Tissue from contralateral breast was taken from 505 patients with invasive breast cancer. Every 5th patient had simultaneous carcinoma in the opposite breast, 7.7% (39/505) had invasive cancer, and 13.1% (66/505) had carcinoma in situ. Invasive cancers in the opposite breast were diagnosed at an earlier stage as compared with the neoplasm of the primary breast. However, 26% of the patients already had positive axillary nodes. The following risk indicators of the bilateral disease were found: age at time of diagnosis, histologic type of tumours, familial breast cancer, suspicious mammography, P2/DY-breast parenchymal pattern (Wolfe) and multicentric cancer of primary breast. Our findings support the proposal to consider bilaterality of breast cancer as a sign of systemic disease of the breasts, involving the ductal and lobular system within eight quadrants of a paired organ (Ober).
67 breast cancers with a maximum diameter of up to 10 mm on the histological section were retrospectively analysed according to the primary situation for medical consultation and the way to cancer diagnosis. 46 women presented themselves with clinical signs. 19 women had an anamnestical risk, whereas only two women were without any risks or symptoms. 34 tumourspecific clinical signs are followed by 25 tumourspecific mammograms. Eight small invasive carcinomas were detected only under the microscope, two of them in mastectomy specimens. Even small cancers, therefore, are mostly diagnosed from the patients themselves. The contribution of mammography is tremendous. Intensified systematic histological examination of biopsies and mastectomy specimens is mandatory especially in high risk patients.
In 1048 breast cancer patients, operated in the period 1969-1985 at the University of Erlangen Clinic of Obstetrics and Gynecology, estimations were made to determine the relative contribution of mammography and meticulous histology to the diagnosis of simultaneous contralateral cancer. The incidence of a bilateral simultaneous disease was 17% (6.1% invasive forms, 10.6% in situ). Complete histological examination of the extirpated tissue as well as the occurrence of discrete radiological signs could account for the detection of 41% of all invasive and 39% of all in situ forms respectively. Those contralateral breast cancer cases detected just by means of mammography, but without any presence of clinical signs, recorded an average diameter of 9 mm and in 20% had metastacised to the axillary lymph nodes. Comparatively, clinically and radiologically diagnosed cases were 17 mm on average and the occurrence of axillary lymph node involvement was 41%. The conclusion is drawn, that a meticulous diagnostic effort is necessary in view of the high incidence of occurrence of simultaneous cancer on the other breast and the prognostic importance of an early diagnosis for many patients. Every minute radiologically detected sign in the other breast of patients with mammary carcinoma requires careful diagnostic clarification. However, it should be considered that the data presented were gathered in a situation in which the radiologist performed the X-ray examination, knowing that an excision would have been carried out in 85 percent of all cases even without his specific localisation. The presence of additional risk factors (lobular cancer, multicentricity and family history of breast cancer) make such an effort justified and obligatory as well.
Material und MethodikDie vorliegenden Daten stammen aus einer gr6Btenteils retrospektiven, seit 1/85 prospektiven Untersuchung, die alle Ovarialmalignome erfaBt, die vom 01.01.66 bis 31.12. 86 an der UFK Erlangen behandelt worden sind. Es wurden alle histologischen Schnittpr/iparate nochmals durchgemustert und die Diagnose Borderline Tumor fiberprfift. In Zweifelsf/illen hatten wir Gelegenheit, die histologischen Schnitte Herrn Prof. Scully, Pathologisches Institut der HarvardMedical-School, Boston, vorzulegen, der unsere Diagnose freundlicherweise fiberprfifte. Es wurde der weitere Verlauf der Patientinnen anhand der Krankenunterlagen, der Aufzeichnungen unserer Tumornachsorge-Sprechstunde, der Auskfinfte der behandelnden Haus/irzte sowie der Einwohnermelde/imter fiberprfift. Der Beobachtungszeitraum erstreckte sich von 12 bis 251 Monaten, Median 114 Monate. 610
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