Analysis of circulating tumor DNA to monitor metastatic breast cancer.

Background: The management of metastatic breast cancer requires monitoring of the tumor burden to determine the response to treatment, and improved biomarkers are needed. Biomarkers such as cancer antigen 15-3 (CA 15-3) and circulating tumor cells have been widely studied. However, circulating cell-free DNA carrying tumor-specific alterations (circulating tumor DNA) has not been extensively investigated or compared with other circulating biomarkers in breast cancer.

What is the significance of flat epithelial atypia and what are the management implications?

Aims: To assess the significance of flat epithelial atypia (FEA) on core biopsy by evaluating the proportion of cases upgraded to in-situ and invasive carcinoma on further sampling with vacuum-assisted biopsy (VAB) or diagnostic surgical biopsy.

Methods: A retrospective analysis was performed of all core biopsies containing FEA and/or atypical intraductal proliferation (AIDP) in the pathology database from April 2008 to April 2010 (n=90). Before April 2009, the majority of core biopsies containing FEA and/or AIDP proceeded to surgical biopsy.

Conservative management of screen-detected radial scars: role of mammotome excision.

Aims: Traditionally, a core biopsy diagnosis of radial scar will prompt diagnostic surgery because of the risk of associated malignancy. However, in the absence of atypia, the risk of malignancy is low. The recent introduction of the mammotome device facilitates vacuum-assisted large-volume sampling of a lesion, such that a benign diagnosis may be accepted more confidently, and if the lesion has been entirely removed, it effectively becomes a therapeutic procedure.