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Augmentation mammoplasty with silicone-gel-filled implants: its effect on mammography
318 The Breast 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.
Prognosis of breast cancer according to timing of surgery and menstrual phase V Galimberti, P Veronesi, S Zurrida, L Bellegotti, G Andreoni, P Zucali, S Monti, G Viale, G Mazzarol and A Luini Istituto Europe0 di Oncologia, Via G. Ripanwnti 435, Milano, Italy To determine whether breast cancer surgery in luteal phase leads to better disease-free and long term survival than surgery conducted during the follicular phase, we started a randomized multicentric trial which had recruited at 16th December, 216 patients from the eleven Italian centres (all members of the GRISO: the Italian Breast Oncology Group). So far, 94 patients have been operated on during follicular phase and 122 during luteal phase. We presently have available nearly complete data on 159 cases. Of the follicular phase patients, 50 received conservative surgery and 19 mastectomy; among the luteal phase patients 62 received conservative surgery and 28 mastectomy. Pathological data are, for follicular phase: 34 Tl, 34 T2 and 1 T3; and for luteal phase: 49 Tl, 38 T2 and 3 T3. Axillary nodes were involved in 35 follicular phase and 53 luteal phase patients. The other cases were NO. Oestrogen receptors were positive in 35 follicular phase and 39 luteal phase, with data still being elaborated on a further 22. Xi-67 factor was less than 20% in 22 follicular phase and in 34 luteal phase, with data still expected for a further 26. Plasma samples have been taken from all patients and are being stored in appropriate conditions pending assay for sex hormone levels. For the great majority of cases recruited at the European Institute of Oncology, transvaginal ultrasound was performed on the day of surgery providing important additional information on the phase of menstrual cycle, which is also deduced from the number of days since last menstruation.
Augmentation mammoplasty with silicone-gel-filled implants: its effect on mammography S Comunale,L Troiano, S Napolitano Div. Chirurgia Generale,Azienda Osp. Gela (CL), Italy The most favorable (occult) breast carcinomas, those with 90-95%, 5 years survival rates, are currently found in asymptomatic women using screening mammography. We must be concerned about any elective surgical procedure that decreases our ability to mammographicaIly visual-
ize breast tissue. Post-augmentation mammograms were done in the standard fashion, with implant compression, as well as with a new technique that displaces the implant posteriorly. Visualized breast tissue was measured using a transparent grid, 51 films were evaluated. Following subglandular standard compression mammography revealed an average decrease in visualized breast tissue of 30% when displacement mammography was used, the average decrease was 24%. Thirty-six submuscular patients did better, compression mammography yielded an average 17% decrease in visualized tissue, while displacement mammography showed a nonsignificant 4% increase. Intramammary scarring yielded numerous post-augmentation mammograms with parenchymal distortions, many revealed areas of band-like breast tissue in which it would be exceedingly difficult to see subtle architectural distortions or microcalcifications. Augmentation mammoplast reduces the ability of mammography, our best diagnostic tool, to visualize breast tissue. State-of-the-art mammography is not possible in most patients augmented with silicon gel filled implants. Should these patients develop breast cancer, it will likely be diagnosed in its palpable rather than occult form. Patients at high risk of developing breast cancer should consider not being augmented. In patients electing AM, the implant should be placed behind the pectoralis major muscle whenever possible.
Contrast enhancement patterns in subtraction breast MRI correlate with tumour angiogenesisin breast cancer M Douek, T Davidson, M Hall-Craggs,E Benjamin, ID Wilkinson, M Davies, H Mumtaz, and I Taylor University College London Medical School, London, UK The enhancement characteristics of breast cancers following injection of a gadolinium chelate contrast agent vary on magnetic resonance (MR) imaging. This may in part be due to differences in tumour vascularity within the tumour. The aim of this study was to compare pre-operative subtraction contrast enhancement patterns on MR imaging with detailed histopathologic angiogenic mapping of the resected tumour specimens. Fifteen breast cancer patients were recruited for tbis prospective study. Pre- and post-contrast enhanced breast MR imaging was performed pre-operatively, using a transverse Tl-weighted three dimensional (3D) FLASH sequence. Pre- and post-contrast 3D data sets were matched by a rotational and translational registration algorithm to correct for inter-scan motion. Subtraction of the registered data sets generated subtraction images. Following tumour resection, the fvted specimens were sliced in a transverse plane at 5 mm intervals. Whole block sections were prepared to include the tumour with adjacent macroscopically normal breast tissue. In addition to H&E staining, immunohistochemical staining was performed with monoclonal antibodies for markers of blood vessel endothelium (factor VIII, CD34, CD31). The distribution and density of microvessels in the whole section was mapped in detail and compared with subtraction images of contrast enhanced breast MR. In serial tumour sections, similar microvessel distributions were seen with the 3 endothelial markers. Patterns of MR enhancement included rim (n = 2), homogeneous (n = 5), non-homogeneous (n = 5), and diffuse patchy enhancement (n = 3). Microvessel density was directly proportional to both the intensity and extent of contrast-enhancement. Subtraction contrast-enhanced MR images provide a quick and reliable method for assessing enhancement patterns and intensity. This technique may prove useful in estimating non-invasively the angiogenic activity in breast carcinomas and may be used to analyse the entire tumour preoperatively.
Prognosis of breast cancer according to timing of surgery and menstrual phase V Galimberti, P Veronesi, S Zurrida, L Bellegotti, G Andreoni, P Zucali, S Monti, G Viale, G Mazzarol and A Luini Istituto Europe0 di Oncologia, Via G. Ripanwnti 435, Milano, Italy To determine whether breast cancer surgery in luteal phase leads to better disease-free and long term survival than surgery conducted during the follicular phase, we started a randomized multicentric trial which had recruited at 16th December, 216 patients from the eleven Italian centres (all members of the GRISO: the Italian Breast Oncology Group). So far, 94 patients have been operated on during follicular phase and 122 during luteal phase. We presently have available nearly complete data on 159 cases. Of the follicular phase patients, 50 received conservative surgery and 19 mastectomy; among the luteal phase patients 62 received conservative surgery and 28 mastectomy. Pathological data are, for follicular phase: 34 Tl, 34 T2 and 1 T3; and for luteal phase: 49 Tl, 38 T2 and 3 T3. Axillary nodes were involved in 35 follicular phase and 53 luteal phase patients. The other cases were NO. Oestrogen receptors were positive in 35 follicular phase and 39 luteal phase, with data still being elaborated on a further 22. Xi-67 factor was less than 20% in 22 follicular phase and in 34 luteal phase, with data still expected for a further 26. Plasma samples have been taken from all patients and are being stored in appropriate conditions pending assay for sex hormone levels. For the great majority of cases recruited at the European Institute of Oncology, transvaginal ultrasound was performed on the day of surgery providing important additional information on the phase of menstrual cycle, which is also deduced from the number of days since last menstruation.
Augmentation mammoplasty with silicone-gel-filled implants: its effect on mammography S Comunale,L Troiano, S Napolitano Div. Chirurgia Generale,Azienda Osp. Gela (CL), Italy The most favorable (occult) breast carcinomas, those with 90-95%, 5 years survival rates, are currently found in asymptomatic women using screening mammography. We must be concerned about any elective surgical procedure that decreases our ability to mammographicaIly visual-
ize breast tissue. Post-augmentation mammograms were done in the standard fashion, with implant compression, as well as with a new technique that displaces the implant posteriorly. Visualized breast tissue was measured using a transparent grid, 51 films were evaluated. Following subglandular standard compression mammography revealed an average decrease in visualized breast tissue of 30% when displacement mammography was used, the average decrease was 24%. Thirty-six submuscular patients did better, compression mammography yielded an average 17% decrease in visualized tissue, while displacement mammography showed a nonsignificant 4% increase. Intramammary scarring yielded numerous post-augmentation mammograms with parenchymal distortions, many revealed areas of band-like breast tissue in which it would be exceedingly difficult to see subtle architectural distortions or microcalcifications. Augmentation mammoplast reduces the ability of mammography, our best diagnostic tool, to visualize breast tissue. State-of-the-art mammography is not possible in most patients augmented with silicon gel filled implants. Should these patients develop breast cancer, it will likely be diagnosed in its palpable rather than occult form. Patients at high risk of developing breast cancer should consider not being augmented. In patients electing AM, the implant should be placed behind the pectoralis major muscle whenever possible.
Contrast enhancement patterns in subtraction breast MRI correlate with tumour angiogenesisin breast cancer M Douek, T Davidson, M Hall-Craggs,E Benjamin, ID Wilkinson, M Davies, H Mumtaz, and I Taylor University College London Medical School, London, UK The enhancement characteristics of breast cancers following injection of a gadolinium chelate contrast agent vary on magnetic resonance (MR) imaging. This may in part be due to differences in tumour vascularity within the tumour. The aim of this study was to compare pre-operative subtraction contrast enhancement patterns on MR imaging with detailed histopathologic angiogenic mapping of the resected tumour specimens. Fifteen breast cancer patients were recruited for tbis prospective study. Pre- and post-contrast enhanced breast MR imaging was performed pre-operatively, using a transverse Tl-weighted three dimensional (3D) FLASH sequence. Pre- and post-contrast 3D data sets were matched by a rotational and translational registration algorithm to correct for inter-scan motion. Subtraction of the registered data sets generated subtraction images. Following tumour resection, the fvted specimens were sliced in a transverse plane at 5 mm intervals. Whole block sections were prepared to include the tumour with adjacent macroscopically normal breast tissue. In addition to H&E staining, immunohistochemical staining was performed with monoclonal antibodies for markers of blood vessel endothelium (factor VIII, CD34, CD31). The distribution and density of microvessels in the whole section was mapped in detail and compared with subtraction images of contrast enhanced breast MR. In serial tumour sections, similar microvessel distributions were seen with the 3 endothelial markers. Patterns of MR enhancement included rim (n = 2), homogeneous (n = 5), non-homogeneous (n = 5), and diffuse patchy enhancement (n = 3). Microvessel density was directly proportional to both the intensity and extent of contrast-enhancement. Subtraction contrast-enhanced MR images provide a quick and reliable method for assessing enhancement patterns and intensity. This technique may prove useful in estimating non-invasively the angiogenic activity in breast carcinomas and may be used to analyse the entire tumour preoperatively.