammography. Conclusions: Additional examinations lead to a change in treatment in a higher percentage of patients in comparison with the initial screening including assessment. An exact reexamination of the findings obtained in the screening is therefore preoperatively necessary in order to guarantee optimum treatment.
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Affiliation(s)
- K-J Winzer
- Department of Gynecology and Gynecologic Oncology, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin
| | - S Unger
- Department of Gynecology and Gynecologic Oncology, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin
| | - U Bick
- Institute of Radiology, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin
| | - F Dieckmann
- Institut für Radiologische Diagnostik, St. Joseph-Stift Bremen, Bremen
| | - E Fallenberg
- Department of Nuclear Medicine, Charité Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin
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