- Email: [email protected]
0-63. Pathological and immunohistochemical prognostic factors in clinical stage I breast cancer patients
242
The Breast
O-61. Use of Tc-99 labelled colloidal albumin for preoperative and intraoperative localization of nonpalpable breast lesions
O-63. Pathological and immunohistochemical prognostic factors in clinical stage I breast cancer patients
Galimberti V, Luini A, Paganelli G, Cassano E, Zurrida S, Veronesi P, Pizzamiglio M, Fiorenza M, Viale G, Sacchini V, Mazzarol G, Bonanni B, Farante G, Andreoni G, Ballardini B European Institute of Oncology, Milan, Italy
Walker RA, Stonelake PS, Dunn JA, Baker PR, Jevons CM, Dodson L, Oates GD, Ellis DJ, Lee MJR, Milligan K, Morrison JM, Spooner D for the West Midlands Breast Group
Clinically occult breast lesions are found frequently now that mammagraphic and ultrasonic screening are widespread. Several methods are used to localize suspicious occult lesions prior to excision, including skinprojection and introduction of a hooked-wire; all suffer from limitations. We have developed a new localization technique in which mammographic or ultrasonic images are used to guide the injection of 0.05 mg of *Tclabelled human serum albumin (6-8 MBq) directly into the lesion (cluster of microcalcifications and/or opacity) on the day before surgery. Subsequently a gamma ray detecting probe locates that lesion and guides its excision. Up to 3 1 July 1996 we had treated 115 patients with non-palpable breast lesions using this technique. In all cases the hot-spot was easily and quickly located both on skin projection and in the parenchyma. X-radiography and scintigraphy of removed specimens checked the presence and centricity of the lesion: in all cases the lesion was within the specimen, although in one case intraoperative re-excision was performed as activity was detected at a resection margin. Pathological examination revealed 69 cancer lesions and no case of carcinoma cell dissemination along the needle track; 68 of these patients were treated by breast conserving surgery, and one received a Patey mastectomy. A limitation of the new technique is that tracer injection directly into the lesion cannot be verified before excision, and should therefore be performed by personnel experienced in the localization of breast lesions. In our hands the technique proved safe and accurate, allowing easy detection of the skin projection (permitting the surgeon to choose the best incision) and fast removal of the lesion, with the added advantage that resection margins could be checked during the operation. Our preliminary data indicate higher excision accuracy, better lesion centricity within the specimen and less need for margin radicalization compared to the hooked wire method.
O-62. The value of contralateral breast screening in primary breast cancer follow-up Kollias J, Evans AJ, Wilson ARM, Ellis IO, Elston CW, Robertson JFR, Blarney RW City Hospital, Nottingham Mammographic screening of the contralateral breast is often advocated in follow-up of women previously treated for primary operable breast cancer. The purpose of this study was to determine the value of this procedure. Between 1987 and 1995 a total of 5102 contralateral screening mammograms were performed on 2511 women aged I 70 years following treatment for primary operable breast cancer. 67 metachronous contralateral breast cancers were identified - 17 (26%) at routine clinical examination, 26 (40%) were mammographically detected and 22 (34%) presented as interval cancers. The prognostic features of metachronous cancers were better or similar to those of the first cancer in 58/65 (89%) cases. Because of the favourable prognostic characteristics of the contralateral cancer, mammographic screening may have contributed to the long term survival of 16/30 women whose first cancer predicted a good prognosis. The cancer detection rate with mammography for these women was 3.13 per 1000 women screened at a total cost of f6042 per cancer detected. The results of this study suggest that surveillance mammography of the contralateral breast is of value in women whose first cancer predicted a favourable prognosis.
The availability of good prognostic markers might improve the selection of patients with high/low risk of relapse. The patients studied were entered into the 2nd West Midlands Breast Group collaborative randomised trial of radiotherapy and adjuvant tamoxifen in the conservation management of clinical stage I breast cancer. Follow-up is available on all patients for a minimum of 3 years, median of 7 years. To date, primary tumours of the 509 trial patients, of whom 161 developed recurrent disease, have been subjected to histopathology review and pS2 and c-erB2 immunohistochemistry (IHC). Of these, 393 tumours had IHC on paraffin sections for a further seven prognostic markers. Log-rank analysis for relapse free survival identified the following as significant prognostic factors: age (5 50 v > 50 years; P = O.OOOS),menopausal status (pre v post; P < O.OOOl), tumour pathological size (5 2 v > 2 cm; P = O.OOOl), tumour grade (1 v 2 v 3; P < O.OOOl), vascular invasion (- v +; P = O.OOOS),ER-H score (I 100 v > 100; P = O.OOOl), PgR-% staining (< 20 v > 20; P = 0.03), c-erbB2 (- v +; P = 0.02), pS2 (- v +; P < 0.0001) and Ki-67 (MIBI) (- v +; P = 0.002). DCIS, cathepsin D, TGFa, EGFR and pS2 were not significantly associated with relapse-free survival. Preliminary Cox regression modelling identified menopausal status, PgR%, grade and size as independent prognostic factors, although other factors associated with these could be substituted in the Cox model. This analysis indicates that several pathological and immunohistochemical factors have prognostic value in patients with clinical stage I breast cancer and may allow targeting of adjuvant therapy.
O-64. pS2 expression provides additional useful prognostic information after 7 years follow-up Thompson AM, Elton RA, Hawkins RA, Chetty U, Steel CM Ninewells Hospital, Dundee and Edinburgh Breast Unit Expression of pS2, an oestrogen-regulated gene, has been associated with a good short-term prognosis and response to endocrine therapy in breast cancer. The aim of this study was to determine whether expression of messenger ribonucleic acid (mRNA) for the pS2 gene in breast cancer could contribute useful information on disease behaviour and survival at medium term follow-up. Northern blotting was used to detect pS2 mRNA in the primary tumour tissue from each of 90 patients with previously untreated breast cancer. Axillary node status was established by sampling or clearance, oestrogen receptor concentration by enzyme immunosorbant assay and follow-up was continued for at least 6 years or until death. At 83 months mean follow-up, 37/90 (41%) patients had recurrent disease and of these, 18 (20%) had died from breast cancer. pS2 mRNA expression, present in 26/90 (29%) of cancers, was significantly associated with freedom from disease recurrence (P = 0.026) and with survival at a minimum of 6 years follow-up (P < 0.001). Pathological node status and tumour size were also significantly associated with disease recurrence (P < 0.001 and P c 0.002 respectively) and inversely with survival (P < 0.001 and P < 0.001 respectively). After multiple Cox regression analysis, pS2 expression was still a significant predictor of recurrence (but not survival) after adjusting for node status and tumour size; oestrogen receptor was an independent predictor of survival. The combination of node status and pS2 expression discriminated patients with particularly good prognosis (node-negative, pS2-positive:
The Breast
O-61. Use of Tc-99 labelled colloidal albumin for preoperative and intraoperative localization of nonpalpable breast lesions
O-63. Pathological and immunohistochemical prognostic factors in clinical stage I breast cancer patients
Galimberti V, Luini A, Paganelli G, Cassano E, Zurrida S, Veronesi P, Pizzamiglio M, Fiorenza M, Viale G, Sacchini V, Mazzarol G, Bonanni B, Farante G, Andreoni G, Ballardini B European Institute of Oncology, Milan, Italy
Walker RA, Stonelake PS, Dunn JA, Baker PR, Jevons CM, Dodson L, Oates GD, Ellis DJ, Lee MJR, Milligan K, Morrison JM, Spooner D for the West Midlands Breast Group
Clinically occult breast lesions are found frequently now that mammagraphic and ultrasonic screening are widespread. Several methods are used to localize suspicious occult lesions prior to excision, including skinprojection and introduction of a hooked-wire; all suffer from limitations. We have developed a new localization technique in which mammographic or ultrasonic images are used to guide the injection of 0.05 mg of *Tclabelled human serum albumin (6-8 MBq) directly into the lesion (cluster of microcalcifications and/or opacity) on the day before surgery. Subsequently a gamma ray detecting probe locates that lesion and guides its excision. Up to 3 1 July 1996 we had treated 115 patients with non-palpable breast lesions using this technique. In all cases the hot-spot was easily and quickly located both on skin projection and in the parenchyma. X-radiography and scintigraphy of removed specimens checked the presence and centricity of the lesion: in all cases the lesion was within the specimen, although in one case intraoperative re-excision was performed as activity was detected at a resection margin. Pathological examination revealed 69 cancer lesions and no case of carcinoma cell dissemination along the needle track; 68 of these patients were treated by breast conserving surgery, and one received a Patey mastectomy. A limitation of the new technique is that tracer injection directly into the lesion cannot be verified before excision, and should therefore be performed by personnel experienced in the localization of breast lesions. In our hands the technique proved safe and accurate, allowing easy detection of the skin projection (permitting the surgeon to choose the best incision) and fast removal of the lesion, with the added advantage that resection margins could be checked during the operation. Our preliminary data indicate higher excision accuracy, better lesion centricity within the specimen and less need for margin radicalization compared to the hooked wire method.
O-62. The value of contralateral breast screening in primary breast cancer follow-up Kollias J, Evans AJ, Wilson ARM, Ellis IO, Elston CW, Robertson JFR, Blarney RW City Hospital, Nottingham Mammographic screening of the contralateral breast is often advocated in follow-up of women previously treated for primary operable breast cancer. The purpose of this study was to determine the value of this procedure. Between 1987 and 1995 a total of 5102 contralateral screening mammograms were performed on 2511 women aged I 70 years following treatment for primary operable breast cancer. 67 metachronous contralateral breast cancers were identified - 17 (26%) at routine clinical examination, 26 (40%) were mammographically detected and 22 (34%) presented as interval cancers. The prognostic features of metachronous cancers were better or similar to those of the first cancer in 58/65 (89%) cases. Because of the favourable prognostic characteristics of the contralateral cancer, mammographic screening may have contributed to the long term survival of 16/30 women whose first cancer predicted a good prognosis. The cancer detection rate with mammography for these women was 3.13 per 1000 women screened at a total cost of f6042 per cancer detected. The results of this study suggest that surveillance mammography of the contralateral breast is of value in women whose first cancer predicted a favourable prognosis.
The availability of good prognostic markers might improve the selection of patients with high/low risk of relapse. The patients studied were entered into the 2nd West Midlands Breast Group collaborative randomised trial of radiotherapy and adjuvant tamoxifen in the conservation management of clinical stage I breast cancer. Follow-up is available on all patients for a minimum of 3 years, median of 7 years. To date, primary tumours of the 509 trial patients, of whom 161 developed recurrent disease, have been subjected to histopathology review and pS2 and c-erB2 immunohistochemistry (IHC). Of these, 393 tumours had IHC on paraffin sections for a further seven prognostic markers. Log-rank analysis for relapse free survival identified the following as significant prognostic factors: age (5 50 v > 50 years; P = O.OOOS),menopausal status (pre v post; P < O.OOOl), tumour pathological size (5 2 v > 2 cm; P = O.OOOl), tumour grade (1 v 2 v 3; P < O.OOOl), vascular invasion (- v +; P = O.OOOS),ER-H score (I 100 v > 100; P = O.OOOl), PgR-% staining (< 20 v > 20; P = 0.03), c-erbB2 (- v +; P = 0.02), pS2 (- v +; P < 0.0001) and Ki-67 (MIBI) (- v +; P = 0.002). DCIS, cathepsin D, TGFa, EGFR and pS2 were not significantly associated with relapse-free survival. Preliminary Cox regression modelling identified menopausal status, PgR%, grade and size as independent prognostic factors, although other factors associated with these could be substituted in the Cox model. This analysis indicates that several pathological and immunohistochemical factors have prognostic value in patients with clinical stage I breast cancer and may allow targeting of adjuvant therapy.
O-64. pS2 expression provides additional useful prognostic information after 7 years follow-up Thompson AM, Elton RA, Hawkins RA, Chetty U, Steel CM Ninewells Hospital, Dundee and Edinburgh Breast Unit Expression of pS2, an oestrogen-regulated gene, has been associated with a good short-term prognosis and response to endocrine therapy in breast cancer. The aim of this study was to determine whether expression of messenger ribonucleic acid (mRNA) for the pS2 gene in breast cancer could contribute useful information on disease behaviour and survival at medium term follow-up. Northern blotting was used to detect pS2 mRNA in the primary tumour tissue from each of 90 patients with previously untreated breast cancer. Axillary node status was established by sampling or clearance, oestrogen receptor concentration by enzyme immunosorbant assay and follow-up was continued for at least 6 years or until death. At 83 months mean follow-up, 37/90 (41%) patients had recurrent disease and of these, 18 (20%) had died from breast cancer. pS2 mRNA expression, present in 26/90 (29%) of cancers, was significantly associated with freedom from disease recurrence (P = 0.026) and with survival at a minimum of 6 years follow-up (P < 0.001). Pathological node status and tumour size were also significantly associated with disease recurrence (P < 0.001 and P c 0.002 respectively) and inversely with survival (P < 0.001 and P < 0.001 respectively). After multiple Cox regression analysis, pS2 expression was still a significant predictor of recurrence (but not survival) after adjusting for node status and tumour size; oestrogen receptor was an independent predictor of survival. The combination of node status and pS2 expression discriminated patients with particularly good prognosis (node-negative, pS2-positive: