Background: Isolated tumor cells or small clusters of tumor cells observed in the vicinity of the main tumor mass in pathology sections, termed tumor budding, are common in cancers and have been associated with prognosis in some settings. This study examined the clinical associations and treatment efficacy implications of tumor budding in breast cancer patients receiving neo-adjuvant therapy. Methods: Breast cancer patients that received neo-adjuvant therapy before definitive surgical treatment in a single cancer center over a 7-year period were included, and their records were reviewed. Data extracted included patient demographics, tumor characteristics and pathologic response to treatment at surgery. The initial breast cancer biopsy before any therapy was reviewed by two pathologists, and a hot spot area was evaluated for tumor budding (defined as 1 to 5 cancer cells observed detached from the main tumor mass). Results: Seventy-five patients who received neo-adjuvant therapy (73 received chemotherapy and 2 received hormonal therapy) were included. Tumor budding was observed in two-thirds of the patients. There were no significant differences in patient (age and menopause status) and tumor (stage, histology and molecular sub-type equivalent) characteristics between the group that had tumor budding and the group that did not have tumor budding in the pre-treatment biopsy. Likewise, no statistically significant differences were observed in the frequency of complete or partial responses between the two groups. Conclusion: In this cohort of breast cancer patients receiving neo-adjuvant therapy, tumor budding was frequent, but it was not associated with tumor characteristics or pathologic responses to treatment. The value of tumor budding as a prognostic factor in the neo-adjuvant setting within the general breast cancer population could not be confirmed, but such a value in specific sub-groups deserves further investigation, given the pathophysiologic rationale and data from other settings.

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In December 1989 the Canadian Standards Association (CSA) published standard Z32.2 regarding electrical safety in patient care areas;' the standard describes the safety requirements for the management of medical electrical equipment, nonmedical electrical equipment and patient-owned electrical devices used in patient care areas. It also covers inspection, testing and maintenance standards. Although compliance is voluntary medical practitioners are strongly encouraged to follow the recommended practices.The standard is aimed primarily at hospitals. However, it also applies to other areas, such as private physicians' offices and medical clinics, where patients are brought into contact with electrical equipment for diagnosis and treatment.The highlights of the standard that are considered most relevant to medical practitioners are as follows.* An electrical safety program is necessary to protect patients and staff from potential electrical hazards. The program should include the education of the entire health care team, the proper design of the building's electrical system and the appropriate maintenance of all electrical equipment.* Patient procedures can be categorized according to the type of contact between the patient and the medical electrical equipment used: (a) cardiac contact (greatest hazard) -intentional contact directly with the heart, (b) body contact (moderate hazard) -intentional contact externally or internally but not directly with the heart and (c) casual contactvoluntary contact with an electrical device not intended to be connected to a patient.* Different areas of a practitioner's office or clinic must reflect the nature of the care provided and the degree of electrical contact (e.g., basic, intermediate and critical). For example, the electrical safety requirements of a surgical suite may differ significantly from those in an area used for diagnosis or recovery because of the procedures performed, the equipment used and the electrical installation necessary.