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Invasive tumor or ductal carcinoma in situ occur in radial sclerosing lesions in one third of the cases therefore, surgical excision is mandatory. Forty-five patients with radial scar morphology were examined. Ultrasound guided fine-needle aspiration biopsy (FNAB) and core biopsy (CB) were performed in all cases. The postoperative pathological findings were compared to the results of preoperative biopsies. Sensitivity of preoperative percutaneous biopsies (FNAB and CB) was 17.6% and 70.6%, false-negative rate was 82.4% with FNAB and 29.4% with CB. The negative predictive value was 48.1% and 84.8% respectively. Had we done preoperative cytology only, we would have had to perform a two-step procedure (sentinel lymph node biopsy) in 7 patients (15.6%), while with preoperative core biopsy it has decreased to 2 patients (4.4%). Preoperative CB in small radial stellate lesions is recommended to achieve accurate diagnosis in order to avoid a two-step surgical procedures., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Proper preoperative staging is vital in the treatment of breast cancer patients. The aim of our study was to assess the value of the diagnostic information provided by PET/CT in surgical practice in breast cancer cases considered early-stage by conventional diagnostic modalities., Methods: Whole-body 18-FDG PET/CT was performed on 115 breast cancer patients in whom traditional diagnostic modalities showed no signs of distant metastases or extensive axillary and/or extra-axillary lymphatic spreading, and the size of the primary tumor was <4 cm., Results: The sensitivity of PET/CT in the detection of the primary tumor was 93%. The sensitivity of the traditional diagnostic modalities in the detection of multifocality was 43.8% while that of PET/CT was 100% (p < 0.001). In the assessment of axillary lymph nodes, ultrasound had a sensitivity of 30% and a specificity of 95%. The corresponding estimates for PET/CT were 72% and 96%, respectively. PET/CT detected distant metastases in 8 patients. TNM classification was modified after PET/CT scanning in 54 patients (47%). PET/CT data changed the treatment plan established upon the results of traditional imaging modalities in 18 patients (15.6%)., Conclusions: PET/CT is able to assess primary tumor size and axillary lymphatic status more accurately than traditional diagnostic methods. It can detect distant metastases in 7-8% of those patients who were declared free of metastasis by clinical investigations. PET/CT scan modifies the disease stage determined by traditional diagnostic modalities in almost half of the patients and leads to a change in the treatment plan in every 6th patient., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Introduction: The widespread use of PET/CT has a potential to change oncological diagnosis fundamentally. In our study we intended to clarify if preoperative PET/CT was able to assess axillary lymph node status, and the potential of these to modify preliminary treatment plans based on conventional diagnostic methods., Patients and Methods: We carried out 18-FDG PET/CT before elective surgery in 52 primary operable breast cancer patients between February 2008 and February 2009 at the DEOEC Clinical Department of Surgery. Total body imaging was performed in all cases; scans were evaluated by two specialists first visually, then semi-quantitatively based on body mass-corrected lesion suvmax values. The assessments were compared with axillary ultrasound and final histological diagnosis., Results: Two patients were excluded from the study due to failure to report for further treatment. Based on the results obtained from the remaining 50 patients, PET/CT showed a sensitivity of 80%, a specificity of 100%, positive and negative predictive values of 100% and 84.6% respectively for detecting axillary lymph node metastases. The same figures for axillary ultrasound, in respective order, were 30%, 81.8%, 60% and 56.2%. Prompted by the PET/CT results, we modified 9 patients' (18%) preliminary, conventional diagnosis-based treatment schemes., Conclusions: In case of a positive axillary PET/CT, it is unnecessary to perform SNB--axillary block dissection is called for with no further deliberation. Preoperative PET/CT can facilitate patient selection as regards possible benefit from neoadjuvant therapy. Preoperative PET/CT has a potential to modify the original management plan in about 15 to 20%. In case of a negative PET/CT scan, further studies are necessary to be able to spare the axilla from surgical intervention with confidence.

Several predictors of local recurrence (LR) after breast conservation in early stage (stage I and II) breast cancer have been reported in the literature, but the importance of the individual factors does not appear to be clear. The presence of intraductal component (IC) is one of those factors; some authors regard it to be a predictor of LR, while others do not, or the latter have found a relationship with LR only if IC and certain other factors were present simultaneously. The authors investigated the impact of the presence of IC of various degrees on LR rate in various tumour sizes and degrees of histological anaplasia. Between 1996 and 2002, 701 patients with early stage breast cancer underwent breast conserving surgery. Based on the presence of IC, the tumours were divided into three groups: IC negative, MIC (IC < 25%) and EIC (IC > 25%). During the 65-month mean follow-up period, LR was discovered in 13.5% of the patients. Local recurrence in tumours without IC was found in 8.7% (recurrence rate: 0.017, 95% CI: 0.012-0.012). The relevant figures in MIC and EIC were 16.8% (recurrence rate 0.032, 95% CI: 0.021-0.047) and 25.6% (recurrence rate: 0.046, 95% CI: 0.033-0.064), respectively (p = 0.0001). If the size of the tumour was T1, the above figures were found to be 6.4%, 11% and 24.3%, while in size T2 tumours they were 11.5%, 22.9% and 27% (p < 0.005). If EIC was associated with G3 degree of differentiation, in IC-free tumours of size T1, the LR rate elevated from 6.1% to 31% (p = 0.008), while in size T2 the elevation was from 15.7% to 33.% (p = 0.02). Based on the above results, the authors concluded that the presence of the intraductal component predicts a greater risk to develop LR. This risk increases significantly if EIC is associated with G3 histological grade. Physicians must consider this fact in designing individually tailored adjuvant therapy for their patients. Special attention should also be paid to the follow-up of this group of patients.

Integrin adhesion receptor expression of different benign and malignant breast tumours was examined by means of immunohistochemical techniques. A panel of seven different anti-alpha and two different anti-beta subunit antibodies was used. Normal breast epithelium displayed a well characterized and constant pattern of integrin expression consisting of strong alpha 1,2,3,6 and alpha v, and a relatively weaker beta 1 and beta 3 staining. No staining for alpha 4 or alpha 5 could be detected on the epithelial cells. Benign fibroadenomas did not show changes in their receptor expression compared to normal tissues. In the cases of different types of breast cancer, there was a significant downregulation of all subunits. The staining pattern was distinct if there could a basement membrane like structure be detected around the invading tumour nodules. When laminin and collagen type IV surrounded the tumour cells, those cells in contact with the extracellular matrix components still displayed strong positivity for the integrin subunits. Other cells inside the tumour cell nests or not surrounded by basement membrane did not express integrins. The positively staining cells might be more differentiated owing to the effect the basement membrane. Myoepithelial labeling of the integrin expressing cells gave negative results. The observed integrin expression heterogeneity renders the histologic picture difficult to interpret with regard to clinical behavior of the tumour.

The plasminogen activation system is a delicately balanced assembly of enzymes which seems to have primary influence on tumour progression. The conversion of plasminogen into serine protease plasmin with fibrinolytic activity depends on the actual balance between plasminogen activators (urokinase type; u-PA and tissue type; t-PA) and their inhibitors (type 1 and 2 plasminogen activator inhibitors; PAI-1 and PAI-2). The purpose of this study was to determine the exact histological localization of all the major factors involved in plasminogen activation, and activation inhibition (plasmin system) in benign and malignant breast tumour samples. Our results show that factors of the plasmin system are present both in benign and malignant tumours. Cancer cells strongly labelled for both u-PA and t-PA, but epithelial cells of fibroadenoma samples were also stained for plasminogen activators at least as intensively as tumour cells in cancerous tissues. In fibroadenomas, all the epithelial cells were labelled for PAI-1. Staining became sporadic in malignant tumours, cells located at the periphery of tumour cell clusters regularly did not show reaction for PAI-1. In the benign tumour samples the perialveolar connective tissue stroma contained a lot of PAI-1 positive cells, showing characteristics of fibroblasts; but their number was strongly decreased in the stroma of malignant tumours. These findings indicate that the higher level of u-PA antigen, detected in malignant breast tumour samples by biochemical techniques, does not necessarily indicate increased u-PA production by tumour cells but it might be owing to the increased number of cells producing u-PA as well.(ABSTRACT TRUNCATED AT 250 WORDS)