Primary systemic therapy (PST) for operable breast cancer enables the identification of in vivo biological markers that predict response to treatment. A total of 118 patients with T2 -4 N0 -1 M0 primary breast cancer received six cycles of anthracycline-based PST. Clinical and radiological response was assessed before and after treatment using UICC criteria. A grading system to score pathological response was devised. Diagnostic biopsies and postchemotherapy surgical specimens were stained for oestrogen (ER) and progesterone (PgR) receptor, HER-2 and cell proliferation (Ki-67). Clinical, radiological and pathological response rates were 78, 72 and 38%, respectively. There was a strong correlation between ER and PgR staining (Po0.0001). Higher Ki-67 proliferation indices were associated with PgRÀ tumours (median 28.3%, PgR þ 22.9%; P ¼ 0.042). There was no relationship between HER-2 and other biological markers. No single pretreatment or postchemotherapy biological parameter predicted response by any modality of assessment. In all, 10 tumours changed hormone receptor classification after chemotherapy (three ER, seven PgR); HER-2 staining changed in nine cases. Median Ki-67 index was 24.9% before and 18.1% after treatment (P ¼ 0.02); the median reduction in Ki-67 index after treatment was 21.2%. Tumours displaying 475% reduction in Ki-67 after chemotherapy were more likely to achieve a pathological response (77.8 vs 26.7%, P ¼ 0.004).

Core biopsy (CB) has now largely replaced fine-needle aspiration cytology (FNAC) in the preoperative assessment of breast cancer in the UK. We studied the contribution of FNAC and CB in the preoperative diagnosis of screen-detected breast carcinoma. Data were prospectively collected on 150 840 women who underwent breast screening over a 4-year period from 1999 to 2003. Data on women who had both FNAC and CB taken from the same lesion preoperatively and in whom surgical excision of the lesion subsequently confirmed malignancy was analysed. In 763 cancers, FNAC was inadequate (C1) in 8% and benign (C2) in 10%. Most of these cases presented with microcalcification (25% were C1 or C2). Core biopsy was not representative (B1) or benign (B2) in 7%. The absolute and complete sensitivities were 65 and 82% for FNAC and 80 and 93% for CB in the diagnosis of cancer. Core biopsy was abnormal (B3 or above) in 86% of the cancers missed by FNAC and FNAC was abnormal (C3 or above) in 65% of those missed by CB. Core biopsy is better than FNAC at preoperative diagnosis of screen-detected breast cancer as it missed fewer cancers. However, combining FNAC resulted in a better preoperative diagnosis rate. The National Health Service Breast Screening Programme (NHSBSP) was introduced in the United Kingdom in 1987, following publication of the findings of an expert committee the previous year. At present, all women aged 50 -70 years are offered two-view screening mammography every 3 years. Patients with radiologically suspicious lesions are recalled for further assessment that may include clinical examination, special mammographic views, ultrasound and collection of tissue for pathological assessment by fine-needle aspiration cytology (FNAC), core biopsy (CB), or more recently, by wide bore vacuum biopsy.In the early stages of NHSBSP, FNAC was the test used in the assessment. Core biopsy was introduced in the assessment process in late 1990s. The experience with this technique has improved considerably and CB is now considered to be the standard. The preoperative diagnosis rate of screen-detected carcinoma has been improving with increasing use of CB. Correspondingly, the use of FNAC is in decline and a number of screening units in the UK have abandoned it completely (Britton et al, 1997).At the Bedfordshire and Hertfordshire Breast Screening Unit, CB was introduced in the assessment of screen-detected breast lesions in 1997, but we continued to perform FNAC in addition in the majority of patients with suspicious lesions. The aim of this study was to assess the performance of FNAC and CB in the preoperative diagnosis of screen-detected breast carcinoma. MATERIALS AND METHODSData were prospectively collected on all women who attended the Bedfordshire and Hertfordshire Breast Screening Unit, England. We reviewed a 4-year period from April 1999 to March 2003. This period was chosen to ensure that operators had gained sufficient expertise in the use of CB, which was introduced in 1997. We selected, for detailed analysis, the women who had ...

No abstract

No abstract