In situ breast carcinomas: a population-based study on frequency, growth pattern, and clinical aspects.
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Adult↗
Biomedical subjects
M Blichert-Toft
Publications and source records attributed to M Blichert-Toft.
Lacking evidence for release of thyroid hormones from circulating thyroglobulin during subtotal thyroidectomy.
The effect of subtotal thyroid resection for thyrotoxicosis on concentrations of serum thyroid hormones and thyroglobulin (Tg), was determined in 10 patients during operation and the subsequent 18 days. Mean serum Tg responded drastically, increasing from a pre-operative value of 0.30 nmol/l to a peak value of approximately 26 nmol/l during operation followed by a gradual decline to levels lower than before surgery on day 18. Mean serum total thyroxine was 114 nmol/l pre-operatively and free thyroxine index (FT4I) 105 units. Both fluctuated only slightly during operation. Postsurgically, the mean values decreased to below 50% of the pre-operative level. Mean serum total triiodothyronine (TT3) was 1.46 nmol/l pre-operatively. It decreased during operation, reaching a nadir of 0.55 nmol/l on day 2, whereafter the concentration increased slightly. Mean serum reverse T3 (rT3) was 0.45 nmol/l pre-operatively, increased 62% during surgery, and decreased postsurgically. The mean value of serum thyroid stimulating hormone (TSH) was 0.61 mU/l pre-operatively and remained below 1 mU/l during and after operation, but from day 10 concentration began to rise steadily. It is concluded that the vast release of Tg during thyroid resection did not contribute to the concentration of serum T4 to an extent of clinical relevance.
Adult↗
Urinary iodine excretion in a geographically stratified Danish population sample not affected by iodination programmes. A change towards higher values.
The excretion of urinary iodine was studied in a representative population sample from the county of Funen, Denmark, comprising 505 persons between 25-44 years of age, stratified according to geography, age, and sex. Urine samples were collected for 5 h during late afternoon and early evening. The 24-h iodine excretion was estimated on the basis of iodine and creatinine determinations using correlation equations determined in a pilot study of 50 men and women. The iodine excretion was significantly higher in men: 89 micrograms/24 h (median) than in women: 76 micrograms/24 h; the whole population: 85 micrograms/24 h. No significant differences were observed among the age groups studied. The iodine excretion was significantly higher in people living on small islands: 98 micrograms/24 h (median) compared with 84 micrograms/24 h in urban regions and 78 micrograms/24 h in rural districts. Median iodine excretion per gram of creatinine was 58.8 micrograms for the whole sample. The iodine excretion for men was 77% higher than reported in an earlier investigation performed in Funen, 1969, but still lower than internationally recommended (WHO).
Adult↗
Diagnostic strategy in the management of patients with breast symptoms. A recommended design and present experience.
The diagnostic problems in patients with breast symptoms have increased as the referral pattern has changed. Patients with vague symptoms and atypical palpatory findings are increasing in number. At the same time, the doctor is faced with the demand for greater diagnostic accuracy and, paradoxically, restraint in the use of diagnostic methods. Accordingly, high priority must be given to an effective diagnostic strategy without unnecessary investigations and delaying procedures. Above all, efforts must aim at reducing the number of 'unnecessary' benign biopsies. We are presenting a suggestion for an integrated diagnostic system based upon close collaboration between the general practitioner on one hand and radiologist, surgeon, and pathologist as the expert hospital team on the other. This design has not only entailed greater diagnostic accuracy, it also complies with the demand for conservation of resources.
Breast Neoplasms↗
Frequency and types of chest wall recurrences among node negative breast cancer patients.
From 1979 to 1982 a total of 2,467 patients with invasive breast carcinoma were included in the DBCG low-risk group (protocol 77a) and treated with mastectomy only. During a follow-up period from 4 to 7 years, 246 cases (10%) were reported with chest wall recurrence as first site of failure. For several reasons 58 cases were omitted. The material therefore comprises 188 cases. By a histo-pathologic re-evaluation the material was classified in three groups, i.e. 1) 31 cases with an evident new primary cancer, 2) 9 cases with a questionable new primary cancer, and 3) 148 cases with a true recurrence. Demonstration of residual breast tissue, multicentricity, and high differentiation of the original cancer, were features significantly related to the group of evident and questionable new primary cancers. Within the follow-up period no difference in mortality between the three groups were found.
Adult↗
Low-risk breast cancer patients treated by mastectomy and lower axillary dissection. The present status of the Danish Breast Cancer Cooperative Group Trial 77-A.
From 1977 to 1982 a total of 2,935 women with breast cancer fulfilled the criteria for inclusion in the low-risk protocol of the Danish Breast Cancer Cooperative Group, DBCG 77-A. The operation performed was a total mastectomy with axillary dissection slightly modified according to Cady. Postoperatively the patients were examined clinically and by chest radiography with intervals for ten years or until recurrence. With a median observation time of seven years loco-regional recurrence appeared in 409 patients (13.9%): chest wall 9.3%, axilla 3.7%. Half of the recurrences were diagnosed within two years postoperatively. Metastases appeared in 396 patients (13.5%), mainly in bones and lungs; 96 patients (23.5%) with loco-regional recurrence and 174 (43.9%) with distant metastases died from breast cancer during the observation time. Life-table analyses of recurrence-free survival (61.7%) and survival (75.4%) are presented. The results of the treatment are in accordance with reports in the literature, but a straightforward comparison is impossible on account of a huge variation in surgical and postsurgical treatment. Finally, the surgical technique in the participating departments in this nation-wide study was evaluated. A high grade of uniformity with respect to loco-regional recurrences was found.
Adult↗
Total mastectomy with special reference to surgical technique, extent of axillary dissection and complications.
Total mastectomy and partial axillary dissection as advised in the DBCG (Danish Breast Cancer Cooperative Group) protocols was performed in 104 consecutive females with operable primary invasive breast cancer, aged 34-82 years, median 47 years. The glandular removal was complete as assessed by microscopic examination of side resection planes and deep fascia of the surgical specimen. The number of removed axillary lymph nodes ranged from 1 to 28, median 8. The mortality was zero. There were no general complications. Wound complications comprised seroma (47.1%), flap margin necrosis (5.8%) and infection (1.9%). The pitfalls in securing total mastectomy are discussed as is the extent of axillary dissection for staging purposes. Furthermore, the problem of axillary dissection and axillary irradiation in node positive patients is considered.
Adult↗
Influence of adjuvant irradiation on the development of late arm lymphedema and impaired shoulder mobility after mastectomy for carcinoma of the breast.
The influence of postoperative radiation therapy on development of late arm lymphedema and shoulder joint disability following mastectomy was evaluated from a series of 57 women with operable carcinoma of the breast. The patients were divided into three groups. Common for all three groups was mastectomy and partial axillary dissection. In addition one group received postoperative irradiation plus systemic therapy and another group systemic therapy alone. The incidence of late arm lymphedema/impaired shoulder mobility was 11%/4% in the group of patients undergoing surgery alone, 46%/38% in the group of patients receiving adjuvant irradiation and 6%/12% in the group of patients receiving adjuvant systemic therapy. It is concluded that adjuvant irradiation to the axilla in patients with metastatic lymph nodes highly increases the risk of late physical sequelae following modified radical mastectomy. Adjuvant systemic therapy can be administered to high risk patients without increasing the risk of late arm lymphedema and shoulder disability.
Adult↗
A Danish randomized trial comparing breast-preserving therapy with mastectomy in mammary carcinoma. Preliminary results.
The present study comprises 847 women operated upon for invasive breast carcinoma at 19 surgical departments and enrolled in protocol DBCG-82TM from January 1983 to November 1987. Among them 662 (78%) were allocated for breast-preserving therapy or mastectomy by randomization, while 185 patients (22%) did not accept randomization. Within the randomized group 6% could not be entered into adjuvant protocols, i.e. subsequent programmes of postoperative therapy and follow-up. This left 619 evaluable patients. In the non-randomized series 26% did not fulfil the demands for entrance into the adjuvant protocols, leaving 136 evaluable patients, 60 of whom had chosen a breast-preserving operation and 76 mastectomy. In the randomized series the patients in the two treatment arms were comparable in age, menopausal status, site of tumour, pathoanatomical diameter of the tumour, number of removed axillary lymph nodes, number of metastatic axillary lymph nodes, and distribution on adjuvant regimens. Ninety per cent of the patients in the randomized group accepted the method offered, whereas 10% declined and wanted the alternate form of operation. The median follow-up period was approximately 1.75 years. The cumulative recurrence rate in the randomized group was 13% and in the non-randomized group 7%. These results are preliminary. Life-table analyses have not so far demonstrated differences in recurrence-free survival either in the randomized or the non-randomized series.
Adult↗
In situ carcinomas of the female breast. Incidence, clinical findings and DBCG proposals for management.
In situ carcinomas of the female breast (CIS) include lobular carcinoma in situ (LCIS) and ductal carcinoma in situ (DCIS). Also associated are controversial forms of epithelial hyperplasia, lobular cell atypia (ALH) and ductal cell atypia (ADH). Based upon recent Danish autopsy studies, it has been estimated that about 25% of all women will develop in situ carcinoma, predominantly in the form of DCIS. Only a fraction of these lesions will evolve into a clinical manifest form, however. Thus, in a clinical setting, the frequency of CIS is 0.09 cases per 1,000 woman-years for a Danish female population aged twenty years or more. The lifetime risk of having CIS demonstrated is estimated at 0.53% for women in this age group. CIS makes up a few per cent of all newly diagnosed breast cancers in Denmark. Enforced employment of mammography in the early detection of breast cancer will increase CIS incidence from about 4-6% to about 9-10% of all newly diagnosed breast cancers, and aggressive DCIS growths will mainly constitute the increment. In concurrence with the new DBCG protocols in 1988, new strategies for the management of in situ carcinomas, based upon histogenetic types and growth patterns, are being introduced. The aim will be breast-conserving treatment whenever it can be achieved.
Breast Neoplasms↗
Bioptic strategy in breast cancer.
The bioptic strategy in breast cancer rests on the following basic conditions at the Department of Surgery K, Odense University Hospital: Firstly, clinical mammography precedes any bioptic procedure. Secondly, the bioptic procedure must secure representative tissue for histological examination. Thirdly, knife-biopsy should preferably be excisional. Finally, tissue examination is exclusively done by the pathologist and always on unfixed tissue. The application and outcome of the employed biopsy methods are illustrated by a series of 365 women with operable, primary invasive breast cancer, treated from 1982 to 1987. Definitive surgery was mainly based on excisional (62%) or needle biopsy (24%). Three-fourths of the patients were treated by the one-stage procedure. However, within the last year of the period the rate of needle biopsy and two-stage procedures was doubled, increasingly employing core-aspirating needle biopsy synchronously with mammography and done by the radiologist. So far, patient compliance and histological outcome is satisfactory.
Biopsy↗
Adjuvant treatment of postmenopausal patients with high risk primary breast cancer. Results from the Danish adjuvant trials DBCG 77 C and DBCG 82 C.
The efficacy of adjuvant treatment with tamoxifen was evaluated in protocol DBCG 77 C. Postmenopausal high risk patients (tumor greater than 5 cm, positive axillary nodes, or invasion to skin/fascia) were randomized after total mastectomy and axillary sampling to postoperative radiotherapy (control) or to radiotherapy plus treatment with tamoxifen (TAM), 30 mg daily for 1 year. A total of 1,716 patients entered the study. At 8 years of follow-up, (7 years median time of observation), we observed a significant increase of recurrence-free survival for the TAM treated group and a reduction in mortality, which is significant for patients less than 70 years of age. Retrospectively, an increased recurrence-free survival in TAM treated patients was significant in the following subgroups: tumor less than 5 cm, positive lymph nodes, anaplasia grade II and estrogen receptor level greater than 100 fmol/mg cytosol protein. In the subsequent trial (DBCG 82 C), 1,347 postmenopausal patients less than 70 years were randomized to one of the following 3 regimens: radiotherapy + tamoxifen, 30 mg daily for 1 year (TAM), TAM alone, or TAM + CMF (CMF i.v. day 1 every 4 weeks x 9). The survival is similar in the 3 groups at 4 years (2 years median time of observation).
Aged↗
The growth pattern of in situ carcinoma in the female breast.
The histopathological growth pattern of in situ carcinoma in the female breast is divided into three forms: 1) microfocal, 2) diffuse, and 3) tumour forming. This classification is clearly correlated to our diagnostic findings and forms furthermore the basis for our planning of treatment, as the growth pattern is probably of prognostic relevance.
Breast Neoplasms↗
Sarcomas of the breast: a clinico-pathological study of 67 patients with long term follow-up.
A national Danish series of 68 breast sarcomas from 66 women and one man (age 17-86 years) was investigated. Tumour sections from 22 stromal sarcomas (SS), 24 phyllodes tumors of malignant type (MCSP), seven phyllodes tumors of borderline type (BLCSP), four malignant fibrous histocytomas (MFH), eight liposarcomas, two angiosarcomas and one leiomyosarcoma were reviewed retrospectively, and all patients were traced with a minimum follow-up of 15 years. Tumor contours appeared to be the best prognostic factor in predicting the risk of metastatic spread. Stromal overgrowth of MCSP was considered less utilizable due to difficulties in distinguishing between MCSP with marked stromal overgrowth and SS, which we consider as a variety of MCSP and which only showed slightly increased death rates compared to MCSP (45% versus 38%). Both angiosarcomas and the leiomyosarcoma proved lethal, and the other sarcoma subtypes had a death frequency of about 50%, with the exception of BLCSP, neither of which proved lethal. All patients, who died from metastases, were dead within 5 years irrespective of treatment. No positive lymph nodes were identified at the time of primary treatment, supporting the findings of previous investigators. We therefore advocate simple mastectomy or local excision with a wide margin as sufficient treatment of breast sarcomas. The indications for adjuvant therapy is as yet unclarified.
Adolescent↗
Breast cancer: risk of axillary recurrence in node-negative patients following partial dissection of the axilla.
The estimated probability of false negative nodal staging was analysed in breast cancer patients who had lower axillary dissection in conjunction with mastectomy and who were initially characterized as node negative. The series comprised 3128 consecutive female patients with invasive mammary carcinoma treated by surgery alone according to a nationwide DBCG protocol, 77-1a (Danish Breast Cancer Co-operative Group). The median number of removed lymph nodes was four, range 0-30. Median followup period was 6.5 years, quartiles 5.5 and 8.0 years. Ipsilateral axillary recurrences appeared in 178 patients (5.7%) during the followup period. The estimated 5-year probability for developing axillary relapse, calculated on the basis of lifetable analyses, was 19% in patients with no lymph nodes removed, 10% with 1-2 removed and negative nodes, 5% with 3-4, 3% with 5-10, and 3% with more than 10 removed and negative lymph nodes. No detectable increase in estimated probability could be traced in patients with five or more nodes removed during followup beyond 5 years, while in patients with less than five nodes removed the probability of axillary recurrence ascended continuously. The study also revealed a significantly decreased survival in groups of patients with less than five nodes removed and negative compared with groups of patients with five or more nodes removed. It is concluded that lower axillary dissection is associated with a certain risk of overlooking lymph nodes metastases, whereby the patients may be deprived of optimal adjuvant therapy. Misjudgment of the qualitative axillary nodal staging is modest, provided that at least five lower lymph nodes are removed.
Actuarial Analysis↗
[Subtotal parathyroidectomy in progressive secondary hyperparathyroidism in uremic patients].
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Adolescent↗
Changing aspects of biopsy of the breast: is breast biopsy a prognostic hazard?
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Biopsy↗
Primary periareolar abscess in the nonlactating breast: risk of recurrence.
The estimated probability of relapse of primary periareolar abscess of the nonlactating breast was 38 percent (95 percent confidence interval 18 to 58 percent) 8 years after simple incision and healing by granulation. Relapses were mainly fistulas in the line of incision. An attempt to identify relapses early was unsuccessful. This finding, in combination with the unsatisfactory results of simple incision and healing by granulation and the character of relapses, suggests improper initial operation and multifactorial causes. Initial incision followed by a search for a possible sinus tract and extensive excision in all patients with primary abscesses has been described and is recommended.
Abscess↗