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1. Schneider-Kolsky ME, Hart S, Fox J, Midolo P, Stuckey J, Hofman M, Ganju V: The role of chemotherapeutic drugs in the evaluation of breast tumour response to chemotherapy using serial FDG-PET. Breast Cancer Res; 2010;12(3):R37
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  • [Title] The role of chemotherapeutic drugs in the evaluation of breast tumour response to chemotherapy using serial FDG-PET.
  • INTRODUCTION: The aims of this study were to investigate whether drug sequence (docetaxel followed by anthracyclines or the drugs in reverse order) affects changes in the maximal standard uptake volume (SUVmax) on [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) during neoadjuvant chemotherapy in women with locally advanced breast cancer.
  • METHODS: Women were randomly assigned to receive either drug sequence, and FDG-PET scans were taken at baseline, after four cycles and after eight cycles of chemotherapy.
  • Tumour response to chemotherapy was evaluated based on histology from a surgical specimen collected upon completion of chemotherapy.
  • Thirty-one received docetaxel followed by anthracyclines (Arm A) and 29 received drugs in the reverse order (Arm B).
  • Most women (83%) had ductal carcinoma and 10 women (17%) had lobular or lobular/ductal carcinoma.
  • All but one tumour were downstaged during therapy.
  • Overall, there was no significant difference in response between the two drug regimens.
  • CONCLUSIONS: Our results show that SUVmax uptake by breast tumours during chemotherapy can be dependent on the drugs used.
  • Care must be taken when interpreting FDG-PET in settings where patients receive varied drug protocols.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Breast Neoplasms / diagnosis. Carcinoma, Ductal, Breast / diagnosis. Carcinoma, Lobular / diagnosis. Fluorodeoxyglucose F18. Positron-Emission Tomography. Radiopharmaceuticals
  • [MeSH-minor] Adult. Aged. Anthracyclines / administration & dosage. Chemotherapy, Adjuvant. Female. Humans. Middle Aged. Neoadjuvant Therapy. Receptor, ErbB-2 / metabolism. Receptors, Estrogen / metabolism. Receptors, Progesterone / metabolism. Survival Rate. Taxoids / administration & dosage. Treatment Outcome

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  • (PMID = 20565953.001).
  • [ISSN] 1465-542X
  • [Journal-full-title] Breast cancer research : BCR
  • [ISO-abbreviation] Breast Cancer Res.
  • [Language] eng
  • [Publication-type] Journal Article; Randomized Controlled Trial
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Anthracyclines; 0 / Radiopharmaceuticals; 0 / Receptors, Estrogen; 0 / Receptors, Progesterone; 0 / Taxoids; 0Z5B2CJX4D / Fluorodeoxyglucose F18; 15H5577CQD / docetaxel; EC 2.7.10.1 / Receptor, ErbB-2
  • [Other-IDs] NLM/ PMC2917032
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2. Mathieu MC, Rouzier R, Llombart-Cussac A, Sideris L, Koscielny S, Travagli JP, Contesso G, Delaloge S, Spielmann M: The poor responsiveness of infiltrating lobular breast carcinomas to neoadjuvant chemotherapy can be explained by their biological profile. Eur J Cancer; 2004 Feb;40(3):342-51
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  • [Title] The poor responsiveness of infiltrating lobular breast carcinomas to neoadjuvant chemotherapy can be explained by their biological profile.
  • The aim of this study was to determine the chemosensitivity of infiltrating lobular breast carcinoma (ILC) in comparison with infiltrating ductal carcinoma (IDC).
  • Between 1987 and 1995, 457 patients with invasive T2>3 cm-T4 breast carcinomas were treated with primary chemotherapy (CT), surgery, radiation therapy.
  • Clinical response, the possibility of breast preservation, pathological response and survival were evaluated according to the histological type.
  • In order to evaluate the biological differences between ILC and IDC patients and their implication with regard to tumour chemosensitivity, additional immunohistochemical stainings (oestrogen receptor (ER), Bcl2, p53, c-erbB-2 and Ki67) were performed on 129 pretherapeutical specimens.
  • 38 (8.3%) ILC were diagnosed by core needle biopsy before CT.
  • ILC was an independent predictor of a poor clinical response (P=0.02) and ineligibility for breast-conserving surgery after neoadjuvant chemotherapy (P=0.03).
  • Histological and biological factors predicting a poor response to CT (histological grade, ER, Ki67 and p53 status) were more frequent in ILC than in IDC patients.
  • After a median follow-up of 98 months (range: 3-166), the low chemosensitivity of ILC did not result in a survival disadvantage.
  • Our results demonstrate that ILC achieved a lower response to CT than IDC because of their immunohistochemical profile.
  • Preoperative CT did not allow a high rate of conservative treatment for ILC and therefore the use of neoadjuvant CT for ILC patients should be questioned.
  • [MeSH-major] Breast Neoplasms / drug therapy. Carcinoma, Ductal, Breast / drug therapy. Carcinoma, Lobular / drug therapy
  • [MeSH-minor] Adult. Aged. Chemotherapy, Adjuvant. Female. Follow-Up Studies. Humans. Immunohistochemistry. Mastectomy / methods. Middle Aged. Survival Analysis. Treatment Failure


3. Zhou M, Johnson N, Gruner S, Ecklund GW, Meunier P, Bryn S, Glissmeyer M, Steinbock K: Clinical utility of breast-specific gamma imaging for evaluating disease extent in the newly diagnosed breast cancer patient. Am J Surg; 2009 Feb;197(2):159-63
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  • [Title] Clinical utility of breast-specific gamma imaging for evaluating disease extent in the newly diagnosed breast cancer patient.
  • BACKGROUND: Breast-specific gamma imaging (BSGI) is a functional imaging modality that has comparable sensitivity but superior specificity compared with magnetic resonance imaging, yielding fewer false-positive results and thereby improving clinical management of the newly diagnosed breast cancer patient.
  • METHODS: A retrospective review was performed from 2 community-based breast imaging centers of newly diagnosed breast cancer patients in whom BSGI was performed as part of the imaging work-up.
  • RESULTS: A total of 138 patients (69 invasive ductal carcinoma, 20 invasive lobular carcinoma, 32 ductal carcinoma in situ, and 17 mixtures of invasive ductal carcinoma, invasive lobular carcinoma, or ductal carcinoma in situ and other) were reviewed.
  • Twenty-five patients (18.1%) had a positive BSGI study at a site remote from their known cancer or more extensive disease than detected from previous imaging.
  • Fifteen patients (10.9%) were positive for a synchronous or more extensive malignancy in the same or contralateral breast.
  • Findings converted 7 patients to mastectomy, 1 patient to neoadjuvant chemotherapy, and 7 patients were found to have previously undetected contralateral cancer.
  • CONCLUSIONS: BSGI detected additional or more extensive malignancy in the same or contralateral breast in 10.9% of newly diagnosed breast cancer patients.
  • BSGI provides accurate evaluation of remaining breast tissue in newly diagnosed breast cancer patients with few false-positive readings.
  • [MeSH-major] Breast Neoplasms / radionuclide imaging

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  • (PMID = 19185109.001).
  • [ISSN] 1879-1883
  • [Journal-full-title] American journal of surgery
  • [ISO-abbreviation] Am. J. Surg.
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Radiopharmaceuticals; 971Z4W1S09 / Technetium Tc 99m Sestamibi
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4. De Cesare A, Burza A, Fiori E, Bononi M, Volpino P, Leone G, Crocetti A, Cangemi V: Assessment of surgical treatment in elderly patients with breast cancer. Tumori; 2008 May-Jun;94(3):314-9
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  • [Title] Assessment of surgical treatment in elderly patients with breast cancer.
  • AIMS AND BACKGROUND: The incidence of breast cancer increases with advancing age and in clinical practice approximately 50% of new cases occur in women over the age of 65 years.
  • Although breast cancer in elderly patients presents more favorable biological characteristics than similar-stage cancer in younger women, disease control still remains uncertain and is becoming a major health problem.
  • PATIENTS AND METHODS: Between 1984 and 2006, 133 patients aged over 65 with operable breast cancer underwent surgical treatment.
  • Patients with ductal or lobular carcinoma in situ, bilateral breast cancer or a previous malignancy were excluded.
  • Breast-conserving surgery was performed in patients with early breast cancer (T1, T2 < 2.5 cm), while most patients with advanced tumors (T2 >2.5 cm, T3, T4) were treated by modified radical mastectomy.
  • Eighty-nine patients underwent adjuvant therapy (chemotherapy, hormonal therapy).
  • The overall mortality from breast cancer was 11%, whereas the cancer-unrelated mortality was 9%.
  • CONCLUSION: There is no evidence that breast cancer has a more favorable prognosis in the elderly and surgical procedures should be carried out as has been established in younger women.
  • However, in the absence of serious comorbid disease, they are able to withstand standard multimodal treatment options as well as do younger patients.
  • [MeSH-major] Breast Neoplasms / pathology. Breast Neoplasms / surgery. Mastectomy
  • [MeSH-minor] Aged. Aged, 80 and over. Axilla. Biomarkers, Tumor / analysis. Carcinoma in Situ / surgery. Carcinoma, Ductal, Breast / surgery. Carcinoma, Lobular / surgery. Disease Progression. Female. Follow-Up Studies. Humans. Lymphatic Metastasis. Neoplasm Staging. Receptors, Estrogen / analysis. Receptors, Progesterone / analysis. Retrospective Studies. Treatment Outcome

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  • (PMID = 18705397.001).
  • [ISSN] 0300-8916
  • [Journal-full-title] Tumori
  • [ISO-abbreviation] Tumori
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Receptors, Estrogen; 0 / Receptors, Progesterone
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5. McLemore EC, Pockaj BA, Reynolds C, Gray RJ, Hernandez JL, Grant CS, Donohue JH: Breast cancer: presentation and intervention in women with gastrointestinal metastasis and carcinomatosis. Ann Surg Oncol; 2005 Nov;12(11):886-94
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  • [Title] Breast cancer: presentation and intervention in women with gastrointestinal metastasis and carcinomatosis.
  • BACKGROUND: Breast cancer metastatic to the gastrointestinal tract or peritoneum is rare.
  • We reviewed the natural history of ductal and lobular carcinoma in women with breast cancer metastatic to the gastrointestinal tract, peritoneum, or both.
  • METHODS: We performed a retrospective review of all patients (1985-2000) with a pathologic diagnosis of breast cancer metastatic to the gastrointestinal tract or peritoneum.
  • The median age at initial breast cancer diagnosis was 55 years.
  • The mean interval between the primary diagnosis and metastatic presentation was 7 years.
  • Infiltrating lobular carcinoma represented 34 (64%) of the 53 gastrointestinal metastases.
  • The median overall survival after diagnosis was 28 months.
  • Advanced age at diagnosis and gastric metastases had a negative effect on survival, whereas treatment with systemic chemotherapy or tamoxifen had a positive effect on survival.
  • CONCLUSIONS: Gastrointestinal metastasis occurred more often in patients with invasive lobular carcinoma.
  • Surgical intervention did not significantly extend overall survival but may be considered in a select group of patients.
  • [MeSH-major] Breast Neoplasms / pathology. Carcinoma, Ductal, Breast / secondary. Carcinoma, Lobular / secondary. Gastrointestinal Neoplasms / secondary. Peritoneal Neoplasms / secondary

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  • (PMID = 16177864.001).
  • [ISSN] 1068-9265
  • [Journal-full-title] Annals of surgical oncology
  • [ISO-abbreviation] Ann. Surg. Oncol.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] United States
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6. Biglia N, Mariani L, Sgro L, Mininanni P, Moggio G, Sismondi P: Increased incidence of lobular breast cancer in women treated with hormone replacement therapy: implications for diagnosis, surgical and medical treatment. Endocr Relat Cancer; 2007 Sep;14(3):549-67
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  • [Title] Increased incidence of lobular breast cancer in women treated with hormone replacement therapy: implications for diagnosis, surgical and medical treatment.
  • A growing body of evidence support the association between the use of hormone replacement therapy (HRT) and a higher risk of both invasive lobular carcinoma (ILC) and invasive ductal-lobular mixed carcinoma (IDLC).
  • Overall biological and clinical features of ILC entail a more cautious diagnostic and therapeutic approach as compared with invasive ductal carcinoma (IDC).
  • Mammography and ultrasound show, therefore, significant limitations, while the higher sensitivity of magnetic resonance imaging in the detection of multifocal and/or multicentric lesions seems to improve the accuracy of preoperative staging of ILCs.
  • Early diagnosis is even more challenging because the difficult in the localization and the sparse cellularity of lobular tumours may determine a false negative core biopsy.
  • ILC is characterized by low proliferative activity, C-ErbB-2 negativity, bcl-2 positivity, p53 and VEGF negativity, oestrogen and progesterone positive receptors, low grade and low likelihood of lymphatic-vascular invasion.
  • Since lobular histology is associated with a higher risk of positive margins, mastectomy is often preferred to breast conservative surgery.
  • Moreover, only few patients with ILC achieve a pathologic response to preoperative chemotherapy and, therefore, in most patients mastectomy can be regarded as the safer surgical treatment.
  • The preoperative staging and the follow-up of patients with ILC are also complicated by the particular metastatic pattern of such histotype.
  • [MeSH-major] Breast Neoplasms / chemically induced. Breast Neoplasms / epidemiology. Carcinoma, Lobular / chemically induced. Carcinoma, Lobular / epidemiology. Estrogen Replacement Therapy / adverse effects
  • [MeSH-minor] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Biopsy, Fine-Needle. Combined Modality Therapy. Feasibility Studies. Female. Humans. Incidence. Intraoperative Period. Magnetic Resonance Imaging. Mammography. Mastectomy, Segmental. Mastectomy, Simple. Neoplasm Invasiveness / diagnosis. Prognosis. Risk Assessment. Sentinel Lymph Node Biopsy. Ultrasonography, Mammary


7. Darvishian F, Ginsberg MS, Klimstra DS, Brogi E: Carcinoid tumorlets simulate pulmonary metastases in women with breast cancer. Hum Pathol; 2006 Jul;37(7):839-44
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  • [Title] Carcinoid tumorlets simulate pulmonary metastases in women with breast cancer.
  • Cases of multiple PCTs diagnosed between 1992 and 2003 in patients with history of breast cancer were identified through a search of the pathology files.
  • We identified 12 women with a history of breast cancer and biopsy-proven PCTs, who were treated at our institution in a period of 12 years.
  • The mean age at diagnosis of the breast cancer was 62.8 years.
  • The breast cancer was invasive carcinoma in 10 cases (9 ductal and 1 lobular) and ductal carcinoma in situ and malignant phyllodes tumor in 1 case each.
  • Six women received radiotherapy; 5, chemotherapy; and 4, hormonal treatment, alone or in combination.
  • Pulmonary carcinoid tumorlets were identified within 5 months from diagnosis of the breast malignancy in 7 patients and at follow-up (range, 57-162 months) in the remaining 5.
  • Misdiagnosis of metastatic carcinoma was rendered intraoperatively by frozen section analysis in 3 cases.
  • None of the patients had known metastatic disease at the time of diagnosis of PCTs.
  • Three patients subsequently developed recurrent disease, including 2 with extramammary spread.
  • Pulmonary carcinoid tumorlets are radiologic and histologic mimickers of pulmonary metastases in patients with a history of breast cancer.
  • Consideration should be given to the possibility of PCTs in patients with breast cancer with pulmonary nodules, even if multiple.
  • [MeSH-major] Breast Neoplasms / pathology. Carcinoid Tumor / pathology. Lung Neoplasms / pathology. Neoplasms, Multiple Primary / pathology
  • [MeSH-minor] Adult. Diagnosis, Differential. Female. Humans. Middle Aged. Tomography, X-Ray Computed


8. Tse GM, Yeung DK, King AD, Cheung HS, Yang WT: In vivo proton magnetic resonance spectroscopy of breast lesions: an update. Breast Cancer Res Treat; 2007 Sep;104(3):249-55
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  • [Title] In vivo proton magnetic resonance spectroscopy of breast lesions: an update.
  • In vivo proton magnetic resonance spectroscopy ((1)H-MRS) has been demonstrated to be successful in the differentiation of benign and malignant breast lesions in a non-invasive manner by detecting increased levels of composite choline (Cho) compounds.
  • Currently there is molecular evidence of increased Cho metabolism in breast cancer cells.
  • In breast malignancies, (1)H-MRS achieved a high-overall sensitivity (82%).
  • Most test cases were infiltrating duct carcinoma, but infiltrating lobular, medullary, mucinous and adenoid cystic carcinomas were also positive by (1)H-MRS.
  • Another potential of (1)H-MRS is to assess patients' response to neoadjuvant chemotherapy.
  • In ductal carcinoma in situ, the results of (1)H-MRS on the limited number of cases were negative.
  • Most of the assessed benign breast lesions including fibroadenoma, fibrocystic changes, cysts and galactoceles, papilloma, tubular adenoma and phyllodes tumours and were mostly negative by (1)H-MRS, with an overall false positive rate was about 8%.
  • Normal breast tissue was almost always negative by (1)H-MRS, whereas, lactating breast tissue showed positivity with a slightly different spectrum on further analysis.
  • With these improvements, (1)H-MRS may potentially be useful in detection of smaller malignant lesions, characterization of malignant lesions into non-invasive or invasive, and as an invaluable tool in disease progression monitoring.
  • [MeSH-major] Breast Neoplasms / diagnosis. Breast Neoplasms / pathology. Magnetic Resonance Spectroscopy / methods
  • [MeSH-minor] Breast / pathology. Carcinoma / metabolism. Carcinoma, Ductal, Breast / diagnosis. Carcinoma, Ductal, Breast / pathology. Choline / metabolism. Disease Progression. False Positive Reactions. Female. Humans. Protons. Reproducibility of Results. Sensitivity and Specificity

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  • (PMID = 17051424.001).
  • [ISSN] 0167-6806
  • [Journal-full-title] Breast cancer research and treatment
  • [ISO-abbreviation] Breast Cancer Res. Treat.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] Netherlands
  • [Chemical-registry-number] 0 / Protons; N91BDP6H0X / Choline
  • [Number-of-references] 36
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9. Rakha EA, Gill MS, El-Sayed ME, Khan MM, Hodi Z, Blamey RW, Evans AJ, Lee AH, Ellis IO: The biological and clinical characteristics of breast carcinoma with mixed ductal and lobular morphology. Breast Cancer Res Treat; 2009 Mar;114(2):243-50
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  • [Title] The biological and clinical characteristics of breast carcinoma with mixed ductal and lobular morphology.
  • Although invasive ductal (IDC) and lobular (ILC) breast carcinomas are well characterised in the literature, the biological and clinical significance of mixed tumours with both ductal and lobular components has not been investigated.
  • In the current study, we have examined a well-characterised series of breast carcinoma with a long term follow-up that comprised 140 mixed tumours, 2170 IDC and 380 pure ILC.
  • RESULTS: Mixed tumours constituted 3.6% of all cases.
  • The majority (59%) of the mixed tumours were grade 2 compared to 33% in IDC and 88% in ILC.
  • Positive lymph nodes (LN) were found in 41% and definite vascular invasion (VI) in 26% of the cases.
  • DCIS was detected in 123 (89%) and LCIS in 43 (31%) (both DCIS and LCIS were found in 39 cases).
  • The majority of tumours were predominantly (>50 of tumour area) of ductal type (57%).
  • When compared to pure IDC, mixed tumours showed an association with lower grade, ER positivity and lower frequency of development of distant metastases.
  • When compared to pure ILC, mixed tumours showed an association with higher grade, positive LN metastasis, VI and development of regional metastasis.
  • There was an association between histologic type of carcinoma in LN metastasis and the predominant histologic type of the primary tumour.
  • Mixed tumours showed metastatic patterns similar to that of ILC with frequent metastasis to bone.
  • No clinically meaningful differences in survival were found between these mixed carcinomas and pure IDC or ILC of the breast or between mixed tumours with predominantly ductal or lobular phenotype.
  • [MeSH-major] Breast Neoplasms / pathology. Carcinoma, Ductal, Breast / pathology. Carcinoma, Intraductal, Noninfiltrating / pathology. Carcinoma, Lobular / pathology
  • [MeSH-minor] Adult. Aged. Biomarkers, Tumor / metabolism. Female. Follow-Up Studies. Humans. Middle Aged. Neoplasm Invasiveness. Neoplasm Recurrence, Local / diagnosis. Neoplasm Recurrence, Local / drug therapy. Prognosis. Retrospective Studies. Survival Rate

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  • (PMID = 18404368.001).
  • [ISSN] 1573-7217
  • [Journal-full-title] Breast cancer research and treatment
  • [ISO-abbreviation] Breast Cancer Res. Treat.
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article
  • [Publication-country] Netherlands
  • [Chemical-registry-number] 0 / Biomarkers, Tumor
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10. Sullivan PS, Apple SK: Should histologic type be taken into account when considering neoadjuvant chemotherapy in breast carcinoma? Breast J; 2009 Mar-Apr;15(2):146-54
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  • [Title] Should histologic type be taken into account when considering neoadjuvant chemotherapy in breast carcinoma?
  • Neoadjuvant chemotherapy is becoming the standard of care in locally advanced breast cancers.
  • We retrospectively identified 49 cases of invasive breast carcinoma treated with neoadjuvant chemotherapy (40 ductal, nine lobular) and examined histologic and biologic features of ductal and lobular carcinoma before and after chemotherapy.
  • Patients with lobular carcinomas presented at a later age and had lower grade tumors that were more likely estrogen and progesterone receptor positive.
  • Ductal carcinomas had a greater frequency of HER-2/neu amplification and increased Ki-67 rate.
  • After chemotherapy, none of the lobular carcinomas had complete pathologic response compared with 28% of the ductal carcinomas (p = 0.01).
  • Lobular carcinomas had more lymph node metastases.
  • At the time of clinical follow-up, no lobular carcinomas had evidence of disease.
  • Only one lobular carcinoma case had any histologic changes after chemotherapy compared with 37-68% of ductal carcinomas (p < 0.05).
  • In ductal carcinomas, higher grade and negative estrogen receptor expression before chemotherapy and presence of foam cell clusters, HER-2/neu expression, and absence of lymphatic or vascular space invasion after chemotherapy correlated with pathologic response (p < 0.05).
  • Decreased Ki-67 rate after chemotherapy correlated with survival (p = 0.024).
  • Breast biomarker status changed in 9% of all lobular carcinomas and 19% of all ductal carcinomas.
  • Lobular carcinomas respond poorly to neoadjuvant chemotherapy as evidence by lack of complete pathologic response and rare histologic tissue response.
  • [MeSH-major] Breast Neoplasms / drug therapy. Breast Neoplasms / pathology. Chemotherapy, Adjuvant / methods
  • [MeSH-minor] Adult. Aged. Carcinoma, Intraductal, Noninfiltrating / drug therapy. Carcinoma, Intraductal, Noninfiltrating / pathology. Carcinoma, Lobular / drug therapy. Carcinoma, Lobular / pathology. Female. Humans. Immunohistochemistry. Ki-67 Antigen / analysis. Middle Aged. Neoplasm Invasiveness. Receptors, Estrogen / analysis. Receptors, Progesterone / analysis. Retrospective Studies. Tumor Suppressor Protein p53 / analysis


11. Straver ME, van Adrichem JC, Rutgers EJ, Rodenhuis S, Linn SC, Loo CE, Gilhuijs KG, Oldenburg HS, Wesseling J, Russell NS, Antonini N, Vrancken Peeters MT: [Neoadjuvant systemic therapy in patients with operable primary breast cancer: more benefits than breast-conserving therapy]. Ned Tijdschr Geneeskd; 2008 Nov 15;152(46):2519-25
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  • [Title] [Neoadjuvant systemic therapy in patients with operable primary breast cancer: more benefits than breast-conserving therapy].
  • [Transliterated title] Neoadjuvante systemische therapie bij het primair operabel mammacarcinoom: meer voordelen dan alleen borstsparende behandeling.
  • OBJECTIVE: To analyse the extent to which primary systemic therapy (PST) achieves the main goals in patients with operable primary breast cancer, these goals being breast-conserving therapy and pathological complete remission (pCR), and to evaluate the response.
  • METHOD: In a retrospective analysis of 254 patients treated with PST in 2000-2007 in the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, patients with inoperable disease (T4 and/or N3) were excluded.
  • The response was mostly evaluated using contrast-enhanced MRI, whereby the chemotherapy regimen was switched if the reduction in the largest diameter of contrast washout was less than 25%.
  • pCR was defined as no evidence of invasive cancer in the breast and axilla in the resection specimen.
  • RESULTS: In patients with ductal carcinoma and lobular carcinoma an increase in breast-conserving therapy was seen in 32% and 17% of patients respectively.
  • Multivariate analysis indicated that molecular type, defined on the basis of the expression of hormone receptors and human epidermal growth factor receptor 2 (HER2), i.e. luminal (oestrogen receptor-positive), basal (hormone receptor-negative and HER2-negative) and HER2-positive tumours treated with trastuzumab was the only independent predictor of pCR; 2%, 28% and 35% respectively (p=0.004).
  • In 43 patients the chemotherapy regimen was adjusted because the tumour did not respond sufficiently.
  • CONCLUSION: The observed increase in the number of breast-conserving therapies after PST was clinically relevant.
  • PST may be more effective when contrast-enhanced MRI is used for interim evaluation, based on which the treatment may be switched.
  • There was a clear difference in histological and molecular types of tumour and therefore the choice of treatment may be adjusted accordingly.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Breast Neoplasms / therapy. Chemotherapy, Adjuvant / methods. Neoadjuvant Therapy / methods. Preoperative Care / methods
  • [MeSH-minor] Adult. Aged. Carcinoma, Ductal. Carcinoma, Ductal, Breast / pathology. Carcinoma, Ductal, Breast / surgery. Carcinoma, Ductal, Breast / therapy. Female. Humans. Lymphatic Metastasis. Mastectomy. Middle Aged. Neoplasm Staging. Retrospective Studies. Treatment Outcome. Young Adult


12. Fisher B, Dignam J, Tan-Chiu E, Anderson S, Fisher ER, Wittliff JL, Wolmark N: Prognosis and treatment of patients with breast tumors of one centimeter or less and negative axillary lymph nodes. J Natl Cancer Inst; 2001 Jan 17;93(2):112-20
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  • [Title] Prognosis and treatment of patients with breast tumors of one centimeter or less and negative axillary lymph nodes.
  • BACKGROUND: Uncertainty about prognosis and treatment of axillary lymph node-negative patients with estrogen receptor (ER)-negative or ER-positive invasive breast tumors of 1 cm or less prompted the analysis of data from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials.
  • Patients with ER-negative tumors received surgery alone or surgery and chemotherapy.
  • Patients with ER-positive tumors received surgery alone; surgery and tamoxifen; or surgery, tamoxifen, and chemotherapy.
  • A result was considered to be statistically significant with a P value of.05 or less; all statistical tests were two-sided.
  • RESULTS: The 8-year RFS of women with ER-negative tumors who received surgery alone or with chemotherapy was 81% and 90%, respectively (P = .06).
  • The 8-year RFS of women with ER-positive tumors was 86% after surgery alone, 93% when tamoxifen was added (P = .01), and 95% after the addition of tamoxifen and chemotherapy (P = .07 compared with tamoxifen).
  • Regardless of ER status or treatment, overall mortality was 8%; one half of the deaths were related to breast cancer.
  • Risk was greater in women with tumors of 1 cm than in those with tumors of less than 1 cm, in women aged 49 years or younger than in those aged 50 years or older, and in women with infiltrating ductal or lobular carcinoma than in those with other histologic tumor types.
  • CONCLUSIONS: Chemotherapy and/or tamoxifen should be considered for the treatment of women with ER-negative or ER-positive tumors of 1 cm or less and negative axillary lymph nodes.
  • [MeSH-major] Antineoplastic Agents / therapeutic use. Breast Neoplasms / pathology. Breast Neoplasms / therapy
  • [MeSH-minor] Antineoplastic Agents, Hormonal / therapeutic use. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Canada. Chemotherapy, Adjuvant. Disease-Free Survival. Estrogen Receptor Modulators / therapeutic use. Female. Humans. Lymphatic Metastasis. Mastectomy / methods. Middle Aged. Multicenter Studies as Topic. Prognosis. Randomized Controlled Trials as Topic. Receptors, Estrogen / analysis. Receptors, Progesterone / analysis. Risk Factors. Survival Analysis. Tamoxifen / therapeutic use. Treatment Outcome. United States

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  • [CommentIn] J Natl Cancer Inst. 2001 Sep 19;93(18):1420-1; author reply 1421-2 [11562395.001]
  • [CommentIn] J Natl Cancer Inst. 2001 Jan 17;93(2):80-2 [11208870.001]
  • (PMID = 11208880.001).
  • [ISSN] 0027-8874
  • [Journal-full-title] Journal of the National Cancer Institute
  • [ISO-abbreviation] J. Natl. Cancer Inst.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / U10CA12027; United States / NCI NIH HHS / CA / U10CA37377; United States / NCI NIH HHS / CA / U10CA69651
  • [Publication-type] Journal Article; Meta-Analysis; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Antineoplastic Agents, Hormonal; 0 / Estrogen Receptor Modulators; 0 / Receptors, Estrogen; 0 / Receptors, Progesterone; 094ZI81Y45 / Tamoxifen
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13. Esses KM, Hagmaier RM, Blanchard SA, Lazarchick JJ, Riker AI: Carcinosarcoma of the breast: two case reports and review of the literature. Cases J; 2009;2(1):15
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Carcinosarcoma of the breast: two case reports and review of the literature.
  • Carcinosarcoma of the breast, often referred to as metaplastic carcinoma of the breast, is a rare malignancy with two distinct cell lines described as a breast carcinoma of ductal type with a sarcoma-like component.
  • Clinically, carcinosarcoma of the breast is an aggressive breast cancer.
  • The prognosis for carcinosarcoma of the breast is less favorable compared to more common types of breast cancer such as infiltrating ductal or lobular carcinoma.
  • Currently, the evaluation of breast carcinoma includes hormone receptor analysis of the tumor tissue, with those positive for estrogen or progesterone responding better to both hormonal and chemotherapy.Trastuzumab (Herceptin(R)) is available as an adjunct treatment for tumors which over-express the HER2/neu gene.
  • Typically, metaplastic carcinomas of the breast do not express the estrogen or progesterone receptors and do not over-express the HER2/neu oncogene.
  • As a result of this "triple negative" phenotype, such tumors tend to be more aggressive and are unlikely to respond to targeted therapy with Herceptin.
  • The epidermal growth factor receptor HER-1/EGFR protein is expressed in the majority of metaplastic carcinomas and thus may serve as a potential therapeutic target for EGFR inhibitors such as gefitinib and cetuximab.
  • The two cases we describe exemplify the aggressive nature of carcinosarcoma of the breast and support the findings that this tumor type does not express the common receptors found in other breast carcinomas.
  • These case reports also emphasize the need for investigating the role for blockade of the HER-1/EGFR receptor with targeted therapies when found to be over-expressed in the primary tumor.






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