bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract P5-15-02: Characteristics and Prognosis of Patients Presenting with Isolated Axillary Nodal Metastases from Occult Breast Primary Carcinoma
Authors: Davidson JA , Tyldesley S , Speers C , Woods R , Chia S. 
Published: April 2011

Abstract
Background: Patients presenting with isolated axillary metastatic carcinoma represent a potentially curable subset of patients. As there are no published randomized trials, literature concerning this uncommon clinical entity is limited to small retrospective reports. These vary widely with respect to the information collected, span a large time period during which diagnostic and therapeutic options have advanced considerably, and are largely without a contemporary control group.
Methods: The British Columbia Breast Cancer Outcomes Unit (BCOU) database was searched to identify patients referred to the British Columbia Cancer Agency with a new diagnosis of isolated axillary metastatic cancer diagnosed between 2000 and 2005. Eligible patients were female, had pathological evidence of lymph node (LN) involvement but no evidence of a primary tumor or distant metastases on clinical workup. A series of control patients, with pathological T1 tumors and N1 involvement at presentation were selected from the BCOU database matched 3:1 for age, diagnosis year, tumor characteristics (histology, estrogen receptor status, HER2 status, and number of affected lymph nodes), and systemic treatment characteristics (adjuvant chemotherapy and/or endocrine therapy).
Results: 36 patients were identified to form the primary axillary cohort. The controls consisted of 1,406 patients, of whom 106 were matched for the above characteristics. Patients in the primary axillary cohort were fairly well-distributed among all diagnosis years, and all tumors exhibited ductal histology. 26 (72%) were estrogen receptor-positive and 8 (22%) were known to be HER2-positive. 9 (25%) patients underwent mastectomy. 33 (92%) patients received radiation therapy and 19 (53%) did not undergo any breast surgery. With a median follow-up of 5.2 and 5.4 years for the primary axillary cohort and the matched controls, the BCSS was 93% and 88% respectively. There were no locoregional recurrences documented in the primary axillary cohort.
Conclusions: This study represents one of the larger contemporary case control series of isolated axillary nodal presentations, demonstrating a good prognosis for this cohort of patients despite approximately half of the patients not having primary breast surgery.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-15-02.
Abstract P5-15-05: Applicability of Breast Cancer Guidelines and Knowledge Translation in a Community Oncology Setting
Authors: Han D , Hogeveen S , Trudeau-Tavara S , Buck J , Brezden-Masley C , Simmons C. 
Published: April 2011

Abstract
Background: The quality of a guideline may impact adherence to that guideline. Cancer Care Ontario (CCO) produces guidelines to help manage all stages of disease. CCO's staging and follow-up guideline suggests patients (pts) with stage I breast cancer require no further staging investigations, bone scan for stage II disease, and for stage III disease in addition to bone scan, chest and abdominal imaging. The guideline on bisphosphonate (BP) use in metastatic breast cancer pts indicates that all pts with bone metastases should be offered a BP. We assessed the efficacy of knowledge translation of these guidelines at a community oncology centre by correlating rate of adherence with the quality of the guideline as scored using the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument.
Methods: The quality of 2 breast cancer guidelines from CCO were assessed using the AGREE instrument. Two cohort studies of breast cancer pts seen were then conducted to evaluate the adherence to these guidelines. Specifically, staging investigations ordered on pts seen in our multidisciplinary clinic between January 2009 and April 2010 were recorded and correlated to pathological stage of disease. Our second cohort study reviewed breast cancer pts with bone metastases who died between 1999 and 2009, and initiation of a BP was recorded in order to determine adherence to the second guideline.
Results: Inadequate adherence was identified and correlated with low applicability scores for these two guidelines (58% and 33% respectively). Only 68 pts (61%) with bone metastases received BP for treatment between 1999 to 2009. 129 pts (56%) underwent unnecessary staging investigations.
Discussions: Non-chemotherapy breast cancer guidelines by CCO scored low in the field of applicability; this was confirmed by two retrospective cohort studies. Improvement in knowledge translation strategies are needed to improve adherence to practice guidelines set out by this national organization.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-15-05.
Abstract P6-01-03: Invasive Micropapillary Carcinoma (IMPC) of the Breast: An Uncommon but Aggressive Special Type of Breast Cancer
Authors: Acs G , Esposito NN , Kiluk J , Laronga C. 
Published: April 2011

Abstract
IMPC is an uncommon type of invasive breast cancer. However, in comparison to invasive ductal carcinoma of no special type (IDC), it is reported to have a more aggressive behavior. Our objective was to compare and contrast IMPC with IDC in terms of clinicopathologic features and outcome. One hundred-thirty-one IMPC cases were compared to 1295 IDC and 189 invasive lobular carcinoma (ILC). Medical records and pathology slides were reviewed for traditional factors (tumor grade, lymphatic invasion [LVI], lymph node [LN] status, stage, receptor status, treatment) and specific tumor features (extent of retraction artifact [RA]). Clinicopathologic features between groups were compared and clinical outcome of IMPC was recorded. All patients were women with a median age of 57.6 yrs (range 22-93) for IMPC, 56.3 yrs (range 22-96) for IDC and 60.7 (range35-85) for ILC, respectively (P&lt;0.0001). There were no differences noted for family history, race, or presentation (symptomatic vs. screening). Surgical treatment was partial mastectomy in 770 (47.7%) and mastectomy in 845 (52.3%). All patients had axillary lymph node biopsy. The median tumor size was 2.2 (range 0.3-15.2) cm for IMPC, 2.0 (range 0.05-11.0) cm for ILC and 1.7 (range 0.05-19.0) cm for IDC, respectively (P&lt;0.). The extent of micropapillary features in IMPC ranged from 3% to 100% with a median value of 20%. LVI was more likely to be present in IMPC (67.9%) compared to IDC (28.3%) and ILC (6.9%) (P&lt;0.0001). Axillary LN metastases were seen in 71.8% of IMPC compared to 44.1 % of IDC and 54.5% of ILC (P&lt;0.0001). IMPC and ILC was significantly more frequently ER and PR positive (P&lt;0.0001 each) compared to IDC, while ILC was significantly less frequently HER2 positive (2.8%) compared to IDC (17.9%) and IMPC (8.2%). The mean percent of tumors showing retraction artifact (RA) was 60.2% in IMPC compared to 25.4% in IDC and 3.8% in ILC (P&lt;0.0001). During a median follow-up of 24.3 months 19 (14.5%) and 17 (13.0%) IMPC patients developed local and distant recurrence, respectively. IMPC is an uncommon special type of invasive breast cancer but it is more aggressive in reference to IDC and ILC based on larger tumor size and more frequent the presence of LVI and LN metastases. The presence of IMPC features in breast cancers, even if present focally, should alert the clinician for the high likelihood of lymphatic tumor spread and an adverse biologic behavior.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-01-03.
Abstract P6-02-02: Evaluation of the Clinical Efficacy of Minimally Invasive Procedures for Breast Cancer Screening at a Teaching Hospital
Authors: Verenhitach BD , Elias S , Nazário AP , Patrocinio AC. 
Published: April 2011

Abstract
Objective: To assess the clinical accuracy of diagnostic procedures for breast cancer at a teaching hospital using internal auditing tools and quality control measures.
Study Design: Retrospective assessment of 500 patients who underwent core needle biopsy (wide-bore needle biopsy - WBN) of palpable or non-palpable breast nodes and also were submitted to at least one cytologic examination [fine needle aspiration cytology (FNA) and/or imprint of a WBN specimen]. For statistical assessment, we utilized the auditing tool and quality control proposed by the National Health Service — Breast Screening Program (NHSBSP).
Results: For FNA, specificity full (SPEC), positive predictive value (PPV), inadequate rates and suspicious rates were satisfactory while absolute sensitivity (AS), complete sensitivity (CS), false-negatives (FNs) and false-positives (FPs) were unsatisfactory. For imprint, AS, CS, inadequate rate from cancers and suspicious rate were satisfactory, and the remaining indicators were unsatisfactory. WBN displayed the best performance with AS, CS, FN, suspicious rate, SPEC and PPV, showing satisfactory results and only one unsatisfactory result (FP).
Comparison of quality control measures of fine-needle aspiration (n=395), imprint (n=182) and core-needle biopsy (n=500) performed at the UNIFESP-EPM Breast Clinic from January 2002 to April 2007 with the
Min — minimuml; Unif — Unifesp-EPM; PPV — Positive predictive value, NA — not applicable
Conclusion: Based on an overall analysis, WBN displayed the highest clinical efficacy compared with FNA and imprint and demonstrated adequate safety for confirming the appropriate diagnosis and management of patients, ensuring the efficacy of the service.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-02-02.
Abstract P6-03-01: High Percentage of Triple Negative Tumors Present as Palpable Masses
Authors: Kalu ON , Kurian A , Wapnir I. 
Published: April 2011

Abstract
Introduction: Approximately 15% of newly diagnosed breast cancers are triple negative tumors (TNT; ER-/PR-/HER2-), a subgroup with a particularly poor prognosis. This clinical-pathologic subtype corresponds to, but is not synonymous with basal-like tumors. These cancers are prevalent among African-Americans and BRCA mutation carriers. We hypothesize that TNT are more likely than other breast tumor subtypes to present as a palpable mass or appear between screening examinations. We compared the screening practices and detection modality of women with TNT at our institution.
Methods: Between December 2000 to February 2010, 346 women with TNT were identified through the Stanford University Cancer Center tumor registry. Medical records were retrospectively reviewed. Breast imaging screening was compared between women whose cancers presented as a palpable mass versus those which were detected on breast imaging. Patients without prior breast imaging, screening occurring &gt;5 y prior to diagnosis or unknown imaging history were grouped together (UNK). 95% confidence intervals (CT)determined by modified Wald method.
Results: Mean age at diagnosis was 53y (range 25 to 97). 82 patients had BRCA mutation testing, of which 41 were positive. 58 women were &lt; 40 y of age; 100 between 40-50 y; and 188 women &gt; 50. 253 were detected on self exam. The rest were found on screening mammography (70), MR imaging (3), non-breast radiologic studies (9); unknown presentation (11).
54 cancers in women &lt; 40 years of age were palpable. Of these, 7% (0.02- 0.18)had screening within 24m(onths), 6% (0.01-0.16)within 2 to 5y(ears) and 87% (0.75-0.94)were UNK. 74 women 40-50y of age with palpable presentations, 36%(0.26-0.48) had screening within 24m, 9%(0.04-0.19) within 2-5y and 54%(0.43-0.65)were UNK. 125 women &gt;50 years of age with palpable presentations, 27%(0.21-0.36) had screening within 24m, 5% (0.02-0.10)within 2-5y and 67%(0.45-0.62) were UNK. Within this group 2 of 4 (&lt;40), 23 of 27 (40-50), and 25 of 34 (&gt;50) had detected masses within 12m of breast imaging. 30 patients carried BRCA mutations. 3 women &lt;40 y had tumor detected on screening; 1 patient had screening at 15m, 2 were UNK. 22 in the 40-50y group were detected on screening; 41% (0.23-0.61)had screening within 24m, and 60%(0.39-0.77) were UNK. 48 women &gt;50y had tumors detected on screening; 50% (0.36-0.64)had screening within 24m,8%(0.03-0.20)within 2-5y, and 42%(0.29-0.56) were ND. In this group, 5 of 9 (40-50), 16 of 24 (&gt;50) had lesions detected within 12m of imaging. 8 patients with image detected tumor carried a BRCA-1 mutation. A total of 249 pts were of screening age and of those 95 were screened within 2 y; yet 65% of those presented with a palpable mass.
BREAST IMAGING PRIOR TO DIAGNOSIS, N(%)
Conclusion: Our data suggests that regardless of age, TNT present as palpable masses even among those undergoing breast screening.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-03-01.
Abstract P6-03-02: Breast Reduction Mammoplasty and Incidence of Occult Carcinoma. A 10 Year Experience
Authors: Mazhar K , Goyal A , Coulson S , Caddy C. 
Published: April 2011

Abstract
Background: The aim of this study was to report the incidence of cancer in reduction mammoplasty specimens and suggest alternative pragmatic cost-effective way of identifying and treating patients with carcinoma. Methods: All patients who underwent breast reduction surgery at Northern General Hospital over a 10-year period were identified from a prospective database. The histopathology reports and case records of all patients with significant abnormalities were analysed. All breast reduction specimens were sliced at 1 cm intervals and examined macroscopically. At least 3 blocks per breast were examined microscopically in addition to sampling of any grossly abnormal tissue.
Results: Between October 1999 and April 2010, 1,588 patients underwent reduction mammoplasty. The median age of patients was 38 years (range 16-75 years). Indications for surgery were macromastia in 1,194 (75.2%), congenital asymmetry in 182 (11.5%) and contralateral symmetry procedure post breast cancer surgery in 178 (11.2%). 9 specimens showed atypical hyperplasia (0.57%). 5 cancers were detected (0.31%). 4 of the 5 patients had normal mammograms 1-3 years before the reduction operation (not done in 1). Of these cancers, 4 were invasive (3 invasive lobular, 1 invasive ductal) (0.25%) (mean invasive tumour size 9 mm (SD 7.4)) and 1 was DCIS (4mm) (0.06%). A lump was felt macroscopically by the pathologist in 2 of the 4 patients with invasive cancer. The median age of patients with invasive cancer was 56 years (range 47-68 years). Patient found to have DCIS did not undergo further surgery while those with invasive disease underwent mastectomy (3) and axillary nodal staging (4). None of the patients with benign/normal post-reduction breast imaging had residual breast cancer on histology.
Conclusion: The incidence of occult carcinoma in reduction mammoplasty specimens is less than 0.5%. Pre-operative mammogram is not useful as 4 of the 5 patients with cancer had a normal mammogram 1-3 years before surgery and invasive lobular cancers are often not detected on mammogram. Mastectomy may be avoided in patients with no residual breast disease on post-reduction imaging.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-03-02.
Abstract P6-03-03: Could We Reduce the Number of Exams in the Follow-Up of Breast Cancer Survivors?
Authors: Tallet AV , Farnault BP , Moureau-Zabotto LV , Esterni BA , Salem N , Gonçalves A , Houvenaeghel GF , Jacquemier JD , Resbeut M. 
Published: April 2011

Abstract
Background. The aim of this retrospective study was to determine by which way was diagnosed any breast cancer recurrence after the end of the adjuvant treatment and to draw guidelines for exams for the follow-up. Materials and methods. Between January 1995 to December 2005, 5419 patients were treated for non metastatic breast cancer in our institute, out of which 662 experienced a relapse either local or metastatic. The charts of 608 of these patients were analysable, and retrospectively reviewed. For each case, we looked at the exams or clinical symptom which revealed the recurrence.
Results. Among the 608 patients who recurred, 173 patients (28%) experienced an isolated local relapse, while 12 experienced a contralateral breast cancer (2%), 423 experienced either a metastatic or metastatic plus local relapse (65% and 5%, respectively). Local relapses were detected in most of cases either clinically (42%) or on mammography and mammary ultrasound (US) (55%). An isolated increase of blood tumor marker (CA 15.3) revealed the relapse in 24% of cases (in 33% of cases for distant relapses and 3% for isolated local relapses). The remaining 67% of cases with metastases were diagnosed by clinical symptoms in 47% of cases, imaging in 22% of cases (bone scan in 6%, liver US 5%, mammography 1%, TDM 5%, chest X-ray 2%). In these cases of radiographically detected metastases clinical exam and/or tumor markers levels were abnormal in 42% of cases.
Conclusion. A follow-up with a systematically clinical exam, mammography and mammary US, and blood tumor markers assessment permits the diagnosis of 100 percent of local relapse, 100% of contralateral breast cancer, and 89% of metastatic disease. Thus imaging exams could be avoided routinely, with less stress for the patient and improvement of the health cost.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-03-03.
Abstract P6-03-04: Opening, Dynamic Prospective Cohort Research on the Small Focus Less than 1.1cm Shown by B Ultrasound in Breast
Authors: Fan Z , Shi A , Du H , Wu D , Fu T. 
Published: April 2011

Abstract
BACKGROUND: Ultrasound is the most frequent clinical way to examine breast in China. Because Chinese have small and high density breasts, mammography can not show some lesions, and it costs too much. There are 5%-10% patients detected small, nonpalpable lesions by ultrasound in clinic and physical examination. Most of the lesions are very small, without typical characteristics of malignant or benign tumor. So many positive results bother doctors and patients. OBJECTIVE To find an appropriate way to detect breast cancer early and reduce unnecessary biopsy. METHODS: A Opening, dynamic prospective cohort research on the small focus less than 1.1cm shown by B ultrasound has been performed from 1 st January 2009. 791 cases and 1064 lesions were selected to the study group. All patients are female, from 35 to 75 years old. The lesions are from 0.25 cm to 1.1cm in ultrasound and less than grade 3 in mammography according to BI-RADS. The patients are divided to 2 groups according to the mammography grade of BI-RADS. The first subgroup concludes 260 cases with grade 3, and the second subgroup concludes 531 cases with less than grade 2. The patients who were more than grade 4 in ultrasound according to BI-RADS accepted biopsy as soon as they got into group. Other patients accept ultrasound per 3 months and mammography per year. We will do biopsy when the lesions rise up to 130% of the original size, and when the lesion reduce to 70% of the original size in consecutive two times examination on ultrasound , the patient will leave the group. RESULTS: Total 70 cases were performed biopsy during 17months. 2 cases (0.7%) without family history of breast cancer were breast cancer during biopsy in the first subgroup.2 cases (0.3%) with family history of breast cancer were mastopathy with atypia during the procedure of follow up—biopsy in the second subgroup. CONCLUSIONS: Most small lesions which are negative on mammography are benign and need not be performed resection. Use of mammography can reduce unnecessary biopsy in Chinese. Ultrasound and family history of breast cancer should be considered well.
the cases of screening and biopsy

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-03-04.
Abstract P6-05-03: Analysis of College of American Pathologists Recommendations for Reporting HER2 Intra-Tumoral heterogeneity (ITH) on 1329 Breast Cancers
Authors: Allison KH , Dintzis SM , Schmidt RA. 
Published: April 2011

Abstract
Background: The College of American Pathologists (CAP) recently published recommendations for reporting intratumoral heterogeneity for HER2 gene amplification in breast cancers. These guidelines recommend reporting cases with between 5-50% of cells with HER2:CEP17 ratios
&gt; 2.2 (or &gt; 6 HER2 signals/cell) as “heterogeneous for HER2 gene amplification.” Because these recommendations lack biological and clinical foundation, we applied them to a large number of historical breast cancers and compared the ITH classification to routine FISH Her2 results. Materials and Methods: We collected Her2 and CEP17 counts in 32,116 tumor cells from 1329 consecutive breast cancer cases analyzed by FISH. Data from Excel counting sheets were imported to a SQL Server database for analysis and statistics; histograms and analyses were also performed in Excel. We specifically computed concordances between guidelines for traditional and intra-tumoral heterogeneity (ITH) reporting.
Results: 309 of 1,329 cases (23%) met the criteria for heterogeneous HER2 gene amplification by HER2:CEP17 ratio, but &gt; 79% of these were non-amplified by standard FISH reporting criteria. Using Her2 signals per cell, ITH was found in 87 (6.5%) of cases and most of these were not amplified or equivocal by standard criteria.
Discussion: A significant proportion of breast cancers contain ITC heterogeneity based on CAP/ASCO reporting recommendations. The majority of these cases are non-amplified without consideration of ITH. Because it is not known whether these patients (who would not currently be treated) would benefit from HER2 targeted therapies, it may be premature to use the ITH reporting recommendations for clinical decision-making. More validation of ITH criteria and biological significance are needed.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-05-03.