| 1. |
- Ringberg, Anita, et al.
(författare)
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Bilateral and multifocal breast carcinoma. A clinical and autopsy study with special emphasis on carcinoma in situ
- 1991
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Ingår i: European Journal of Surgical Oncology. - 1532-2157. ; 17:1, s. 20-29
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Tidskriftsartikel (refereegranskat)abstract
- Bilateral clinical breast carcinoma has been reported to appear in up to approximately 10% of patients with breast carcinoma. Increasing diagnostic activity has raised figures of bilaterality, mainly due to detection of lesions of the in situ type. Knowledge of the natural history of carcinoma in situ is incomplete and clinical implications are uncertain. In the present study bilateral lesions were analysed by extensive histological examination in the following groups of patients: (1) Forty-six women (median age 44 years) with clinical and mammographical unilateral invasive breast carcinoma, where the contralateral breast was removed at subcutaneous mastectomy (SCM) during the course of breast reconstruction, 24/46 (52%) had bilateral malignant lesions, four invasive carcinomas and 20 in situ carcinomas (two ductal carcinomas in situ /DCIS/, 15 lobular carcinomas in situ (LCIS), three both DCIS and LCIS). (2) Fifty-two women (median age 50 years) with a unilateral diagnosis of in situ carcinoma (32 DCIS, 16 LCIS, four both DCIS and LCIS), in whom both breasts were removed at SCM. 25/52 (48%) had bilateral malignant lesions, one invasive carcinoma, 24 in situ carcinomas (three DCIS, 18 LCIS, three both DCIS and LCIS). Twelve of 20 cases with LCIS (60%) were bilateral. Of 36 cases with DCIS, seven (19%) were bilateral. (3) The contralateral breast was removed at autopsy in 64 women previously unilaterally mastectomized (at median age 65) for invasive breast carcinoma. Fifteen of 64 (23%) had contralateral primary carcinoma at autopsy, four invasive carcinomas, 11 in situ carcinomas (six DCIS, five LCIS) and 8/64 (13%) had metastases in the breast. Multifocal malignant findings were also analysed in 47 SCM specimens after excisional biopsy for in situ carcinoma. In 35/47 (75%) further malignant lesions were present in spite of normal mammographic and clinical findings. Four were invasive and 31 had in situ lesions (16 DCIS, 10 LCIS, five both DCIS and LCIS): These findings may favour the hypothesis that some carcinomas in situ may remain silent or even regress. It is thus important to embark upon randomized trials to clarify the natural history of breast carcinoma in situ. Such a trial has been started in the southern region of Sweden.
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| 2. |
- Ringberg, Anita, et al.
(författare)
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Breast carcinoma in situ in 167 women--incidence, mode of presentation, therapy and follow-up
- 1991
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Ingår i: European Journal of Surgical Oncology. - 1532-2157. ; 17:5, s. 466-476
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Tidskriftsartikel (refereegranskat)abstract
- In the city of Malmo, in southern Sweden, 1693 women were diagnosed as having breast carcinoma during 1976 through 1984. Of these, 167 women had pure in situ breast carcinoma (9.9%). One hundred and thirty-two had ductal carcinoma in situ (DCIS) alone or in combination with lobular carcinoma in situ (LCIS), intracystic carcinoma and/or Paget's disease of the nipple. Thirty-three had pure LCIS and two had pure intracystic carcinomas. The incidence of breast carcinoma in situ (CIS) in women 20 years of age or older was 18.7 per 10(5) woman years with high rates of DCIS for all ages above 40, whereas a decline in incidence rate was seen for LCIS in the postmenopausal age groups. The ratio of DCIS to LCIS was 4:1. Of the 132 patients with DCIS, 46% were asymptomatic and were diagnosed by mammography, 35% presented with clinical symptoms, and 19% of the cases were incidental findings in breasts operated on for benign lesions. Mammography had been performed on all patients with DCIS and contributed to diagnosis in 75%. Sixty-one per cent of all DCIS lesions had microcalcifications suspicious for carcinoma. Eighty-nine of 132 patients with DCIS underwent fine-needle aspiration biopsy (FNAB) before surgical biopsy. FNAB was suspicious or diagnostic for carcinoma in 57/89 (64%). Of 33 cases with LCIS all but one were incidental findings. In one of 28 cases with LCIS examined by mammography there was suspicion of carcinoma. Sixteen per cent of the patients with DCIS were treated by a breast-conserving operation (BCO), the remaining patients by mastectomy (ME) (52%) or subcutaneous mastectomy (SCM) (33%) with immediate reconstruction. Thirty-three per cent of the patients with LCIS were treated by BCO, the remaining patients by ME (18%) or SCM (49%) with immediate reconstruction. Only one patient had radiotherapy postoperatively. In 60% of all CIS cases where an excisional biopsy had been performed there were further foci of CIS in the final ME/SCM specimen. After a median follow-up of 7 years for the DCIS group, three patients out of 21 treated by BCO had invasive carcinoma appearing ipsilaterally. They were alive and without symptoms of recurrent disease 2.5 to 6 years following further surgery. One patient treated by SCM died from generalized ductal breast carcinoma. In the LCIS group (median follow-up 8 years) one patient out of 11 had an invasive tubular carcinoma diagnosed 4 years after BCO. Eight years later she was alive and well after bilateral SCM.
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| 3. |
- Ringberg, Anita
(författare)
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Subcutaneous mastectomy – surgical techniques and complications in 176 women
- 1990
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Ingår i: European Journal of Plastic Surgery. - 0930-343X. ; 13:1, s. 7-15
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Tidskriftsartikel (refereegranskat)abstract
- Since the 1960's, subcutaneous mastectomy (SCM) and reconstruction with an implant has been used to treat recurrent benign breast tumors and in situ breast carcinomas. It has also been used as a prophylactic operation in women with a high risk of developing breast carcinoma and to achieve symmetry following breast reconstruction. Reports on surgical complications have been discordant. Recent prospective studies have revealed negative psychosocial effects. Therefore, a retrospective analysis of the techniques used and early and late complications in the first 176 SCM performed from 1968 to 1981 was performed. Necrosis of the skin or nipple-areolar complex left persistent scar deformities in most patients. Necrosis over a submuscular implant never led to implant loss, in contrast to several subcutaneous implants. Smoking was associated with an increased frequency of necrosis. Infection of the implant pocket resulted in removal of 75% of the implants. The most common complication was capsular contracture (CC), this was less frequent with submuscular implants — no causative factor was found in this study. Indentation tonometry was found to be a useful means to quantify CC. Although results have improved and complications decreased during the period studied, SCM is still an operation that should be performed only with well defined indications.
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