Perspectives in Breast Cancer Pathology
Michael D. Lagios, MD
The Clinical Significance of Immunohistochemically Detectable Epithelial Cells in Sentinel Lymph Node and Bone Marrow in Breast Cancer — Michael D. Lagios, MD
02/13/2012
The application of immunohistochemical techniques capable of detecting single epithelial cells in the sentinel lymph node and in the bone marrow of breast cancer patients has resulted in much confusion among treating oncologists. Many breast cancer patients, particularly those with immunohistochemically positive sentinel nodes, have been upstaged and treated as if they had significant metastatic disease. Such single cell metastases are often regarded as entirely comparable to gross metastases a million-fold or greater in size for which many decades of outcome data confirm prognostic significance.
Factors Influencing the Accuracy of a Core Biopsy Diagnosis of Atypical Hyperplasia - A Perspective on a Frequent Problem — Michael D. Lagios, MD
12/13/2011
One of the few diagnostic limitations of stereotactic biopsy evident in initial reports of its utility (Jackman et al, 1994, 1999; Liberman et al, 1995) was a 48-58% rate of underdiagnosing DCIS or DCIS with invasion as demonstrated in a subsequent open biopsy. This initial experience has generated a widely recognized mandate for the necessity of an open biopsy for any diagnosis of ADH in a stereotactic biopsy. However, this mandate is an oversimplification. In fact, use of more precise pathologic and mammographic guidelines can markedly reduce the need for reexcision of stereotactic biopsies demonstrating ADH.
Contradictory treatment recommendations for ductal carcinoma in situ (DCIS) — Michael D. Lagios, MD
08/15/2011
The vast majority of women with DCIS are told that in addition to surgical excision, radiation therapy and tamoxifen (or an aromatase inhibitor in postmenopausal patients) will be required for local control of their disease in program of breast conservation. Yet, half of US women with DCIS who elect breast conservation forgo radiation therapy, an option recognized by the NCCN and others. These competing recommendations sow much confusion and anxiety in patients. This problem reflects the contrast between the historical, but limited results of the randomized trials of radiation therapy for DCIS, and modern prospective studies which have utilized a different approach.
↑ Return to top