Stuart J. Schnitt

Vascular permeability factor (vascular endothelial growth factor) expression and angiogenesis in patients with ductal carcinoma in situ of the breast.

Prior studies have indicated that ductal carcinoma in situ (DCIS) lesions are capable of inducing a vascular stroma. However, the mechanisms responsible for angiogenesis in DCIS currently are not defined. The goal of this study was to determine the relationship between the expression of the angiogenic cytokine vascular permeability factor (VPF), also known as vascular endothelial growth factor (VEGF), and angiogenesis in patients with DCIS.

A prospective study of conservative surgery alone in the treatment of selected patients with stage I breast cancer

Randomized clinical trials have clearly demonstrated that the use of radiation therapy (RT) following breast‐conserving surgery (CS) substantially reduces the risk of local recurrence. However, the low rate of local recurrence after CS and RT for patients without known risk factors, and the recent increase in the detection of smaller cancers due to mammographic screening have led to the speculation that a subgroup of patients who have a low risk of local recurrence without RT might be identified. In 1986, we initiated a one‐arm, prospective clinical trial of CS alone for treatment of highly selected breast cancer patients without known risk factors for local recurrence.

Extensive apoptosis in ductal carcinoma in situ of the breast.

More than 50% of breast ductal carcinomas in situ (DCIS) contain significant histologic necrosis, an important prognostic factor for determining recurrence and progression to invasive breast cancer. We have examined whether the mechanism of this spontaneous cell death might be apoptosis, a genetically encoded suicide pathway that may be triggered by various events including dysregulated cell proliferation.

Relationship of tumor grade to other pathologic features and to treatment outcome of patients with early stage breast carcinoma treated with breast-conserving therapy

Although histologic grade has previously been described as a predictor of distant failure, it is uncertain whether histologic grade should be used to decide which patients should undergo axillary lymph node dissection and whether grade should be considered as a selection factor for breast‐conserving therapy.

The relationship between shaved margin and inked margin status in breast excision specimens.

The presence of tumor at the inked margins (IMs) of breast specimens is associated with an increased risk of local recurrence after breast‐conserving therapy for invasive breast carcinoma and ductal carcinoma in situ (DCIS). Given the importance of margin status, some have advocated the use of shaved margins (SMs) as a means of conducting a more complete examination of the specimen margins than could be done with sections taken perpendicular to the IMs. However, it is not known whether these two methods of margin assessment provide comparable information.

Predictors of local recurrence following excision alone for ductal carcinoma in situ

The treatment of ductal carcinoma in situ (DCIS) remains controversial, particularly in regard to the selection of patients who may be appropriately treated with wide excision alone. To help identify such patients, the authors assessed prognostic factors for local recurrence in patients with DCIS treated with excision alone.

Breast‐conserving therapy for Stage I‐II synchronous bilateral breast carcinoma

Synchronous bilateral breast carcinoma (SBBC) is an uncommon presentation, and the management of patients with this disease is not well established.

Angiogenesis in Preinvasive Lesions of the Breast

t is now well established that several key aspects of tuI mor progression are critically dependent on angiogenesis, the complex process whereby solid tumors, including breast cancers, induce a vascular stroma. Folkman (1,2) has demonstrated the critical role of angiogenesis in the growth of tumors beyond a minimal size. More recent studies have focused on the association between angiogenesis and clinical outcome in patients with cancer, particularly in those with invasive breast cancer. Some, but not all of these studies, have demonstrated a significant association between the number of blood vessels in the stroma surrounding invasive breast cancer and the likelihood of subsequently developing (and dying from) metastatic disease ( 3 ) . While the study of angiogenesis in invasive breast cancer is clearly of considerable interest, it may be of equal or even greater importance to examine the role of angiogenesis in earlier stages of breast cancer development. This may be particularly relevant in the era of screening mammography, as an increasing proportion of patients are being diagnosed with preinvasive lesions, including in situ cancers (4). A number of studies have indicated that, similar to invasive breast cancers, some preinvasive breast lesions are capable of inducing neovas-

Chest wall recurrence of ductal carcinoma in situ of the breast after mastectomy

Background. Optimal management of ductal carcinoma in situ (DCIS) of the breast is a problem that is occurring with greater frequency, mostly because of the increasing use of mammographic screening. The traditional role of mastectomy for DCIS has been challenged by breast‐conserving procedures. Regardless of the method of treatment used, local control with complete tumor eradication is the major goal in the management of DCIS.

The increasing prevalence of benign proliferative breast lesions in Japanese women

Background. Although the increasing incidence of breast cancer in Japan has been well‐documented, the possibility that there also has been an increase in the frequency of benign proliferative breast disease in Japanese women has not been previously studied.