Vrijednosti pojedinih dijagnostičkih metoda u otkrivanju patoloških promjena u dojci

For diagnosing pathologic changes in the breast, depending on age, clinical examination combined with ultrasound, mammography and cytology are most commonly used. Any positive finding requires a biopsy for a final diagnosis. The biopsy precedes surgical treatment usually performed during the same operative session. To assess the value of some diagnostic methods for detection of pathologic breast changes a retrospective study was carried out on a sample of 78 patients diagnosed and treated at the Eljuga Polyclinic from March 1999 to March 2003. In diagnosing for pathohistologic changes, the aforementioned methods were applied in all of the 78 studied patients (aged 23-77). The patients were assigned to two age groups including patients over 35 (mean age 49) and under 35 yrs of age (mean age 29), respectively. The first group was further divided into 6 subgroups, depending on the correlation between a particular diagnostic method and final pathohistologic finding. The correspondence between pathohistologic finding and all other diagnostic procedures was as follows: clinical examination, US, mammography and cytological analysis showed accuracy in 92.30% (72/78), 96.15% (75/78), 92.53% (62/67, excluding 11 patients <35 yrs not requiring mammography – benign changes), and 84.62 % (64/73, technically failed samples excluded) of the cases, respectively. Ultrasound breast imaging demonstrated superior accuracy over mammography, clinical examination and cytologic puncture. The results lead to the conclusion that in the majority of breast patients, a combination of several diagnostic methods should be used to get an accurate diagnosis.U dijagnosticiranju patoloških promjena u dojci, ovisno o dobi, najčešće se primjenjuju klinički i ultrazvučni pregled, mamografija i citološka analiza. Pozitivan nalaz bilo koje od tih metoda pretrage indicira biopsiju kao konačnu dijagnostičku metodu. Ona prethodi kirurškom liječenju i najčešće se vrši u istom aktu s operacijom. U svrhu procjene vrijednosti pojedinih dijagnostičkih metoda u otkrivanju patoloških promjena u dojci, provedena je retrospektivna studija na uzorku od 78 bolesnica, podvrgnutih dijagnosticiranju i liječenju promjena u dojci u Poliklinici "Eljuga" u razdoblju između ožujka 1999. i ožujka 2003. U svih 78 bolesnica (u dobi između 23 i 77 godina) u postupku dijagnosticiranja patoloških promjena u dojci primjenjivane su sve navedene dijagnostičke metode. Bolesnice su podijeljene u dvije dobne skupine: one starije od 35g. (prosječne dobi od 49 godina) i one mlađe od 35g. (prosječne dobi od 29 godina). Prva skupina bolesnica podijeljena je u daljnjih 6 podskupina, ovisno o korelaciji između pojedinih dijagnostičkih metoda i konačnog patohistološkog nalaza. Podudarnost patohistološkog nalaza i svih drugih dijagnostičkih postupaka bila je sljedeća: klinički pregled pokazao se točnim u 92,30 % ( 72/78 ) bolesnica, UZV u 96,15 % ( 75/78 ), mamografija u 92,53 % ( 62/ 67, izuzeto 11 bolesnica <35 god. kojima nije bila potrebna mamografija-benigne promjene), a citološka analiza u 84,62 % bolesnica ( 64/73, s izuzetkom tehnički neuspjelih uzoraka). Najtočnijom metodom pokazao se UZV pregled dojki, kojeg slijede mamografija, klinički pregled, te citološka punkcija. Rezultati nameću zaključak, da kod većine bolesnica samo kombinacija više dijagnostičkih metoda može dovesti do ispravne dijagnoze

Vrijednosti pojedinih dijagnostičkih metoda u otkrivanju patoloških promjena u dojci

For diagnosing pathologic changes in the breast, depending on age, clinical examination combined with ultrasound, mammography and cytology are most commonly used. Any positive finding requires a biopsy for a final diagnosis. The biopsy precedes surgical treatment usually performed during the same operative session. To assess the value of some diagnostic methods for detection of pathologic breast changes a retrospective study was carried out on a sample of 78 patients diagnosed and treated at the Eljuga Polyclinic from March 1999 to March 2003. In diagnosing for pathohistologic changes, the aforementioned methods were applied in all of the 78 studied patients (aged 23-77). The patients were assigned to two age groups including patients over 35 (mean age 49) and under 35 yrs of age (mean age 29), respectively. The first group was further divided into 6 subgroups, depending on the correlation between a particular diagnostic method and final pathohistologic finding. The correspondence between pathohistologic finding and all other diagnostic procedures was as follows: clinical examination, US, mammography and cytological analysis showed accuracy in 92.30% (72/78), 96.15% (75/78), 92.53% (62/67, excluding 11 patients <35 yrs not requiring mammography – benign changes), and 84.62 % (64/73, technically failed samples excluded) of the cases, respectively. Ultrasound breast imaging demonstrated superior accuracy over mammography, clinical examination and cytologic puncture. The results lead to the conclusion that in the majority of breast patients, a combination of several diagnostic methods should be used to get an accurate diagnosis.U dijagnosticiranju patoloških promjena u dojci, ovisno o dobi, najčešće se primjenjuju klinički i ultrazvučni pregled, mamografija i citološka analiza. Pozitivan nalaz bilo koje od tih metoda pretrage indicira biopsiju kao konačnu dijagnostičku metodu. Ona prethodi kirurškom liječenju i najčešće se vrši u istom aktu s operacijom. U svrhu procjene vrijednosti pojedinih dijagnostičkih metoda u otkrivanju patoloških promjena u dojci, provedena je retrospektivna studija na uzorku od 78 bolesnica, podvrgnutih dijagnosticiranju i liječenju promjena u dojci u Poliklinici "Eljuga" u razdoblju između ožujka 1999. i ožujka 2003. U svih 78 bolesnica (u dobi između 23 i 77 godina) u postupku dijagnosticiranja patoloških promjena u dojci primjenjivane su sve navedene dijagnostičke metode. Bolesnice su podijeljene u dvije dobne skupine: one starije od 35g. (prosječne dobi od 49 godina) i one mlađe od 35g. (prosječne dobi od 29 godina). Prva skupina bolesnica podijeljena je u daljnjih 6 podskupina, ovisno o korelaciji između pojedinih dijagnostičkih metoda i konačnog patohistološkog nalaza. Podudarnost patohistološkog nalaza i svih drugih dijagnostičkih postupaka bila je sljedeća: klinički pregled pokazao se točnim u 92,30 % ( 72/78 ) bolesnica, UZV u 96,15 % ( 75/78 ), mamografija u 92,53 % ( 62/ 67, izuzeto 11 bolesnica <35 god. kojima nije bila potrebna mamografija-benigne promjene), a citološka analiza u 84,62 % bolesnica ( 64/73, s izuzetkom tehnički neuspjelih uzoraka). Najtočnijom metodom pokazao se UZV pregled dojki, kojeg slijede mamografija, klinički pregled, te citološka punkcija. Rezultati nameću zaključak, da kod većine bolesnica samo kombinacija više dijagnostičkih metoda može dovesti do ispravne dijagnoze

Važnost rekonstrukcijske kirurgije kod bolesnica s rakom dojke

Breast cancer is the most common cancer in women in Croatia. Thanks to modern diagnostics and national program of early detection of breast cancer, tumors today are diagnosed in earlier stage, which has favorable effect on the prognosis of disease, but also on the possibilities of surgical treatment. Surgical treatment of breast cancer is progressing rapidly, from breast conserving surgical procedures to skin sparing mastectomies and primary reconstruction of removed breast which became the standard of modern surgical treatment. Apart from the primary reconstruction, patients are offered the opportunity of secondary reconstruction. In patients with early breast cancer (T1 and T2 stage), skin sparing mastectomy followed with breast reconstruction is a safe method from oncologic viewpoint and from the aspect of patient, it reduces psychological trauma that is associated with removal of the entire breast (feeling of mutilation, depression, decreased sexuality). This method also gives plastic surgeons ability to achieve excellent aesthetic appearance of new breast.Rak dojke najčešći je rak u žena u Hrvatskoj. Zahvaljujući suvremenoj dijagnostici i nacionalnom probiru u mogućnosti smo otkrivati rak dojke u ranijoj fazi. Važnost rane dijagnostike povoljno utječe ne samo na prognozu bolesti, već i na mogućnost odabira optimalnog kirurškog zahvata s kojim i počinje liječenje u žena s rakom dojke. Od kirurških zahvata u obzir dolaze poštedni zahvati na dojci, od mastektomije s poštedom kože i primarnom rekonstrukcijom do sekundarnih rekonstrukcija. U svih bolesnica s T1 i T2 tumorom, mastektomija s poštedom kože i primarnom rekonstrukcijom kirurški je postupak koji nudi jednaku onkološku sigurnost kao i standardna mastektomija, a nakon primarne rekonstrukcije u bolesnica se umanjuje psihološka trauma, koje tim zahvatom ne gube osjećaj ženstvenosti. ženama se također vraća povjerenje u vlastito tijelo, a samim time i odnos prema partneru te drugima u zajednici

Važnost ranog otkrivanja raka dojke u očuvanju psihičkog i tjelesnog integriteta žene

Breast cancer remains a major public health problem in the entire developed world. The first and the biggest reason is an ever increasing number of breast cancer diagnoses and consistently high mortality from this disease. Due to the continuous improvement of standard methods and introduction of new diagnostic tests breast cancer can be detected at an early stage, when a high percentage of cases are likely to be successfully treated and/or cured. One of many different types of surgery is usually the first step in treating breast cancer. Each in their own way affects woman’s quality of life. Efforts should be made to detect breast cancer as early as possible to entirely avoid some of the treatment modalities and thus significantly improve woman’s quality of life in all its aspects.Rak dojke i dalje ostaje velik javnozdravstveni problem u cijelom razvijenom svijetu. Prvi i najveći razlog svakako je sve veći broj oboljelih žena i konstantno visoka smrtnost od ove bolesti. Zahvaljujući stalnom usavršavanju standardnih te uvo|enju novih dijagnostičkih metoda rak dojke moguće je otkriti u najranijoj fazi kada je bolest u visokom postotku uspješno liječiva i/ili izlječiva. Prvi korak u liječenju raka dojke najčešće je jedan od više tipova operativnih zahvata. Svaki od njih na svoj način utječe na kvalitetu života žene. Rak dojke treba nastojati što ranije otkriti kako bi se neki od modaliteta liječenja u cijelosti izbjegli što značajno podiže kvalitetu života žene u svim njegovim aspektima

Važnost ranog otkrivanja raka dojke u očuvanju psihičkog i tjelesnog integriteta žene

Breast cancer remains a major public health problem in the entire developed world. The first and the biggest reason is an ever increasing number of breast cancer diagnoses and consistently high mortality from this disease. Due to the continuous improvement of standard methods and introduction of new diagnostic tests breast cancer can be detected at an early stage, when a high percentage of cases are likely to be successfully treated and/or cured. One of many different types of surgery is usually the first step in treating breast cancer. Each in their own way affects woman’s quality of life. Efforts should be made to detect breast cancer as early as possible to entirely avoid some of the treatment modalities and thus significantly improve woman’s quality of life in all its aspects.Rak dojke i dalje ostaje velik javnozdravstveni problem u cijelom razvijenom svijetu. Prvi i najveći razlog svakako je sve veći broj oboljelih žena i konstantno visoka smrtnost od ove bolesti. Zahvaljujući stalnom usavršavanju standardnih te uvo|enju novih dijagnostičkih metoda rak dojke moguće je otkriti u najranijoj fazi kada je bolest u visokom postotku uspješno liječiva i/ili izlječiva. Prvi korak u liječenju raka dojke najčešće je jedan od više tipova operativnih zahvata. Svaki od njih na svoj način utječe na kvalitetu života žene. Rak dojke treba nastojati što ranije otkriti kako bi se neki od modaliteta liječenja u cijelosti izbjegli što značajno podiže kvalitetu života žene u svim njegovim aspektima

Važnost rekonstrukcijske kirurgije kod bolesnica s rakom dojke

Breast cancer is the most common cancer in women in Croatia. Thanks to modern diagnostics and national program of early detection of breast cancer, tumors today are diagnosed in earlier stage, which has favorable effect on the prognosis of disease, but also on the possibilities of surgical treatment. Surgical treatment of breast cancer is progressing rapidly, from breast conserving surgical procedures to skin sparing mastectomies and primary reconstruction of removed breast which became the standard of modern surgical treatment. Apart from the primary reconstruction, patients are offered the opportunity of secondary reconstruction. In patients with early breast cancer (T1 and T2 stage), skin sparing mastectomy followed with breast reconstruction is a safe method from oncologic viewpoint and from the aspect of patient, it reduces psychological trauma that is associated with removal of the entire breast (feeling of mutilation, depression, decreased sexuality). This method also gives plastic surgeons ability to achieve excellent aesthetic appearance of new breast.Rak dojke najčešći je rak u žena u Hrvatskoj. Zahvaljujući suvremenoj dijagnostici i nacionalnom probiru u mogućnosti smo otkrivati rak dojke u ranijoj fazi. Važnost rane dijagnostike povoljno utječe ne samo na prognozu bolesti, već i na mogućnost odabira optimalnog kirurškog zahvata s kojim i počinje liječenje u žena s rakom dojke. Od kirurških zahvata u obzir dolaze poštedni zahvati na dojci, od mastektomije s poštedom kože i primarnom rekonstrukcijom do sekundarnih rekonstrukcija. U svih bolesnica s T1 i T2 tumorom, mastektomija s poštedom kože i primarnom rekonstrukcijom kirurški je postupak koji nudi jednaku onkološku sigurnost kao i standardna mastektomija, a nakon primarne rekonstrukcije u bolesnica se umanjuje psihološka trauma, koje tim zahvatom ne gube osjećaj ženstvenosti. ženama se također vraća povjerenje u vlastito tijelo, a samim time i odnos prema partneru te drugima u zajednici

Polymorphisms in survivin (BIRC5 gene) are associated with age of onset in breast cancer patients

Survivin, encoded by BIRC5 gene (baculoviral IAP repeat containing 5), belongs to the family of inhibitors of apoptosis proteins (IAPs). In mammalian cells it participates in the control of mitosis, apoptosis regulation, and cellular stress response. Its expression is increased in almost all types of cancers. The aim of this study was to investigate the role of BIRC5 polymorphisms in breast cancer (BC) and to connect survivin expression with various clinicopathological characteristics of BC patients. Blood and archival tumour tissue samples were collected from 26 BC patients from Croatia. Survivin expression was determined immunohistochemically. BIRC5 promoter, coding region, and 3’UTR were genotyped. DNA from 74 healthy women was used as control. BIRC5 polymorphisms and survivin expression were tested against age of onset, histological grade, tumour type and size, lymph node status, oestrogen, progesterone, Her2, and Ki67 status. Numbers of samples with weak, moderate, and strong survivin expression were 9 (33.3%), 11 (40.7%), and 7 (25.9%), respectively. Most patients had nuclear survivin staining (92.6%). High survivin expression was significantly associated with negative oestrogen receptor status (p=0.007) and positive Ki67 expression (p=0.032). Ki67 expression was also positively correlated with histological grade (p=0.0009). Fourteen polymorphisms were found in BC samples, located mostly in promoter and 3’UTR of BIRC5. There was no significant difference in the distribution of polymorphisms between BC and control samples. Among clinicopathological characteristics of BC patients, alleles of five BIRC5 polymorphisms were associated with younger age of onset: c.-644T&gt;C (55.8 years [y] vs. 48.1 y ; p=0.006), c.-241C&gt;T (54.2 y vs. 45.0 ; p=0.029), c.9809T&gt;C (55.8 y vs. 48.1 y ; p=0.006), c.-1547C&gt;T (58.3 y vs. 50.9 y ; p=0.011), and c.9386T&gt;C (50.8 y vs. 59.5 y ; p=0.004). To assess the significance of BIRC5 polymorphisms and survivin expression as predictive and prognostic biomarkers for BC further research with a larger sample size is needed

GUIDELINES FOR GENETIC COUNSELLING AND TESTING FOR HEREDITARY BREAST AND OVARIAN CANCER

Tijekom posljednjih desetljeća svjedoci smo velikog napretka u izvedivosti i kliničkoj iskoristivosti genetičkog testiranja kod nasljednih karcinoma. Nasljedni karcinomi dojke i jajnika najčešće su posljedica mutacija u genima BRCA1 i BRCA2. Ovim smjernicama obuhvatili smo kriterije za upućivanje pacijenata na genetičko savjetovanje i testiranje; kriterije za upućivanje zdravih pojedinaca na prediktivno testiranje ako nije moguće testiranje oboljelog člana obitelji; postupak genetičkog savjetovanja prije i nakon testiranja; nalaz testiranja, kategorije nalaza i razine rizika; preporuke za daljnje praćenje osoba s povišenim rizikom; kemoprevenciju i profilaktičku kirurgiju kod nositelja/-ica patogenih mutacija gena BRCA 1 i BRCA 2; očuvanje reproduktivne funkcije u žena oboljelih od raka dojke i nositeljica mutacija BRCA i pristanak informiranog bolesnika na genetičko testiranje. Smjernice su namijenjene svim specijalistima koji su na bilo koji način uključeni u zbrinjavanje oboljelih od nasljednih karcinoma dojke i jajnika, a sastavila ih je radna skupina prema podacima iz relevantne medicinske literature te kliničkim iskustvima članova radne skupine.The last few decades have witnessed a great progress in feasibility and clinical utilization of genetic testing for hereditary cancers. Hereditary breast and ovarian cancers are most often the result of BRCA1 and BRCA2 gene mutations. In these guidelines we have covered: the criteria for referral of patients to genetic counselling and testing; the criteria for referral of healthy family members to predictive testing in the event when there is no possibility of testing the patient; the process of genetic counselling before and after testing; test results, their categories and risk levels; recommendations for monitoring of individuals with an increased risk; chemoprevention and prophylactic surgery for carriers of BRCA1 and BRCA2 gene mutations; preservation of reproductive function in women with breast cancer and in carriers of BRCA mutations; and informed consent for genetic testing. The guidelines are intended for all specialists who are in any way involved in the care of patients with hereditary breast and ovarian cancer, and are compiled by the working group according to the data from the relevant medical literature and from clinical experience of the members of the working group

GUIDELINES FOR GENETIC COUNSELLING AND TESTING FOR HEREDITARY BREAST AND OVARIAN CANCER

Tijekom posljednjih desetljeća svjedoci smo velikog napretka u izvedivosti i kliničkoj iskoristivosti genetičkog testiranja kod nasljednih karcinoma. Nasljedni karcinomi dojke i jajnika najčešće su posljedica mutacija u genima BRCA1 i BRCA2. Ovim smjernicama obuhvatili smo kriterije za upućivanje pacijenata na genetičko savjetovanje i testiranje; kriterije za upućivanje zdravih pojedinaca na prediktivno testiranje ako nije moguće testiranje oboljelog člana obitelji; postupak genetičkog savjetovanja prije i nakon testiranja; nalaz testiranja, kategorije nalaza i razine rizika; preporuke za daljnje praćenje osoba s povišenim rizikom; kemoprevenciju i profilaktičku kirurgiju kod nositelja/-ica patogenih mutacija gena BRCA 1 i BRCA 2; očuvanje reproduktivne funkcije u žena oboljelih od raka dojke i nositeljica mutacija BRCA i pristanak informiranog bolesnika na genetičko testiranje. Smjernice su namijenjene svim specijalistima koji su na bilo koji način uključeni u zbrinjavanje oboljelih od nasljednih karcinoma dojke i jajnika, a sastavila ih je radna skupina prema podacima iz relevantne medicinske literature te kliničkim iskustvima članova radne skupine.The last few decades have witnessed a great progress in feasibility and clinical utilization of genetic testing for hereditary cancers. Hereditary breast and ovarian cancers are most often the result of BRCA1 and BRCA2 gene mutations. In these guidelines we have covered: the criteria for referral of patients to genetic counselling and testing; the criteria for referral of healthy family members to predictive testing in the event when there is no possibility of testing the patient; the process of genetic counselling before and after testing; test results, their categories and risk levels; recommendations for monitoring of individuals with an increased risk; chemoprevention and prophylactic surgery for carriers of BRCA1 and BRCA2 gene mutations; preservation of reproductive function in women with breast cancer and in carriers of BRCA mutations; and informed consent for genetic testing. The guidelines are intended for all specialists who are in any way involved in the care of patients with hereditary breast and ovarian cancer, and are compiled by the working group according to the data from the relevant medical literature and from clinical experience of the members of the working group

Smjernice za genetičko savjetovanje i testiranje na nasljedni rak dojke i jajnika [Guidelines for genetic counselling and testing for hereditary breast and ovarian cancer]

The last few decades have witnessed a great progress in feasibility and clinical utilization of genetic testing for hereditary cancers. Hereditary breast and ovarian cancers are most often the result of BRCA1 and BRCA2 gene mutations. In these guidelines we have covered: the criteria for referral of patients to genetic counselling and testing; the criteria for referral of healthy family members to predictive testing in the event when there is no possibility of testing the patient; the process of genetic counselling before and after testing; test results, their categories and risk levels; recommendations for monitoring of individuals with an increased risk; chemoprevention and prophylactic surgery for carriers of BRCA1 and BRCA2 gene mutations; preservation of reproductive function in women with breast cancer and in carriers of BRCA mutations; and informed consent for genetic testing. The guidelines are intended for all specialists who are in any way involved in the care of patients with hereditary breast and ovarian cancer, and are compiled by the working group according to the data from the relevant medical literature and from clinical experience of the members of the working group