Claude Colin

Estradiol and Progesterone Regulate the Proliferation of Human Breast Epithelial Cells

OBJECTIVE To study the effects of estradiol and progesterone on the proliferation of normal human breast epithelial cells in vivo. DESIGN Double-blind randomized study. SETTING Departments of gynecology and of cell biology at a university hospital. PATIENT(S) Forty postmenopausal women with untreated menopause and documented plasma FSH levels of >30 mIU/mL and estradiol levels of <20 pg/mL. INTERVENTION(S) Daily topical application to both breasts of a gel containing a placebo, estradiol, progesterone, or a combination of estradiol and progesterone during the 14 days preceding esthetic breast surgery or excision of a benign lesion. MAIN OUTCOME MEASURE(S) Plasma and breast tissue concentrations of estradiol and progesterone. Epithelial cell cycles were evaluated in normal breast tissue by counting mitoses and performing quantitative proliferating cell nuclear antigen immunolabeling analyses. RESULT(S) Increasing the estradiol concentration enhanced the number of cycling epithelial cells, whereas increasing the progesterone concentration significantly limited the number of cycling epithelial cells. CONCLUSION(S) Exposure to progesterone for 14 days reduced the estradiol-induced proliferation of normal breast epithelial cells in vivo.

Relationship of mastodynia with its endocrine environment and treatment in a double blind trial with lynestrenol.

ZusammenfassungBei 33 Patienten mit Mastodynie und 20 Kontrollpatienten wurden Serumanalysen 7 Tage vor der Menstruation durchgeführt. Die Untersuchung hat ergeben, daß der Progesterongehalt häufig abnimmt; der Prolaktingehalt jedoch ansteigt verglichen mit Kontrollpersonen gleichen Alters.In einem Doppelblindversuch zeigte die Verabfolgung von Lynestrenol (10 mg/Tag; 10.–24. Zyklustag) bei 47 Patienten eine signifikante Verminderung der Mastodynie in 80% der Fälle.Die therapeutischen Versager können durch Abnormalitäten in der Prolaktinsekretion erklärt werden und können möglicherweise auch verursacht werden durch unterschiedliche Ansprechbarkeit.SummarySerum analysis carried out about 7 days before menstruation in 33 patients with mastodynia and 20 controls confirmed that progesterone is frequently decreased and prolactinaemia increased in the patients with mastodynia compared with controls of the same age.In a double blind trial, administration of Lynestrenol to 47 patients with mastodynia (each of whom was given 10 mg per day from the 10th to the 24th day of the cycle) resulted in a significant improvement of this condition in 80% of the treated cases. The therapeutic failures may be explained by anomalies in the secretion of prolactin, and may possibly be linked to individual sensitivity factors.

En bloc excision of nonpalpable breast lesions using the advanced breast biopsy instrumentation system: an alternative to needle guided surgery?

Abstract This study was prospectively conducted to evaluate the clinical potential of the advanced breast biopsy instrumentation (ABBI) system as an alternative to needle localization and open surgery in the management of nonpalpable breast lesions (NPBL). One hundred and eighty-six consecutive patients were referred for management of NPBL. Thirty-six underwent an ABBI procedure, offered as a first step before possible surgery for lesions which would in any case have required complete excision. The 18 patients with a malignant ABBI biopsy underwent re-excision of the biopsy site and axillary dissection was carried out in cases of infiltrating carcinoma. The other 150 patients underwent image-guided needle biopsy. Following these procedures, 60/150 (40 %) patients underwent needle-guided surgery. Finally, 96/186 (51 %) patients required complete excision. A total of 43 benign lesions and 53 carcinomas were confirmed. Thirty-six out of 96 (38 %) excisions were obtained with the ABBI system; 17/43 (40 %) benign lesions and 11/53 (21 %) carcinomas were completely removed with the ABBI system. Out of 9 malignant specimens with a pathological size less than 10 mm, 5/9 (55 %) had tumor-free margins and in 8/9 (89 %) no residual disease was found at re-excision. The preliminary results of this study suggest that, in selected cases, en bloc excision using the ABBI procedure could be an alternative to conventional surgery.

Stereotactic breast biopsy with an 8-gauge, directional, vacuum-assisted probe: initial experience.

Abstract. This study was prospectively conducted to assess the feasibility, safety and accuracy of an 8-G directional vacuum-assisted biopsy (DVAB) probe in the diagnostic management of nonpalpable breast lesions (NPBL). Of 170 planned procedures which were indicated for investigation of BI-RADS category-3 to category-5 lesions, 153 were performed in 138 consecutive patients. The probe was targeted by the stereotactic unit of a prone table (United States Surgical Corporation, Norwalk, Conn.; and Lorad, Danbury, Conn.). Four to 18 (mean 8) core specimens were obtained for each lesion. In case of complete removal of the lesion, a localizing clip was deployed at the biopsy site. Adequate material for histopathologic examination was obtained in all cases (100%). Four of 138 (3%) patients experienced mild hematomas. We observed 15 of 39 failures (38%) to place the localizing clips. Thirteen of 153 (8%) procedures were inconclusive and required reintervention. Following DVAB, 42 of 138 (30%) patients underwent surgery. Subject to incomplete follow-up of the entire cohort, we observed no false-positive and one false-negative diagnosis. These preliminary results suggest that DVAB using an 8-G probe are feasible, safe and accurate. In our experience, clip placement was problematic. It is probable that increasing the dimensions of DVAB will only be relevant in a limited number of clinical situations, primarily the desire to obtain complete radiologic resections of the target abnormality.

Tumor associated markers in breast cancer.

Several tumor markers have been assayed in serum of patients suffering from breast diseases in order to improve the early detection of cancer, to contribute to its diagnosis, to evaluate the local and metastatic extension of the neoplasia, to monitor the follow-up of previously diagnosed cancer and to provide useful prognosis information. In this article, the potential interest of some tumor markers will be stressed as the limits of some others.

Interventional Radiology in Breast Cancer

Women pay a heavy toll to breast cancer. They are told they have a cumulative lifetime risk of developing the disease of approximately 1 in 10 and are encouraged to undergo regular physical and mammographic examinations as of 40 years of age. In the absence of an established preventive treatment, they insist upon early diagnosis, which will offer them the best chance of survival, and less aggressive and less mutilating treatments. This demand is motivated by the published results of the controlled screening programs that seem to confirm the model of tumor growth, proposed by Koscielny et al., based on the observation of a highly significant correlation between breast-tumor size, and the probabilities of distant spread and relatively late metastatic dissemination during the natural history of the disease (Koscielny et al. 1985). Consequently, the allegation of an error in the diagnosis of breast cancer is the most common reason for malpractice claims made against physicians, and the leading cause of indemnity payments for any single medical condition (Osuch and Bonham 1994; Brenner 1995; Berlin 1999).