NSABP-32: Phase III, randomized trial comparing axillary resection with sentinal lymph node dissection: a description of the trial.

The NSABP-32 trial is a randomized, phase III clinical trial to compare sentinel node (SN) resection to conventional axillary dissection in clinically node-negative breast cancer patients. The primary aims of the trial are to determine if removal of only SNs provides survival and regional control equivalent to those of axillary dissection, while diminishing the magnitude of surgically related side effects. In order to ensure consistency of the outcomes for this trial, a standardized method of SN surgery has been utilized for all cases.

Workshop on partial breast irradiation: state of the art and the science, Bethesda, MD, December 8-10, 2002.

Breast conserving surgery followed by radiation therapy has been accepted as an alternative to mastectomy in the management of patients with early-stage breast cancer. Over the past decade there has been increasing interest in a variety of radiation techniques designed to treat only the portion of the breast deemed to be at high risk for local recurrence (partial-breast irradiation [PBI]) and to shorten the duration of treatment (accelerated partial-breast irradiation [APBI]). To consider issues regarding the equivalency of the various radiation therapy approaches and to address future needs for research, quality assurance, and training, the National Cancer Institute, Division of Cancer Treatment and Diagnosis, Radiation Research Program, hosted a Workshop on PBI in December 2002.

Confirmatory factor analysis of the Family Emotional Involvement and Criticism Scale: evidence of the dimensionality of expressed emotion.

Using a convenience sample of 152 married couples, the present study tested models that alternately considered family members' perceptions of Expressed Emotion to be a one-, two-, three-, or four-factor construct as measured by the Family Emotional Involvement and Criticism Scale. Results of confirmatory factor analysis procedures indicated that perceptions of Expressed Emotion were best represented by a four-factor model that consisted of involvement, criticism, upset feelings, and approval. The methodological implications of these findings are discussed.

Technical limitations of sentinel node biopsy in breast cancer: a single surgeon's experience.

Few studies have attempted to critically identify patient- and tumor-related factors that limit sentinel node biopsy (SNB). These studies have been limited by sample size and surgeon variability. The present study attempts to enumerate these limitations in a unique group of patients.

Sentinel node biopsy after neoadjuvant chemotherapy for breast cancer.

Background: After neoadjuvant chemotherapy, while results of sentinel node biopsy (SNB) are encouraging, conditions that may affect sentinel node (SN) detection and false negative rates with respect to clinical and pathological tumor response after neoadjuvant therapy require investigation.

Methods: Thirty-four patients with clinical stage I, II and IIIA invasive breast cancer underwent neoadjuvant chemotherapy with doxorubicin/cyclophosphamide or doxorubicin/cyclophosphamide and docetaxel/segmental resection, SNB, and axillary node dissection (AND).

Results: SNs were found in 31 of 34 patients (91.

Atypical squamous metaplasia of seromas in breast needle aspirates from irradiated lumpectomy sites: a potential pitfall for false-positive diagnoses of carcinoma.

The presence of squamous metaplasic cells is an uncommon finding in fine-needle aspiration (FNA) biopsies of the breast. We report that FNA smears containing atypical squamous metaplastic cells derived from the lining of seroma-type cavities following lumpectomy and irradiation in patients with breast cancer can be a potential pitfall for a false-positive diagnosis of recurrent malignancy. Four fine-needle breast aspirates from two adult patients with previous histories of invasive breast carcinoma were retrieved.

Sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer.

Background: Sentinel lymph node biopsy (SLNB) is a developing alternative to axillary dissection and may prove to be accurate in the detection of micrometastases in lymph nodes of breast cancer patients. Limited studies exist in the use of SLNB after neoadjuvant therapy. This study was undertaken to determine the accuracy of SLNB after neoadjuvant chemotherapy.

Distinctive patterns of Her-2/neu, c-myc, and cyclin D1 gene amplification by fluorescence in situ hybridization in primary human breast cancers.

Background: Human solid tumors undergo clonal evolution as they progress, but evidence for specific sequences of genetic changes that occur in individual tumors and are recapitulated in other tumors is difficult to obtain.

Methods: Patterns of amplification of Her-2/neu, c-myc, and cyclin D1 were determined by fluorescence in situ hybridization (FISH) in relation to the presence of p53 dysfunction and ploidy in 60 primary human breast cancers.

Results: We show that there are clusters of genophenotypic abnormalities that distinguish lobular breast cancers from nonlobular tumors; that cyclin D1 amplification occurs prior to the divergence of lobular breast cancers from nonlobular cancers; that p53 dysfunction, Her-2/neu amplification, and c-myc amplification are characteristic features of nonlobular breast cancers, but not of lobular breast cancers; and that the frequencies of amplification of all three oncogenes examined increase progressively with increasing aneuploidy, but that each gene exhibits a different profile of increasing amplification in relation to tumor progression.

MRI: a role in clinical trials.

The diagnosis and treatment of breast cancer has evolved significantly over the last 20 years. Breast-conserving therapy is replacing the Halstedian concept of "en bloc" resection. Difficulties in detection, pre- and postoperative planning and follow up continue to challenge the clinician.

Correlations among p53, Her-2/neu, and ras overexpression and aneuploidy by multiparameter flow cytometry in human breast cancer: evidence for a common phenotypic evolutionary pattern in infiltrating ductal carcinomas.

Human solid tumors develop multiple genetic abnormalities that accumulate progressively in individual cells during the course of tumor evolution. We sought to determine whether there are specific sequences of occurrence of these progressive evolutionary changes in human breast cancers by performing correlated cell-by-cell measurements of cell DNA content, p53 protein, Her-2/neu protein, and ras protein by multiparameter flow cytometry in 56 primary tumor samples obtained at surgery. In addition, p53 allelic loss and Her-2/neu gene amplification were determined by fluorescence in situ hybridization in cells from the same samples.

Vulvar vestibulitis syndrome: a form of reflex sympathetic dystrophy?

Objective: Our purpose was to determine whether vulvar vestibulitis syndrome is a form of reflex sympathetic dystrophy syndrome.

Materials And Methods: Between October 1, 1998, and February 16, 1999, 20 subjects attending a gynecology clinic at a tertiary care center received diagnoses of vulvar vestibulitis syndrome. A history was recorded, and a gynecological examination was performed for each, including a detailed description of the vulva, vaginal Gram's stain, vaginal culture, pH, and wet preparation of any discharge.

Long-term follow-up post-cryosurgery in a sheep breast model.

This study constitutes the advanced stage of an ongoing project for the development of cryosurgical devices and techniques for breast cryosurgery. The current study focuses on the long-term follow-up post-cryosurgery in a sheep breast model. Results of this study indicate that the cryotreatment site in a sheep breast model cannot be identified up to 5 months post-cryosurgery by means of ultrasound, mammography, or MRI.

A graduating medical school class evaluates their educational experience.

Objective: To determine how graduating medical students perceive instructional settings, materials, and teachers as to importance or influence upon their education and how they would change curriculum and allocate educational resources based on their experience.

Materials And Methods: One hundred thirty-nine graduating medical students at the University of Wisconsin, Madison were offered five dollars to complete and return the survey. Students were asked to rate the importance or influence (1 = most important or influential, 5 = least important or influential) of more than forty educational settings, materials, teachers, and which aspects of the curriculum should be emphasized or preserved when educational resources become more limited.

Medical education at the University of Wisconsin-Madison: comparison of medical student and resident education as to the number of physicians practicing in the state of Wisconsin.

Unlabelled: The primary mission of a state-supported medical education is to produce physicians who will practice in that state. Medical school and residency graduates at the University of Wisconsin-Madison were compared as to how often they practice in the state after completing training.

Methods: Six hundred ninety-three medical student graduates from 1987 to 1991 were compared with 657 residency graduates from 1992 to 1996 at the University of Wisconsin-Madison.

Vulvar pain: diagnoses, evaluation, and management.

In 1975, the International Society for the Study of Vulvar Disease recommended the term vulvodynia to describe vulvar pain regardless of its cause. For most clinicians, vulvar pain is, to say the least, confusing. It is not one disease but, in most cases, the manifestation of several diseases often erroneously lumped together because they are uncomfortable and occur on the vulva.

Gross damage accumulation on frozen rabbit liver due to mechanical stress at cryogenic temperatures.

The second phase of a pilot study dealing with the mechanical response of frozen biological tissues to external compressive load is presented. This stage deals with histological observations of the damage accompanying mechanically induced permanent deformation in frozen rabbit liver. no significant gross histological damage was observed in the liver samples due to either processing the tissue in the frozen state, due to slow cooling of the liver tissues down to -20 degrees C, or due to rapid cooling of the samples down to -196 degrees C.

A compact cryosurgical apparatus for minimally invasive procedures.

A new liquid-nitrogen-based apparatus for minimally invasive cryosurgery is presented. The cryoprobe was designed for application to breast tumors; however, it can be used for the treatment of other tumors. The cryoprobe has three major components, a cryoneedle, a thermal insulation shell, and a protective tube, which may be assembled as part of the operation.