Search

The assessment and categorization of papillary lesions remains one of the most challenging areas in breast pathology. In this review, we will focus on several diagnostic and management issues related to papillary breast lesions that are frequently encountered in daily practice. These include: (i) the distinctions among papillomas with atypia (atypical papillomas), papillomas with ductal carcinoma in situ, and papillary ductal carcinoma in situ; (ii) recent developments in our understanding of encapsulated (‘intracystic’) papillary carcinomas and solid papillary carcinomas; and (iii) the impact of core needle biopsy on management decisions and specimen evaluation. The role of immunohistochemistry in the evaluation of these lesions, particularly the role of myoepithelial cell markers, will be emphasized. [ABSTRACT FROM AUTHOR]

Comments on a study on the outcome of breast-conserving therapy for patients with early stage mucinous, medullary or tubular breast carcinoma. Criticism of the analysis of the survival rates of patients who underwent breast therapy and infiltrating ductal carcinoma treatment; Efforts of the researchers to evaluate locoregional and distant control rates in patient with breast cancer; Importance of the research to breast cancer patients with different histological subtypes.

Prospective, randomized clinical trials have demonstrated that the alternatives of mastectomy or conservative surgery plus radiation therapy provide equivalent survival for patients with invasive breast cancer. The identification of a subset of women who could undergo conservative surgery without radiotherapy would avoid the costs, inconvenience, and complications of radiotherapy and is an important research goal. Four randomized trials comparing conservative surgery alone with conservative surgery plus radiotherapy have demonstrated an average reduction in the risk of disease recurrence in the breast of 84% with the use of radiotherapy. No significant differences in survival have been observed, although the available studies lack sufficient numbers of patients to demonstrate a potential small, but clinically important, survival advantage for patients treated with radiotherapy. Subset analysis in the randomized trials and prospective studies of highly selected patients have failed to consistently identify a group of patients who do not benefit from radiation therapy. Any recurrence of breast cancer is psychologically devastating, and fewer than one half of the patients who have had disease recurrence after conservative surgery alone have undergone further breast-conserving treatment. At present, a group of patients who do not require radiotherapy has not been reproducibly identified, and radiotherapy should remain a part of breast-conserving therapy for invasive carcinoma. [ABSTRACT FROM AUTHOR]

Discusses the selection of the proper treatment for ductal carcinoma in situ (DCIS). Increase in DCIS incidence rates; Confusing variety of treatments for the disease; Role of tamoxifen; Mastectomy, excision and radiation therapy, and excision alone; Importance of tailoring the intensity of cancer treatment with respect to an individual's risk of recurrence.

The article comments on a study conducted by J. S. Wong et al. which aims to assess whether localized low- or intermediate-grade ductal carcinoma in situ (DCIS), diagnosed with mammography and subjected to pathologic evaluation and excised with 1 centimeter (cm) or greater margins, could be treated with resection alone and result in acceptably low local recurrence rates. It argues that DCIS can be a confusing diagnosis for the cancer patient.