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Aims: To assess the validity of grading in the Edinburgh Breast Conservation Series; a consecutive cohort of 1812 early breast cancer patients treated by breast conservation and radiotherapy between 1981 and 1998 in a single specialist centre with ≥9 years’ follow-up and full staging data. Methods and results: A single pathologist (J.St.J.T) graded 1650 cases using the Elston and Ellis method (EE) with particular reference to the component data: acinar differentiation, nuclear pleomorphism and mitotic counts. The original method was then compared with binary scoring of the same components and the relationship to prognosis reassessed. EE grades and individual grade components were prognostic (P

The p53 locus on the short arm of chromosome 17 at 17p 13.1 was examined for loss of heterozygosity, mutation, mRNA and protein expression in 60 primary breast cancers. Allele loss around the p53 locus was detected in 19/45 informative tumours (42%). p53 mutations in the evolutionarily conserved exons 5 to 9 were detected in 17/60 (28%) by amplification mismatch and confirmed by direct DNA sequencing. p53 mRNA expression was detected by Northern blot in 36/59 (61%) of tumours, and p53 protein expression using antibody 1801 on frozen-tissue sections in 13/44 of the tumours examined. p53 mutation was significantly associated with oestrogen-receptor-poor tumours (p less than 0.01) and hence with poor prognosis, but not with other clinical or pathological parameters. There was no statistical correlation between loss of heterozygosity around the p53 locus at 17p13.1 and p53 mutation. Furthermore, p53 mutation was not associated with p53 expression detected by immunohistochemical staining with antibody 1801 or as p53 mRNA. In addition, events on 17p (allele losses, p53 mutation, p53 expression) were independent of c-erbB-2 expression. In breast cancer, by contrast with colorectal, lung and ovarian cancer, there appears to be no clear association between p53 DNA abnormalities and p53 expression.

A prospective study was performed in 202 patients with 219 fibroadenomas, diagnosed by a combination of clinical examination, ultrasonography and fine-needle aspiration cytology. Patients were given the choice of excision or conservative management with regular monitoring by ultrasonography. Sixteen patients with 18 fibroadenomas opted for excision and all 18 lesions were histologically confirmed as fibroadenomas. A further 152 patients with 163 fibroadenomas were observed for a minimum period of 2 years; 13 fibroadenomas increased significantly in size (all 13 were excised and confirmed histologically as fibroadenomas), 19 decreased significantly in size, 42 resolved and the remaining 89 showed no change in size. Conservative management of fibroadenomas in patients under the age of 40 is safe and acceptable to the majority of women.