Sentinel lymph node biopsy for risk-reducing mastectomy

Risk-reducing mastectomy (RRM) confers 90-95% decreased risk of breast cancer, and may reduce mortality, especially in high-risk groups such as BRCA carriers. Risk of occult disease in RRM specimen is ~5%. This demands axillary staging: sentinel lymph node (SLN) biopsy is no longer possible, axillary clearance confers significant risks and may prove negative. Contemporaneous SLN biopsy allows axillary staging with minimal further dissection. Women undergoing RRM and SLN biopsy between June 2005 and July 2010 were reviewed retrospectively from our prospectively maintained database of 1,522 SLN procedures in 1,498 patients. SLN(s) localized using routine tracer methods. SLNs and mastectomy specimens underwent routine histologic examination. Eighty-three RRMs with SLN biopsy were performed in 71 patients (12 bilateral). Indications for RRM: contralateral invasive (55), in situ (5) disease, BRCA 1/2 mutation (12), and strong family history (10). Mean number of SLNs: 1.35. Occult disease was detected in four cases (4.8%), with one case of occult invasive lobular carcinoma (1.2%). Remaining occult disease was lobular in situ neoplasia (LISN). SLNs were negative in all cases. Our findings are comparable to those in the literature: 4.8% rate of occult disease overall, 1.2% invasive. The significant risk with SLN biopsy is lymphoedema, quoted around 7%. We have had no reports of symptomatic lymphoedema in patients undergoing RRM and SLN biopsy. We propose that SLN at the time of mastectomy requires only limited further dissection, and confers minimal risk compared with secondary axillary surgery.

Matrix metalloproteinase-8 functions as a metastasis suppressor through modulation of tumor cell adhesion and invasion

Collagenase-2 (matrix metalloproteinase-8, MMP-8) is an MMP mainly produced by neutrophils and associated with many inflammatory conditions. We have previously described that MMP-8 plays a protective role in cancer through its ability to regulate the inflammatory response induced by carcinogens. Moreover, it has been reported that experimental manipulation of the expression levels of this enzyme alters the metastatic behavior of human breast cancer cells. In this work, we have used mutant mice deficient in MMP-8 and syngenic melanoma and lung carcinoma tumor cells lines overexpressing this enzyme to further explore the putative antimetastatic potential of MMP-8. We report herein that MMP-8 prevents metastasis formation through the modulation of tumor cell adhesion and invasion. Thus, tumor cells overexpressing MMP-8 have an increased adhesion to extracellular matrix proteins, whereas their invasive ability through Matrigel is substantially reduced when compared with control cells. Analysis of MMP-8 in breast cancer patients revealed that the expression of this metalloproteinase by breast tumors correlates with a lower incidence of lymph node metastasis and confers good prognosis to these patients. On this basis, we propose that MMP-8 is a tumor protective factor, which also has the ability to reduce the metastatic potential of malignant cells in both mice and human.

Fine needle aspiration cytology as an adjunct to core biopsy in the assessment of symptomatic breast carcinoma

INTRODUCTION

Core biopsy (CB) has now largely replaced fine needle aspiration cytology (FNAC) in the pre-operative assessment of breast cancer. We studied the contribution of FNAC, when done as an adjunct to CB, in cancer patients presenting symptomatically.

PATIENTS

112 patients had both CB and FNAC pre-operatively and subsequently had surgery (wide local excision or mastectomy). CB & FNAC were done clinically in half the patients and under ultrasound guidance in the majority of others.

RESULTS

The complete sensitivity of FNAC was 90% and that of CB was 99%. Absolute sensitivity was 67% and 94%, respectively. CB was not suspicious of malignancy (B1) only in 1 patient in whom FNAC was suspicious (C3). In this patient there was a high degree of suspicion of breast cancer clinically & radiologically so a negative CB would not have been accepted even in the absence of FNAC.

CONCLUSIONS

FNAC, when performed in addition to CB, does not provide useful additional information in symptomatic breast cancer patients.

Bactofection of mammalian cells by Listeria monocytogenes: improvement and mechanism of DNA delivery

Bacteria-mediated transfer of plasmid DNA into mammalian cells (bactofection) is a potent approach to express plasmid-encoded heterologous proteins (protein antigens, toxins or enzymes) in a large set of different cell types including phagocytic and nonphagocytic mammalian cells. Previously, we have described a Listeria monocytogenes-mediated DNA delivery system, which releases plasmid DNA directly into the cytosol of mammalian cells by partial self-destruction of the carrier bacteria. Here we report on a second generation of this phage lysin supported bactofection system, which is greatly improved with respect to plasmid stability, transfer efficacy and biosafety. In this case, DNA release is initiated by spontaneous bacterial lysis in the infected cells cytosol which is subsequently enhanced by the simultaneously released phage lysin produced by the intracellular carrier bacteria. Bacteria that are capable of cell-to-cell spread are found to be much more efficient in bactofection than their non spreading counterparts.

Antibodies against listerial protein 60 act as an opsonin for phagocytosis of Listeria monocytogenes by human dendritic cells

Human-monocyte-derived dendritic cells (MoDC) are very efficient in the uptake of Listeria monocytogenes, a gram-positive bacterium which is an important pathogen in humans and animals causing systemic infections with symptoms such as septicemia and meningitis. In this work, we analyzed the influence of blood plasma on the internalization of L. monocytogenes into human MoDC and compared the uptake of L. monocytogenes with that of Salmonella enterica serovar Typhimurium and Yersinia enterocolitica. While human plasma did not significantly influence the uptake of serovar Typhimurium and Y. enterocolitica by human MoDC, the efficiency of the uptake of L. monocytogenes by these phagocytes was strongly enhanced by human plasma. In plasma-free medium the internalization of L. monocytogenes was very low, whereas the addition of pooled human immunoglobulins resulted in the internalization of these bacteria to a degree comparable to the highly efficient uptake observed with human plasma. All human plasma tested contained antibodies against the 60-kDa extracellular protein of L. monocytogenes (p60), and anti-p60 antibodies were also found in the commercially available pooled immunoglobulins. Strikingly, in contrast to L. monocytogenes wild type, an iap deletion mutant (totally deficient in p60) showed only a minor difference in the uptake by human MoDC in the presence or the absence of human plasma. These results support the assumption that antibodies against the listerial p60 protein may play an important role in Fc-receptor-mediated uptake of L. monocytogenes by human MoDC via opsonization of the bacteria. This process may have a major impact in preventing systemic infection in L. monocytogenes in immunocompetent humans.

[Scintigraphic assessment of function in renal dystopia]

In patients with renal dystopia radionuclide urography in commonly used technique may yield inaccurate results concerning split renal function. In a case of unilateral pelvic kidney a simple strategy to avoid this methodical error is demonstrated.

Strategies for sampling black and ethnic minority populations

BACKGROUND

The objective of the study was to describe the design and sampling methods used to carry out face-to-face interviews with a sample of the black and ethnic minority population of the area. This study was conducted in the city of Bristol, England (part of Bristol and District Health Authority).

METHODS

The sample was based on up to 1000 interviews with black Caribbean/African, South Asian and Far-East Asian residents. The design of the study focuses on the problems of definition of the appropriate group to sample and the various sampling techniques that were necessary to procure the interviews.

RESULTS

A total of 574 interviews were carried out by bilingual interviewers matched for sex and ethnicity of the respondent, thereby allowing analysis that would be beneficial to the Health Authority in its planning and decision-making.

CONCLUSIONS

The use of name spotting and 'snowball' sampling proved the most productive. The Electoral Register was preferred to the Family Health Services Authority lists. Interviewers must be carefully selected and adequately trained to work in this difficult area. The questionnaire must be culturally and linguistically acceptable across all the ethnic groups.

[The value of scintigraphic functional assessment in extreme hydronephrosis]

Renographic studies are occasionally suspected of overestimating the excretory function of obstructed kidneys. Presenting the case of a ten months old boy with obstruction of the ureterovesical junction and severe hydronephrosis, we discuss the validity of the assessment of renal function by radionuclide urography. Normal postoperative excretion as well as renographic controls confirmed the good relative function of the hydronephrotic kidney. Instead of nephrectomy a reconstructive operative procedure was employed.