The fourth edition of the European guidelines for quality assurance in breast cancer screening and diagnosis was published by the European Commission in 2006. The present supplements to the fourth edition have been produced by the same groups of experts originally established under the Europe Against Cancer programme that have developed and updated the guidelines since the early 1990s. Over the years, the scope and the depth of the multidisciplinary guidelines have expanded, and recommendations and protocols have been updated to keep pace with developments in the field. The present supplements lay a cornerstone for a new, completely revised fifth edition of the guidelines

/pdf/european-guidelines-for-quality-assurance-in-breast-cancer-34igkumbby.pdf

European guidelines for quality assurance in breast cancer screening and diagnosis

Rak piersi jest najczestszą przyczyna zgonu wśrod kobiet i stanowi istotny problem kliniczny. Wczesne
wykrycie raka piersi dzieki regularnie prowadzonym badaniom przesiewowym za pomocą mammografii
umozliwia rozpoznanie choroby w stadium, w ktorym leczenie jest skuteczniejsze i zazwyczaj wiąze sie
z lepszą jakością zycia. Jednakze mammografia moze byc przyczyną niepotrzebnego stresu, dolegliwości,
kosztow finansowych oraz narazenia na promieniowanie jonizujące. Z tego powodu nalezy polozyc
mozliwie najwiekszy nacisk na kontrole jakości. Opracowanie Europejskich zalecen dotyczących kontroli
jakości badan przesiewowych i rozpoznawania raka piersi bylo inicjatywą programu Europa przeciwko
rakowi . Czwartą edycje interdyscyplinarnych zalecen opublikowano w 2006 roku. Sklada sie z okolo 400
stron podzielonych na 12 rozdzialow przygotowanych przez ponad 200 autorow i wspolautorow. Interdyscyplinarna
rada wydawnicza przygotowala streszczenie dokumentu w celu przedstawienia podstawowych
zasad i zalozen, na ktorych powinny opierac sie badania przesiewowe oraz diagnostyka raka piersi.
Opracowanie zawiera takze tabele podsumowującą wskaźniki wydajności, aby szersze grono naukowcow
moglo sie z nią zapoznac.

/pdf/european-guidelines-for-quality-assurance-in-breast-cancer-2ik5vahzpv.pdf

European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition - summary document

BACKGROUND

This report is an 8-year update of the authors' previous findings from National Surgical Adjuvant Breast Project (NSABP) Protocol B-17, which relates to the influence of pathologic characteristics on the natural history and treatment of intraductal carcinoma (DCIS).



METHODS

Nine pathologic features observed in a pathologic subset of 623 of 814 evaluable women enrolled in this randomized clinical trial were assessed for their role in the prediction of second ipsilateral breast tumors (IBT), other events, and selection of breast irradiation (XRT) following lumpectomy.



RESULTS

The frequency of subsequent IBT was reduced from 31% to 13% (P = 0.0001) by XRT. The average annual hazard rates for IBT were reduced by XRT for all pathologic features examined. Four characteristics were individually noted to be significantly related to IBT, but only moderate-to-marked and absent-to-slight comedo necrosis were found to be independent high and low risk predictors, respectively, for such an event in patients of both treatment groups. XRT effected a 7% absolute reduction at 8 years in the low risk group. Despite a relatively high incidence (≈40%) of IBT consisting of invasive cancer, mortality due to breast carcinoma after DCIS for the entire cohort was found to be only 1.6% at 8 years.



CONCLUSIONS

The degree of comedo necrosis in patients with DCIS appears to be sufficient for discriminating between high and low risks for IBT following lumpectomy for DCIS. Although margin status, unlike in our previous report, was found to have only a slight or borderline influence on the frequency of IBT at 8 years, excision of DCIS with free margins is advised. The low risk group exhibits a statistically significant reduction of IBT from XRT. The decision to forgo XRT in the treatment of this singular subset of patients would appear to depend on clinical considerations and the input of informed patients rather than being standard practice. [See editorial on pages 375–7, this issue.] Cancer 1999;86:429–38. © 1999 American Cancer Society.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/%28SICI%291097-0142%2819990801%2986%3A3%3C429%3A%3AAID-CNCR11%3E3.0.CO%3B2-Y

Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight-year update of Protocol B-17: intraductal carcinoma.

Between 1960 and 1980, 518 patients with T1, T2, N0, N1a, invasive breast cancer were treated by limited surgery at Institute Curie with (183 patients) or without (335 patients) axillary node dissection, followed by radiation therapy to breast and nodes. Median follow-up was 8.6 years (1.3 to 25 years). Fifty-six breast recurrences occurred, including 49 breast recurrences alone, 3 simultaneous breast and node recurrences, and 4 simultaneous breast recurrences and metastasis. Five-year, 10-year, and 15-year actuarial risks of breast recurrences were 7 +/- 1%, 11 +/- 1.5%, and 18 +/- 3%, respectively. Univariate analysis of 14 clinical and pathological prognostic factors revealed that local control in breast was significantly impaired by young age, premenopausal status, inadequate gross surgical excision, extensive ductal in situ component, and endolymphatic extension. On multivariate analysis with a Cox regression model, the most important contributors to local breast control in order of importance were age (p less than 10(-4), relative risk = 2.44), adequacy of surgery (p = 0.003, relative risk = 2.78), and endolymphatic extension (p = 0.03, relative risk = 2.98). The 5-year actuarial survival rate following breast recurrence was 73%, and was significantly worse when breast recurrence occurred in the first 3 years after treatment: 44% versus 87%, respectively (p less than 0.01). This study confirms the relationship between young age and low breast control rates, and demonstrates the importance of adequate initial surgical procedures. It emphasizes the adverse prognosis of early breast recurrences as compared to the relatively favorable outcome of late recurrences.

Prognostic factors of breast recurrence in the conservative management of early breast cancer: a 25-year follow-up.

Purpose Locoregional failure after breast-conserving surgery is associated with increased risk of distant disease and death. The magnitude of this risk in patients receiving chemotherapy has not been adequately characterized. Patients and Methods Our study population included 2,669 women randomly assigned onto five National Surgical Adjuvant Breast and Bowel Project node-positive protocols (B-15, B-16, B-18, B-22, and B-25), who were treated with lumpectomy, whole-breast irradiation, and adjuvant systemic therapy. Cumulative incidences of ipsilateral breast tumor recurrence (IBTR) and other locoregional recurrence (oLRR) were calculated. Kaplan-Meier curves were used to estimate distant–disease-free survival (DDFS) and overall survival (OS) after IBTR or oLRR. Cox models were used to model survival using clinical and pathologic factors jointly with IBTR or oLRR as time-varying predictors. Results Four hundred twenty-four patients (15.9%) experienced locoregional failure; 259 (9.7%) experienced IBTR, and 1...

https://ascopubs.org/doi/pdf/10.1200/jco.2005.04.3273

Prognosis After Ipsilateral Breast Tumor Recurrence and Locoregional Recurrences in Five National Surgical Adjuvant Breast and Bowel Project Node-Positive Adjuvant Breast Cancer Trials

The perilobular hemangioma is generally considered uncommon. We found a high incidence (11%) of this little-recognized benign mammary lesion during the course of a recently completed autopsy study designed to assess bilateral, four-quadrant, and subareolar disease of the breast in 210 consecutive forensic post-mortem examinations on female subjects between 15 and 97 years of age. Despite the lesion's name, its distribution was found to involve any of the stromal components of the breast. The unexpected frequency of the perilobular hemangioma within breasts in this study and the reported rarity of mammary angiosarcomas indicate that malignant transformation, if it occurs, must be rare.

Incidence of perilobular hemangioma in the female breast.

Attention is directed to a unique but apparently heretofore undescribed and overlooked form of intraductal carcinoma of female breast characterized by varying numbers of intraductal neoplastic cells with eccentric nuclei and either ground-glass or optically clear, mucin-containing cytoplasm. Eight examples have been observed in breast tissue submitted consultatively for the distinction of hyperplasia and intraductal carcinoma. This lesion, designated as intraductal signet ring carcinoma, may be found in some of the ducts of otherwise benign fibrocystic disease and radial scars, as well as breasts with other forms of intraductal carcinoma or invasive carcinoma. Four hundred consecutive examples of the latter examined prospectively revealed this intraductal lesion in 12 or 3%. Only 3 of the 12 examples were associated with either pure or combination forms of lobular invasive carcinoma.

Intraductal signet ring carcinoma. A hitherto undescribed form of intraductal carcinoma of the breast.

In an attempt to identify antigens expressed during breast differentiation, three murine monoclonal antibodies, CIBr2, CIBr7, and CIBr18, were produced against the human pleomorphic breast carcinoma cell line PMC42. All three monoclonal antibodies reacted with previously undescribed antigenic determinants on the PMC42 cell line. Antibody CIBr18 reacted only with the immunizing cell line PMC42, whereas antibodies CIBr2 and CIBr7 showed minimal reactivity toward a panel of 34 human leukemia- and solid tumor-derived cell lines. The antigenic determinants detected by the three antibodies were distinct, and each showed variable expression in PMC42 monolayer and organoid cultures. The heterogeneity of staining seen on PMC42 cultures may reflect the fact that this cell line contains up to eight morphologically distinct cell types. Antigen expression correlated with cell type in some instances, whereas in other instances phenotypic subdivision within a cell type was apparent. Antigens recognized by antibodies CIBr7 and CIBr18 were characterized biochemically. In Western blotting, antibody CIBr7 identified a single band of an apparent molecular weight of 38,000 within PMC42 cell lysates. Sodium dodecyl sulfate-polyacrylamide gel analysis of polypeptides immunoprecipitated by antibody CIBr18 from [35S]methionine-labeled PMC42 cell lysates identified two glycoproteins of apparent molecular weights of 115,000 and 120,000, respectively. No biochemical data for the CIBr2 antigen are yet available. All three antigens were detected in human mammary epithelium and some non-breast tissues. The expression of these antigens in normal and neoplastic mammary epithelia is discussed in terms of antigen heterogeneity and changes in antigen expression upon conversion to the malignant state.

Development of Monoclonal Antibodies to the Human Breast Carcinoma Cell Line PMC42

The histology of breast lumps in five patients with hyperprolactinemia showed benign mammary dysplasia with vacuolation of acinar and duct lining cells. In two cases, foci of lobular development resembling lactating breast tissue were also noted. In the past, focal secretory change has been considered to be idiopathic, but these cases indicate a possible association with hyperprolactinemia. Among other causes hyperprolactinemia may be a manifestation of occult pituitary adenoma. Therefore it is suggested that patients with benign breast nodules showing focal secretory change should be screened for clinical and laboratory evidence of hyperprolactinemia. Although it is accepted that in mice and rats prolactin plays an important role in chemically induced mammary tumorigenesis, a consensus has not been reached with regard to its role in man.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%2819820701%2950%3A1%3C125%3A%3AAID-CNCR2820500123%3E3.0.CO%3B2-D

Breast tumors in patients with hyperprolactinemia

Fluorescence of Fungi—Not Autofluorescence

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