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This investigation was undertaken to assess the risk to the embryo/fetus associated with sentinel lymph node biopsy and lymphoscintigraphy of the breast performed in pregnant patients. Approximately 92.5 MBq (2.5 mCi) of filtered Tc-99m sulfur colloid was injected peritumorally the day before surgery in two nonpregnant women with breast cancer. The whole-body distribution of the radiopharmaceutical was evaluated using a gamma camera 1 hour after injection. We then calculated the absorbed dose to the embryo/fetus for three theoretical extreme scenarios of biodistribution and pharmacokinetics: 1) all of the injected radiopharmaceutical remains in the breast and is eliminated only by physical decay; 2) all of the injected radiopharmaceutical is instantaneously transported to the urinary bladder, where it remains and is eliminated only by physical decay; and 3) the injected radiopharmaceutical behaves as though it were administered intravenously, that is, it has the biodistribution and pharmacokinetics of Tc-99m sulfur colloid injected for a liver/spleen or bone marrow scan. The fetal radiation absorbed dose was then estimated for two Tc-99m dosages: 18.5 MBq (0.5 mCi) and 92.5 MBq (2.5 mCi). The Medical Internal Radiation Dosimetry (MIRD) program was used to estimate the absorbed doses to the embryo/fetus for the first two scenarios. Published data were used to calculate the doses for the third scenario. A single breast is not among the source organs in the MIRD program, so the heart was used as a surrogate in the first scenario. In the two breast cancer patients, whole-body gamma-camera images obtained 1 hour after radiopharmaceutical injection revealed no radioactivity except in the vicinity of the injection site. In the theoretical scenarios, with 92.5 MBq, the highest absorbed doses to the embryo/fetus were as follows: scenario 1, 7.74 x 10(-2) mGy at 9 months of pregnancy; scenario 2, 4.26 mGy during early pregnancy; and scenario 3, 0.342 mGy at 9 months of pregnancy. The maximum absorbed dose to the fetus of 4.3 mGy calculated for the worst-case scenario is well below the 50 mGy that is believed to be the threshold absorbed dose for adverse effects. Thus breast lymphoscintigraphy during pregnancy appears to present a very low risk to the embryo/fetus.

Black women with breast cancer have significantly poorer survival rates, a more advanced stage distribution, and are diagnosed at younger ages compared to white patients in the United States. We evaluated tumor response and survival with respect to race and age after induction chemotherapy. The study population consisted of 303 patients (229 white, 74 black) registered in two prospective trials of induction chemotherapy for locally advanced breast cancer [stage II (T >/= 4 cm), stage III (noninflammatory), and stage IV (supraclavicular lymph node involvement only)] between 1989 and 1996. Chemotherapy regimens utilized 5-fluorouracil, cyclophosphamide, and doxorubicin (FAC). Response was defined as complete (CR, no clinical/radiographic detectable disease), partial (PR, >/=50% reduction in disease), minor (MR

Thirty-five patients with pregnancy-associated breast carcinoma diagnosed between 1985 and 1995 were identified and characterized from a prospectively generated database. Twenty-two of these patients had stage 1 or 2 disease and were therefore potential candiates for conservative surgical management. The median age was 36 years. Two thirds of the patients were pregnant at the time of diagnosis; the median gestational age of the fetus at diagnosis was 7 months. Twenty-one of the 22 of the patients presented with a palpable mass. The majority of tumors were estrogen-receptor negative. Nine patients were treated with breast-conservation therapy, and 13 were treated with mastectomy. In the breast-conservation therapy group, there were three distant recurrences and no local recurrences with a median follow-up of 24 months. In the mastectomy group, two patients developed distant metastases and one developed a local recurrence with a median follow-up of 28 months. The results of breast-conservation therapy are similar to the results of mastectomy for stage 1 and 2 cancers associated with pregnancy. Therefore, breast-conservation therapy is an option for selected patients with pregnancy-associated breast cancer.

Paget's disease of the nipple represents an extremely uncommon disease in men. This report documents the occurrence of bilateral Paget's disease of the nipple in a 49-year-old male within a nine-month period. There was no family history of breast cancer. Bilateral mastectomy revealed intraductal carcinoma bilaterally and associated tiny foci of invasive carcinoma unilaterally. The clinical presentation, diagnosis, and natural history of this rare disease are emphasized. Appropriate treatment of this lesion must address the underlying malignancy often associated with this disease.