The significance of circumscribed malignant mammographic masses in the surveillance of BRCA 1/2 gene mutation carriers

Kaas, R.; Kröger, R; Hendriks, Jan H. C. L.; Besnard, A.P.E.; Koops, Willem; Pameijer, Frank A.; Prevoo, Warner; Loo, Claudette E.; Müller, Sara

doi:10.1007/s00330-004-2307-3

Cited by 43 publications

(37 citation statements)

References 17 publications

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“…BRCA2 mutation carriers were diagnosed with relatively more DCIS and T1A/T1B tumors and fewer interval cancers, findings which have been found before (4-6, 10, 20). One possible explanation is that the sensitivity of mammography for BRCA1 tumors may be lower, due to different tumor characteristics (5,12,25,26). These tumors show more continuous pushing margins, thereby mimicking benign lesions on a mammogram.…”

Section: Discussionmentioning

confidence: 99%

Differences in Natural History between Breast Cancers in BRCA1 and BRCA2 Mutation Carriers and Effects of MRI Screening-MRISC, MARIBS, and Canadian Studies Combined

Heijnsdijk

Warner

Gilbert

et al. 2012

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: It is recommended that BRCA1/2 mutation carriers undergo breast cancer screening using MRI because of their very high cancer risk and the high sensitivity of MRI in detecting invasive cancers. Clinical observations suggest important differences in the natural history between breast cancers due to mutations in BRCA1 and BRCA2, potentially requiring different screening guidelines.Methods: Three studies of mutation carriers using annual MRI and mammography were analyzed. Separate natural history models for BRCA1 and BRCA2 were calibrated to the results of these studies and used to predict the impact of various screening protocols on detection characteristics and mortality.Results: BRCA1/2 mutation carriers (N ¼ 1,275) participated in the studies and 124 cancers (99 invasive) were diagnosed. Cancers detected in BRCA2 mutation carriers were smaller [80% ductal carcinoma in situ (DCIS) or 10 mm vs. 49% for BRCA1, P < 0.001]. Below the age of 40, one (invasive) cancer of the 25 screen-detected cancers in BRCA1 mutation carriers was detected by mammography alone, compared with seven (three invasive) of 11 screen-detected cancers in BRCA2 (P < 0.0001). In the model, the preclinical period during which cancer is screen-detectable was 1 to 4 years for BRCA1 and 2 to 7 years for BRCA2. The model predicted breast cancer mortality reductions of 42% to 47% for mammography, 48% to 61% for MRI, and 50% to 62% for combined screening.Conclusions: Our studies suggest substantial mortality benefits in using MRI to screen BRCA1/2 mutation carriers aged 25 to 60 years but show important clinical differences in natural history.Impact: BRCA1 and BRCA2 mutation carriers may benefit from different screening protocols, for example, below the age of 40. Cancer Epidemiol Biomarkers Prev; 21(9); 1458-68. Ó2012 AACR.

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Section: Discussionmentioning

confidence: 99%

Differences in Natural History between Breast Cancers in BRCA1 and BRCA2 Mutation Carriers and Effects of MRI Screening-MRISC, MARIBS, and Canadian Studies Combined

Heijnsdijk

Warner

Gilbert

et al. 2012

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Core needle biopsy and aspiration cytology may aid in a pre-operative diagnosis, but the probability of misdiagnosis would increase in the presence of hemorrhage or necrosis due to inadequate sampling or a poor choice of puncture region (1). In the majority of cases, the transition foci between metaplastic carcinoma and invasive ductal carcinoma were only observed following surgical biopsy (1,3,9,11). Therefore, extensive sampling by surgical biopsy and immunohistochemical examination should be performed to avoid misdiagnosis.…”

Section: Pathological Type Of Carcinoma Sonography ------------------mentioning

confidence: 99%

Metaplastic carcinoma of the breast: Imaging and pathological features

Bian

et al. 2016

Oncology Letters

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Abstract. Metaplastic carcinoma of the breast is a rare form of breast cancer. The aim of the present study was to investigate the imaging and pathological features of metaplastic carcinoma. The features identified on mammography and sonography were retrospectively reviewed in 13 women with metaplastic carcinoma of the breast. The results from the mammographs and sonographs were additionally evaluated using immunohistochemical staining for the expression of the estrogen receptor (ER) and progesterone receptor (PR), receptor tyrosine-protein kinase erbB-2 (CerbB-2) and P53. The most common features observed in the mammographs were as follows: Irregular and oval shaped masses, 53.8 and 46.2%, respectively; spiculated and circumscribed margins, each 30.8%; and high and marginally high density masses, 69.2 and 30.8%, respectively. The most common sonography features observed were as follows: Hypoechoic masses, 84.6%; complex echogenicity, 76.9%; irregular, round and oval shaped masses, 69.2, 30.8 and 30.8%, respectively; indistinct and circumscribed margins, 53.8 and 46.2%, respectively; an abundant blood flow, 53.8%; and posterior acoustic enhancement, 61.5%. The immunohistochemical (IHC) profile for 13 patients demonstrated that ER was not expressed in 100% of patients, PR and CerbB-2 were not present in 92.3% of patients, and P53 was present in 63.6% of patients. Therefore, metaplastic carcinoma of the breast exhibits more benign IHC features compared with invasive ductal carcinoma. In addition, it may be challenging to diagnose patients that do not possess posterior acoustic enhancement or express hormone receptors from other types of breast cancer. IntroductionMetaplastic carcinoma of the breast is a rare form of breast cancer and possesses a poorer prognosis than other common types of breast cancer (1). Metaplastic carcinoma exhibits the metaplastic transformation of glandular epithelium to squamous epithelium and mesenchymal tissue, and accounts for <5% of all breast cancers (2) and may contain glandular and non-glandular components with mixed epithelial and mesenchymal tissue. Involvement of the axillary lymph node is rare, with hematogenous metastasis occurring more commonly in cases of metaplastic carcinoma (1,3). Metaplastic carcinoma demonstrates a poorer prognosis and a higher risk of recurrence compared with other types of breast cancer (3). It typically presents as triple negative, therefore the effects of hormonotherapy are limited (3,4). Due to the heterogeneity of metaplastic carcinoma and its increased complexity compared with more common types of breast cancer, mixed chemotherapy regimens and dose schedules may be more effective and appropriate (2). Due to the distinction in surgical treatment and chemotherapy between metaplastic carcinoma and other breast cancers, it is particularly important to diagnose the tumor correctly (2). Metaplastic carcinoma demonstrates a number of benign features similar to invasive ductal carcinoma in mammograms and sonograms, and subsequently may be misdiagnosed as ...

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“…Tarama programları nedeniyle LİMK hasta oranlarının oldukça düşük olması dikkat çekici (1)(2)(3)(4)(5). Neoadjuvan tedavi çalışmalarının meme kanseri tedavi geleceğinde ve özgün çalışma üretiminde önemine inanmalarından dolayı hemen her aksilla pozitif veya T2 hastada tedaviye neoadjuvan kemoterapi (KT) ile başlanıyor (6)(7)(8)(9).…”

Section: Neoadjuvan Tedavi Yaklaşımlarıunclassified

Treatment Approaches for Breast Cancer in Netherland Cancer Institute

2013

J Breasth Health

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The care of patients with breast cancer has become increasingly complex with advancements in diagnostic modalities, surgical approaches, and adjuvant treatments. A multidisciplinary approach to breast cancer care is essential to the successful integration of available therapies. This article addresses the key components of multidisciplinary breast cancer care in Netherland Cancer Institute, with a special emphasis on new and emerging approaches in the fields of diagnosis and treatment. 103 Meme kanseri tedavi yaklaşımlarını ve klinik işleyişlerini gözlemlemek amacıyla Netherland Cancer Institute/Antoni van Leeuwenhoek Hospital (NKI/AVL)'de kısa bir süre bulunma fırsatı elde ettim. Çok sayıda meslektaşımızın yakından bildiği üzere Avrupa'da devam eden çok sayıda çalışmaya aktif katılım gösteren bu merkezin klinik uygulamalarını yakından izledim. Meme kanserinde multidisipliner tedavi yaklaşımının önemine dikkat çe-ken bu merkezin tanı ve tedavi yaklaşımları ile güncel çalışmalarının özetini bulacağınız makalenin yararlı olmasını dilerim. Neoadjuvan tedavi yaklaşımlarıNeoadjuvan tedavi indikasyonları lokal ileri evre meme kanseri (LİMK) ile sınırlı değil. Tarama programları nedeniyle LİMK hasta oranlarının oldukça düşük olması dikkat çekici (1-5). Neoadjuvan tedavi çalışmalarının meme kanseri tedavi geleceğinde ve özgün çalışma üretiminde önemine inanmalarından dolayı hemen her aksilla pozitif veya T2 hastada tedaviye neoadjuvan kemoterapi (KT) ile başlanıyor (6-9).Enstitüde çeşitli ilaç kombinasyonlarının kullanıldığı birçok neoadjuvan çalışması devam ediyor. Neoadjuvan KT başlanma kararı verilen her hastada hem tümör yatağına hem de aksiler ultrasonografi (US) ile saptanan ve korteks kalınlığı en fazla olan nod içerisine yarı-lanma ömrü 60-90 gün olan I-125 ile işaretli seed yerleştiriliyor (10-12). Klinikte tanı amaçlı ince iğne aspirasyon biyopsisi (İİAB) tercih edilse de neoadjuvan KT adayı hastalarda US altında trucut biyopsi ve I-125 seed yerleştirilmesi genellikle eş zamanlı olarak yapılıyor. Aksillada şüpheli lenfadenopati varlığında İİAB yapılıyor, yine aksilla pozitif hastalarda saptanan korteksi en kalın ve patolojik olduğu düşünülen lenf noduna seed yerleştiriliyor. Aksillası İİAB ile negatif olup neoadjuvan tedavi adayı olan hastalarda neoadjuvan tedavi öncesinde sentinel lenf nodu biopsisi (SLNB) yapılıyor. SLNB sonucu pozitif olan hastalarda, neoadjuvan tedavi sonrasında her durumda aksiller diseksiyon uygulanıyor. Neoadjuvan tedavi öncesi SLNB ile aksillası negatif hastalarda KT sonrasında aksiller girişim yapılmıyor (13). Neoadjuvan KT öncesinde İİAB ile aksiller metastaz saptanan ve seed yerleştirilen hastalara ise KT sonunda cerrahi sırasında, önce aksiler küçük bir kesi ile seed in bulunduğu nod çıkarılıyor, arkasından diseksiyon yapılıyor (10). Özetle, aksillası neoadjuvan KT öncesinde İİAB veya SLNB ile pozitif olduğu saptanan her hastaya neoadjuvan KT sonunda aksiler diseksiyon (AD) yapılıyor. Neoadjuvan KT sonrasında SLNB, kemoterapi başında pozitron emisyon tomografi (PET) ile ak...

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The significance of circumscribed malignant mammographic masses in the surveillance of BRCA 1/2 gene mutation carriers

Cited by 43 publications

References 17 publications

Differences in Natural History between Breast Cancers in BRCA1 and BRCA2 Mutation Carriers and Effects of MRI Screening-MRISC, MARIBS, and Canadian Studies Combined

Differences in Natural History between Breast Cancers in BRCA1 and BRCA2 Mutation Carriers and Effects of MRI Screening-MRISC, MARIBS, and Canadian Studies Combined

Metaplastic carcinoma of the breast: Imaging and pathological features

Treatment Approaches for Breast Cancer in Netherland Cancer Institute

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