Objective: To investigate inter-observer reproducibility in the pathologic diagnosis of breast intraductal proliferative lesions (BDPL).
Methods: Forty three BDPL patients were diagnosed by criterion of Page. Every specimen from each case was sorted randomly. All slides were classified as mild usual hyperplasia, moderate-severe usual hyperplasia, mild atypical hyperplasia, moderate-severe atypical hyperplasia, ductal carcinoma in situ, or ductal carcinoma in situ with invasion. Inter-observer agreement of the two groups was statistically analyzed using Kappa test. Then we compared all the diagnoses of individual pathologist with the consensus opinion confirmed by two breast pathologists to analyze the diagnostic accuracy and undue diagnosis.
Results: Inter-observer reproducibility of the trial group was higher than that of the control group (The total K value of 6, 3, and 2 diagnoses in the two groups were 0.289 3, 0.337 1, 0.492 8, 0.100 3, 0.150 3 and 0.340 3, respectively). When the categories were simplified, inter-observer reproducibility increased. There were still undue diagnoses of different degrees among pathologists of the trial group.
Conclusion: Using the same criteria is an important method to increase the diagnostic reproducibility and accuracy. More practice is needed to familiarize with these criteria.
from:http://www.cjebm.org.cn/oa/DArticle.aspx?type=view&id=041106
Tuesday, 28 October 2008
Clinical Value of Serum Tumor Markers in Monitoring Patients with Recrudescent and Metastatic Breast Cancer
Objective: To study the usefulness of combined detection of 4 tumor markers in patients with recrudescent and metastatic breast cancer.
Methods: The serum levels of CA153, CEA, TPS and CA125 were determined by chemiluminescence immunoassay. A total of 1245 subjects entered the study. Sensitivities of the tests were evaluated in 1 000 patients with breast cancer (102 preoperative patients and 898 postoperative patients) and 245 with benign breast disease.
Results: The serum levels of CA153, CEA and TPS were significantly elevated in preoperative patients compared with metastatic patients (P<0.001). The serum levels of CA153, CEA, TPS and CA125 were significantly elevated in metastatic patients compared with non-metastatic patients (P<0.001). The sensitivity of the 4 tumor markers were significantly elevated in metastatic patients compared with preoperative and postoperative non-metastatic patients (P<0.05). The sensitivity of combined detection of the 4 tumor markers were 56.72% and 94.68% in preoperative patients and metastatic patients, respectively. The CEA elevation was strongly correlated with CA153 and TPS levels (all P=0.000 1, r=0.410 and 0.396, respectively).
Conclusion: Combined detection of the 4 tumor markers may play a guiding role in post-therapeutic monitoring of breast cancer in progressive, recrudescent and metastatic patients.
Methods: The serum levels of CA153, CEA, TPS and CA125 were determined by chemiluminescence immunoassay. A total of 1245 subjects entered the study. Sensitivities of the tests were evaluated in 1 000 patients with breast cancer (102 preoperative patients and 898 postoperative patients) and 245 with benign breast disease.
Results: The serum levels of CA153, CEA and TPS were significantly elevated in preoperative patients compared with metastatic patients (P<0.001). The serum levels of CA153, CEA, TPS and CA125 were significantly elevated in metastatic patients compared with non-metastatic patients (P<0.001). The sensitivity of the 4 tumor markers were significantly elevated in metastatic patients compared with preoperative and postoperative non-metastatic patients (P<0.05). The sensitivity of combined detection of the 4 tumor markers were 56.72% and 94.68% in preoperative patients and metastatic patients, respectively. The CEA elevation was strongly correlated with CA153 and TPS levels (all P=0.000 1, r=0.410 and 0.396, respectively).
Conclusion: Combined detection of the 4 tumor markers may play a guiding role in post-therapeutic monitoring of breast cancer in progressive, recrudescent and metastatic patients.
Survey on the Influence of Pain on Quality of Life in Breast Cancer Patients
Objective: To identify the perception of pain among breast cancer patients and their quality of life, and to assess the influence of pain on their quality of life.
Methods: We did a cross-sectional study. A face-to-face survey was administered to 200 breast cancer patients, using two scales: Chinese Cancer Pain Assessment Tool (CCPAT) and European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire (Version 3) [EORTIC QLQ-C30].
Results: Among the 200 breast cancer patients, 84 suffered from pain, while 116 did not. In regard to quality of life, the scores of physical function, role function and social function were higher among women without pain than among those in the pain group (P<0.05). There were no significant differences in scores of emotional function, cognitive function and global quality of life between the two groups (P>0.05). There was a significant negative correlation between pain and quality of life in the pain group, the non-pain group and the whole sample (r= –0.731, P<0.001).
Conclusion: Pain has negative effects on physical function, role function and social function of breast cancer patients. The exacerbation of pain is associated with a decreased global quality of life for breast cancer patients.
Methods: We did a cross-sectional study. A face-to-face survey was administered to 200 breast cancer patients, using two scales: Chinese Cancer Pain Assessment Tool (CCPAT) and European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire (Version 3) [EORTIC QLQ-C30].
Results: Among the 200 breast cancer patients, 84 suffered from pain, while 116 did not. In regard to quality of life, the scores of physical function, role function and social function were higher among women without pain than among those in the pain group (P<0.05). There were no significant differences in scores of emotional function, cognitive function and global quality of life between the two groups (P>0.05). There was a significant negative correlation between pain and quality of life in the pain group, the non-pain group and the whole sample (r= –0.731, P<0.001).
Conclusion: Pain has negative effects on physical function, role function and social function of breast cancer patients. The exacerbation of pain is associated with a decreased global quality of life for breast cancer patients.
Breast Conserving Therapy after Neoadjuvant Chemotherapy in Operable Breast Cancer Patients: A Systematic Review
Objective: To evaluate the effect of neoadjuvant chemotherapy (NAC) on breast conserving surgery and the outcomes of treatment for women with operable breast cancer.
Methods: We searched The Cochrane Library (Issue 1, 2007), CENTRAL (1970 to 2007), PUBMED (1978 to March 2007), CBM (1978 to 2006), CNKI (1994 to 2007), CMCC (1994 to May 2007) and other relevant databases and journals. We identified randomized controlled trials (RCTs) comparing NAC plus breast conserving therapy (BCT) or mastectomy versus BCT or mastectomy plus postoperative chemotherapy in women with operable breast cancer. Two reviewers independently assessed trial quality and extracted data. Meta-analyses were performed for homogenous studies by using The Cochrane Collaboration’s RevMan 4.2.10.
Results Three eligible studies involving 2?391 women were included. The median follow-up in the studies ranged from 17 to 137 months. The methodological quality of the three RCTs was high. Meta-analyses showed that NAC had no significant effect on overall survival (OS) (RR 0.99, 95%CI 0.92 to 1.07), disease-free survival (RR 1.04, 95%CI 0.94 to 1.15) and ipsilateral breast cancer recurrence (RR 1.34, 95%CI 0.84 to 2.13). Two RCTs revealed that NAC significantly increased the rate of BCT in operable breast cancer patients, but the other RCT reported similar rates of BCT in both groups. One RCT indicated that NAC did not increase the incidence of surgery-related local complications.
Conclusions: NAC is safe for the treatment of women with operable breast cancer, which may increase the rate of BCT and help to evaluate chemosensitivity. There is insufficient evidence to assess the effect of NAC on conserving surgery procedure and survival rate in operable BCT patients. More large-scale RCTs are needed to define further the role of NAC in the treatment of operable breast cancer patients.
Methods: We searched The Cochrane Library (Issue 1, 2007), CENTRAL (1970 to 2007), PUBMED (1978 to March 2007), CBM (1978 to 2006), CNKI (1994 to 2007), CMCC (1994 to May 2007) and other relevant databases and journals. We identified randomized controlled trials (RCTs) comparing NAC plus breast conserving therapy (BCT) or mastectomy versus BCT or mastectomy plus postoperative chemotherapy in women with operable breast cancer. Two reviewers independently assessed trial quality and extracted data. Meta-analyses were performed for homogenous studies by using The Cochrane Collaboration’s RevMan 4.2.10.
Results Three eligible studies involving 2?391 women were included. The median follow-up in the studies ranged from 17 to 137 months. The methodological quality of the three RCTs was high. Meta-analyses showed that NAC had no significant effect on overall survival (OS) (RR 0.99, 95%CI 0.92 to 1.07), disease-free survival (RR 1.04, 95%CI 0.94 to 1.15) and ipsilateral breast cancer recurrence (RR 1.34, 95%CI 0.84 to 2.13). Two RCTs revealed that NAC significantly increased the rate of BCT in operable breast cancer patients, but the other RCT reported similar rates of BCT in both groups. One RCT indicated that NAC did not increase the incidence of surgery-related local complications.
Conclusions: NAC is safe for the treatment of women with operable breast cancer, which may increase the rate of BCT and help to evaluate chemosensitivity. There is insufficient evidence to assess the effect of NAC on conserving surgery procedure and survival rate in operable BCT patients. More large-scale RCTs are needed to define further the role of NAC in the treatment of operable breast cancer patients.
A Survey on Correlative Symptoms and Its Influence on Quality of Life in Breast Cancer Patients
Objective: To identify the correlative symptoms of breast cancer patients and their influence on quality of life.
Methods :The cross-sectional study was used. A face-to-face survey was administered to 200 breast cancer patients, using two scales: ① Memorial Symptom Assessment Scale(MSA); ② European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire (Version 3) [EORTIC QLQ-C30].
Results The top five most highly prevalent symptoms were: lack of energy, hair loss, nervousness, sweating and worry. The five most frequent symptoms were: lack of energy, difficulty in sleeping, dry mouth, lack of appetite and sweating. The five most severe symptoms were: hair loss, lack of energy, difficulty in sleeping, nervousness and a change in food preference. The top five symptoms causing much distress were: hair loss, a feeling of“I don’t look like myself”, difficulty in sleeping, lack of appetite and lack of energy. The major factors influencing quality of life were: lack of energy, worry, pain, difficulty in sleeping, constipation, irritability, dry mouth, sweating, numbness/tingling in hands/feet, changes in skin, diarrhea, nausea, lack of appetite, and shortness of breath. Adjusted R square was 0.790.
Conclusions :The most conspicuous symptom in breast cancer patients is lack of energy. The symptom that distresses patients most is hair loss. The other notable symptoms are: “I don’t look like myself”, difficulty in sleeping, and lack of appetite. In addition, the quality of life is influenced by fourteen symptoms, and these symptoms account for 79.0% of the variance in quality of life.
Methods :The cross-sectional study was used. A face-to-face survey was administered to 200 breast cancer patients, using two scales: ① Memorial Symptom Assessment Scale(MSA); ② European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire (Version 3) [EORTIC QLQ-C30].
Results The top five most highly prevalent symptoms were: lack of energy, hair loss, nervousness, sweating and worry. The five most frequent symptoms were: lack of energy, difficulty in sleeping, dry mouth, lack of appetite and sweating. The five most severe symptoms were: hair loss, lack of energy, difficulty in sleeping, nervousness and a change in food preference. The top five symptoms causing much distress were: hair loss, a feeling of“I don’t look like myself”, difficulty in sleeping, lack of appetite and lack of energy. The major factors influencing quality of life were: lack of energy, worry, pain, difficulty in sleeping, constipation, irritability, dry mouth, sweating, numbness/tingling in hands/feet, changes in skin, diarrhea, nausea, lack of appetite, and shortness of breath. Adjusted R square was 0.790.
Conclusions :The most conspicuous symptom in breast cancer patients is lack of energy. The symptom that distresses patients most is hair loss. The other notable symptoms are: “I don’t look like myself”, difficulty in sleeping, and lack of appetite. In addition, the quality of life is influenced by fourteen symptoms, and these symptoms account for 79.0% of the variance in quality of life.
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