Lowell W. Rogers

Continued local recurrence of carcinoma 15–25 years after a diagnosis of low grade ductal carcinoma in situ of the breast treated only by biopsy

Background. The stratification of ductal carcinoma in situ (DCIS) of the human breast into prognostically relevant categories by size and histologic pattern is a current concern. Few studies have been able to follow women after the identification of any type of DCIS when they have had biopsy only.

Ductal involvement by cells of atypical lobular hyperplasia in the breast: A long-term follow-up study of cancer risk

A cohort study of women with ductal involvement by cells of atypical lobular hyperplasia (DIALH) revealed an incidence of 1.4% in benign biopsy specimens. When combined with diagnostic lobular unit alterations of atypical lobular hyperplasia (ALH), a consequent risk of invasive carcinoma of 6.8 times that in the general population was found. This relative risk for women with ALH and DIALH approaches the risk for lobular carcinoma in situ, whereas the risk for ALH with or without DIALH is 4.3 and the risk for ALH without DIALH is reduced to 2.7. Only definitive changes of DIALH with an insinuated characteristic population of cells between attenuated luminal cells and basement membrane should be so diagnosed. DIALH in association with lobular alterations that are borderline with regard to a diagnosis of lobular carcinoma in situ will increase the certainty that a medically meaningful increased risk for subsequent invasive cancer is indicated.

Diabetic Mastopathy: Adjunctive Use of Ultrasound and Utility of Core Biopsy in Diagnosis

Abstract: Diabetic mastopathy is uncommon but occurs in long‐term insulin‐dependent diabetic patients who develop hard palpable breast masses which mimic breast cancer and are occult mammographically. Ultrasound evaluation is useful to analyze the masses. There is a spectrum of ultrasound findings from marked acoustic shadowing to a vague hypoechoic area without shadowing. Ultrasound‐guided core biopsy (CB) is recommended for a definitive diagnosis since fine needle aspiration biopsy (FNAB) yields insufficient material for diagnosis secondary to extensive fibrosis. Four of the 11 patients in our series had FNAB, which was reported as insufficient material for diagnosis. However, 10 of 11 patients with diabetic mastopathy were successfully diagnosed by ultrasound‐guided CB, helping to avoid an unnecessary surgical excisional biopsy.

Fixation Time Does Not Affect Expression of HER2/neu A Pilot Study

It is said that HER2/neu expression by immunohistochemical analysis varies with the time of fixation. The purpose of this pilot study was to determine the impact of the length of fixation in 10% buffered formalin on the expression of HER2/neu by immunohistochemical analysis. We studied tissue samples from 10 invasive breast cancer cases after fixation for 3, 48, 72, 96, and 120 hours. The tissue was processed immediately after fixation, resembling routine practice. The 50 resulting blocks were then batch stained with PATHWAY HER2/neu clone 4B5 rabbit monoclonal antibody using the Ventana Ultraview DAB detection kit in a Ventana BenchMark XT processor (Ventana, Tucson, AZ). The stained slides were reviewed and scored. We found no significant difference in the intensity of the stain or the percentage of cells stained regardless of the time in fixation. Fixation times between 3 and 120 hours in 10% buffered formalin do not appear to have an impact on the expression of HER2/neu by immunohistochemical analysis.

Fixation Time Does Not Affect the Expression of Estrogen Receptor

The purpose of this pilot study was to determine the impact of the length of fixation in 10% buffered formalin on the expression of estrogen receptor by immunohistochemical analysis. We studied tissue samples from 10 invasive breast cancer cases after fixation for 1, 3, 6, and 9 to 10 hours. The tissue was processed immediately after fixation, resembling routine practice. Then the 40 blocks were incubated with antiestrogen receptors SP1, 6F11, and 1D5. The stained slides were reviewed and scored. We found no significant difference in the intensity of the stain or the percentage of cells stained regardless of the time in fixation or the antibody used. Fixation times between 1 and 9 hours in 10% formalin do not seem to have an impact on the expression of estrogen receptor by immunohistochemical analysis, at least in these high-expressing tumors.

Micro-Papillary Hyperplasia with Atypical Features in Female Breasts, Resembling Gynecomastia

Some of the multiple and varied patterns of mammary epithelial hyperplasia have created concern about their implication for breast cancer risk, particularly since recent studies have shown such predictive implications.1,2 We have recognized a pattern of hyperplasia in the female breast, which resembles that seen in the florid phase of gynecomastia. The concern engendered by this pattern of hyperplasia in women comes directly from its similarity to micro-papillary carcinoma in situ of the ductal type1 and some related patterns accepted as atypical hyperplasia of ductal pattern. This pattern, however, does not have a proven association with an increased risk of breast cancer. This study is presented in order to recognize this special pattern of mammary epithelial hyperplasia, despite its merging into other patterns, and to highlight that it does not indicate cause for concern.

Discrimination of breast cancer by anti-malignin antibody serum test in women undergoing biopsy.

Purpose: The anti-malignin antibody serum (AMAS) test (Oncolab, Boston, MA) has been reported as 97% sensitive and 95% specific for malignancies. To objectively assess accuracy of this test for discrimination of breast cancer, we studied a series of women undergoing core breast biopsy. Subjects and Methods: Seventy-one core-needle breast biopsies were classified as malignant, suspicious, or benign by two independent pathologists blinded to AMAS results. Corresponding sera were read as AMAS positive, negative, or borderline by criteria used by Oncolab and also using criteria derived from receiver-operator curves based on values for slow (S-tag), fast (F-tag), and their difference (Net-tag) antibody reported by Oncolab. We calculated sensitivity and specificity and analyzed distributions by Fishers exact test. Results: Biopsies were read as 42 (59%) benign, 12 (17%) suspicious, and 17 (24%) malignant. By Oncolab criteria, sensitivity (59%) and specificity (62%) were maximized by pooling suspicious with malignant and AMAS borderline with positive (P = 0.098). Receiver-operator curves showed best sensitivity (62%) and specificity (69%) for the criterion AMAS positive if Net-Tag > 135 μg/mL or S-Tag > 220 μg/mL (P = 0.015). Conclusions: The AMAS test discriminates suspicious and malignant from benign lesions, but sensitivity is insufficient to identify patients to be spared biopsy and false-positive rates are too high for population screening.

Fixation Time and HER2/neu Assessment

To the Editor We read with great interest the report by Ibarra and Rogers1 on the issue of fixation time and HER2/neu expression. The authors report that fixation times do not seem to have an impact on the expression of HER2/neu by immunohistochemical analysis. Preanalytic factors, including time from excision to fixation and time of fixation, are critical to obtain reproducible and reliable immunohistochemical HER2/neu results.2–4 Tissue fixation is an important process that requires placing the tumor in …