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This study is a comparative analysis of the prevalence, absolute number and aggregation status of bone marrow micrometastases (BMM) between breast (n = 234) and gastric (n = 102) cancer patients based on a standardized number of I X lo6 bone marrow-derived cells per patient. Additionally, expression of the epithelial cell adhesion molecule E-cadherin was analyzed on disseminated tumor cells. A positive BMM status was demonstrated in 88f234 breast and 45/ 102 gastric cancer patients. The presence of CKI 8+ cells positively correlated with parameters of advanced tumor progression in breast, but not in gastric cancer. Interestingly, 25.2% of the nodenegative patients already had micrometastatic cells in the bone marrow at diagnosis. Regarding the absolute number of CK18+ cells and the frequency of CK18+ cell clusters, no significant difference was found between the 2 tumor types. However, clusters consisting of more than I0 CKI 8+ cells (type II clusters) were present exclusively in breast cancer patients. Additionally, co-expression of CK18 and E-cadherin was detectable in 15/21 micrornetastases-positive breast but in only I / 9 gastric cancer patients. While prevalence of micrometastatic cells in bone marrow is discussed as an early indicator for systemic disease, aggregation status and a certain antigen profile might be indicative for site-specific differences in the manifestation pattern of solid metastases.o 1996 Wiley-Liss, Inc.In most carcinoma patients a local curative resection can be achieved. The fate of these patients, however, depends on the capacity of primary tumor cells to disseminate to distant organs in an early stage of cancer. In this situation the tumor disease may already be considered systemic. Identification of tumor cell dissemination on the single-cell level, termed "micrometastases," is a direct approach to defining the disseminative potential of an individual tumor and may be a useful tool for selecting groups of patients at high risk for tumor recurrence. Immunocytochemical approaches to identifying micrometastatic cells in bone marrow have been used in various types of carcinoma (for review see Riethmiiller and Johnson, 1992). Several studies reported a positive correlation between bone marrow micrometastases (BMM) status, tumor progression and survival in breast, gastric and lung cancer (Berger et al., 1988;Dearnaley et al., 1991;Mansi et at., 1991;Schlimok et al., 1991; Die1 et al., 1992;Pantel et al., 1993; Harbeck et al., 1994). A positive BMM status was identified in a multivariate analysis as an independent prognostic factor in colorectal carcinoma (Lindemann et al., 1992). These findings pushed the clinical acceptance of the evaluation of BMM status, which is proposed as an optional subdivision for the revised version of the existing T-, N-and M-categories in 1997 (P. Hermanek, personal communication).The present study compares BMM status in breast (n = 234) and gastric (n = 102) cancer patients, regarding prevalence, absolute number and aggregation status of micrometastatic c...

We describe a method of localizing suspicious breast lesions only visible by MRI that does not require additional hardware and can be carried out on any MRI-scanner suited for MR-mammography. We have performed a total of 48 localizations with different techniques: 28 charcoal/Gd-DTPA, 18 with wires and two skin markings. All localizations have been successful; wire localizations provided the best results, since the position of the wire could be corrected under MR-guidance. Until suitable localization- and biopsy coils become available the methods employed by us provide a satisfactory alternative which allows radiologists who perform diagnostic MR-mammography with techniques to carry out precise pre-operative localisations of breast lesions.

Skin-sparing mastectomy with immediate breast reconstruction has shown to be oncologically safe while providing dependable aesthetic results. However, flap inset into the skin defect of the excised biopsy site and nipple-areola complex often results in a patchlike effect and transverse scars. By keeping the mastectomy incision solely around the areola, all breast skin can be preserved. Thus, in immediate breast reconstruction with replacement of the nipple and areola by a small skin island from a deepithelialized TRAM flap or latissimus dorsi muscle flap, the scar is kept at the natural border between areola and breast skin. Reconstruction of the nipple-areola complex further helps to camouflage the incision line. This may result in the best possible aesthetic outcome after mastectomy to date. The technique has been used in 17 breast cancer patients (intraductal cancer, n = 5; T1/T2 ductal cancer, n = 13) with good to excellent results. No local or distant recurrences have been seen; however, mean follow-up time is short (10 months). As the procedure of choice, a free TRAM flap was performed in nine patients for immediate reconstruction. The other eight patients were too slim for an autologous reconstruction; therefore, a latissimus dorsi muscle flap with a small skin island and a silicone implant were used. There were no major complications in either group. In contrast to traditional skin-sparing mastectomy, all breast skin is preserved with the periareolar approach. Therefore, special surgical expertise is required to ensure tumor free margins, especially with respect to the skin overlying the tumor. If these requirements are met, excellent results in breast reconstruction are amenable with adequate oncologic safety.

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