Abstract
Genetic abnormalities in cell proliferation-regulating genes have been described in premalignant lesions. The aims here were to evaluate c-myc protein expression in non-palpable breast lesions associated with microcalcifications, detected by screening mammography, and to compare these results with histopathological, clinical and epidemiological variables. Analytical cross-sectional study, with retrospective data collection, in a university hospital in São Paulo. Seventy-nine female patients who underwent routine mammography between 1998 and 2004 were studied. Lesions classified by the Breast Imaging Reporting and Data System (BI-RADS) as 4 or 5 underwent percutaneous biopsy using a large-core needle. Ninety-eight lesions were studied anatomopathologically. Paraffin blocks properly representing the lesions were selected for immunohistochemical analyses using the streptavidin-biotin-peroxidase technique with monoclonal mouse c-myc antibodies. Among the 98 lesions, 29 (29.6%) contained malignant neoplasia; 40 (40.8%) had a positive immunohistochemical reaction for c-myc. When the groups were divided between lesions without atypias versus atypical lesions plus malignant lesions, 31.03% of the 58 lesions without atypias were positive for c-myc and 55% of the 40 malignant and atypical lesions (P = 0.018). Comparing the atypical lesions with ductal carcinoma in situ versus the benign lesions without atypias, c-myc was present in 51.61% of the 31 atypical lesions and 31.03% of the benign lesions without atypias (P = 0.057). C-myc protein was more frequently expressed in atypical and malignant lesions than in benign lesions without atypias. C-myc expression correlated with the presence of atypias (P = 0.018).
Highlights
At present, the best screening method for breast cancer is routine annual mammography examinations for women over 40 years of age
The c-myc antigen was more frequently expressed in cases of invasive ductal carcinoma (IDC) and atypical ductal hyperplasia (ADH) (Table 1)
Comparing the atypia cases (ADH) with the benign cases, it was seen that negative findings for c-myc were predominant in the benign cases, and that this was statistically significant (P = 0.039; Table 2)
Summary
The best screening method for breast cancer is routine annual mammography examinations for women over 40 years of age. This has been correlated with a reduction of up to 30% in the mortality rates due to breast cancer, around the world. Screening using mammography is an extremely sensitive method for detecting both malignant and benign breast lesions, and the great majority of breast lesions seen on mammographs are non-palpable. 10 to 40% of biopsies on areas of microcalcifications find malignant lesions.[1,2,3,4] Precursor lesions or even minimally invasive lesions associated with these microcalcifications provide greater accuracy in identifying lesions at early stages. Microcalcifications have come to represent 15 to 20% of the breast radiographic abnormalities diagnosed in screening tests.[5,6,7]
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