P3-12-03: A Prognostic Index of Ipsilateral Breast Tumor Recurrence in Patients Treated with Breast-Conserving Surgery after Preoperative Chemotherapy: Validation of M.D. Anderson Prognostic Index

Background: Preoperative chemotherapy (PCT) is widely used to increase the possibility of breast-conserving treatment (BCT). However, the appropriate indication for BCT after PCT is controversial, because the rates of ipsilateral breast tumor recurrence (IBTR) may be higher than those reported for BCT when surgery is used first. We performed a multicenter retrospective study to evaluate factors that were associated with IBTR in patients with BCT after PCT, and validated M. D. Anderson Prognostic Index (MDAPI) (Cancer 2005;103:689–95) using our data set.

Patients and Methods: From eight Japanese hospitals, data were extracted on a total of 381 patients with invasive breast cancer (BC) who were treated with ≥3 cycles of PCT followed by breast-conserving surgery and irradiation. The rates of IBTR were evaluated by MDAPI including clinical N2 or N3 disease, pathologic residual tumor >2 cm, multifocal pattern of residual disease, and lymphovascular space invasion in the specimen. Kaplan-Meier method was used to estimate cumulative recurrence rates. Log-rank test and Cox's proportional hazard model were used for statistical analyses.

Results: Median age at diagnosis of the primary tumor was 48 years; median size of the primary tumor at diagnosis was 4.0 cm. One hundred and forty-six patients received postoperative chemotherapy and 211 received postoperative endocrine therapy. At a median follow-up period of 50 months, 18 of 381 patients developed IBTR, which resulted in 5-year IBTR-free rate of 94.1%. Univariate analyses revealed that estrogen receptor (ER) status both before and after PCT (positive vs. negative), pathological nodal status after PCT (≥4 vs. 0–3 positive nodes), and pathologically residual invasive tumor (≥1.8 vs. ≤1.7 cm) were significantly associated with IBTR (all P < 0.05). Pathological margin status did not affect IBTR rate (P=0.88). Multivariate analysis revealed that significant independent predictors of IBTR included ER status after PCT (Hazard Ratio [HR], 0.10; P<0.01), size of residual invasive tumor (HR, 5.29; P=0.03), and pathological nodal status after PCT (HR, 3.59; P=0.02). The rates of IBTR of patients with MDAPI 0–3 were 1.3%, 2.9%, 16.0%, and 3.6%, respectively. Based on the data of our multivariate analysis, ER status after PCT (ER positive;0 and ER negative; 1 was added to MDAPI. Total scores of the prognostic index including MDAPI and ER status after PCT ranged between 0 and 5. The rates of IBTR correlated well with this prognostic index. The 5-year IBTR-free survival rates were 0% for 23 patients in score 0, 3.4% for 89 in score 1, 3.9% for 51 in score 2, 21.2% for 33 in score 3, and 16.7% for 6 in score 4 (P < 0.01).

Conclusion: Our prognostic index (MDAPI plus ER status) would be useful for clinical decision making according to surgical procedures after PCT. BCT is an appropriate treatment option for patients with the low prognostic index (0 to 2). The high risk population with the high prognostic index (3 to 5) may benefit from mastectomy.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-12-03.

Modified primary tumour/vessel tumour/nodal tumour classification for patients with invasive ductal carcinoma of the breast

Background:

We previously reported that the primary tumour/vessel tumour/nodal tumour (PVN) classification is significantly superior to the UICC pTNM classification and the Nottingham Prognostic Index for accurately predicting the outcome of patients with invasive ductal carcinoma of the breast in a manner that is independent of the nodal status and the hormone receptor status.

Methods:

The purpose of the present study was to compare the outcome predictive power of a modified PVN classification to that of the newly devised pathological UICC pTNM classification and the reclassified Nottingham Prognostic Index in a different group of patients with invasive ductal carcinoma (n=1042) using multivariate analyses by the Cox proportional hazard regression model.

Results:

The modified PVN classification clearly exhibited a superior significant power, compared with the other classifications, for the accurate prediction of tumour recurrence and tumour-related death among patients with invasive ductal carcinoma in a manner that was independent of the nodal status, the hormone receptor status, and adjuvant therapy status.

Conclusion:

The modified PVN classification is a useful classification system for predicting the outcome of invasive ductal carcinoma of the breast.

Abstract P4-10-05: Factors Associated with Ipsilateral Breast Tumor Recurrence in Breast Cancer Patients Treated with Breast Conserving Surgery and Radiotherapy after Preoperative Chemotherapy

Background: Although preoperative chemotherapy (PCT) was originally used to make locally advanced breast cancers (BC) operable, it is now frequently utilized to make relatively large primary tumors small enough for breast conserving treatment (BCT). A large number of studies have been performed to identify risk factors of ipsilateral breast tumor recurrence (IBTR) after breast conserving treatment for originally small tumors. However, those studies for patients (Pts) who received BCT after PCT for relatively large tumors are limited. We have done a multicenter retrospective study to identify factors which were associated with IBTR in Pts treated with BCT after PCT.

Patients and methods: From 7 Japanese hospitals, data, which regard characteristics of tumors and Pts, and treatment, of Pts who fulfilled the following criteria; 1. Female BC Pts who started PCT before January 2007 2. Her tumor was invasive, clinically solitary, and 2 cm or largerby palpation at diagnosis 3. She received 3 or more cycles of PCT 4. She received breast conserving surgery as a definitive surgery after PCT including axillary dissection or sentinel node biopsy 5. She received radiotherapy at least to the conserved breast. Pts with inflammatory BC and BC Pts who received preoperative treatment(s) other than chemotherapy were excluded. Kaplan-Meier method was used to estimate cumulative recurrence rates. Log rank test and Cox's proportional hazard model were used for statistical analyses. Receiver Operating Characteristic (ROC) Curves and C statistics were used for evaluating the prediction ability of Cox's proportional hazard model about IBTR.

Results: A total of 324 Pts were registered. The median age at diagnosis of them was 48 years old. The median size of the primary tumors by palpation at diagnosis was 4 cm. For PCT anthracycline-based regimens were used for 83 Pts, taxane-based regimens were for 29, and anthracycline-taxane regimens were for 212. One hundred forty two Pts (43.8%) received postoperative chemotherapy, 180 (55.6%) had postoperative endocrine therapy, and only 7 had postoperative trastuzumab therapy. The median follow-up period was 45 months. Nineteen Pts (5.9%) developed IBTR. The cumulative 4-year IBTR rate was 5.5%. Univariate analyses revealed that estrogen receptor (ER) status both before and after PCT, pathological nodal status after PCT, and pathologically residual invasive tumor (solitary vs. multifocal, 1.7 cm or smaller vs. 1.8 cm or larger) were statistically significantly associated with IBTR (P < 0.05 for all of them). Pathological margin status did not affect IBTR rate (P=0.73). ER status prior to PCT (positive vs. negative)(Hazard Ratio [HR], 6.76; P=0.012), size of the residual invasive tumor (1.7 cm or smaller vs. 1.8 cm or larger)(HR, 4.74; P=0.020), and pathological nodal status after PCT (0-3 positive nodes vs. 4 or more)(HR, 3.03; P=0.041) were associated with IBTR on multivariate analysis. C statistic was 78.3%.

Conclusion: Mastectomy may be a better choice for the Pts who have tumors with negative ER, pathologically large (1.8 cm or larger) residual invasive lesions after PCT, or 4 or more pathologically positive nodes after PCT in terms of local control.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-10-05.

FcγR2A and 3A polymorphisms predict clinical outcome of trastuzumab in both neoadjuvant and metastatic settings in patients with HER2-positive breast cancer

BACKGROUND

Antibody-dependent-mediated cytotoxicity (ADCC) is one of the modes of action for trastuzumab. Recent data have suggested that fragment C γ receptor (FcγR) polymorphisms have an effect on ADCC. This prospective phase II trial aimed to evaluate whether these polymorphisms are associated with clinical efficacies in patients who received trastuzumab.

PATIENTS AND METHODS

Patients in a neoadjuvant (N) setting received Adriamycin and cyclophosphamide followed by weekly paclitaxel/trastuzumab. Patients in a metastatic (M) setting received single trastuzumab until progression. In total, 384 distinct single nucleotide polymorphisms of different FcγR, HER2, and fucosyltransferase loci were assessed.

RESULTS

Fifteen operable and 35 metastatic HER2-positive breast cancer patients were enrolled in each of the N and M settings, respectively. The FcγR2A-131 H/H genotype was significantly correlated with the pathologically documented response (pathological response) (P = 0.015) and the objective response (P = 0.043). The FcγR3A-158 V/V genotype was not correlated with the pathological response, but exhibited a tendency to be correlated with the objective response. Patients with the FcγR2A-131 H/H genotype had significantly longer progression-free survival in the M setting (P = 0.034).

CONCLUSION

The FcγR2A-131 H/H polymorphism predicted the pathological response to trastuzumab-based neoadjuvant chemotherapy in early-stage breast cancer, and the objective response to trastuzumab in metastatic breast cancer.

Utility of Intraoperative Frozen-Section Examinations of Surgical Margins: With Special Reference to the Implication of Features of Margin-Exposed Tumor Components on Further Surgical Treatment

Purpose: The assessment of surgical margins is important in breast conserving surgery (BCS). In BCS, we usually resect additional specimens after the diagnosis of positive margin by intraoperative frozen-section examinations (IFE). However, we often experience the patients who received additional resections after positive results by IFE but no tumors were detected in the permanent sections. If we can predict the absence of residual tumor components from IFE, it may be possible to avoid additional mastectomy. In the present study, we tried to identify histological characteristics of margin-exposed tumor components on IFE as predictive factors for the residual tumor components in the additionally resected specimens. Methods: 1,835 cases underwent BCS between October 1999 and July 2008 at the National Cancer Center Hospital, Tokyo, Japan. By the review of the pathological database, we chose patients who had positive surgical margins determined by IFE and had undergone immediate additional resection. Two observers (MK, HT) reviewed the slides of frozen sections and confirmed the presence of tumor components. Results: 220 cases (12%) were eligible for this study. Within the specimens of additional resection, residual tumors existed in 114 cases (51.8%) and no tumors existed in 106 cases (48.2%). As characteristics of the primary tumors, invasive lobular carcinoma, pT3, EIC(+) and lymphatic invasion were significantly associated with the residual tumor components. As characteristics of margin-exposed tumor components on IFE, the number of positive margins, their maximum diameter and histological type were correlated with the residual tumors. The rate of detection of the residual tumors was significantly higher in the group with multiple positive margins (50/72, 69%) than in the group with a single positive margin (64/148, 43%) (p=0.0003). The residual tumors were detected in 36.5% (38/104), 60.8% (62/102), and 100% (14/14) of the groups with <6 mm, ≥6 to <20 mm, and ≥20 mm of the maximum diameter of the exposed tumor components, respectively (p=0.0005). Although there was no significant relationship in the rate between the group with exposed noninvasive components and that with exposed invasive components, the residual tumor components were detected more frequently in the group with exposed lobular carcinoma components (20/29, 69%) than in the group with exposed ductal carcinoma components (94/191, 49%) (p=0.047). By a multivariate analysis, the number of positive margins and the maximum diameter were independent risk factors of the residual tumors. Conclusion: The diagnosis of positive margins by IFE was useful for the prediction of residual tumors, and three histological properties of margin-exposed tumor components were correlated with the absence of residual tumor components. It may be possible to consider stratification of additional surgical therapy according to the characteristics of margin-exposed tumor components on IFE.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4118.

Utility of Breast CT in the Management of Breast Cancer – Results from a Prospective Multi-Institutional Study

Background:In order to obtain negative margins after breast conserving surgery (BCS), even repeated surgery is widely accepted. Before surgery, it is important to conduct a precise assessment of the extent of the breast cancer so that each patient can receive individualized surgery. To evaluate the utility of breast computed tomography (CT) as a tool to manage BCS, a multi-institutional prospective study was conducted in Japan.Patients and Methods:Patients were eligible to participate in this study if they had histologically proven breast cancer and were determined to be BCS candidates based on palpation, mammography (MMG) and ultrasonography (US). Written informed consent was obtained from each patient. First, the surgeon marked the line of planned excision on the skin using information from the MMG and US. Next, an expired angiographic catheter was placed on the mark to show the original surgical margin on the CT image. Breast CT was scanned 60 seconds after the bolus injection of the contrast material in the supine surgical position. The surgeon determined the extent of surgery based on the breast CT results. Surgical specimens were serially sectioned in 5-mm slices.Results:Three hundred and two patients were enrolled in this study. The CT scanners used in this study varied from a single helical CT to a 64-row multidetector CT. The results of the breast CT changed the extent of resection in 14.7% of patients. Among the 5 patients who were recommended to undergo a mastectomy, 4 patients had multicentric tumors pathologically and 1 patient had a widely spread intraductal component. The other patients were recommended to have a quadrantectomy based on the extent of breast cancer that was visualized by CT. Three patients (1%) who required conversion from a lumpectomy to quadrantectomy resulted in overexcision. In short, breast CT correctly changed the extent of surgery in 13.7% of the examined patients.Conclusion:This prospective study suggested that breast CT is useful for hospitals equipped with any type of CT and can be used to provide patients with individualized surgery.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5021.

Evaluation of clinicopathological features from core needle biopsy and CT imaging as predictors of response to primary systemic therapy for operable breast cancer

11086

Background: Primary systemic therapy (PST) is standard therapy for patients with locally advanced breast cancer and increasingly used for early-stage operable disease. Clinical and pathologic responses are important prognostic parameters and clinicopathological markers to predict response to PST are needed to individualize treatment. Methods: From 1998 to 2005, 403 primary breast cancer patients were underwent curative surgical treatment after PST (Anthlacycline and/or Taxane) at NCCH. We retrospectively evaluated the clinicopathological features (age, histological type, histological grade, ER, PgR and HER-2) and classification of tumors using CT (localized tumor type and diffused tumor type) at before PST and analyzed the correlation with clinical response and pathological complete response (pCR). The log-rank statistic was used for univariate comparisons and multivariate analysis performed using Cox hazard model. Results: Overall response and pCR rate were 87% and 18%. Breast conserving surgery was performed 37% patients. Histological grade 3 (p<0.0001), ER negative (p<0.0001), PgR negative (p<0.0001), solid-tubular type (p=0.0006), age (>50) (p=0.008) and localized tumor type (p=0.02) correlated with pCR. In multivariate analysis, Histological grade 3 (p=0.01) and localized tumor type (p=0.036) were independent predictors for pCR. ER positive, histological grade 2 or 1, invasive lobular carcinoma and diffuse tumor type associated with low chemosensitivity and low breast conserving surgery rate. Conclusions: Clinical and pathological response significantly associated with ER status and histological grade. Furthermore the classification of tumor type using CT was effective to predict of response to PST.

No significant financial relationships to disclose.

Frequent overexpression of epidermal growth factor receptor (EGFR) in mammary high grade ductal carcinomas with myoepithelial differentiation

AIMS

To evaluate the expression of common biological markers and the epidermal growth factor receptor (EGFR) in mammary high grade ductal carcinomas with myoepithelial differentiation (DCMDs).

MATERIALS/METHODS

Thirty DCMDs were clinicopathologically and immunohistochemically analysed and compared with 36 control cases of high grade conventional invasive ductal carcinoma (IDC).

RESULTS

EGFR, HER2/neu, oestrogen receptor, progesterone receptor, and p53 expression was seen in 21, one, three, four, and 20 of the 30 DCMDs, compared with eight, nine, 18, 17, and five of the 36 conventional IDCs (p<0.05), respectively. In 16 of the 30 DCMDs, metastases were found in the brain, lung, bone, and liver, within a maximum of 47 months (mean, 13.9) after initial surgery, whereas only four of the 36 conventional IDCs metastasised to the lung and bone within a maximum of 27 months (mean, 18.0) after initial surgery (p=0.0001). There was a significant difference in disease free survival between DCMD and conventional IDC (p=0.001). EGFR was frequently overexpressed in DCMD compared with conventional IDC, whereas the expression of HER2/neu and hormone receptors was lower in DCMD. Fluorescent in situ hybridisation revealed that the mean EGFR to chromosome 7 centromere (CEP7) ratio of the 24 DCMD cases available for evaluation was 1.03, and EGFR gene amplification was not detected in the 21 DCMD cases with EGFR overexpression.

CONCLUSION

Immunohistochemistry for myoepithelial markers and EGFR is useful for the accurate diagnosis and molecular target treatment of high grade DCMD.

Differences in the progesterone receptor contents between familial breast cancers and sporadic breast cancers stratified by patient age

In the present study, we investigated the estrogen (ER) and progesterone receptor (PR) contents of familial breast cancers (FBCs) and compared the findings with those of sporadic breast cancers., stratified by the patients' age. To evaluate the hormone receptor contents of Japanese FBCs, we collected a consecutive series of 250 FBCs and 2,533 sporadic breast cancers (SBCs). These patients were divided into the three groups stratified by the patients' age at initial surgery (group I, under 40 years old; group II, 40-60 years old; group III, over 60 years old). The clinicopathological features of FBCs and SBCs, including ERs and PRs, were analyzed for each group. In all age groups, the PR contents of FBCs were significantly lower than those of SBCs, particularly for group III. In FBCs, the PR content was significantly lower in group III than in groups I or II. In addition, there was a nonsignificant trend towards a high frequency of ER-positive, PR-negative tumors in FBC patients aged 60 years and over. These data indicate that the loss of ER function and/or loss of binding capacity of PR to progesterone was associated with some late-onset FBCS.

Two special types of breast cancer presenting as progressive disease after neoadjuvant chemotherapy with docetaxel plus doxorubicin

Seventy-eight patients with primary breast cancer over 3 cm in diameter in stages II A, II B, III A and III B according to the UICC classification received neoadjuvant chemotherapy from August 1, 1998 to June 30, 2000 at the Breast Division of the National Cancer Center Hospital. Neoadjuvant chemotherapy consisted of doxorubicin (Adriamycin: ADM) 50 mg/m(2) and docetaxel (Taxotere: DOC) 60 mg/m(2) every three weeks. The overall clinical response to this regimen was 88% (69/78). Although neoadjuvant chemotherapy with this regimen achieved good responses in patients with breast cancer, 2 patients presented with progressive disease (PD) after treatment. One patient had inflammatory breast cancer (IBC) and the other had primary squamous cell carcinoma (SCC) of the breast. There were 4 cases of IBC and one case of SCC of the breast who received neoadjuvant chemotherapy in this series. Our observations suggest that this regimen might not be effective for these types of breast cancer.

Diabetic mastopathy: a case report with reference to the findings of enhanced computed tomography

We report a case of insulin-dependent diabetic fibrous mastopathy with special reference to the findings of computed tomography (CT). The patient was a 27-year-old woman with a history of insulin-dependent diabetes mellitus from childhood who presented with a right breast tumor. Physical examination showed a stony-hard, ill-defined but freely movable mass under the nipple of the right breast without nipple discharge. Mammography revealed a high-density mass shadow without microcalcifications or spicular formation. Ultrasonographic examination revealed an irregularly-shaped hypoechoic lesion with marked posterior acoustical shadowing. Contrast-enhanced CT revealed poor early phase contrast enhancement and slight delayed phase heterogeneous enhancement. Since core needle biopsy revealed fibrocystic disease, the lesion was suspicious for diabetic mastopathy. Incisional biopsy of the right breast lump was performed. On histopathological examination, the lesion showed fibrosis with dense lymphocytic infiltration around the lobules. Diabetic fibrous mastopathy was diagnosed. Physicians should be aware of the association of long-standing diabetes mellitus with the development of fibrous mastopathy. CT is considered a useful tool to differentiate diabetic mastopathy from breast cancer.

Association of breast cancer with meningioma: report of a case and review of the literature

We report a case of meningioma subsequently developed in a patient with primary breast carcinoma. A 53-year-old woman received a left modified radical mastectomy because of stage IIA breast carcinoma. Histologically, the tumor was a predominantly intraductal carcinoma with negative lymph node metastasis. Estrogen receptor (ER) was negative but progesterone receptor (PR) of the left tumor was positive by immunohistochemistry. Four years later, cranial bone and/or brain metastasis was suspected from a routine follow-up bone scintigram. The patient showed no symptoms or signs at that time. Magnetic resonance imaging (MRI) and angiography revealed that the right parasagittal mass was suspicious of meningioma. A complete tumor removal was performed. On histological examination, this brain tumor was a transitional-type meningioma (meningotheliomatous and fibrous type) without malignant findings. ER was negative but PR was positive also in this tumor. She is currently well 6 years after the initial surgery. A review of the literature is presented with emphasis on the association between breast cancer and meningioma, which indicates a possible hormonal relationship. The knowledge of this association is important in the differential diagnosis of patients with breast cancer who develop central nervous manifestations.

A case of malignant phyllodes tumor of the breast with osteosarcomatous features

A 64-year postmenopausal woman had noticed a left breast lump 5 months before presentation and was admitted due to increasing tumor size. Physical examination showed a well demarcated, movable mass 5 cm in diameter in the upper outer quadrant of the left breast. The lesion was not painful. She had no past history of malignancy or chest wall irradiation. She had no family history of malignancy. Mammography revealed an irregular tumorous lesion with coarse calcifications in the left breast. Intracystic papillary cancer was suspected by ultrasonography. Aspiration breast cytology yielded insufficient material for diagnosis. Laboratory findings were all within the normal limits including alkaline phosphatase and three tumor markers (CEA, CA 15-3, ST-439). An excisional biopsy of the left breast tumor was performed. Histopathological examination revealed malignant phyllodes tumor with osteosarcomatous features and negative tumor margins. Positive vimentin and negative cytokeratin staining was confirmed by immunohistochemistry, suggesting that the tumor did not originate from epithelial cells of the breast. The estrogen receptor (ER) status of the tumor was negative but progesterone receptor (PgR) was weakly positive. Positive p53 nuclear immunoreaction but negative c-erbB-2 overexpression by immunohistochemical staining was observed in this tumor. There was no evidence of generalized disease. She has been well 6 months after surgery without adjuvant therapy.

Pattern of chromosome 16q loss differs between an atypical proliferative lesion and an intraductal or invasive ductal carcinoma occurring subsequently in the same area of the breast

Atypical proliferative lesions of the breast, such as atypical ductal hyperplasia and atypical papilloma, are considered to be precursors of breast carcinomas and have frequently been shown to have loss of heterozygosity (LOH) on chromosome 16q at the DNA level. We evaluated whether an atypical proliferative lesion and a carcinoma that subsequently occurred in the same area of the ipsilateral breast were of identical clonal origin in seven patients. Using DNA isolated from microdissected archival tissue of epithelial components of both the biopsy specimen of the atypical proliferative lesion and the mastectomy specimen of the carcinoma, the pattern of LOH on 16q was compared between these two lesions using polymerase chain reaction -microsatellite LOH analysis. As a control, LOH on 16q was examined in 13 cases of usual ductal hyperplasia, 10 usual papillomas, and 6 atypical ductal hyperplasias. In the seven cases, LOH on 16q was detected in three of the six atypical proliferative lesions and in five of the seven carcinomas, but the allele with LOH or a deleted region always differed between the two. LOH was detected in both atypical proliferative lesions and carcinomas in one case, only in the atypical proliferative lesion in two cases, and only in carcinomas in three cases. In the controls, LOH on 16q was absent in usual ductal hyperplasias or usual papillomas but was detected in two of six atypical ductal hyperplasias. Although atypical proliferative lesions were frequently confirmed to be of clonal nature with LOH on 16q, these lesions and carcinomas were considered to be clones, probably originated from a field with these clones.

Seven cases of breast cancer recurrence limited to the central nervous system without other visceral metastases

We report 7 rare cases of recurrent breast cancers who presented with central nervous system (CNS) metastases as the initial relapse site without any other organ metastases. The average age of the patients at surgery was 42.6 years old of age (median 45:range 32-60), and 6 of the 7 cases (86%) were premenopausal. The mean disease-free period was 25.7 months (median 22, range 2-60 months). The primary tumors were all invasive ductal carcinomas. The estrogen receptor and progesterone receptor status of the 3 tumors available for study were all negative. The metastatic CNS lesions included the cerebrum (4 cases), cerebellum, cervical spinal cord, and meninges. In 6 out of these 7 cases (86%), the CNS metastasis was the initial recurrent lesion. Multidisciplinary treatments including surgery, radiotherapy and systemic or intrathecal chemotherapy were given. Although the mean survival time from clinical manifestations of the metastases of the 4 deceased patients was 20 months (median 20.5; range 6-33), one patient treated with surgery and radiotherapy is been still alive18 years later. These cases were also notable for the fact that the only metastatic site was in the CNS only during the entire clinical course, except for 2 cases, one with ocular adnexa metastasis, and the other with cervical lymph node metastasis. Premenopausal patients with negative hormone receptor status are more likely to develop this type of recurrence, regardless of the histological type. It is necessary to pay attention to neurological symptoms and signs during follow-up of breast cancer patients.

Validation and problems of St-Gallen recommendations of adjuvant therapy for node-negative invasive breast cancer in Japanese patients

BACKGROUND

The objectives of this study were to confirm the favorable outcome of invasive breast cancer in Japanese patients without lymph node metastasis who did not receive adjuvant therapies and to validate the St-Gallen recommendations in this population.

METHODS

The subjects were a consecutive series of 920 node-negative invasive breast cancer patients who underwent surgery between 1987 and 1994 at our hospital. These patients did not receive adjuvant chemotherapy. Ten-year disease-free (DFS) and overall survival (OS) rates were analyzed by the St-Gallen risk categories (Minimal/Low, Intermediate, High).

RESULTS

The median age of the patients at surgery was 52 years and the median follow-up period of patients was 10.2 years. At 10 years, the respective DFS and OS rates of all patients were 84.6 and 86.7%. The DFS and OS of patients in the Minimal/Low risk category (25 patients) both showed 100%. The DFS and OS of patients in the Intermediate risk category (356 patients) showed 92.0 and 93.1%, respectively. The DFS and OS of patients in the High risk category (539 patients) showed 79.4 and 82.2%, respectively, indicating a significant difference between those in the Minimal/Intermediate risk category (381 patients) (p < 0.001, p < 0.001, respectively). The DFS and OS of patients who had one pathological lymph node metastasis (775 patients) showed 72.7 and 75.2%, respectively, which indicated a non-significant difference between those in the High risk category (381 patients) (p = 0.10). These data support the validation of adjuvant therapy for high-risk node-negative breast cancers in Japanese patients. However, quality control is needed to define the histological grade included in the risk categories.

CONCLUSION

Japanese patients with invasive breast cancer without lymph node metastasis showed a survival advantage compared with their Caucasian counterparts. However, patients in the High risk group as defined by St-Gallen recommendations should be indicated for adjuvant therapy.

Evaluation of histopathological criteria for identifying node-negative breast cancer with high risk of early recurrence in the NSAS-BC protocol study

BACKGROUND

The histopathological criteria for high-risk node-negative primary breast cancer stated in the National Surgical Adjuvant Study of Breast Cancer (NSAS-BC) protocol were used to grade a consecutive series of 488 cases at our hospital.

METHODS

To validate the criteria retrospectively, we examined the histological features of node-negative primary breast cancers which showed early relapse within 2 years after surgical therapy.

RESULTS

Early relapse occurred in 12 patients, distant metastases in 11, and local recurrence in one. Among 278 cases followed for up to 1.5 years or longer, early systemic relapse was detected in 10 (5.8%) of 172 higher-grade tumors (9 invasive ductal carcinomas of nuclear grade 3 and one invasive ductal carcinoma of nuclear grade 2) and one stromal cell sarcoma. Among the 115 low-risk tumors, only one case (0.9%) of invasive ductal carcinomas with nuclear grade 1 showed early local recurrence. Early relapse occurred in only one (1.5%) of 67 tumors with an invasive component of 1.0 cm but in 11 (5.2%) of 211 tumors with an invasive component of 1.1 cm. The recurrence rate increased to 9.3% (8/86) when tumor invasion was 2.1 cm. In 12 cancers showing recurrence, strand structure, large central acellular zones, and squamoid features were histologically observed in four, two, and three cases, respectively. The present results confirmed the reported tendency of correlation between strand pattern and bone metastasis, large central acellular zones and lung and brain metastasis, and squamoid features and lung metastasis. Synchronous bilateral and unilateral multiple cancers were characterized by lower nuclear grades.

CONCLUSIONS

At our hospital, the criteria used in the NSAS-BC protocol were demonstrated to identify node-negative cancers with high risk of early recurrence at a hospital level. To further identify groups prone to recurrence, longer follow-up would be necessary. In addition, the histological criteria could be improved to correlate with patient outcome more accurately.

Treatment of noninvasive carcinoma: fifteen-year results at the National Cancer Center Hospital in Tokyo

The introduction of screening mammography (MMG) will lead to increased detection of preclinical early breast cancer in Japan. It has become more important to understand the nature of these lesions. We tried to elucidate the long term prognosis and clinical and pathological characteristics of noninvasive cancers. A total of 336 (5.4%) ductal carcinoma in situ (DCIS) and 32 (0.5%) lobular carcinoma in situ (LCIS) were diagnosed in 6 277 breast carcinomas at the National Cancer Center Hospital from 1962 to 1995. Most (80%) LCIS occurred in premenopausal women. LCIS has significantly higher bilaterality than that of DCIS. Local recurrence occurred in approximately 10% of patients after breast conserving surgery for DCIS and LCIS. Four patients died of breast carcinoma, which were initially diagnosed as noninfiltrating carcinoma. The 15-year cause specific survival rates of patients with DCIS and LCIS were 98.5 % and 100 %, respectively.

A proposal for the histopathological diagnosis of ductal carcinoma in situ of the breast

BACKGROUND

As the incidence of ductal carcinoma in situ (DCIS) is increasing, it is necessary to make a guideline for the pathological examination and diagnosis of DCIS, by creating criteria based on clinical and biological aspects of the disease.

METHOD

We collected biopsy specimens originally diagnosed as benign lesions, from patients who subsequently developed invasive carcinoma in the ipsilateral breast. The histology of the biopsy specimens was re-evaluated principally according to the 1995 Philadelphia Consensus on DCIS. Histopathological agreement on each biopsy specimen was made by the JBCS Study Group members under a multiviewer microscope. In the course of making conclusive agreements among the pathologists, we developed a consensus for the histopathological diagnosis of DCIS, especially non-comedo types.

RESULTS

DCIS is defined as a carcinoma of ductal epithelial origin, without any evidence of stromal invasion. It is necessary to note the methods of pathologic examination required to diagnose DCIS. Stromal invasion is an important prognostic factor, and should be diagnosed with caution. Classification of proliferative ductal lesions as benign or malignant (DCIS), the subtype of DCIS (nuclear grade, architecture, and necrosis), and the histological grading of DCIS are proposed and recommended.

CONCLUSION

Although we have made a new proposal according to current concepts, there are still several unresolved problems. Thus further examination and modification will be necessary in the future.

Differences in estrogen receptor status, HER2, and p53 comparing metachronous bilateral breast carcinoma

BACKGROUND AND OBJECTIVES

We analyzed the clinicopathologic characteristics and tumor biology of metachronous bilateral breast carcinoma with regard to p53, HER2 and hormone receptor status.

METHODS

A consecutive series of 54 female metachronous bilateral breast carcinoma patients treated at the National Cancer Center Hospital between 1980 and 1997 were the primary source of these retrospective data. Clinicopathologic background factors were analyzed, and immunohistochemical staining for p53, HER2, and hormone receptor status was carried out on paraffin-embedded specimens.

RESULTS

There were no significant differences in clinical stage, p53 and HER2 expression levels between the first and second primary tumors. The positive rates for ER and PR were 48% (25 of 52) and 46% (25 of 54) for the first tumors, but only 19% (10 of 52) and 32% (17 of 54) for the second tumors (P = 0.004 for ER, P = 0.16 for PR), showing a significant loss of ER.

CONCLUSIONS

Our findings indicate that p53 and HER2 expression levels in the second tumors might be the same as those of the first tumors in metachronous bilateral breast carcinoma; however, loss of ER was more frequently observed in the second primary tumors than in the first tumors.

Multicentricity and histopathological background features of familial breast cancers stratified by menopausal status

BACKGROUND

We investigated histopathological background and multicentricity in patients with familial breast cancers (FBCs) in comparison with these features in patients with sporadic breast cancers (SBCs), stratifying patients by menopausal status.

METHODS

We collected a consecutive series of 469 FBC patients and 3334 SBC patients treated at our hospital between 1965 and 1995. The following criteria were used to define FBC, regardless of the presence or absence of a family history of other cancer or the patient's past history of malignancies: (1) Three or more second-degree relatives had been affected by breast cancer; (2) two first-degree relatives had been affected by breast cancer, and either one of them was under 40 years of age and/or had had bilateral breast cancers. The presence or absence of background proliferative lesions (PL; ductal/lobular hyperplasia and/or adenosis) and the multicentricity of breast carcinomas in FBCs and SBCs were analyzed for each group.

RESULTS

In premenopausal FBC patients, there was a non-significant trend towards a high frequency of multicentricity compared with findings in patients with SBCs overall (P = 0.087; odds ratio [OR], 1.43; 95% confidence interval [CI], 0.96-2.13). In premenopausal FBC patients, the frequency of background proliferative lesions with/or without fibroadenomas (FA) in the resected specimen was significantly higher than that in SBC patients overall (P = 0.001 for PL; OR, 1.47; 95% CI, 1.18-1.83; P < 0.001 for PL +/- FA; OR, 6.84; 95% CI, 4.93-9.49). With regard to the other clinicopathological factors examined, there were no significant differences between the two groups, except for the higher frequency of premenopausal patients among the FBC patients.

CONCLUSION

These results indicate that premenopausal patients with FBCs had more proliferative lesions in the histopathological background and more multicentric breast cancers than premenopausal patients with SBCs.

Accuracy of contrast-enhanced computed tomography in the prediction of residual breast cancer after neoadjuvant chemotherapy

Determination of the extent of residual disease after neoadjuvant chemotherapy is sometimes inaccurate by conventional diagnostic methods. The purpose of this study was to evaluate the accuracy of contrast-enhanced computed tomography (CE-CT) in depicting the extent of residual carcinomas. Fifty-seven patients with breast carcinomas of 3 cm diameter or more received neoadjuvant chemotherapy with four cycles of AT (doxorubicin and docetaxel). Before surgery, the patients underwent clinical examination, mammogram (MMG), ultrasonography (US), and CE-CT. Thirteen patients were not evaluated by CE-CT before surgery. Enhancement patterns on CE-CT were classified into multiple spots, tumor and spots, solid tumor type, and no enhancement. When all types of cancers were included in the analysis, clinical examination showed the best correlation with the pathology of the extent of residual carcinomas. However, except in invasive lobular carcinoma (ILC) and inflammatory breast carcinoma (IBC), CE-CT showed the best correlation (R insertion mark2 = 0.537). More than half of the residual microcalcifications on MMG after neoadjuvant chemotherapy suggested residual viable tumor. In conclusion, CE-CT is the most accurate noninvasive technique for identifying the extent of the residual carcinoma after neoadjuvant chemotherapy if cases of IBC and ILC are excluded.

Changes in findings of mammography, ultrasonography and contrast-enhanced computed tomography of three histological complete responders with primary breast cancer before and after neoadjuvant chemotherapy: case reports

We report the changes in the findings of imaging examinations (mammography, ultrasonography and contrast-enhanced computed tomography) of three patients with primary breast cancer before and after neoadjuvant chemotherapy, who obtained histologically complete responses after the chemotherapy. The neoadjuvant chemotherapy consisted of four cycles of doxorubicin and docetaxel. All patients were clinically judged as partial responders, because of the remaining tumorous lesions in the imaging examinations. However, these tumorous lesions could be related to the chemotherapy-induced fibrosis and tumor necrosis or the remaining fibrocystic changes. In this study, it was considered very difficult to estimate the extent of residual tumors accurately in patients with primary breast cancer after neoadjuvant chemotherapy by any type of imaging examination.

Atypical medullary carcinoma of the breast with cartilaginous metaplasia in a patient with a BRCA1 germline mutation

We examined a 34-year-old premenopausal woman who had noticed a left-breast lump a month previously. She had no past history of malignancies but had a family history of breast and ovarian cancers. Her mother had suffered from ovarian cancer when aged 47 years and had died of the disease at age 52. The younger two of the patient's four aunts had developed breast cancer when they were 37 and 48 years old. A physical examination showed an ill-defined mass, 1.5 cm in diameter, located in the upper outer quadrant of the patient's left breast. Mammography revealed diffuse microcalcification in both breasts but ultrasonography revealed an irregular tumorous lesion only in the left breast. Aspiration breast cytology revealed adenocarcinoma of the left breast. Modified radical mastectomy of the left breast and excision of a biopsy specimen from the right breast were carried out simultaneously. Histopathologically the left-breast tumor was an atypical medullary carcinoma with cartilaginous metaplasia, of histological grade 3, and the right-breast specimen showed fibrocystic changes with atypical ductal hyperplasia. Estrogen receptors were positive, but progesterone receptor was not detected on the tumor cells, which were immunopositive for nuclear p53 although c-erbB-2 overexpression was not observed. A nonsense germline mutation of the BRCA1 gene (exon5) was detected. The patient has been well since the operation (10 months). These findings may provide useful information about the carcinogenesis and biological behavior of BRCA1-associated breast cancers.

c-erbB-2 protein overexpression and p53 immunoreaction in primary and recurrent breast cancer tissues

BACKGROUND AND OBJECTIVES

We investigated whether expression levels of c-erbB-2 and p53 proteins in breast cancer tissues differ in primary and metastatic lesions.

METHODS

Immunohistochemical staining or sandwich enzyme immunoassay was used to determine expression levels of c-erbB-2 and p53 proteins in 42 breast cancer samples from 21 patients. Estrogen (ER) and progesterone receptors (PgR) were also measured by enzyme immunoassay in each case. All patients had undergone radical surgery for primary tumors and surgical resection of asynchronous metastatic lesions. Thirteen patients (62%) were premenopausal and 14 (67%) received postoperative adjuvant therapies. Median disease-free survival time was 26 months (range, 5-104). The resected metastatic lesions included 1 in the liver, 3 in the lung, and 3 in the supraclavicular lymph nodes. The remaining 14 were local skin lesions.

RESULTS

There was no difference in the positivity rate of c-erbB-2 (38%: 8/21) and p53 (39%: 7/18) expression between the primary tumors and the recurrent lesions. In addition, no discordant c-erbB-2 or p53 expression was observed between the primary tumors and their respective metastatic lesions. Positivity rates for ER and PgR were 50% (10/20) and 60% (12/20) for the primary tumors, but only 25% (5/20) and 30% (6/20) for the recurrent lesions, respectively (P = 0. 19 for ER and P = 0.11 for PgR).

CONCLUSIONS

c-erbB-2 and p53 expression levels in breast cancer cells were almost unchanged as the disease progressed and/or in response to adjuvant therapies, regardless of the hormone receptor status.

Prognosis of a series of 763 consecutive node-negative invasive breast cancer patients without adjuvant therapy: analysis of clinicopathological prognostic factor

BACKGROUND AND OBJECTIVES

The objectives of this study were to confirm the favorable outcome of Japanese invasive breast cancer patients without lymph node metastasis, after treatment with surgery alone, and to evaluate clinicopathological prognostic factors in this population.

METHODS

The subjects were 763 consecutive node-negative invasive breast cancer patients who underwent surgery without adjuvant therapies between 1988 and 1993 at our hospital. Disease-free survival (DFS) and overall survival (OS) rates were analyzed by clinicopathological factors.

RESULTS

The median age of the patients at surgery was 52 years and the median follow-up period of patients was 74 months. At 5 years, the respective DFS and OS rates of all patients were 90.8% and 93.9%. Patients with a pathological tumor size of invasive component of more than 2 cm (319 patients) had a significantly lower DFS than those with tumors measuring 2 cm or less (361 patients) (P = 0.045). Patients with positive hormone receptor status (280 patients) (estrogen and/or progesterone receptor positive) tended to have a better OS than those negative for both hormone receptors (92 patients) (P = 0.078). Meanwhile, patients with tumors of histological grade 3 (328 patients) had a much poorer prognosis than those with tumors of histological grade 1 or 2 (413 patients) (P = 0.008 for OS and P = 0.042 for DFS). The respective 5-year DFS and OS rates of patients with histological grade 3 tumors larger than 2 cm in pathological tumor size of invasive component (195 patients) were 85.5% and 87.6%, indicating that these node-negative patients form a high risk group.

CONCLUSIONS

Japanese invasive breast cancer patients without lymph node metastasis tended to show a survival advantage compared with their Caucasian counterparts. Histological grade was the most useful prognostic factor in this population.

Contrast-enhanced computed tomography detection of occult breast cancers presenting as axillary masses

Some non-palpable breast cancers presenting as axillary metastases (occult breast cancer, OBC) are not clinically detectable by either mammography (MMG) or ultrasonography (US). We performed contrast-enhanced computed tomography (CE-CT) in order to locate the primary tumors in five cases of OBC and succeeded in locating all of them.

Changes in the treatment outcome of node-positive breast cancer stratified by menopausal status: comparison of patients treated in 1965-75 versus those treated in 1976-86

OBJECTIVE

The objective of this study was to examine whether and to what extent the outcome of treatment for lymph-node positive breast cancer patients improved between the periods 1965-75 and 1976-86.

METHODS

The subjects were 1595 patients with breast cancer positive for lymph node metastasis who were treated at the National Cancer Center Hospital between 1965 and 1986. In order to analyze background factors and treatment outcome, we classified the patients into four groups stratified by the time of initial surgery (1965-75/1976-86) and menopausal status (premenopause/postmenopause).

RESULTS

With respect to the clinicopathological background factors, significant changes between the periods 1965-75 and 1976-86 were more frequent use of modified radical mastectomy and postoperative adjuvant chemoendocrine therapy and less frequent use of postoperative radiotherapy in both pre- and postmenopausal patients. The 10-year disease-free and overall survival rates improved by approximately 15-20% between 1965-75 and 1976-86 in this group of patients, regardless of menopausal status.

CONCLUSION

The patients with node-positive disease treated at our hospital showed an increase in both disease-free and overall survival from 1965 to 1986.

Axillary node metastasis from T1N0M0 breast cancer: possible avoidance of dissection in a subgroup

BACKGROUND

Axillary lymph node dissection is now no longer considered to be the standard treatment in all patients with invasive breast cancer. We have attempted to identify a sub-group of patients with invasive breast carcinoma who may not need to undergo axillary lymph node dissection.

METHODS

Patients (n = 823) with T1 N0M0 invasive breast cancer treated at our hospital between 1970 and 1994 were studied. We investigated the relationship between positive axillary lymph nodes and the following clinico-pathological factors: patient age, menopausal status, contralateral breast cancer (synchronous or asynchronous), tumor location, tumor size (T:cm), histopathology, histological grade, presence or absence of malignant microcalcification or spiculation on mammography and estrogen receptor status.

RESULTS

The incidence of axillary lymph node metastases in patients with T1N0M0 invasive breast cancer was 25% (208/823). The node-negative group was significantly older than the node-positive group. Premenopausal patients had a higher rate of lymph node metastases although this was not significant. The frequency of nodal metastases when related to the tumor size was as follows: T< or =1.0 cm, 17%; T< or =1.5 cm, 25%; T< or =2.0 cm, 29%. Mammography revealed that patients with malignant calcification or spiculation had a significantly higher rate of nodal metastases than those without these findings. Certain tumor types (medullary, mucinous and tubular carcinomas) had lower positive rates for lymph node involvement. With regard to the histological grade, lymph node positivity increased significantly with high-grade tumors. No correlation was observed between any other factors and the presence or absence of lymph node metastases.

CONCLUSIONS

It may be possible to avoid axillary lymph node dissection in postmenopausal patients (50 years or older) where the histological type is favorable when the tumor diameter is < or =1.0 cm and when microcalcification or spiculation is absent on mammography.

Diagnostic value of contrast-enhanced computed tomography for diagnosing the intraductal component of breast cancer

BACKGROUND

It is important to reduce local residual cancer to avoid local recurrence after breast conserving treatment. We therefore tried to detect the intraductal components and small invasive foci of breast cancers by contrast-enhanced helical computed tomography (CE-CT).

METHODS

In 122 women whose breasts were examined by CE-CT preoperatively, intraductal spread detected on ultrasound (US), mammography (MMG), and CE-CT, and extensive intraductal components (EICs) detected by histological examination were analyzed for correlations among the extent and subtypes of intraductal components, and deviations in tumor size.

RESULTS

EICs were present in 44 patients. The sensitivities of EIC detection by US, MMG, and CE-CT were 35%, 61%, and 88%, respectively, and the corresponding specificities were 83%, 86%, and 79%, respectively. The sensitivities of detecting EIC and small invasive foci were 34%, 57%, and 91%, respectively. In 5 patients, EIC could only be visualized by CE-CT. The median deviation of the size of intraductal spread revealed by CE-CT from pathological EIC was 0.0 cm (range + 3.0 to - 1.7 cm).

CONCLUSIONS

CE-CT is useful for visualizing intraductal spread and small invasive foci of breast cancer.

Breast cancer in Cowden's disease: a case report with review of the literature

We report a case of invasive breast cancer in a 62-year-old female patient with Cowden's disease. A left modified radical mastectomy was performed and histopathology of the tumor showed invasive ductal carcinoma, histological grade 3, without lymph node metastasis. The patient had a past history of endometrial cancer at 55 but did not have a family history of malignant disease. Goiter was palpable but aspiration cytology revealed no malignancy. There were several papillomas on the oral mucosa and multiple papillomatous lesions on the right femur. Barium X-ray and endoscopic examination revealed multiple, small, hyperplastic polypoid lesions on the esophagus, stomach and rectum. Histopathology of the biopsy specimens from the esophagus and stomach showed acanthotic squamous epithelium and foveolar hyperplastic polyps. The patient was followed up closely to monitor the thyroid lesions and polyposis of the digestive tract. A total of 12 breast cancer patients who also had Cowden's disease have been reported in Japan and these cases are reviewed in this report.

Microinvasive breast carcinoma with extensive involvement of level III axillary lymph nodes: a case report

A 44-year-old woman presented with a right huge axillary mass. Both mammography and ultrasonography revealed a primary cancer of 2.8 cm maximum diameter in the right breast and metastases in the axillary lymph nodes, both being confirmed by aspiration cytology as ductal carcinoma. Right standard radical mastectomy with level III axillary lymph node dissection was carried out. Pathologically, the tumor was diagnosed as ductal carcinoma in situ with microinvasion (DCISM), histologic grade 3. The area of stromal invasion measured 1 mm at its widest point. Sixteen of the 17 resected axillary lymph nodes contained metastases, including six level III lymph nodes. Immunohistochemical studies of the tumor revealed overexpression of p53 protein, but not that of c-erbB-2 protein. The frequency of lymph node metastases from DCISM is reported to be very low. Therefore, the present case with extensive involvement of level III lymph nodes was unusual.

Diagnostic Value of Enhanced Computed Tomography in the Detection of the Widely Spreading Intraductal Component of Breast Cancer: Case Reports

We report cases of breast cancer with extensive intraductal component (EIC), the extent of which could be detected only by contrast-enhanced computed tomography (CT) scan. One case was a 32-year-old woman who presented left nipple bloody discharge without breast mass palpation. Mammography (MMG), galactography and ultrasonography (US) showed no abnormalities. Contrast helical CT scan revealed numerous patchy enhancement in the upper-outer quadrant of the left breast. Histological examnation revealed invasive ductal carcinoma with a predominant intraductal component. The second case was a 36- year-old woman who had noticed a left breast mass 2.4 cm in diameter. MMG and US suggested a localized breast cancer. Contrast helical CT scan revealed numerous patchy enhancement throughout the mammary gland in addition to the index tumor near the nipple. Histopathological results indicated invasive ductal carcinoma with widely spread ELC. In these two cases, the extent of intraductal cancer also correlated well with the CT findings. Breast CT scan can be an effective tool for determining the extent of the intraductal component of breast cancer, which is an important factor when considering breast-conserving therapy.

A Case of Dermatofibrosarcoma Protuberans in the Skin over the Breast

Dermatofibrosarcoma protuberans (DFSP) is a slow-growing but locally aggressive, fibrous tumor that has a high rate of local recurrence after surgical resection. This tumor occurs most commonly in the trunk and proximal extremities. In this report we present a case of dermatofibrosarcoma protuberans in the skin over the breast which was re-excised after pathological diagnosis, considering cosmetic aspects. Only three other cases of dermatofibrosarcoma protuberans of the anterior chest wall have been encountered in our hospital, and all of these cases were male. The presence of this tumor in the skin over the breast appears to be rare in females. Careful complete resection is recommended for this type of tumor.

Prognostic value of histopathological therapeutic effects and mitotic index in locally advanced breast cancers after neoadjuvant chemotherapy

A study was conducted to examine whether or not the histopathological therapeutic effects of preoperative chemotherapy could be useful for determining prognosis in women with locally advanced breast cancer. The patients were 37 women with locally advanced breast cancer who received preoperative chemotherapy between 1977 and 1987. The histological grade of malignancy (HGM) and histopathological therapeutic effects of chemotherapy (TEf) were examined in resected specimens. Patients with HGM 3 showed a poorer 10-year overall survival (38%) than those with HGM 1 or 2 (62%). Patients showing a better histopathological response (TEf 1b plus 2) had a poorer 10-year overall survival (20%) than those with a poorer response (TEf 0 plus 1a) (60%). Therapeutic effects were significantly related to histological grade, nuclear atypia and mitotic index (p = 0.03, 0.005 and 0.002, respectively). Histopathological therapeutic effects were not directly correlated with patient prognosis. Cox proportional hazard regression analysis revealed that mitotic index was the most significant prognostic factor related to 10-year overall survival.

Male breast cancer in patients with a familial history of breast cancer

We describe herein the clinical characteristics of five male breast carcinoma (MBC) patients with a familial history of breast carcinoma (FHBC). Four of these patients suffered from multiple primary cancers, being gastric and prostate cancer in 1, gastric cancer in 1, and asynchronous bilateral breast cancers in 2. The average age of these patients at diagnosis was not lower than that of MBC patients with no such familial history. The aggregation of cancer in these families had three prominent characteristics: (1) The families included women with early-onset breast cancers which had occurred at the ages of 38, 38, and 35 years, respectively, and/or early-onset uterine cancer which had occurred at the age of 35 years. (2) The incidence of multiple primary cancers was significantly higher in the siblings of MBC patients with a FHBC than without. (3) There were many cancers in hormone-related organs in two families.

Clinicopathological Characteristics of Non-palpable Breast Cancer Presenting as Axillary Mass

We present the clinical and pathological findings of non-palpable breast cancer presenting an axillary mass in 8 patients at the National Cencer Center Hospital and in 89 cases previously reported in Japan. Mammography and ultrasonography were positive in 26.4% and 26.8% of cases, respectively. 82(94.3%) of 87 patients underwent mastectomy as a local control. In 19(30.6%) of 62 patients, the pathological size of the lesion was less than 5 mm. In 15 patients primary tumors could not be identified pathologically. The number of nodes involved ranged from 1-55 with a median of 5. There was no significant correlation between the number of involved nodes and the size of the axillary mass, nor between the number of involved nodes and the pathological size of the primary breast lesion. The 5-year survival rate was 59.4%. There was no statistically significant difference in 5-year survival rates between occult breast cancer and palpable breast cancer in each nodal category. Only the number of involved nodes was a reliable prognostic factor. Unlike palpable breast cancer, the pathological size of the primary tumor was not a predictor of prognosis. In this respect, the biological behavior of occult breast cancer is quite different from that of palpable breast cancer.

Higher Level of P-glycoprotein Expression in Human Breast Cancer Cells after Radiation Therapy

We investigated the effects of radiation on the expression of p53 protein and P-gp in breast cancer cells. Thirty-two preoperatively irradiated surgical specimens of stage I primary breast cancer were examined, and 39 surgical specimens of non-irradiated stage I breast cancer were selected as a control group. p53 and P-gp expression was detected by an immunohistochemical technique using rabbit polyclonal antibodies (RSP-53 and NCL-pGLYPp). The expression of p53 protein, defined as a nuclear immunoreaction in 20% or more of tumor cells, was detected in 4(13%) of the 32 cases in the irradiated group and 7 (18%) of the 39 cases in the non-irradiated group without any statistically significant difference. The expression of P-gp, defined as the presence of strong staining in more than 75% of the tumor cells, was detected in 19 (59%) of the cases in the irradiated group and 12(31%) of the cases in the non-irradiated group. P-gp expression was significantly higher in the former group than in the latter (P <0.05). There was no significant difference in P-gp expression between the stromal invasive component and the intraductal component in either the irradiated or the non-irradiated group. Radiotherapy possibly induces membranous P-gp expression in human breast cancer cells.