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Aim: Management of papillary breast lesions is a controversial issue, as complete excision implies surgery of numerous benign lesions. The purpose of this study was to assess concordance between percutaneous and surgical biopsy of papillomas along with factors predictive of malignancy., Patients and Methods: The study consisted of a retrospective review of papilloma cases between 2009 and 2013 at three breast cancer centers. All cases of papilloma histologically diagnosed by percutaneous biopsy and confirmed by surgical specimen were included. The biopsy results were compared with final surgical pathology. Lesion size and clinical and radiological features were recorded., Results: A total of 259 cases were included (188 simple and 71 complex papillomas). Concordance between histology after percutaneous and surgical biopsy was lower for complex papillomas, regardless of type, than for simple papillomas (p<0.001). The risk of having a complex papilloma was shown to be significantly higher in postmenopausal patients (p=0.023), and was 20 times higher if the percutaneous biopsy was malignant as opposed to benign (p<2.10). However, the false-negatives for percutaneous biopsy in complex papilloma cases were mainly related to atypical and in situ lesions., Conclusion: Percutaneous biopsy does not appear adequate for identifying papillomas requiring surgical excision due to the risk of underestimation of cancerous lesions. However, certain factors predictive of malignancy may assist with surgical management, such as age and menopausal status, lesions peripheral to the nipple, and atypia on percutaneous biopsy., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim: Breast-conserving surgery with radiation therapy is the primary treatment for ductal carcinoma in situ (DCIS). Re-excision is indicated when clear resection margins have not been achieved, although in some cases the procedure may be unnecessary as there is no residual tumor. The purpose of our three-Center retrospective study was to identify predictors of positive re-excision findings following breast-conserving surgery for DCIS., Patients and Methods: A total of 285 patients underwent re-excision following conservative treatment for DCIS between 01/01/08 and 12/31/13 at three breast-cancer referral Centers. We conducted a retrospective, comparative review of the factors that differentiated patients with a residual tumor from those without. The study was based on clinical, radiological, surgical and pathological criteria., Results: A total of 180 patients (63%) had residual tumor after conservative treatment. Six factors were predictive on univariate analysis: young age (p=0.025), non-menopausal status (p=0.016), absence of preoperative biopsy (p=0.0029), high nuclear grade (p=0.0181), lesion size >30 mm (p=0.032), and positive surgical margins (p=0.0016). Four factors remained independently predictive on multivariate analysis: non-menopausal status (p=0.0017), high nuclear grade (p=0.0031), lesion size >30 mm (p=0.012) and positive surgical margins (p=0.0013). We calculated a 93% probability of positive re-excision findings if all four factors were combined. On the other hand, if none of the factors were present, the rate fell to 18%., Conclusion: In cases of DCIS, where risk factors for both involved lumpectomy margins and recurrence are carefully studied, knowledge of the risk factors for residual tumor can help guide therapeutic choices., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Objectives: To assess cervical regeneration after large loop excision of the transformation zone (LLETZ) by ultrasound (US) measurements of cervical length (CL) before conization as well as in the postoperative short- and long-term and to identify factors affecting regeneration., Patients and Methods: This was a prospective observational study including patients under 45 years of age treated by LLETZ for Cervical Intraepithelial Neoplasia (CIN) with repeated measurements of CL by transvaginal US before and just after LLETZ, at 1 and 6 months postoperatively., Results: A total of 83 patients were enrolled, out of which 53 were included in the study. The mean CL was 28.6 mm (±5.7) preoperatively versus 18.3 mm (±4.2) after surgery; 21.8 mm (±4.4) at 1 month and 25.5 mm (±4.9) at 6 months. The mean cone length estimated by US was 10.3 mm (±3.4). The differences in CL before/after conization and CL after conization/at 6 months were statistically significant (p<0.0001). Cervical regeneration at 6 months was 71% (±20), statistically greater than regeneration at 1 month (32%, ±16) (p<0.0001)., Discussion: Post-conization cervical tissue regeneration occurred with almost three quarters of the initial cervical length restored at 6 months. Further studies evaluating obstetric outcomes after LLETZ according to cervical regeneration might subsequently be used in clinical practice to identify high-risk pregnancies by pre- and postoperative US measurements of the cervical length. A rigorous assessment of CIN treatment risks and benefits remains essential when considering treating patients of childbearing age given a potential obstetric risk from conization., (Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)