ABSTRACT
Breast carcinoma is most'y diagnosed beyond stage I in Egyptian patients. Here, we evakiate the use of preoperative ultrasonography to predict axillary lymph nodes involvement. We speculate that preoperative ultrasonographic evaluation may be of paramount importance in the era of sentinel node biopsy. Consecutive 110 clinically node-negative breast carcinomas were ultrasonographically examined for axillary nodes using 10 MHz linear transducer The images were recorded for analysis. Descriptive statistics of morphologic features of the examined lymph node in relation to final pathology were performed. Mean age was 47.5 years. Axillary lymph nodes were pathologically invaded in 80 patients [72.7%] with an average infiltration of 4.2 nodes per axilla. Compared to pathologic find ings, gray sca'e ultrasonography was highly significant in differentiating malignant from benign tumors [p<0.001], Gray sca'e examination had a sensitivity for detecting nodal metastases of 85.0%, specificity of 63.3% and overall accuracy of 79.1%. Surgeon-performed axillary ultrasonography is a helpful adjunct to clinical examination to improve preoperative staging in clinically node negative breast cancer especially in larger-sized tumors. However if sonography is negative sentinel node biopsy should be done due to considerable percentage of false negative results
Subject(s)
Humans , Female , Axilla/diagnostic imaging , Sentinel Lymph Node Biopsy , Preoperative PeriodABSTRACT
Background: Although radiotherapy is very effective in reducing pain in painful bone metastases, the optimum dose and fractionation schedule for the palliative irradiation of painful bone metastases is controversial. Also, the optimal dose for preventing fractures remains unknown, but a clear relationship exists between reduced bone density and increased fracture risk
Objectives: To compare the efficacy and side effects as well as re-treatment and pathological fracture rates in single fraction versus multiple fractions radiotherapy in the treatment of painful bone metastases. In addition, evaluation of the degree of re-mineralization resulting from palliative radiotherapy using computed tomography bone density measurements in osteolytic bone metastases
Methods: One hundred and fifty patients with painful bone metastases requiring palliative radiotherapy were included into a prospective randomized clinical trial comparing 8 Gy single fraction with multi-fraction regimens [20 Gy/5 fractions or 30 Gy/10fractions]. The primary endpoint of treatment benefit was pain relief However the secondary endpoint of treatment was to compare the short term side effects of both radiotherapy schedules as well as to estimate the effect of radiotherapy on re-treatment and pathological fracture rates. Only thirty patients with osteolytic bone metastases had computed tomography bone density before and 3-months after palliative radiotherapy
Results: The overall survival at 12 months was 38% with no statistically significant difference apparent between randomized groups [[P=0.284]. The overall pain-response rates for single fraction radiotherapy and multifraction radiotherapy were 78% and 79%, respectively, giving an odds ratio [OR] of 1.06] [[ 95% confidence interval [CI] of 0.465-2.149], [P=0.888]], indicating no difference between the two radiotherapy schedules. There was also no dWerence in complete pain response rates for single fraction radiotherapy 34% and multifraction radiotherapy 32%, with an OR of 0.913 [[ 95% CI of 0.44-1.87], [P=0.806]]. Patients treated by single fraction radiotherapy had a higher re-treatment rate 22% compared with 7% of patients in the multi-fraction radiotherapy group with an OR of 0.267 [ [ 95 % CI of 0. 096-0.739], [P=0.008]]. The pathologicalfractare rate was also higher in single fraction radiotherapy group 6% compared with 2% for those treated by multi-fraction radiotherapy with an OR of 0.158 [ [ 95% CI of 0.016-0.562], [P=0.043]]. The median % density change following single 8 Gy, 20 Gy /5 fractions and 30 Gy/10 fractions were: 105 [range 76-255], 128 [range 79-275] and 181 [range 67-342], respectively [P=0.049]. Moreover, the median % density change of complete responders was 243 [range 188-342], the partial responders was 128 [range 101-190] and in patients with progressive disease was 79 [range 67-95] [P=0.0001]. There is also statistically significant correlation between pathologicalfractures and the range of bone density before and 3-months after radiotherapy [P=0.001]
Conclusion: Single fraction radiotherapy was as effective as multi-fraction radiotherapy in relieving metastatic bone pain. However, the re-treatment and pathological fracture rates were higher after single fraction radiotherapy. The CT bone density measurements showed re-mineralization of osteolytic bone metastases after palliative radiotherapy Moreover, there is statistical correlation between dose fractionation schedules, response and pathological fracture with the range of bone density before and three months after radiotherapy