BMC Cancer 2008, 8:36 http://www.biomedcentral.com/1471-2407/8/36 Figure1 tSoFitsfirgstouhunergembCr1iceOraoXsta-r2rapyosietcivtitoynoonf idmumctuanlocahrisctionochmeamiinc-aslitsuta(iDniCngISi)n Strong COX-2 positivity on immunohistochemical staining in tissue microarray section of ductal carcinoma in-situ (DCIS) of the breast. Original magnification, ×400. Results There were a total of 69 women included in the analysis; 31 cases (those women who developed an ipsilateral non- invasive or invasive in-breast recurrence during the study period, 1992–2002) and 38 controls (those women who did not recur). The clinical characteristics of the study population are shown in Table 2. The mean age for the cases was 53.3 years and the mean age for the controls was 53.7 years. Ages ranged from 35 to 80 years. The mean tumor size was 17.7 mm in the cases and 11.9 mm in the controls. This difference was of borderline statistical sig- Figure 2 tFNioiugnculoeraferd2upcotsailticvaitrycifnoormPaP AinR-sgitaum(mDaCiInS)tiosfsutheembirceroasatrray sec- Nuclear positivity for PPAR gamma in tissue microarray sec- tion of ductal carcinoma in-situ (DCIS) of the breast. Original magnification, ×400. nificance (p = 0.062). The majority of the patients in our study group had DCIS lesions that were classified as histo- logical Grade 2. More Grade 3 tumors were found in the cases in comparison to controls; this difference too, was of borderline statistical significance (p = 0.069). The major- ity of women (approximately 90% in each group) had free resection margins defined as 2 mm or greater documented on the review of pathologic material performed for this study. Margins of resection were involved with DCIS in three controls and two cases, and were unknown in five controls and one case. All radiotherapy was to the whole breast. The proportion of patients receiving radiation ther- apy was similar between cases (65%) and controls (61%) and was not associated with recurrence risk (OR 1.2, 95% CI 0.45–3.3) The use of adjuvant tamoxifen therapy was equally infrequent between cases (32%) and controls (32%), and was not associated with a decreased risk of recurrence (OR0.99, 95% CI 0.64–1.51). Many of these patients were treated prior to 2003, when ER testing was not routine clinical practice at our institution. Tamoxifen recommendations were not based on ER status of DCIS prior to this date. When we examined the tamoxifen use based on ER data generated on the TMAs produced for this study, we found no differences in the proportion of ER positive cases and controls who received tamoxifen ther- apy (7/12 ER positive controls vs. 6/10 ER positive cases). The mean time to recurrence in the cases was 38.5 months (range 6–114 months). Eight cases (26%) experienced an invasive ipsilateral recurrence and 23 cases (74%) had a DCIS recurrence. Our target retention rate in successive TMA sections was 70% of cores, and was not related to the overall size of the DCIS lesions. There were 18 subjects (4 cases and 14 con- trols) with target loss of both cores for at least one marker. The mean size of the DCIS in these 18 women was 13.8 mm; the mean tumor size among lesions with target loss was similar to those in which target tissue was retained (17.67 vs. 17.72 mm in cases and 11.4 vs. 11.9 in con- trols). Thus the loss of DCIS target was not attributable to tumor size (p = 0.7). However, there was a trend towards better retention of DCIS target with increasing grade. Of 18 Grade 1 lesions, target tissue was lost for at least one marker in seven subjects (39%); among Grade 2 lesions the corresponding proportion was 10/34 (29%), and among Grade 3 lesions it was 1/17 (6%) (p = 0.070). A number of biomarkers were initially evaluated as part of our study. These biomarkers were chosen because of their role in cell cycle regulation, proliferation, differentiation, and apoptosis as well as evidence of prognostic ability in invasive breast cancer. Individually these were found not to be associated positively or negatively with any ipsilat- eral recurrence (see Table 3), with the exception of COX- Page 4 of 11 (page number not for citation purposes)