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To evaluate the prognostic significance of proliferating cell nuclear antigen (PCNA) in patients with lymph node-positive primary breast cancer.A retrospective study.A tertiary care hospital.A consecutive series of 123 patients with lymph node-positive primary breast cancer.The PCNA-labeling index [(PCNA-positive cells/1000 cells) x 100] was quantified in paraffin-embedded tissue specimens from 123 patients with lymph node-positive primary breast cancer by immunohistochemical staining. Other important clinicopathological variables, including estrogen receptor status, histological grade, lymph node status, primary tumor status, ploidy pattern, S-phase fraction, and TNM staging, were also identified and evaluated.The influence of the PCNA-labeling index on the disease-free survival rate and overall survival rate.The PCNA-labeling index of the tissue specimens tested from 123 patients ranged from 11% to 82%. The PCNA-labeling index was closely related to primary tumor status, histological grade, TNM staging, and S-phase fraction. Between patients with a high PCNA-labeling index (35%) and those with a low PCNA-labeling index (or = 35%), there were significant (P.01) differences in both 5-year disease-free survival rates (2% vs 85%) and 5-year overall survival rates (2% vs 92%). When the PCNA-labeling index and all the clinicopathologic variables were entered into a multivariate analysis for either disease-free survival or overall survival by the Cox proportional hazards model, the PCNA-labeling index emerged as an independent prognostic factor.Based on our results, the PCNA-labeling index potentially is a useful prognostic factor for lymph node-positive primary breast cancer.

Background: A difficultly retrieved, impacted distal common bile duct stone is sometimes encountered during supraduodenal common bile duct exploration. Transduodenal sphincteroplasty is usually performed when such stones cannot be retrieved by conventional methods, but not without risk. Objectives: To achieve clearance of such complicated stones and to avoid the potential risks of transduodenal sphincteroplasty. Design: Prospective clinical trial. Setting: Medical college–affiliated hospital and tertiary care center. Patients: From July 1991 to April 1993, 10 patients met the following inclusion criteria: (1) an impacted distal common bile duct stone found during supraduodenal common bile duct exploration and (2) failure of conventional methods such as stone forceps, a basket, flushing with normal saline solution, or a Fogarty catheter to retrieve stones via the supraduodenal choledochotomy. Another 10 patients with the same problem, treated with transduodenal sphincteroplasty from February 1989 to May 1991, were used as a comparison group. Intervention: Intraoperative choledochoscopic electrohydraulic lithotripsy was applied with continuous visualization through a choledochoscope. Main Outcome Measures: Effectiveness of stone fragmentation and possible complications. Results: Stones were fragmented and successfully removed by a basket and flushing with normal saline solution. Mild oozing was noted in one patient, but soon stopped spontaneously. The mean operative time of the clinical trial group was significantly shorter ( P =.004) than that of the comparison group; the mean postoperative stay was 4 days shorter. The complication rate of the clinical trial group (10%) was lower than that of the comparison group (40%). The 10 successfully treated patients of the clinical trial group remain well, with a mean follow-up of 22 months. Conclusion: Intraoperative choledochoscopic electrohydraulic lithotripsy is a safe and effective method for removal of impacted distal common bile duct stones. (Arch Surg. 1995;130:430-432)