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Biomedical subjects

S A Feig

Publications and source records attributed to S A Feig.

At least 73 records · Page 4Linked to original sources
PubMed1994

Treatment of advanced acute leukaemia with allogeneic bone marrow transplantation from unrelated donors.

Bone marrow transplantation from a histocompatible sibling donor may produce complete remission in patients with induction failure or relapsed acute leukaemia. Through the National Marrow Donor Program, histocompatible bone marrow from unrelated donors has become available for high-risk patients. In this study we analyse the results of matched unrelated bone marrow transplant in 55 patients with highly advanced acute myelogenous and acute lymphoblastic leukaemia. 28 patients with advanced acute lymphoblastic leukaemia and 27 patients with advanced acute myelogenous leukaemia, age 2-51, were treated with high-dose chemoradiotherapy and transplantation of 6/6 HLA matched (n = 46) or one antigen mismatched (n = 9) unrelated donor bone marrow. After a median follow-up of 36 months, 13 patients remain alive 17-74 months after transplant for a 2-year actuarial disease-free and overall survival of 23 +/- 12% (median disease-free survival 3.5 months). The actuarial risk of relapse is 24 +/- 16% at 1 year. Moderate to severe graft-versus-host disease occurred in 27/47 evaluable patients (57%). Significant prognostic factors for poor leukaemia-free survival include age > 21, abnormal karyotype, and active leukaemia at the time of transplant. Other pretreatment characteristics such as gender or type of leukaemia were not significant prognostic factors. Our results show that matched unrelated bone marrow transplant for patients with advanced acute leukaemia may provide long-term leukaemia-free survival, but transplant-related complications produce a significant impact on survival with older age and adverse disease characteristics predicting for poor prognosis.

Adolescent↗
PubMed1994

Stability of malignant breast microcalcifications.

PURPOSE: To determine the frequency of stability in malignant microcalcifications and its relationship to specific histologic diagnoses. MATERIALS AND METHODS: During a 34-month period, microcalcifications were proved malignant in 182 patients referred for needle-guided biopsy. In 105 patients, the mammograms were compared with one or more than one previous mammogram. These patients were classified on the basis of interval change in two groups: those with stable and those with increasing or new microcalcifications. The histologic diagnoses were reviewed. RESULTS: Microcalcifications were stable for 8-63 months (mean, 25.4 months) in 26 patients (24.8%), only three (12%) of whom had invasive ductal carcinoma, which was found in 29 (37%) of the 79 patients with increasing or new microcalcifications. CONCLUSION: The odds for presence of invasive ductal carcinoma are statistically significantly lower (P < .025) among patients with stable microcalcifications than among those with increasing or new microcalcifications. Stability of indeterminate or suspicious microcalcifications is unreliable for exclusion of a diagnosis of malignancy.

Breast Neoplasms↗
PubMed1994

Chemotherapy for induction of remission of childhood acute myeloid leukemia followed by marrow transplantation or multiagent chemotherapy: a report from the Childrens Cancer Group.

PURPOSE: In an effort to evaluate the usefulness of bone marrow transplantation, the Childrens Cancer Group (CCG) initiated a multiinstitutional study comparing bone marrow transplantation versus chemotherapy after successful induction of remission for previously untreated children and young adults with acute myeloid leukemia. PATIENTS AND METHODS: From 1979 to 1983, 508 patients were entered onto this study and 490 were treated. After induction, patients with an HLA mixed leukocyte culture (MLC)-compatible sibling underwent bone marrow transplantation. Patients not eligible for bone marrow transplantation were eligible for randomization to two chemotherapy maintenance regimens. All patients undergoing bone marrow transplantation were conditioned with cyclophosphamide and total-body irradiation (TBI). Methotrexate was used to prevent or modify graft-versus-host disease (GVHD). RESULTS: Three hundred eighty-one patients achieved bone marrow remission (78%). Eighty-nine patients had an HLA/MLC-compatible sibling donor and were eligible for bone marrow transplantation, and 252 had no match. Comparison of survival estimates for patients eligible for transplantation versus not eligible at 3 years (52% v 41%), 5 years (50% v 36%), and 8 years (47% v 34%) showed a significant difference in favor of bone marrow transplantation (P < .05). Disease-free survival (DFS) demonstrated similar results. Application of a cure model to the results showed a better outcome for those eligible for transplantation (P = .04). Patients randomized between the two chemotherapy regimens did not show any significant difference between those treated with a continuous maintenance versus a cyclic regimen (P = .16). CONCLUSION: Children and young adults who successfully achieved a remission with multiple-agent chemotherapy who had an HLA/MLC-compatible donor and were thus eligible for an allogeneic bone marrow transplant had better survival than those not eligible for transplantation.

Acute Disease↗
PubMed1994

Imaging findings in mucin-containing carcinomas of the breast: correlation with pathologic features.

OBJECTIVE: Breast carcinomas may contain varying quantities of extracellular mucin. The purpose of this study was to correlate the mammographic and sonographic appearance of mucin-containing carcinomas of the breast with the histologic features of these tumors. MATERIALS AND METHODS: The tumor registry and breast imaging files at our institution identified 34 women with 37 mucin-containing breast carcinomas for which mammographic and histologic slides were available for review. By consensus, two radiologists determined the mammographic margin characteristics (circumscribed, microlobulated, indistinct, spiculated) and, when available, the sonographic properties of the carcinomas. Doubling time in days was estimated from sequential mammograms when possible. A pathologist reviewed the histologic slides and divided the 37 carcinomas into three categories based on the percentage by volume of mucin seen: pure mucinous (> or = 90% mucin), 23 cases; moderately mucinous (< 90% and > 30% mucin), seven cases; and minimally mucinous (< or = 30% mucin), seven cases. To determine the contribution of varying percentages of mucin to the radiologic appearance of the tumors, the margin characteristics were correlated with the histologic percentage of mucin, microscopic margin appearance (displacing or infiltrating), nuclear grade (I, II, III), and lymph node status. RESULTS: Tumors with circumscribed and microlobulated margins on mammography had a higher percentage of mucin histologically (p < .01; chi 2). A trend of slower growth rate on mammograms, lower histologic nuclear grade, and less frequent axillary node involvement were also seen in tumors with a higher percentage of mucin. Spiculated mammographic margins were seen when there were decreasing volumes of mucin and when tumor margins histologically were infiltrating; these tumors had higher nuclear grades and more frequent axillary node involvement (p < .01). CONCLUSION: The radiologic and pathologic correlation of mucin-containing breast carcinomas demonstrates that lesions with higher percentages of mucin have mammographic appearances that reflect less aggressive histologic margins, lower nuclear grades, and slower growth rates. Carcinomas that have small percentages of mucin have mammographic and histologic characteristics of more aggressive, invasive ductal carcinomas.

Adenocarcinoma, Mucinous↗
PubMed1994

Mammographic screening of women aged 40 to 49 years. Is it justified?

Breast cancer among women aged 40 to 49 is of major importance, because about 25% of all deaths from breast cancer among women of all age groups occur in women who had their breast cancer diagnosed when they were in their 40s. Although mortality reduction through screening has been proved in randomized trials for women aged 50 and older, no single randomized trial has been adequately designed to specifically evaluate women aged 40 to 49. Results from seven randomized trials and follow-up studies that were not randomized support annual screening of all women aged 40 to 49 by mammography, physical examination, and monthly breast self-examination. If such screening were performed with current state-of-the-art mammography, as opposed to the older mammographic techniques used in the trials, it is likely that mortality reduction would be substantially greater than that found in those trials.

Adult↗
PubMed1994

Management of clinically occult (nonpalpable) breast lesions.

In the past generation, mammography has become a major, if not the best available, diagnostic tool for the earlier detection of breast cancer. We have certainly come far from hard-to-imagine anecdotes of the early 1970s that "if I can't feel it, it's not there!" Although current controversy questions the earliest age at which screening mammography truly lowers the death rate from breast cancer, that mammography does detect breast cancer years before it might be discovered as a mass in the breast cannot be challenged. Mammographic techniques have improved so that smaller and smaller areas of suspicion may be identified, and mammographers have gained greater judgment in the interpretation of these minute radiographic abnormalities. This has inevitably led to an increase in procedures designed to explain them. The incurred costs, both emotional and economic, of positive mammographic "calls" are considerable. Whether practicing medicine as patients' advocates or, as unfortunately currently seems to be of equal importance, exercising politically correct and cost-effective mandates, the management of nonpalpable breast lesions certainly bears witness to the correlation of cognitive and procedural skills and cooperation between physicians, as well as the technical achievements of contemporary medicine.

Biopsy↗
PubMed1993

Imaging of the radiographically dense breast.

Despite recent improvements in mammography equipment and technique, the radiographically dense breast remains difficult to image. The problems in imaging the dense breast account for a large percentage of the cases of mammographically "missed" carcinomas. Other imaging modalities--such as ultrasonography, transillumination, thermography, computed tomography, magnetic resonance imaging, and radionuclide imaging--have been investigated for use in breast cancer detection. This overview discusses the current problems associated with imaging of the radiographically dense breast and suggests some avenues for investigation to develop solutions to these problems.

Breast↗
PubMed1993

The Canadian National Breast Screening Study: a critical review.

Public health planners around the world had been awaiting the preliminary results of the randomized, controlled trial of breast cancer screening performed by the Canadian National Breast Screening Study (CNBSS) during the 1980s. It had been hoped that this large study would answer, with statistical validity, many of the questions concerning breast cancer screening that had not been answered satisfactorily by previous studies. Among the major unresolved issues is the desire to establish "absolute" proof that mammographic screening can benefit women who are between 40 and 49 years old.

Adult↗
PubMed1993

Outcome of BMT during first complete remission of AML: a comparison of two sequential studies by the Children's Cancer Group.

One hundred and fifty children with AML in first remission were treated with allogeneic BMT in two sequential studies of the Childrens Cancer Group. The absence of differences in baseline variables justified comparison between the two studies. In the initial study (CCG-251), patients received GVDH prophylaxis with MTX alone (17 doses over 102 days). In an attempt to diminish the morbidity and mortality of acute GVDH, a second study (CCG-213) employed stronger GVHD prophylaxis with 6 months of CYA and short-course MTX (four doses over 11 days). Outcome was compared between these two non-randomized populations of children with AML transplanted in first remission. Augmented GVHD prophylaxis substantially diminished treatment-related mortality from 31% to 11% (p = 0.0033), but this effect was counterbalanced by an increase in the relapse risk from 22% to 35% (p = 0.29). Event-free survival at 2 years was 54% on CCG-251 and 59% on CCG-213 (p = 0.21). We observed a marginal diminution of relapse risk among patients with chronic GVHD compared with those without chronic GVHD (19% vs. 35%, respectively; p = 0.10). No anti-leukemic effect of acute GVHD was observed.

Adult↗
PubMed1992

Determination of the maximum tolerated dose of idarubicin when used in a combination chemotherapy program of reinduction of childhood ALL at first marrow relapse and a preliminary assessment of toxicity compared to that of daunorubicin: a report from the Childrens Cancer Study Group.

An escalating-dose trial of idarubicin, used weekly for 3 doses in combination with vincristine, prednisone, and L-asparaginase (VPLI), to reinduce remission of childhood ALL at first bone marrow relapse was conducted by the Childrens Cancer Study Group (CCSG). The maximum tolerated dose (MTD) of idarubicin, used in the manner, was determined to be 12.5 mg/m2/dose. Twelve of 16 (75%) evaluable patients in first marrow relapse of ALL treated at a dose of 10 or 12.5 mg/m2 entered a second complete remission, compared to 41 of 69 evaluable patients (59%) treated in a comparable way with daunorubicin (30 mg/m2) (VPLD). Prolonged myelosuppression was observed in both groups, but the frequency of documented bacterial sepsis and the duration of required hospitalization were greater among patients treated with idarubicin. No additional toxicity, specifically attributable to idarubicin, was observed at these doses.

Adolescent↗
PubMed1992

Expression of myeloid differentiation antigens in acute nonlymphocytic leukemia: increased concentration of CD33 antigen predicts poor outcome--a report from the Childrens Cancer Study Group.

Ninety-eight cryopreserved specimens of acute nonlymphocytic leukemia (ANLL) cells obtained at initial diagnosis of children enrolled on the Childrens Cancer Study Group 251 protocol (CCG 251) were examined by indirect immunofluorescence using four monoclonal antibodies to myeloid differentiation antigens. The relationship between the level of differentiation of ANLL cells as determined by their antigen phenotype and the clinical outcome of treatment, including complete remission (CR) rate, survival, and event-free survival, was evaluated. Most leukemic specimens were determined to express the CD33 antigen (L4F3), a 67-kD protein. Because the level of differentiation of normal myeloid cells is reflected by the concentration of the CD33 antigen expressed, samples were categorized as CD33-bright (immature) versus CD33-dull (mature). Patients with CD33-bright leukemic blasts had a marginally inferior CR rate to those with CD33-dull blasts (P = 0.08). With respect to survival and event-free survival, there was a significantly inferior outcome in the CD33-bright patients (P = 0.04 and P = 0.06, respectively). Reactions of ANLL with anti-CD15 antibody (1G10), anti-CD36 antibody (5F1), or anti-CD17 antibody (T5A7) did not predict clinical outcome. This study indicates that patients whose ANLL blasts displayed the CD33 antigen in an amount associated with immature myeloid cells experienced a worse outcome than patients with ANLL blasts that expressed a phenotype associated with more mature cells.

Antibodies, Monoclonal↗
PubMed1992

Breast masses. Mammographic and sonographic evaluation.

Asymmetric breast tissue can nearly always be distinguished from a true mass by means of mammographic evaluation. Stellate masses from early invasive breast cancer are often extremely subtle so that optimal technique and meticulous interpretation are essential. Benign stellate masses such as post-biopsy scarring and fat necrosis frequently have a characteristic appearance. A radial scar is usually indistinguishable from malignancy on the mammogram. Nearly all circumscribed masses are benign and are usually cysts, fibroadenomas, or intramammary lymph nodes. A few circumscribed masses represent in situ or invasive carcinoma or both. Characteristics that may allow a definitively benign diagnosis for a circumscribed mass include the presence of fat and certain calcification patterns on the mammogram and features of a simple cyst on the sonogram. Management decisions for other circumscribed masses will depend on characteristics such as shape, margins, calcification, multiplicity, size, stability, and sonographic features as well as patient age and risk factors. Most nonspecific circumscribed masses should be followed rather than biopsied as they are commonly present on mammograms and have a change of malignancy of less than 5%. Even when biopsied on the basis of interval change, most small circumscribed cancers will not have metastasized to the regional nodes. For palpable breast masses, selection of mammography or ultrasonography as the primary imaging modality will depend on patient's age and risk factors.

Breast Diseases↗
PubMed1991

Management of patients with nonpalpable breast lesions.

Ever-increasing use of mammography brings with it a growing number of breast biopsies. The authors describe the five radiologic findings that mandate a surgical consultation. About 30% of their biopsies for nonpalpable breast lesions prove to be invasive or in situ carcinomas. When a mammogram is ambiguous, the authors recommend a repeat mammogram in 6 months. They use needle-localization, and feel that dye marking is superfluous. The films, duly marked by the radiologist, should accompany the patient to the OR. The biopsy is an outpatient procedure, and only local anesthesia, sometimes with IV sedation, is required. It is not necessary to remove the skin over the biopsy site, nor all of the tissue traversed by the needle localizer. The authors describe their surgical procedure for biopsy, state that x-ray of the specimen is mandatory, and that frozen sections are not desirable. Their procedure takes longer, but it's better, they say.

Biopsy, Needle↗