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Mammographic features and tumor size can help predict invasion in patients who have DCIS on core biopsy. Patients who have features other than calcification on mammography or have tumor size > or =5 cm should be considered for a sentinel node biopsy.

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Purpose:This study investigates the role of the p160 coactivators AIB1and SRC-1independently, and their interactions with the estrogen receptor, in the development of resistance to endocrine treatments. Experimental Design: The expression of the p160s and the estrogen receptor, and their interactions, was analyzed by immunohistochemistry and quantitative coassociation immunofluorescent microscopy, using cell lines, primary breast tumor cell cultures, and a tissue microarray with breast cancer samples from 560 patients. Results: Coassociation of the p160s and estrogen receptor a was increased in the LY2 endocrine-resistant cell line following treatment with tamoxifen in comparison with endocrinesensitive MCF-7 cells. In primary cultures, there was an increase in association of the coactivators with estrogen receptor a following estrogen treatment but dissociation was evident with tamoxifen. Immunohistochemical staining of the tissue microarray revealed that SRC-1 was a strong predictor of reduced disease-free survival (DFS), both in patients receiving adjuvant tamoxifen treatment and untreated patients (P < 0.0001 and P = 0.0111, respectively). SRC-1 was assigned a hazard ratio of 2.12 using a Cox proportional hazards model. Endocrine-treated patients who coexpressed AIB1with human epidermal growth factor receptor 2 had a significantly shorter DFS compared with all other patients (P = 0.03). Quantitative coassociation analysis in the patient tissue microarray revealed significantly stronger colocalization of AIB1and SRC-1with estrogen receptor a in patients who have relapsed in comparison with those patients who did not recur (P = 0.026 and P = 0.00001, respectively). Conclusions: SRC-1is a strong independent predictor of reduced DFS, whereas the interactions of the p160 proteins with estrogen receptor a can predict the response of patients to endocrine treatment.Adjuvant endocrine therapy offers substantial benefit in terms of reduction in risk of tumor recurrence in women with estrogen receptor -positive tumors. However, although most patients initially respond to tamoxifen, in 30% to 40% of cases these tumors recur within 5 years. This precipitates cessation of the regime and the initiation of second-line therapy. However, despite new targeted treatments for breast cancer, the vast majority of patients still depend on endocrine manipulation for management of their breast cancer.The magnitude of estrogen receptor gene regulation is influenced not only by the ligand but also by the presence of specific coregulatory proteins, present at rate-limiting levels, which modulate transcription. Over the past 10 years a number of nuclear receptor -interacting proteins have been isolated using various screening strategies. These include the p160 family coactivator proteins -steroid receptor coactivator-1 (SRC-1/NCoA-1), SRC-2 (TIF2/GRIP1), and SRC-3 (AIB1/ pCIP/RAC3/ACTR). The coactivator proteins drive nuclear receptor transcriptional activity by doing the significant reactions required for control of enhancer-d...

Management of lesions in the B3 categorization must be tailored to the patient because the specific lesion types are associated with highly variable rates of malignancy. A repeat biopsy or a therapeutic wide local excision should be undertaken in lesions with a B4 NCB categorization because such lesions are associated with a particularly high risk of malignancy at excision.

Ultrasound guidance should be used to perform core biopsies in evaluating all breast abnormalities visible on ultrasound. Adherence to principles of triple assessment following biopsy allows for early recognition of the majority of false-negative cases.

A total of 45% of patients who had tumor 2 to 5 mm from the radial margin had residual disease on reoperation. Our results support a policy of requiring a 5-mm margin in patients undergoing breast-conserving therapy for invasive disease.

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