ABSTRACT
Molecular diagnostic methods have played and continuing to have a critical role in clinical laboratories in recent years. Therefore, standardization is an evolutionary process that needs to be upgrade with increasing scientific knowledge, improvement of the instruments and techniques. The aim of this study was to design a quality assurance program in order to have similar conditions for all medical laboratories engaging with molecular tests. We had to design a plan for all four elements; required space conditions, equipments, training, and basic guidelines. Necessary guidelines was prepared and confirmed by the launched specific committee at the Health Reference Laboratory. Several workshops were also held for medical laboratories directors and staffs, quality control manager of molecular companies, directors and nominees from universities. Accreditation of equipments and molecular material was followed parallel with rest of program. Now we are going to accredit medical laboratories and to evaluate the success of the program. Accreditation of medical laboratory will be succeeding if its basic elements are provided in advance. Professional practice guidelines, holding training and performing accreditation the molecular materials and equipments ensured us that laboratories are aware of best practices, proper interpretation, limitations of techniques, and technical issues. Now, active external auditing can improve the applied laboratory conditions toward the defined standard level
ABSTRACT
Breast conserving surgery [BCS] followed by local radiotherapy is the standard treatment for early stage of breast cancer. Margin status may have an important impact on local recurrence and overall survival of patients treated with BCS, but this has not been defined adequately. In this study, we investigated the relationship between microscopic margins and outcome of BCS. Three hundred eighty four patients treated with BCS between 1999 and 2010 were included in our study. All surgeries were performed by a single surgical team. Margins were defined as close if surgical margins were less than 2 mm, as free if surgical margins were more than 2 mm and as positive if malignant cells were present in one of the tissue edges. Demographic, clinical, and pathological factors as well as biological markers, recurrence, and survival rates were compared between the close and the free margins groups. The mean age of patients at the time of diagnosis was 54.2 years. There were 34 [9%] recurrence cases and overall survival was 128.7 months and ten years survival rate was 81%. There was no significant difference between the close and the free margins groups in terms of demographic parameters, tumor characteristics, biological factors [estrogen and progesterone receptor status] and lymphovascular invasion. Also recurrence rate did not differ significantly between these two groups. Our study indicates that there is no significant difference between the patients with close and the free margins in terms of treatment results. There is no clear consensus in the surgeons' community over the definition of acceptable margin width in BCS, so additional studies are required to find the right answer
ABSTRACT
Breast carcinoma is the first malignancy among Iranian ladies and the second cause of death due to cancers after gastric carcinoma. According to the World Health Organization the annual incidence rate of breast cancer will rise 1.8 to 2 percent. It is one of the most important health problems. Five year survival is one of the indicators used for evaluation of the quality of care to different types of malignancies. In this study we decided to compare the result of mastectomy and breast conserving surgery in the survival of patients with breast carcinoma. This is a retrospective study using data from breast carcinoma cases in a private clinic under supervision of the author during years 1994 until 2007. These cases base on the clinical status underwent surgery as mastectomy or breast conserving with other necessary treatment. The number of patients with acceptable follow up was 464 cases that 441 were included to define survival. The data were analyzed by SPSS and survival estimated by Kaplan Mayer method. Survival curve was estimated for 441 cases of them, six cases were men and the age of patients was 22 to 104 years old with average of 53.24 years and standard deviation of 12.41. The most cases were among 45-55 years old. Five and ten years survival for all cases was 81% and 77% respectively. These data for mastectomies patients was 78 and 70 percent and for breast preserving cases was 86 and 78 percent which was not significant in log rank test with p-value equally 0.13. There was no significant difference between mastectomies patients versus breast preserving cases in all clinical stages although the crude data shows better situation in breast preserving surgery [BPS]. Breast cancer is one of the most important health problems, nowadays breast preserving surgery is choice treatment for stage I and II throughout the world. In this study overall 5 years survival was 81% comparable with developed countries with different health delivery system and quality of care and it is much better than other reports from Iran, regional and comparable countries. Because of many reasons such as physical, social and psychological effect of BPS, we recommend it as the best choice for managing breast cancer patients in stage I and II and even III in clinically approved cases in Iran similar to other countries