Nova Scotia Breast Screening Program experience: use of needle core biopsy in the diagnosis of screening-detected abnormalities

PURPOSE

To evaluate a mammography screening program that uses a multidisciplinary team approach and needle core biopsy.

MATERIALS AND METHODS

A total of 10,000 asymptomatic women (aged 40-74 years) underwent screening in the Nova Scotia Breast Screening Program between June 1991 and April 1994. Women aged 50-69 years were the target group. All mammograms were read by one of four radiologists. Patients with abnormal screening findings underwent work-up, which included needle core biopsy, at one of two diagnostic centers.

RESULTS

Of 10,000 women, 2,794 were aged 40-49 years; 4,097, 50-59 years; 2,941, 60-69 years; and 168, 70-74 years, with 3.9, 6.4, 12.2, and 23.8 cancers detected per 1,000 patients, respectively. The overall rate was 7.7 cancers detected per 1,000 patients. Abnormalities were detected at screening in 838 patients (8.4%), 181 of whom underwent open surgery, with malignancy diagnosed in 77 (42%). Sixty-one (79%) of 77 patients had stage 0 or I cancer. In 43 (72%) of 60 patients in whom node status was assessed, findings were negative.

CONCLUSION

A screening program with needle core biopsy and a multidisciplinary team approach to diagnosis is effective.

Phase II trial of 10-EDAM in advanced soft tissue sarcoma. A study of the Canadian Sarcoma Group and the National Cancer Institute of Canada Clinical Trials Group

BACKGROUND

Inoperable locally recurrent soft tissue sarcomas (STS) are incurable with chemotherapy. Therefore the National Cancer Institute of Canada Clinical Trials Group are performing phase II studies in an attempt to find better drugs.

PATIENTS AND METHODS

Thirty-one evaluable patients with incurable soft tissue sarcoma were treated with the antifol 10-EDAM at a dose of 80 mg per m2/week.

RESULTS

Mucositis was the most common toxicity. Only 41% of patients received > or = 90% of the planned dose time because of dose modification mainly for grade 1 mucositis. Two patients died after neutropenic episodes. Toxicity otherwise was generally mild (< grade 2). One patient had a pathologically confirmed complete response but relapsed after four months. Another had a partial response lasting 16 weeks. Eleven other patients had stabilization of disease.

CONCLUSIONS

In this study, 10-EDAM was not found to be an effective agent to treat advanced soft tissue sarcoma.

Auerbach's myenteric plexus. A possible site of origin for gastrointestinal stromal tumors in von Recklinghausen's neurofibromatosis

We present a case of multiple benign spindle cell tumors of the jejunum in a patient with von Recklinghausen's neurofibromatosis and describe the light-microscopic, immunohistochemical, and ultrastructural features of these lesions. Two small spindle cell nodules were located in the region of Auerbach's myenteric plexus and a third larger tumor produced a subserosal mass. The immunohistochemical profile of these tumors revealed that they were actin and S100-protein negative but positive for neuron-specific enolase. At the ultrastructural level, the tumors recapitulated features of Auerbach's plexus. These lesions are similar to previously described gastrointestinal autonomic nerve tumors, and we propose that this may be the site of origin of enteric stromal tumors in von Recklinghausen's neurofibromatosis.

Prognostic factors in colorectal carcinoma of young adults

To determine why the prognosis for colorectal cancer in young adults is poor, survival and prognostic factors in patients under 40 years of age were compared with those in patients between 40 and 50 years of age. In a 10-year period, 122 patients less than 50 years of age (88 between 40 and 50 years) presented at the Victoria General Hospital in Halifax, NS, with colorectal cancer. Their charts were retrospectively reviewed. Follow-up was obtained for all patients. Of the 34 patients younger than 40 years, 71% (24) were men compared with 38% (33) of older patients. Symptoms, their duration and the location of primary tumours were similar in the two groups. Patients younger than 40 years presented with advanced lesions (Dukes' stages C and D) in 67% of cases compared with 52% of the older group. Mucinous tumours were twice as common in patients less than 40 years old (p = 0.036) and actuarial survival rates were lower at all stages for the same group. The authors conclude that the poorer prognosis in patients less than 40 years of age is not due to late symptom reporting or delay in diagnosis, but to more aggressive disease.

Lomustine, vincristine, and procarbazine in the treatment of metastatic malignant melanoma

Sixty-five previously untreated patients with metastatic malignant melanoma were treated with lomustine, vincristine, and procarbazine. Sixty-four patients were evaluable for response, with a response rate of 13%. Only one complete response was observed, in a patient with nodal disease only. Three partial responses were observed in patients with disease confined to soft tissue, and four partial responses were observed in patients with pulmonary metastases. Median survival for all patients was 22 weeks. We conclude that this regimen offers no improvement compared to other drug combinations.

A phase II study of spirogermanium in patients with metastatic malignant melanoma. An NCI Canada Clinical Trials Group Study

The National Cancer Institute of Canada Clinical Trials Group conducted a phase II study of spirogermanium given daily for 5 days every 3 weeks to previously untreated patients with malignant melanoma. In 21 evaluable patients one complete response was seen (response rate 5%). Disease progression occurred in the other 20 patients. Toxicity was primarily neurologic and mild or moderate in most patients, though there was one treatment related death. In this schedule spirogermanium has extremely limited activity against malignant melanoma and will not contribute significantly to the systemic therapy of this disease.

Immunochemotherapy of malignant melanoma with chlorambucil-bound antimelanoma globulins: preliminary results in patients with disseminated disease

Thirteen consecutive patients with inoperable recurrent malignant melanoma were treated by immunochemotherapy with the use of chlorambucil noncovalently bound to goat or rabbit antihuman melanoma globulins. The next consecutive 11 patients fulfilling the criteria for admission into this study were treated with chemotherapy only, i.e., dimethyltriazenoimidazole carboxamide (DTIC). Follow-up was for a minimum of 29 months or until death. Two patients showing an objective response to immunochemotherapy had disease confined to lymph nodes and cutaneous sites; 5 others showed stabilization of cutaneous, nodal, and visceral disease, and 6 patients showed progression of their disease. The median survival of the responders and stabilizers was 20 months, but only 3.5 months for patients with disease progression. None of the 11 patients treated with DTIC had objective tumor regression, and all died within 11 months of the start of treatment with a median survival of 3 months. Immunochemotherapy significantly prolonged the survival compared to that in the DTIC-treated group (P less than 0.05). No hematologic or renal toxicity was detected after immunochemotherapy, but 2 patients in this group developed anaphylactic reactions. Skin reactivity tests to dinitrochlorobenzene and purified protein derivative were of no prognostic value

Immunochemotherapy of cancer with chlorambucil-carrying antibody

Cell-surface localizing heterologous antibodies against the mouse EL4 lymphoma and a human malignant melanoma could be bound to chlorambucil without causing the loss of the alkylating activity of chlorambucil or interfering with the reactivity of the antibodies with their respective tumour cells. When given to mice preinoculated with tumour cells 2, 24, 72, and 120 hours before the beginning of treatment the chlorambucil-bound antibody was a much more effective tumour inhibitor than chlorambucil or the antibody alone. In a patient with disseminated malignant melanoma injection of the chlorambucil-bound anti-melanoma antibody first locally into a few metastatic nodules and then by the intravenous route was followed by the regression of all the metastatic nodules.