The optimal management of the axillae of patients with microinvasive breast cancer in the sentinel lymph node era
ABSTRACT For patients with microinvasive breast cancer, the value of intraoperative analysis of sentinel lymph nodes (SLNs) and complete axillary lymph node dissection (CALND) is not well known.
All patients staged T1mic from 2001 to 2005 were analyzed.
Among all 81 patients, 4 (5%) had SLN metastases detected with hematoxylin and eosin staining and 2 (2%) had metastases identified by immunohistochemistry staining only. Seventy-seven patients (95%) underwent SLN biopsy; 3 (4%) had hematoxylin and eosin SLN metastases and 2 (3%) had immunohistochemistry-detected metastases. One SLN metastasis was identified on frozen section analysis. No patient with a SLN metastasis had additional metastases on CALND. The patient charges for frozen section analyses were $39,578 for 77 patients. This prevented 1 reoperative CALND at a charge of $20,274.
Frozen section analysis should be used only in select patients with microinvasive breast cancer and CALND is of limited value for these patients.
- SourceAvailable from: A. Lee Swindlehurst
Conference Paper: Improved signal copy with partially known or unknown array response[Show abstract] [Hide abstract]
ABSTRACT: Blind adaptive algorithms extract signals that overlap in time and frequency by exploiting their temporal structure, but ignore any available spatial (array response) data. On the other hand, direction-finding based methods compute the signal copy weights using estimates of the signal directions, but ignore information about signal structure. In this paper, we present two simple iterative techniques that attempt to incorporate both temporal and spatial information in estimating the signal waveforms received by an array of sensors. The first technique assumes an initial blind signal estimate is available, and uses least-squares to approximate the array response and refine the signal estimate. The second method is applicable to digitally modulated signals, and uses bit decisions made on an initial signal estimate to recompute the signal copy weight vectors. A theoretical performance analysis of both algorithms is conducted for the high SNR case, and some representative simulation results are includedAcoustics, Speech, and Signal Processing, 1994. ICASSP-94., 1994 IEEE International Conference on; 05/1994
Article: Microinvasive breast carcinoma[Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND Microinvasive breast carcinoma (MIC) has a good prognosis but specific definitions have varied in the past, making the clinical significance of MIC a subject of debate.METHODS Microscopic slides of 59 cases of breast carcinoma originally diagnosed as MIC were reviewed retrospectively. Histologic parameters were correlated with clinical findings and outcome to define diagnostic criteria better.RESULTSOn review, the 59 cases were recategorized as follows: pure DCIS (N = 16), DCIS with foci equivocal for microinvasion (N = 7), DCIS with ≥ 1 focus of microinvasion (N = 11), T1 invasive carcinomas with ≥ 90% DCIS (N = 18), and T1 tumors with < 90% DCIS (N = 7). The MIC cases in the current study averaged 3 separate foci of early infiltration outside the basement membrane, each one not > 1.0 mm. The mean follow-up was 95 months. Six patients (10%) had only local recurrence: 1 case each in patients with equivocal microinvasion, microinvasion, and T1 tumors with < 90% DCIS and 3 cases among the patients with T1 tumors with ≥ 90% DCIS. Four patients, all with T1 tumors with ≥ 90% DCIS, had distant failure (7%). In the MIC group, only one patient developed a local recurrence after breast conservation. No patient had axillary lymph node metastasis. For the entire series, factors associated with local recurrence were younger age, breast conservation versus mastectomy, and close surgical margins. The only factor associated with distant failure was the size of the DCIS component. Seven patients with T1 tumors with ≥ 90% DCIS experienced local or distant failure and 5 of these (71%) developed progressive disease or died of disease. All other patients who developed a recurrence were disease free at last follow-up. In a retrospective series, poorer outcome in carcinomas with ≥ 90% DCIS may be related to the greater likelihood of missed larger areas of invasive carcinoma. Therefore, meticulous and extensive sampling of these carcinomas is required.CONCLUSIONSMIC as defined has a good prognosis. It has a different biology than T1 invasive carcinoma with ≥ 90% DCIS, which may progress and cause death. Large tumors with multiple foci of microinvasion may have metastatic potential. Cancer 2000;88:1403–9. © 2000 American Cancer Society.Cancer 03/2000; 88(6):1403 - 1409. DOI:10.1002/(SICI)1097-0142(20000315)88:6<1403::AID-CNCR18>3.0.CO;2-S · 4.89 Impact Factor
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ABSTRACT: The increased rate of early detection of breast cancer due to widespread mammographic screening has led to an increased incidence not only of in situ but also microinvasive carcinoma (MC). MC has been reported to have a favourable prognosis, but specific definitions have varied in the past making the clinical significance of this entity a subject of debate. In fact, although the diagnosis of MC often appears in pathology reports, this term has not been used in a consistent, standardized manner. In addition, the histological diagnosis of MC can be problematical for the pathologist due to a variety of in situ patterns and artefacts that may be misinterpreted as stromal invasion. Definitions and diagnostic criteria of MC are reviewed and discussed. Based on a review of literature, incidence of axillary lymph node involvement, according to different definitions of microinvasion, is reported.Pathology & Oncology Research 02/2008; 14(2):105-11. DOI:10.1007/s12253-008-9054-8 · 1.86 Impact Factor