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By J. Michael Dixon

Breast surgical procedure meets the wishes of surgeons in greater education and training specialists for a latest and evidence-based account of this sub-specialty that's correct to their common surgical perform. it's a functional reference resource incorporating the most up-tp-date details on contemporary advancements, administration concerns and operative systems. The textual content is carefully referenced and supported by way of evidence-based thoughts anyplace attainable, distinguishing among powerful facts to aid a end, and facts suggesting advice might be reached at the stability of chances.

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The latter depends on a number of intrinsic biological characteristics, some of which have already been evaluated, such as morphological features, growth rate and hormone responsiveness. Accurate prognostication is now required on an individual patient basis and this can only be achieved by using a Prognostic Index that includes both timedependent and biological factors. The best way to obtain such an index is to take potential factors that have been shown to have some value in univariate analysis and submit them to multivariate analysis.

104,114 In metastatic disease, expression patterns can be used to establish the origin of the metastatic lesion in patients with more than one primary. Transcription profiling has also been shown to differentiate accurately breast cancers with germ-line mutations in BRCA1/BRCA2 from those without such mutations. Such findings, if validated in other studies, open the way for molecular phenotyping in high-risk families. In addition, gene expression profiling has been used to develop expression predictors (class prediction studies) that can be used for many types of clinical management decisions, including risk assessment, diagnostic testing, prognostic stratification and treatment selection.

EGFR EGFR expression has been well studied in breast cancer. Consequent on major differences in study designs, the EGFR assay used and confounding ­factors such as adjuvant therapy, there is no consensus on its prognostic value. With the development of tyrosine kinase inhibitor (TKI)- and EGFR-directed biotherapies, there is now a growing impetus to not only standardise assays for detecting EGFR but also to delineate accurately its prognostic and predictive potential. Methods of testing Several techniques directed at DNA, RNA, protein (and functionally active (activated) as well) or serum can be employed to identify EGFR expression in breast cancer.

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