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Breast cancer patient(invasive ductal carcinoma, ER[+], PgR[+], HER2[3+], Ki-67: 30%)had neoadjuvant chemotherapy( FEC followed by docetaxel plus trastuzumab). After surgical operation(mastectomy and Ax)was performed and she received trastuzumab plus hormone therapy. After 2 years later, she had liver metastasis that showed IDC, ER(+), PgR (+), HER2(-). In addition, BRCA positive was shown. Therefore, the patient received olaparib tablets(300 mg twice daily). After 2 months later, liver metastasis reduced dramatically.

Summary The surgical management of axillary lymph nodes in early breast cancer remains controversial, although several maneuvers have been developed such as axillary node clearance (ANC), four node axillary sampling (4NAS), and sentinel node biopsy. A total of 237 cases of primary breast cancer at stages I and II were studied prospectively to elucidate the correlation between 4NAS and ANC. All calculated values by 4NAS showed high sensitivity, specificity, and overall accuracy as follows in this study: 92.9%, 100% and 98.5% for stage I, and 93.8%, 100% and 98.3% for stage II. Likewise, the false negative (FN) rates were 7.1% for stage I, 6.3% for stage II, 6.7% for T1, 6.4% for T2, 7.4% for N0, 0% for N1, and 6.5% for all cases. These rates were very low, although 7.4% for N0 and 0% for N1 were quite clearly different. This implies that all FN cases were N0, and were caused by micrometastases with normal consistency and size. 4NAS may be as accurate a procedure as ANC in assessing axillary nodal stage.

Background. Breast carcinoma and precancer are thought to start in the lining of the milk duct or lobule. Methods. At 5weeks of age, rats received a intraperitoneal (ip) injection of MNU for carcinogenesis. After mammary tumors were identified macroscopically using fiberscope, the rats were treated with perductal (pd) or ip injection of paclitaxel tri-weekly. At 36 weeks after MNU injection, tumor burden (No. of >1cm palpable mammary tumors/rat), total number of mammary carcinoma, apoptosis (AI), and microvessel density (MVD) were measured. Results. The administration of paclitaxel through the duct did not produce any toxic side effect. The tumor burden and total number of mammary carcinoma in the pd paclitaxel-treated group were significantly reduced compared to those seen in the ip paclitaxel-treated group. In addition, in the pd paclitaxel-treated group, AI was also increased and MVD was decreased, compared to those in the ip paclitaxel-treated group. Conclusion. Local administration of paclitaxel may be useful for treatment of breast cancer.

Ninty-three cases of both invasive ductal and lobular carcinoma were examined to clarify the relationship between the clinicopathological factors and cellularity (cell density) or total cancer cells number in carcinoma tissues. The cellularity showed significant correlation with tumor size and vascular invasion, but not with other clinicopathological factors (menopausal status, operation method, ER status, histological grade or type, lymph node stage) and prognosis. The total cancer cell number revealed a positive relationship with survival (overall survival) and disease-free interval (DFI) by univariate analysis, even though it did not show any positive correlation with other clinicopathological factors in this study. Moreover, it was not found to have any stronger impact than other previously reported prognostic factors such as tumor size, lymph node stage or tumor grade by multivariate analysis. From these evidences, we speculate that the cellularity correlates with expansion or invasion of tumor cells and the total number of cancer cells reflects the prognosis of the tumor-bearing host, although it does not play a major role in prediction.

Detection of breast cancer at an early stage is the key to successful treatment and outcome. In tumors confined to the breast at diagnosis, stage is the most important prognostic factor. If detected early, breast cancer is eminently curable. We measured loss of heterozygosity (LOH) using 9 microsatellite markers in epithelial cells obtained by ductal lavage (DL) from 59 women before breast surgery (excisional biopsies, duct resections, and mastectomies). In addition, we analyzed LOH obtained by DL in the contralateral breast of breast cancer patients. As a result, histological examination revealed 46 malignancies and 13 benign lesions. Sensitivity, specificity, and diagnostic accuracy were 100.0, 15.4, and 82.3% for LOH. LOH frequency in DL of breast cancer was significantly greater than that in DL of benign tumors. In terms of the contralateral breast of breast cancer patients, DL showed that one subject (3.4%) was malignant, and LOH frequency was similar to breast carcinoma. In conclusion, breast tissues that appear non-neoplastic pathologically often harbor genetic changes that can be important in understanding the breast environment within which the cancer develops.

The Nottingham Prognostic Index (NPI) is used to predict survival in patients with breast cancer. This index is based on tumor size, lymph node stage, and histological grade and allows the stratification of patients into three different prognostic groups. Our aim was to verify the effect of some prognostic variables on survival and to establish the independent influence of each of these variables by a survival regression analysis. We applied the NPI to the same group of patients to assess its predictive power and reproducibility.We evaluated 311 women with breast cancer treated between January 1993 and December 1998.In a multivariate analysis (Cox proportional hazard model), only size, lymph node involvement, and histological grade were independent prognostic factors. The survival curves obtained after applying the NPI were similar to those for the factors with independent prognostic significance derived from our multivariate analysis.The NPI allows us to accurately predict prognosis, and we advocate its standardized use.

Breast conserving therapy (BCT) was originally developed to achieve the same survival outcome as mastectomy while improving the quality of life. In fact, this approach resulted in high local control rates, but 30% of patients treated with BCT using electrocautery had a fair or poor cosmetic result at the 3-year follow-up. In 106 patients with stage I and II breast cancer treated by wide excision and axillary dissection using scalpel plus scissor or electrocautery followed by radiation therapy, the histological damage and cosmetic results were analyzed. The duration of operation in the scalpel plus scissor group was shorter than that in the electrocautery group, although blood loss was greater. The electrocautery caused extensive histological tissue damage to the stump compared with the scalpel plus scissor group. The cell death by TUNEL method was significantly increased on electrocautery groups. In addition, although the global cosmetic result of the electrocautery group was similar to that of the scalpel plus scissor group after surgery, the scalpel plus scissor group had a much better cosmetic outcome after surgery and radiation therapy at the 3-year follow-up. Clinical tumor size T1 and pathological tumor size over 2 cm were factors that negatively affected the cosmetic score after surgery in each group. Scalpel plus scissor in breast conserving surgery has less tissue damage and better cosmetic results at the 3-year follow-up.

BACKGROUND Breast carcinoma and precancer are believed to start in the lining of the milk duct or lobule. Ductography and fiberoptic ductoscopy (FDS) are used to identify abnormal intraductal lesions, although it is difficult to distinguish malignant from benign cases. Therefore, we studied the clinical usefulness of fluorescence in situ hybridization (FISH) analysis of a numerical aberration of chromosomes (aneusomy) using ductal lavage from patients with nipple discharge. METHODS We applied ductography and FDS to 90 women who had nipple discharge. Ductal lavages obtained from patients with positive ductography and/or FDS findings were subjected to cytology and FISH analysis using centromere probes for chromosomes 1, 11, and 17. Patients with samples that showed aneusomy in at least one of the three chromosomes were diagnosed as positive. RESULTS Histologic evaluation revealed 54 benign lesions and six malignancies. The sensitivity, specificity, and diagnostic accuracy were 33.3%, 88.9%, and 83.3%, respectively, for cytology and 100%, 100%, and 100%, respectively, for FISH. CONCLUSION The results demonstrated that FISH has a diagnostic accuracy comparable to cytology. This technique has 100% specificity is making a definitive diagnosis of malignancy in patients with indeterminate cytologic results, suggesting that FISH diagnosis can be a good adjunct to cytology. Cancer 2003;97:690–4. © 2003 American Cancer Society. DOI 10.1002/cncr.11091