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  • 1
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract:  We report our experience with excision of hooked-wire bracketed breast carcinomas in a community hospital setting. The mammographic and pathology reports from 36 nonpalpable or minimally palpable breast cancers were retrieved from a single surgical oncologist's office records and a number of factors that might influence a successful initial surgical excision were examined. The median lesion size was 1 cm. The radiographic abnormalities were microcalcifications only in 14 cases (39%), combined mass/density and microcalcifications in 9 cases (25%), and mass/density without microcalcifications in 13 cases (36%). The median number of bracketing wires placed was two. A prior fine-needle aspiration (FNA) or core biopsy was performed in 29 of the 36 cases (81%). Of these, 27 were positive for malignancy. The tumor was considered to be inadequately excised if it was present within 5 mm of any surgical margin; this outcome occurred in 21 of the 36 cases (58%). Fifteen cases (42%) had tumor involving either the margin or extending to within 1 mm of the margin. Inadequately excised lesions were more commonly seen with increasing tumor size, a radiographic appearance of microcalcifications without an associated mass, and a pathologic diagnosis of ductal carcinoma in situ (DCIS). An intraoperative consult led to taking additional marginal tissue in 23 cases and was successful in achieving final clear histologic margins in 8 of these (35%). Our experience suggests that there are at least two ways to optimize the adequacy of conservative excision of nonpalpable or difficult-to-palpate breast cancers using standard modalities presently available in most community hospitals. These are (a) having the pathologist and radiologist available for intraoperative consultation and (b) obtaining a tissue diagnosis of malignancy preoperatively. The use of bracketing wires to better delineate the margins of tissue to be excised may also be helpful, but this needs to be further evaluated in a randomized study. 
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The noninvasive technique of nipple aspiration as a potential source of biomarkers of breast cancer risk was evaluated. The feasibility of performing mutagenesis assays, amplifying DNA, and performing protein electrophoresis on nipple aspirate fluid was explored. A tool was developed to measure the level of discomfort, if any, from this procedure. Twenty-five healthy women (20 premenopausal and 5 postmenopausal) were enrolled. Fluid was obtained using a modified breast pump. Premenopausal women were scheduled for four to six weekly aspirations, and postmenopausal women were scheduled for one to two weekly aspirations. Mutagenesis assays were performed using the Salmonella (Ames) assay. DNA amplification of several microsatellite regions was carried out using polymerase chain reaction. Protein was quantified, and two-dimensional protein electrophoresis was performed. Overall, fluid was obtained from 80% of the women, and the level of discomfort was minimal. Acid hydrolysis of one sample resulted in mutagenicity; all six nonhydrolyzed samples were not mutagenic. The ability to amplify DNA ranged from 34% to 96%, depending on length of the microsatellite region examined. The average protein concentration was 71 μg/mL. Two-dimensional protein electrophoresis was successfully performed on samples from two subjects. Nipple aspiration is a simple technique and is easily learned and well tolerated, which yields a reagent useful for a variety of investigations. This technique may facilitate the identification and application of biomarkers for future breast cancer risk assessment and chemopreventive protocols.
    Type of Medium: Electronic Resource
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