W Böcker

Institute For Hematopathology Hamburg, Hamburg, Hamburg, Germany

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Publications (392)914.78 Total impact

  • Cancer Research 04/2011; 70(24 Supplement):P6-01-07-P6-01-07. · 9.28 Impact Factor
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    ABSTRACT: To evaluate the rate, the histological spectrum and the positive predictive value (PPV) for malignancy of minimally invasive biopsies with "uncertain malignant potential (B3)" in digital mammography screening. Consecutive data of 37,178 participants of one digital unit of the German screening program were included. The B 3 rate was 15.1 % (148 / 979). The frequencies of lesion subtypes were as follows: atypical epithelial proliferation of ductal type (AEPDT) 35.1 % (52 / 148), radial scar (RS) 28.4 % (42 / 148), papillary lesions (PAP) 20.3 % (30 / 148), lobular carcinoma in situ 8.8 % (13 / 148), flat epithelial atypia 5.4 % (8 / 148), and mucocele-like lesions 2.0 % (3 / 148). The PPV for malignancy in surgical excisions was overall 0.28 (25 / 91); in detail 0.40 (19 / 47) for AEPDT, 0.20 (5 / 25) for RS, 0.08 (1 / 12) for PAP. Despite a higher B 3 rate of minimally invasive biopsies with "uncertain malignant potential" in digital screening, the benign surgical biopsy rate is not disproportionally increased compared with analog screening programs. Together with defined management protocols, this results in an increased cancer detection rate per screening participant with surgical excision.
    RöFo - Fortschritte auf dem Gebiet der R 04/2011; 183(8):743-8. · 2.76 Impact Factor
  • Artery Research 12/2010; 4(4):182-182.
  • Senologie - Zeitschrift für Mammadiagnostik und -therapie 06/2010; 7(02).
  • Senologie - Zeitschrift für Mammadiagnostik und -therapie 06/2009; 6(02).
  • Senologie - Zeitschrift für Mammadiagnostik und -therapie 06/2009; 6(02).
  • W Böcker, T Decker
    Der Pathologe 03/2009; 30(1):4-5. · 0.64 Impact Factor
  • W Böcker, D Hungermann, T Decker
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    ABSTRACT: The human breast consists of lobes with a luminal glandular and a basal myoepithelial layer. Immunofluorescence studies have shown that the breast epithelium contains cytokeratin (CK)5/14-positive precursor cells which give rise to CK8/18-positive glandular or sm-actin-positive myoepithelial cells. Only some of the glandular cells contain estrogen receptors. The luminal epithelium of the lobules shows a much higher glandular differentiation than the ductal system. Diagnostically important cytokeratins of normal breast epithelium and its proliferative epithelial processes include luminal cytokeratins (CK7, CK8 and CK18) as markers of glandular differentiation and basal cytokeratins (CK5, CK14 and CK17) as markers of progenitor cells and early cells of the glandular and myoepithelial differentiation pathway. The most important myoepithelial markers are currently CD10, SMA, SMM-HC and Calponin.
    Der Pathologe 03/2009; 30(1):6-12. · 0.64 Impact Factor
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    ABSTRACT: The definition of atypical ductal hyperplasia (ADH) encompasses qualitative and quantitative criteria. Qualitative criteria include cytological and architectural features similar to those of low grade ductal carcinoma in situ (DCIS), the quantitative criteria are characterized by metric features (2 mm or 2 ductules) or by the confines of lobules. In this article we discuss the morphology of ADH, the status of ADH in the low grade pathway of breast carcinoma development and its clinical significance. Furthermore, we comment some special forms of atypical epithelial proliferations of the ductal type.
    Der Pathologe 02/2009; 30(1):42-8. · 0.64 Impact Factor
  • T Decker, D Hungermann, W Böcker
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    ABSTRACT: Prognostic factors supply information on the course of a disease (recurrence-free and total survival) and are independent of the therapy. The most important prognostic factors are lymph node status, tumor diameter and histological differentiation stage, lymph and blood vessel invasion as well as staging, factors which can all be determined by pathologists. The Nottingham prognostic index (NPI) combines the strongest prognostic factors and according to study results is a suitable model for prognosis of breast cancer. Predictive factors give prior information on the probability of the response of a tumor to a defined therapy and include hormone receptor status, the invasion marker uPA/PAI-1, detection of isolated tumor cells, a residual tumor and the histological resection border.Prognostic or predictive factors are clinically relevant when therapy decisions are made possible by their recognition, which lead to an improvement in the total survival, recurrence-free survival or quality of life. The international consensus recommendation of St. Gallen 2007 requires the following as a basis for risk-adapted therapy decisions: tumor size, stage, age, nodal status, hormone receptor status and Her2 overexpression or amplification status.
    Der Pathologe 02/2009; 30(1):49-55. · 0.64 Impact Factor
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    ABSTRACT: Proliferative epithelial breast lesions include a wide variety of benign hyperplastic and noninvasive neoplastic lesions, as well as invasive carcinomas. Mammographically these lesions may show microcalcifications, architectural distortions or mass lesions. The task of the pathologist begins with a preoperative diagnosis by means of minimally invasive biopsy. His diagnosis forms the basis for not only the radiological-pathological correlation diagnosis, but also for the management of benign proliferative breast disease lesions, as well as therapeutic decisions in the case of malignant lesions.In daily practice, immunohistochemistry is the method of choice for clarifying difficult cases. The aim of this chapter is to describe the relevant markers in breast pathology and to provide an algorithmic approach to different proliferative breast disease lesions.
    Der Pathologe 02/2009; 30(1):13-9. · 0.64 Impact Factor
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    ABSTRACT: In mammography screening programmes carried out according to European guidelines, minimally invasive biopsies (MIB) are performed on up to 3% of participants. The aim of this study was to analyse the spectrum of histopathological findings including B categories in MIBs with microcalcifications compared to MIBs without microcalcifications. Prospectively collected histological findings of MIBs taken during the period July 2006 to June 2007 were analysed using the Breast Screening Pathology Database of the Reference Centre in Münster. Of the 4,326 MIBs investigated, 2,161 were benign (B1-B3) whereas 2,165 were malignant (B4-B5) resulting in an overall malignancy rate of 50.04%. Of the MIBs 1,809 contained microcalcifications and 2,517 did not. Cases with microcalcifications showed a different distribution of B categories: B2 was found in 44.5% versus 24.2%, B3 in 18.2% versus 5.5% and the malignancy rate of cases with microcalcifications was 36.8% versus 59.5%. Of all cases of ductal carcinoma in situ (DCIS) detected in the screening programme, 83.35% were diagnosed in MIBs containing microcalcifications. MIBs containing microcalcifications showed a different spectrum of diagnoses, especially higher rates of B3 lesions. Even though MIBs without microcalcifications showed a higher overall malignancy rate, most cases of DCIS were diagnosed in MIB containing microcalcifications.
    Der Pathologe 02/2009; 30(1):31-5. · 0.64 Impact Factor
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    ABSTRACT: Entsprechend der WHO ist die flache epitheliale Atypie (FEA) definiert als ein- oder mehrschichtige Proliferation von monomorphen Zellen mit geringgradigen Atypien in der terminalen duktulolobulären Einheit. Sie weist kein intraluminales Wachstum auf und bildet keine Sekundärarchitektur aus. Radiologisch ist der Mikrokalkbefund charakteristisch (psammomatöse Sekretverkalkungen und subepitheliale Verkalkungen in einer eosinophilen Matrix, sogenannte „ossifizierende Verkalkungen“). Die klinische Relevanz ist abhängig davon, ob die Läsion isoliert vorliegt und ob es sich um eine Exzisionsbiopsie oder eine minimal-invasive Biopsie handelt. Nach den vorliegenden spärlichen Daten ist davon auszugehen, dass das Risiko eines ipsilateralen metachronen invasiven Mammakarzinoms nach Diagnose einer FEA sehr niedrig ist. Die Differenzialdiagnose umfasst die atypische duktale Hyperplasie, das duktale Carcinoma in situ niedrigen Kernmalignitätsgrades, Clinging-Typ, die Blunt-Adenosen und apokrine Metaplasien. According to the WHO, flat epithelial atypia (FEA) is defined as a neoplastic epithelial proliferation of ductal type in either a single or in multiple terminal duct lobular unit(s) limited to the periphery of the ductules in a clinging growth pattern. The atypical cells may form between one and several layers of epithelial cells that show low grade cytologic atypia. FEA most often presents as mammographic microcalcifications, which are typically round (secretory type and psammomatous calcification in an eosinophilic matrix, so-called ossifying calcifications). Clinical relevance is dependent on whether the lesion appears in isolation or whether it is an excision biopsy or a minimally invasive biopsy. Currently available data suggest that the risk of subsequent breast carcinoma in the ipsilateral breast is very low following the diagnosis of FEA. The differential diagnosis should include atypical ductal hyperplasia, low-grade clinging ductal carcinoma in situ, blunt duct adenosis and apocrine metaplasia.
    Der Pathologe 02/2009; 30(1):36-41. · 0.64 Impact Factor
  • T. Decker, D. Hungermann, W. Böcker
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    ABSTRACT: Prognosefaktoren geben Informationen über den Krankheitsverlauf (Rezidivfreiheit und Gesamtüberleben), die unabhängig von der Therapie sind. Zu ihnen gehören der axilläre Lymphknotenstatus, Tumordurchmesser und histologischer Differenzierungsgrad, Lymph- und Blutgefäßinvasion sowie das Staging – Faktoren, die alle durch den Pathologen bestimmt werden. Der „Nottingham Prognostic Index“ (NPI) vereint die stärksten Prognosefaktoren und ist nach Studienergebnissen als Modell für die Brustkrebsprognose geeignet. Prädiktive Faktoren sagen die Wahrscheinlichkeit des Ansprechens eines Tumors auf eine bestimmte Therapie voraus. Hierzu gehören der Hormonrezeptorstatus, die Invasionsmarker uPA/PAI-1, der Nachweis von isolierten Tumorzellen, ein Residualtumor und der histologische Resektionsrand. Prognostische oder prädiktive Faktoren sind klinisch relevant, wenn durch ihre Kenntnis Therapieentscheidungen ermöglicht werden, die zu einer Verbesserung des Gesamtüberlebens, des rezidivfreien Überlebens oder der Lebensqualität führen. Die internationale Konsensempfehlung von St.Gallen 2007 fordert als Grundlage für risikoadaptierte Therapieentscheidungen: Tumorgröße, Grad, Alter, Nodalstatus, Hormonrezeptorstatus sowie Her2-Überexpressions- oder -Amplifikationsstatus. Prognostic factors supply information on the course of a disease (recurrence-free and total survival) and are independent of the therapy. The most important prognostic factors are lymph node status, tumor diameter and histological differentiation stage, lymph and blood vessel invasion as well as staging, factors which can all be determined by pathologists. The Nottingham prognostic index (NPI) combines the strongest prognostic factors and according to study results is a suitable model for prognosis of breast cancer. Predictive factors give prior information on the probability of the response of a tumor to a defined therapy and include hormone receptor status, the invasion marker uPA/PAI-1, detection of isolated tumor cells, a residual tumor and the histological resection border. Prognostic or predictive factors are clinically relevant when therapy decisions are made possible by their recognition, which lead to an improvement in the total survival, recurrence-free survival or quality of life. The international consensus recommendation of St. Gallen 2007 requires the following as a basis for risk-adapted therapy decisions: tumor size, stage, age, nodal status, hormone receptor status and Her2 overexpression or amplification status.
    Der Pathologe 02/2009; 30(1):49-55. · 0.64 Impact Factor
  • W. Böcker, D. Hungermann, T. Decker
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    ABSTRACT: Die weibliche Brustdrüse setzt sich aus Einzeldrüsen (engl. „lobe“) zusammen mit einem luminalen glandulären Epithel und einem basalen Myoepithel. Immunfluoreszenzmikroskopische Untersuchungen haben gezeigt, dass das Epithel Zytokeratin (CK)5/14-positive „Stammzellen“ besitzt, die sich zu CK8/18-positiven glandulären oder sm-Aktin-positiven myoepithelialen Zellen entwickeln können. Nur ein Teil der glandulären Zellen enthält Östrogenrezeptoren. Das luminale Epithel der Läppchen weist im Vergleich zum Gangsystem eine deutlich höhere glanduläre Differenzierung auf. Die Expression von diagnostischen Zytokeratinen im normalen Mammagewebe und in proliferativen epithelialen Prozessen umfasst luminale Zytokeratine (CK7, CK8 und CK18), die in der Mamma als Marker der glandulären Differenzierung benutzt werden können, und basale Zytokerative (CK5, CK14 und CK17) als Marker von Progenitorzellen und Zellen der frühen glandulären und myoepithelialen Differenzierung. Diagnostisch wichtige myoepitheliale Marker sind CD10, sm-Aktin, SMMHC und Calponin. The human breast consists of lobes with a luminal glandular and a basal myoepithelial layer. Immunofluorescence studies have shown that the breast epithelium contains cytokeratin (CK)5/14-positive precursor cells which give rise to CK8/18-positive glandular or sm-actin-positive myoepithelial cells. Only some of the glandular cells contain estrogen receptors. The luminal epithelium of the lobules shows a much higher glandular differentiation than the ductal system. Diagnostically important cytokeratins of normal breast epithelium and its proliferative epithelial processes include luminal cytokeratins (CK7, CK8 and CK18) as markers of glandular differentiation and basal cytokeratins (CK5, CK14 and CK17) as markers of progenitor cells and early cells of the glandular and myoepithelial differentiation pathway. The most important myoepithelial markers are currently CD10, SMA, SMM-HC and Calponin.
    Der Pathologe 02/2009; 30(1):6-12. · 0.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: According to the WHO, flat epithelial atypia (FEA) is defined as a neoplastic epithelial proliferation of ductal type in either a single or in multiple terminal duct lobular unit(s) limited to the periphery of the ductules in a clinging growth pattern. The atypical cells may form between one and several layers of epithelial cells that show low grade cytologic atypia. FEA most often presents as mammographic microcalcifications, which are typically round (secretory type and psammomatous calcification in an eosinophilic matrix, so-called ossifying calcifications). Clinical relevance is dependent on whether the lesion appears in isolation or whether it is an excision biopsy or a minimally invasive biopsy. Currently available data suggest that the risk of subsequent breast carcinoma in the ipsilateral breast is very low following the diagnosis of FEA. The differential diagnosis should include atypical ductal hyperplasia, low-grade clinging ductal carcinoma in situ, blunt duct adenosis and apocrine metaplasia.
    Der Pathologe 02/2009; 30(1):36-41. · 0.64 Impact Factor
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    ABSTRACT: Die proliferativen epithelialen Mammaläsionen umfassen ein faszinierend vielfältiges Spektrum von den benignen hyperplastischen über die nichtinvasiven neoplastischen Läsionen bis zu invasiven Karzinomen. Radiologisch werden diese Läsionen durch Mikrokalzifikationen, Architekturstörungen oder Herdbefunde detektiert. Bei der dann notwendig werdenden präoperativen Abklärung durch minimal-invasive Biopsien ist der Pathologe bereits in die Diagnostik eingebunden. Eine verlässliche morphologische Diagnose des bioptischen Präparats ist die Basis nicht nur der pathologisch-radiologischen Korrelationsdiagnostik sondern auch des weiteren Managements von benignen proliferativen Mammaläsionen und der therapeutischen Entscheidungen beim Mammakarzinom. In der täglichen Praxis ist die Immunhistochemie in schwierigen Fällen die entscheidende Methode zur Beurteilung der Läsion. Schwerpunkt dieser Arbeit ist es, die wichtigsten Marker zu beschrieben und ihren Einsatz beispielhaft anhand charakteristischer Differenzialdiagnosen darzustellen. Proliferative epithelial breast lesions include a wide variety of benign hyperplastic and noninvasive neoplastic lesions, as well as invasive carcinomas. Mammographically these lesions may show microcalcifications, architectural distortions or mass lesions. The task of the pathologist begins with a preoperative diagnosis by means of minimally invasive biopsy. His diagnosis forms the basis for not only the radiological-pathological correlation diagnosis, but also for the management of benign proliferative breast disease lesions, as well as therapeutic decisions in the case of malignant lesions. In daily practice, immunohistochemistry is the method of choice for clarifying difficult cases. The aim of this chapter is to describe the relevant markers in breast pathology and to provide an algorithmic approach to different proliferative breast disease lesions.
    Der Pathologe 02/2009; 30(1):13-19. · 0.64 Impact Factor
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    ABSTRACT: HintergrundIm Rahmen des Mammographie-Screenings nach EU-Leitlinien wird bei bis zu 3% der Teilnehmerinnen eine Biopsie durchgeführt. Ziel der Untersuchung war der Vergleich des Befundspektrums der histopathologischen Ergebnisse der im Screening durchgeführten minimal-invasiven Biopsien (MIB) mit Mikrokalk im Vergleich zu MIB ohne Mikrokalk. Material und MethodenAnalyse der prospektiv erfassten histologischen Befundkomponenten der von Juli 2006 bis Juni 2007 durchgeführten MIB anhand der Brust-Screening-Pathologie-Datenbank am Referenzzentrum Münster. Ergebnisse4326 MIB wurden untersucht. 2161 MIB ergaben benigne (B1 bis B3) und 2165 maligne (B4 bis B5) Ergebnisse mit einer Gesamtmalignitätsrate von 50,04%. 1809 MIB trugen Mikrokalk und 2517 waren frei von Mikrokalk. Die histologischen Befunde und die Verteilung der B-Kategorien der MIB mit und ohne Mikrokalknachweis divergierten: Der Anteil der B2-Befunde betrug 44,5% vs. 24,2%, die B3-Rate 18,2% vs. 5,5% und die Malignitätsrate 36,8% vs. 59,5%. 83,3% der duktalen Carcinoma in situ (DCIS) wurde in mikrokalkhaltigen MIB gefunden. SchlussfolgerungMikrokalkhaltige MIB bieten im Vergleich zu MIB ohne Mikrokalk ein komplett anderes Diagnosespektrum, insbesondere mit großem B3-Anteil. Bei niedrigerer Malignitätsrate werden an mikrokalkhaltigen MIB bei weitem die meisten DCIS diagnostiziert. BackgroundIn mammography screening programmes carried out according to European guidelines, minimally invasive biopsies (MIB) are performed on up to 3% of participants. The aim of this study was to analyse the spectrum of histopathological findings including B categories in MIBs with microcalcifications compared to MIBs without microcalcifications. Material and methodsProspectively collected histological findings of MIBs taken during the period July 2006 to June 2007 were analysed using the Breast Screening Pathology Database of the Reference Centre in Münster. ResultsOf the 4,326 MIBs investigated, 2,161 were benign (B1-B3) whereas 2,165 were malignant (B4-B5) resulting in an overall malignancy rate of 50.04%. Of the MIBs 1,809 contained microcalcifications and 2,517 did not. Cases with microcalcifications showed a different distribution of B categories: B2 was found in 44.5% versus 24.2%, B3 in 18.2% versus 5.5% and the malignancy rate of cases with microcalcifications was 36.8% versus 59.5%. Of all cases of ductal carcinoma in situ (DCIS) detected in the screening programme, 83.35% were diagnosed in MIBs containing microcalcifications. ConclusionsMIBs containing microcalcifications showed a different spectrum of diagnoses, especially higher rates of B3 lesions. Even though MIBs without microcalcifications showed a higher overall malignancy rate, most cases of DCIS were diagnosed in MIB containing microcalcifications.
    Der Pathologe 01/2009; 30(1):31-35. · 0.64 Impact Factor
  • W. Böcker, T. Decker
    Der Pathologe 01/2009; 30(1):4-5. · 0.64 Impact Factor
  • The Thoracic and Cardiovascular Surgeon 01/2009; 56. · 1.08 Impact Factor

Publication Stats

7k Citations
914.78 Total Impact Points

Institutions

  • 2011–2014
    • Institute For Hematopathology Hamburg
      Hamburg, Hamburg, Germany
  • 1988–2013
    • University of Münster
      • • Institute of Neuropathology
      • • Gerhard-Domagk-Institute of Pathology
      • • Department of Obstetrics and Gynaecology
      • • Department for Cranio-Maxillofacial Surgery
      Muenster, North Rhine-Westphalia, Germany
  • 1997–2009
    • Universitätsklinikum Münster
      • Gerhard-Domagk-Institut für Pathologie
      Münster, North Rhine-Westphalia, Germany
    • Hochschule Hannover
      Hanover, Lower Saxony, Germany
  • 2003–2007
    • Martin Luther University of Halle-Wittenberg
      • • Institut für Klinische Epidemiologie
      • • Poliklinik für Diagnostische Radiologie
      Halle, Saxony-Anhalt, Germany
    • Klinikum Osnabrück
      Osnabrück, Lower Saxony, Germany
  • 2000
    • University of Nottingham
      Nottigham, England, United Kingdom
  • 1998
    • University of Liverpool
      Liverpool, England, United Kingdom
  • 1993–1994
    • University of Innsbruck
      • Institute of Biochemistry
      Innsbruck, Tyrol, Austria
    • Otto-von-Guericke-Universität Magdeburg
      • Institute for Pathology
      Magdeburg, Saxony-Anhalt, Germany
  • 1992
    • Kyoto University
      Kioto, Kyōto, Japan
  • 1974–1989
    • University of Hamburg
      • • Department of Pathology
      • • Zoological Institute
      Hamburg, Hamburg, Germany
  • 1987
    • Universität Heidelberg
      Heidelburg, Baden-Württemberg, Germany
  • 1985
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States
  • 1979–1984
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany
  • 1981
    • Institut für Interdisziplinäre Medizin Hamburg
      Hamburg, Hamburg, Germany