RESUMO
Within the past few years, the measurement of serum and tissue markers, especially the latter, has assumed a more significant role influencing clinical decisions about treatment and follow-up of patients with malignant disease. Breast cancer is a useful paradigm to illustrate the types and importance of these various markers. Tissue markers, including nuclear grade, steroid hormone receptors, DNA index, ploidy, expression of oncogenes or tumor-suppressor genes, epidermal growth factors, cathepsin D, proliferating cell nuclear antigen (PCNA), Ki-67, p32, and others, may influence choices of initial treatment as well as adjuvant chemotherapy and (or) hormone administration. The serial measurement of serum markers, those currently available and those on the horizon, for example, may offer a way to monitor patients at risk for recurrent cancer. Although the current role of these markers may be controversial, as information about them is collected and refined, in the future perhaps a panel of such studies could be incorporated into forthcoming clinical staging systems for carcinoma of the breast and other malignancies to define both treatment and outcome.
Assuntos
Biomarcadores Tumorais/análise , Neoplasias da Mama/diagnóstico , Biomarcadores Tumorais/sangue , Neoplasias da Mama/sangue , Neoplasias da Mama/química , Neoplasias da Mama/genética , Feminino , Humanos , PrognósticoRESUMO
Ever-increasing use of mammography brings with it a growing number of breast biopsies. The authors describe the five radiologic findings that mandate a surgical consultation. About 30% of their biopsies for nonpalpable breast lesions prove to be invasive or in situ carcinomas. When a mammogram is ambiguous, the authors recommend a repeat mammogram in 6 months. They use needle-localization, and feel that dye marking is superfluous. The films, duly marked by the radiologist, should accompany the patient to the OR. The biopsy is an outpatient procedure, and only local anesthesia, sometimes with IV sedation, is required. It is not necessary to remove the skin over the biopsy site, nor all of the tissue traversed by the needle localizer. The authors describe their surgical procedure for biopsy, state that x-ray of the specimen is mandatory, and that frozen sections are not desirable. Their procedure takes longer, but it's better, they say.
Assuntos
Neoplasias da Mama/diagnóstico , Biópsia por Agulha/métodos , Feminino , Humanos , Mamografia , Palpação , Manejo de Espécimes/métodos , Fatores de TempoRESUMO
As capital investments in the health care industry have changed in popularity, mergers and acquisitions of and by hospitals have created supersystems of health care that are based on the assumption that economies of scale offer greater protection from a variety of forces. The acquisition of West Park (Jefferson Park) Hospital by Thomas Jefferson University and the infusion of Jefferson management into Methodist Hospital have provided the institution with unique opportunities to broaden its population base for acute care admissions and to permit greater diversification within the entire health care market.
Assuntos
Centros Médicos Acadêmicos/organização & administração , Instituições Associadas de Saúde/organização & administração , Hospitais Comunitários/organização & administração , Gastos de Capital/organização & administração , Área Programática de Saúde , Instituições Associadas de Saúde/economia , Hospitais com 100 a 299 Leitos , Hospitais com mais de 500 Leitos , Planejamento Hospitalar/economia , Planejamento Hospitalar/organização & administração , Hospitais de Doenças Crônicas/organização & administração , Humanos , Investimentos em Saúde/economia , PhiladelphiaRESUMO
Fifty breasts with nonpalpable ductal carcinoma in situ (DCIS) were examined for the presence of microinvasion, multicentricity, and number of involved ducts to see if the biopsy specimen could have predicted the findings in the remainder of the breast. When DCIS was an incidental finding, fewer ducts were involved and no evidence of either microinvasion or multicentricity was found. Solid and cribriform DCIS were rarely multicentric or microinvasive; micropapillary DCIS was often multicentric, rarely microinvasive; comedocarcinoma was more likely to be both microinvasive and multicentric. Ductal carcinoma in situ as an incidental finding may be treated by excision alone; papillary and micropapillary DCIS are best treated by therapy aimed at the entire breast, although axillary dissection may not be required. Therapy for comedocarcinomas should include the entire breast and the axillary nodes.
Assuntos
Neoplasias da Mama/patologia , Carcinoma in Situ/patologia , Carcinoma Intraductal não Infiltrante/patologia , Neoplasias Primárias Múltiplas/patologia , Adulto , Idoso , Neoplasias da Mama/terapia , Carcinoma in Situ/terapia , Carcinoma Intraductal não Infiltrante/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Primárias Múltiplas/terapiaRESUMO
Preoperative ultrasonography was used as an alternative to x-ray mammography to localize 92 breast lesions encountered in 82 patients. Recommendation for biopsy was made on the basis of the ultrasonographic finding of a nonpalpable mass or an area of architectural distortion, or in the presence of equivocal physical findings if sonomammography demonstrated a solid or an anechoic mass. Sonomammography was performed in the operating room, just before anticipated biopsy, with a hand-held high-resolution scanner. When the suspicious area was imaged and its precise location noted, the breast was then prepared and draped in the usual manner, and a biopsy was performed. If the suspicious area could not be easily localized after the incision was made and the breast explored, the transducer was "gowned" and used directly in the wound to help find the lesion. This technique has proven effective and accurate. In selected patients ultrasonography may be used as well as, or instead of, x-ray needle localization for the precise excision of nonpalpable breast lesions, excluding calcifications.
Assuntos
Biópsia por Agulha , Doenças Mamárias/diagnóstico , Mamografia , Palpação , Ultrassonografia , Adulto , Idoso , Biópsia por Agulha/métodos , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Ultrassonografia/instrumentação , Ultrassonografia/métodosRESUMO
One hundred women with American Joint Committee (AJC) stage III (T2, N2; T3, N0/1/2; T4, N0/1/2) carcinoma of the breast were treated with combination chemotherapy following biopsy to confirm the diagnosis and determine hormone receptor status before any other treatment of the local disease (so-called neoadjuvant chemotherapy). Response was assessed after three cycles of treatment, and responders were treated until the tumor and/or axillary nodes failed to show further regression. Definitive surgery was then performed, usually radical mastectomy. Chemotherapy was resumed following surgery for a total of 12 cycles. Ninety patients are assessable, and 70% have responded to chemotherapy. Outcomes of both responders and nonresponders were analyzed. Radical mastectomy without postoperative radiotherapy seems to be the preferable surgical treatment for the responders. Median follow-up of the assessable patients was 27 months; projected five-year disease-free survival of the responders is greater than 65%, and projected overall five-year survival of this group is greater than 85%. Because the follow-up of these patients suggests a marked improvement in outcome compared with similar patients treated traditionally with mastectomy or radiotherapy followed by adjuvant chemotherapy, we advocate more widespread use of combination chemotherapy before definitive treatment for stage III carcinomas of the breast.