Frozen section is superior to imprint cytology for the intra-operative assessment of sentinel lymph node metastasis in Stage I Breast cancer patients

BACKGROUND: A standard intra-operative procedure for assessing sentinel lymph node metastasis in breast cancer patients has not yet been established. PATIENTS AND METHODS: One hundred and thirty-eight patients with stage I breast cancer who underwent sentinel node biopsy using both imprint cytology and frozen section were analyzed. RESULTS: Seventeen of the 138 patients had sentinel node involvement. Results of imprint cytology included nine false negative cases (sensitivity, 47.1%). In contrast, only two cases of false negatives were found on frozen section (sensitivity, 88.2%). There were two false positive cases identified by imprint cytology (specificity, 98.3%). On the other hand, frozen section had 100% specificity. CONCLUSION: These findings suggest that frozen section is superior to imprint cytology for the intra-operative determination of sentinel lymph node metastasis in stage I breast cancer patients

Post-operative breast cancer patients diagnosed with skeletal metastasis without bone pain had fewer skeletal-related events and deaths than those with bone pain

<p>Abstract</p> <p>Background</p> <p>Skeletal metastases are often accompanied by bone pain. To investigate the clinical meaning of bone pain associated with skeletal metastasis in breast cancer patients after surgery, we explored whether the presence of bone pain was due to skeletal-related events (SREs) or survival (cause specific death, CSD), retrospectively.</p> <p>Methods</p> <p>Consecutive breast cancer patients undergoing surgery between 1988 and 1998 were examined for signs of skeletal metastasis until December 2006. Patients who were diagnosed as having skeletal metastasis were the subjects of this study. Bone scans were performed annually for 5, 7 or 10 years; they were also conducted if skeletal metastasis was suspected. Data concerning bone pain and tumor markers at the time of skeletal metastasis diagnosis, and data relating to various factors including tumors, lymph nodes and hormone receptors at the time of surgery, were investigated. The relationships between factors such as bone pain, SRE and CSD were analyzed using the Kaplan-Meier method and Cox's analysis.</p> <p>Results</p> <p>Skeletal metastasis occurred in 668 patients but the pain status of two patients was unknown, therefore 666 patients were included in the study. At the time of skeletal metastasis diagnosis 270 patients complained of pain; however, 396 patients did not. Analysis of data using Cox's and Kaplan-Meier methods demonstrated that patients without pain had fewer SREs and better survival rates than those with pain. Hazard ratios regarding SRE (base = patients without pain) were 2.331 in univariate analysis and 2.243 in multivariate analysis. Hazard ratios regarding CSD (base = patients without pain) were 1.441 in univariate analysis and 1.535 in multivariate analysis. Similar results were obtained when analyses were carried out using the date of surgery as the starting point.</p> <p>Conclusion</p> <p>Bone pain at diagnosis of skeletal metastasis was an indicator of increased SRE and CSD. However, these data did not support recommendations of follow-up bone surveys in breast cancer patients.</p

An open cohort study of bone metastasis incidence following surgery in breast cancer patients

Background: To help design clinical trials of adjuvant bisphosphonate therapy for breast cancer, the temporal incidence of bone metastasis was investigated in a cohort of patients. We have tried to draw the criteria to use adjuvant bisphosphonate.Methods: Consecutive breast cancer patients undergoing surgery between 1988 and 1998 (5459 patients) were followed up regarding bone metastasis until December 2006. Patients characteristics at the time of surgery were analyzed by Cox method, with bone metastasis as events. Patient groups were assigned according to Cox analysis, and were judged either to require the adjuvant bisphosphonate or not, using the tentative criteria: high risk (>3% person-year), medium risk (1-3%), and low risk (3% per person-year, patients with stage I <1% per person-year, andthose with stages II were between 1 and 3%. Further analysis with histology in stage II patients showed that stage IIB with high risk histology also had a high incidence (3% person year), whereas stage IIA with medium risk histology were <1%.Conclusions: Bone metastasis incidence remained constant for many years. Using pN, T, and histopathology, patients could be classified into high, medium, and low risk groups

A Clinicopathologic Study of Breast Cancer Patients during Pregnancy

Background & Aims: The purpose of this study was to investigate the influence of pregnancy on breast cancer prognosis by analyzing clinical and pathological features of young patients with breast cancer in relation to last birth. Method: A total of 622 young breast cancer patients under 35 years of age undergoing surgical treatment between 1960 and 1990 at Cancer Institute Hospital were included in this study. The patients were classified into four groups; group A patients who were diagnosed during pregnancy or within one year after delivery, group B patients who were diagnosed from one to three years after delivery, group C patients who were diagnosed three years or more after delivery, and group D patients who were nulliparous. All four groups were examined from the viewpoint of clinical and pathological findings with regard to age, disease duration, first childbirth, clinical stage, histopathological type, lymph node metastasis, and survival. Furthermore, nuclear grade and immunohistochemical staining of both estrogen receptor (ER) and factor-VIII were examined in early-stage breast cancer patients. Result: The incidence of early-stage(0, I and II) breast cancer was significantly(p＜ 0.05) lower in group A (69％) than in groups C (88％) and D (85％). The incidence of nodal involvement decreased from group A (61％), B (59％), C (51％) to D (43％) in that order. The incidence of nodal involvement in group D was significantly (p＜0.05) lower than that in groups A and B. The positive rate of estrogen receptor increased from group A (50％), B (56％) to C (72％) in that order. Disease-free survival was significantly (p＜0.05) more favorable in group D than in groups A and C. The similar result was obtained in patients with clinically early-stage breast cancer. Conclusion: Patients who developed breast cancer during pregnancy or within less than one year postpartum have a poor prognosis among patients under 35 years old. Patients having no childbirth history generally have a high risk factor of developing breast cancer, however, breast cancer patients without childbirth history under 35 years old result in a favourable prognosis