Vacuum biopsy in the UK

Michell

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• Publié par: biomed
• Publié le: 01 janvier 2002
• Nombre de lectures: 6
• Langue: English

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Available onlinehttp://breastcancerresearch.com/supplements/4/S1

Abstracts from Symposium Mammographicum 2002 University of York, 17–19 July 2002

1 Molecularpathology of breast cancer SR Lakhani The Breakthrough Toby Robins Breast Cancer Research Centre, Institute of Cancer Research & The Royal Marsden Hospital, London, UK The multistep model of carcinogenesis in the breast suggests aago, scientists studied disease initiation and progression in a transition from normal epithelium to invasive carcinoma vialinear fashion, identifying and examining one cancerrelated nonatypical and atypical hyperplasia andin situcarcinoma. moleculeat a time. The recent development of technologies The introduction of mammographic screening has led to thethat allow a large number of genes and gene products to be increased detection of preinvasive disease, and this has highanalysed simultaneously has brought renewed interest to lighted deficiencies in the biology and classification of suchbreast cancer research, with the hope of identifying a unique lesions. The excitement surrounding the development of DNA‘fingerprint’ for each tumour and hence individualised treat microarray analysis and proteomics has raised expectationsment. To date, histopathological assessment has been at the about the role of these techniques in understanding the biologyheart of clinical management – does the new technology herald and translating these data to clinical practice. Only a few yearsthe end? 2 Hormonereplacement therapy (HRT): indications and side effects MI Whitehead Department of Obstetrics & Gynaecology, King’s College Hospital, London, UK Late submission, see page S22

3 Breastcancer and hormone replacement therapy (HRT): collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer

V Beral, for the Collaborative Group on Hormonal Factors in Breast Cancer Secretariat, ICRF Cancer Epidemiology Unit, Radcliffe Infirmary, Oxford, UK

The Collaborative Group on Hormonal Factors in Breast Cancerwas no significant excess of breast cancer overall or in relation has brought together and reanalysed about 90% of the world to duration of use. There was no marked variation in the results wide epidemiological evidence on the relation between risk ofaccording to hormonal type or dose but little information was breast cancer and use of hormone replacement therapy (HRT).available about long durations of use of any specific preparation. Data on 52,705 women with breast cancer and 108,411Cancers diagnosed in women who had ever used HRT tended women without breast cancer from 51 studies in 21 countriesto be less advanced clinically than those diagnosed in never were collected, checked and analysed centrally. Among currentusers. In North America and Europe the cumulative incidence of users of HRT or those who ceased use 1–4 years previously,breast cancer between the ages of 50 and 70 in neverusers of the relative risk of having breast cancer diagnosed increased byHRT is about 45 per 1,000 women. The cumulative excess a factor of 1.023 (95% confidence interval [CI] 1.011–1.036;numbers of breast cancers diagnosed between these ages per 2P= 0.002) for each year of use; the relative risk was 1.35 1,000 women who began use of HRT at age 50 and used it for (95% CI 1.21–1.49; 2Pfor women who had used= 0.00001)5, 10 and 15 years respectively, are estimated to be 2 (95% CI HRT for 5 years or longer (average duration of use in this group 1–3), 6 (95% CI 3–9) and 12 (95% CI 5–20). Whether HRT 11 years). Five or more years after cessation of HRT use, thereaffects mortality from breast cancer is not known. 4 Hormonereplacement therapy (HRT) and its effect on mammographic specificity and sensitivity JC Litherland Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK It is now widely recognised that the use of hormone replaceeither of a generalised increase in background density or focal ment therapy (HRT) can influence mammographic pattern.changes such as cyst formation or an increase in the size of Approximately 17–24% of women using HRT may havefibroadenomata. In addition to demonstrable change, HRT may demonstrable changes on sequential mammography consistingalso lead to maintenance of breast density, so that the natural S1

Breast Cancer ResearchVol 4 Suppl 1

Symposium Mammographicum 2002

involution usually seen with age is not visualised. As the number of women taking HRT increases, and these women are in the age group targeted by breast screening programmes, there has been an increasing interest in the influence of HRT on the sensitivity and specificity of mammography.

Over the past few years several studies have been published addressing this issue and the results of these will be reviewed within the lecture. Overall, there is evidence of a reduction in sensitivity with HRT use, although this may be confined to women with a dense background pattern only. In addition, there is also evidence of decreased specificity in women taking HRT.

5 Technologyupdate KC Young National Coordinating Centre for the Physics of Mammography, Royal Surrey County Hospital, Guildford, UK Full field digital mammography has continued to develop.2000 × 2500 resolution are becoming standard. While such There is now a remarkable variety of different designs. Onesystems may be readily introduced into a symptomatic role, of the oldest (photostimulable phosphors) has received atheir use in screening remains problematic. All the digital new lease of life with the introduction of dual reading techsystems can overcome the latitude limitations of the tradi nology at a 50µ tional film screen mammography, and appear to offer advan m resolution. Systems using a selenium detector plate with a 70µm resolution are being introducedtages in terms of image quality, particularly with better this year. Such systems have the advantage of converting Xcontrast resolution. The overall contrast can also be opti ray energy directly to an electrical signal. A low dose system,mised for each image. The main limitations to the wider use which uses a scanning technique with a linear array of siliconof this technology remain the high startup costs and the lack detectors, has also been developed. Dual displays with of proven clinical advantages. 6 Computeraided detection P Taylor Centre for Health Informatics and Multiprofessional Education, Royal Free & University College London Medical School, London, UK

Computer analysis of digitised mammograms is now remarkablyaffect specificity. The evidence that they can improve radiol sensitive for the detection of calcifications and masses. This sen ogists’ sensitivity is less certain, although there are now sitivity, however, is only achieved at low levels of specificity.studies showing that improvements have been achieved. The System developers have tried to get around this difficulty bykey unanswered question is what is the potential impact of developing prompting systems, in which the computer algorithmsthese tools on the decisionmaking of radiologists and radi are used to alert film readers to possible areas of abnormality.ographers working in the UK screening programme? A large The idea is that the computer may be able to improve a radiolo scale evaluation, involving 50 filmreaders, is underway to gist’s, or radiographer’s, sensitivity while relying on his or her proassess this impact. Interim results will be presented at Sym fessional judgement to maintain acceptable levels of specificity.posium Mammographicum. Issues include the significance of abnormalities other than masses and calcifications, and the Research in the United States has shown that the algorithmsrelative importance of errors of detection and errors of are sensitive and that prompting systems do not adversely decisionmaking. 7 Reviewof clinical trials RE Hendrick Department of Radiology & Lynn Sage Breast Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Clinical trials of fullfield digital mammography to date haveonly by digital mammography, 15 only by screenfilm mammo compared sensitivity, specificity, and receiver operating characgraphy, 18 by both, and 8 by neither modality. The difference in teristic (ROC) curves of digital to screenfilm mammography,cancer detection was not statistically significant (P> 0.1). typically in paired studies of the two modalities. The largestDigital mammography resulted in fewer recalls than screenfilm study to date has been conducted in women at two institutions(799versus1,007;PROC curve areas were 0.74< 0.001). in the USA involving 6,736 paired examinations of women agedfor digital and 0.80 for screenfilm (P> 0.1).Results of other 40 and over presenting for screening mammography at the Unitrials conducted to date, primarily diagnostic studies for regula versity of Colorado and University of Massachusetts Medicaltory approval, will also be described, along with the design of Centers. Of 1,467 subjects recommended for additional evalu the National Cancer Institute sponsored American College of ation on at least one modality, 181 biopsies were performed,Radiology Imaging Network (ACRIN) DMIST study of 49,500 S2 women, which is currently underway.yielding detection of 42 cancers. Nine cancers were detected