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Cyclooxygenase type-2 (COX-2) is overexpressed in malignant tumours including breast cancers, though the mechanism of upregulation is unclear. This study aimed to determine COX-2 expression in ductal carcinoma in situ (DCIS) in comparison to invasive breast cancer (IBC) and normal breast, and also to investigate the relationship of COX-2 expression with HER-2 expression, oestrogen receptor (ER), tumour grade and cellular proliferation (Ki67) in DCIS. Cyclooxygenase type-2, HER-2, ER and Ki67 expression were determined by immunohistochemistry on paraffin tissue sections of DCIS (n=187), IBC (n=65) and normal breast reduction tissue (n=60). Cyclooxygenase type-2 expression in DCIS (67%, P<0.001) and IBC (63%, P<0.001) was significantly greater than in normal breast (23%). There was no difference in COX-2 expression level between DCIS and IBC (P=0.87) or between normal breast from reduction mammoplasty tissue and normal breast ducts around DCIS (22%, P=0.29). In DCIS, COX-2 expression was associated with higher cellular proliferation rates (P<0.0001), nuclear grade (P=0.003), with ER negativity (P=0.003) and with HER-2 positivity (P<0.0001). Cyclooxygenase type-2 expression is upregulated in in situ breast cancer and is associated with surrogate markers of an aggressive DCIS phenotype including nonoestrogen-regulated signalling pathways. Cyclooxygenase type-2 inhibition may potentially prevent the development of ER-positive and ER-negative breast cancers.British Journal of Cancer (2004) 90, 423-429. doi:10.1038/sj.bjc.6601534 www.bjcancer.com [ABSTRACT FROM AUTHOR]

Aims: Stereotactic core biopsy has resulted in an increased preoperative diagnosis of DCIS and has replaced wire-localized open biopsy for screen-detected microcalcification, potentially reducing the need for reoperation to obtain clear excision margins. Our aim was to assess the impact of the introduction of stereotactic core biopsy on the reoperation rate for screendetected impalpable DCIS. Methods: A retrospective analysis was performed on a cohort of 221 women with screen-detected pure DCIS with (after 1997, n=74) and without (before 1997, n=147) a preoperative core biopsy diagnosis. An intraoperative specimen X-ray was performed to assess the adequacy of excision. The two groups of patients were matched for age and DCIS nuclear grade. Results: Pathological and mammographic DCIS tumour sizes were similar (r=0.71, P < 0.001). Conclusion: Changes from diagnostic to therapeutic primary operative excision for screen-detected DCIS have not resulted in a reduction in the total number of operations required to complete treatment, because mammography underestimates DCIS tumour size in 30 per cent of patients. [ABSTRACT FROM AUTHOR]

Aims: Over 80 per cent of women have a preoperative diagnosis of DCIS made by core biopsy, but a cohort of patients require reoperation to complete surgical treatment. Preoperative factors which identify these women would reduce the reoperation rate. Our aim was to determine factors predictive for reoperation following breast conserving surgery for core biopsy diagnosed, screen-detected DCIS. Methods: Consecutive women diagnosed with pure DCIS (n=160) after stereotactic core biopsy were included. A primary therapeutic local excision was attempted in all patients, with completeness of excision assessed by intraoperative specimen X-ray. Risk factors for reoperation were assessed by univariate binary logistic regression. Results: Occult invasive cancer was found at operation in 64 patients (40 per cent), with 57 women requiring reoperation for either close (<1mm) or involved excision margins (±axillary staging, 86 per cent) or for axillary staging alone (16 per cent). Pathological and radiological estimates of DCIS size were similar (r=0.49, P < 0.001). Conclusions: Preoperative factors and intraoperative assessment of completeness of excision did not predict for reoperation. Despite an increased preoperative core biopsy diagnosis, re-excision after primary "therapeutic" DCIS operations will remain necessary in 40 per cent of patients. [ABSTRACT FROM AUTHOR]

Aims: The presence of cerbB-2 oncoprotein is said to predict failure to respond to endocrine therapy in breast cancer (particularly tamoxifen). The aim of the study was to determine whether the effect of oestrogen deprivation (by stopping HRT) on breast cancer is related to cerbB-2 oncoprotein expression. Methods and study: We identified 129 women who were on HRT at the time of diagnosis of breast cancer by core biopsy. Out of 129 women, 114 stopped HRT and 15 continued HRT till surgery. Ki67 (a marker of cell proliferation), progesterone receptor (PR), ER (oestrogen receptor) and cyclin D1 (a cell cycle inducer) were measured by immunohistochemistry on paired sections of core biopsy and operative specimens. CerbB-2 was measured on the operative specimen and was scored from 0 to 3. Results: Stopping HRT led to a significant fall in epithelial proliferation compared to continued group (P = 0.05), more so in ER positives (P = 0.045)[sup *] Mann-Whitney test. PR (P=0.007)[sup *] and cyclin D1 (P=0.05)[sup *] decreased significantly in responding tumours regardless of cerbB-2 status (P = 0.498, Kruskal-Wallis test). Conclusion: CerbB-2 expression does not prevent fall in cell proliferation due to HRT withdrawal. Aromatase inhibitors may still be the optimal strategy for ER and cerbB-2-positive breast cancers. [ABSTRACT FROM AUTHOR]

Compares the performance of margin status with van Nuys index in recurrence prediction of ductal carcinoma in situ following breast conserving surgery. Analysis of the clinico-pathological data; Application of logistical regression; Advantage of close resection margins.