Ability of clinical nodal staging to predict histologic nodal status in breast cancer patients.

Axillary lymph node metastasis is the most important prognostic factor for breast cancer. Pathologic examination of axillary lymph node dissection specimens is the gold standard for determining if the tumour has metastasized. Clinical nodal staging may help the physician to plan for management and to decide what advice to give the breast cancer patients. We studied the metastasis predictive ability of clinical lymph node staging, and tried to identify subgroups that were more reliable for clinical staging. Patients and Methods: We did a cross-sectional study by collecting the data of patients who had their breast cancers treated at Siriraj Hospital from 1983 to 1993. The lymph node status from preoperative physical examination was compared to the pathologic result of axillary lymph node dissections. Results: Of 1,355 breast cancer patients, 4 patients were stage 0, 224 were stage I, 891 were stage II, 161 were stage III, and 40 patients were stage IV (with 35 missing). Mean diameter of the cancer was 3.6 cm. The average age at diagnosis was 48.5 years. Fifty one percent (697 patients) had at least one palpable node from preoperative physical examination, and 50% of cases (678 patients) had pathologic axillary lymph node positive for metastasis. When compared to pathologic examination, the accuracy of clinical lymph node staging was 70.6%, with 70% sensitivity and 71% specificity. The accuracy was increased in patients with small (T1) or large primary tumor (T3,4) subgroups. Conclusion: Physical examination of axillary lymph node could be used as a guide for predicting metastasis of breast cancer, but with 25-30% of uncertainty.

Surgical treatment of phyllodes tumour of the breast in Siriraj Hospital.

The authors studied retrospectively the surgical treatment of phyllodes tumour of the breast patients between 1989-1994 in the Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University. 24 patients were found. Their ages ranged from 18-60 years (mean 40 years). 17 patients were single and 7 patients were married. The pathological diagnoses of the growths were 15 benigns, 6 borderline malignants and 3 malignants. The size clinically were 1.5 to 30 cm (mean 10.7 cm.) and pathologically were 2 to 48 cm. (mean 10.98 cm.). 7 patients (29.17%) suffered recurrence of the growths. The time that the breast masses were detected before coming to the hospital ranged from 1 to 36 months (mean 7 months). The follow-up period ranged from 4 to 71 months (mean 17 months). The latest surgical procedures were 12 excisions, 7 simple mastectomies 2 subcutaneous mastectomies, 2 modified radical mastectomies, and 1 extended radical mastectomy.

Bloody and serosanguineous nipple discharge.

Spontaneous bloody and serosanguineous nipple discharge is not only a relatively uncommon condition but also an alarming experience for women who suffer it. The objective of this study is to find the underlying causes, clinical pattern and proper management for the individual patient. From 1986 to June 1993 at the Department of Surgery, Siriraj Hospital, 32 cases were identified from the surgical records. All were female who had nonlactational, solitary, unilateral and spontaneous bloody or serosanguineous nipple discharge. Their ages ranged from 16 to 76 years with a mean age of 42 years. 11 of the 32 cases also had an associated definite breast mass and 2 had a subareolar induration. All but one were surgically treated by microdochectomy, segmental resection, excisional biopsy of the mass, and frozen section with mastectomy in 18, 6, 5 and 2 cases respectively. Intraductal papilloma or papillomatosis was the leading underlying cause followed by invasive ductal carcinoma which was found in 9 cases or 28% of the series. The malignant patents tended to be older and almost always had an associated breast mass on physical examination (8 in 9 cases). The risk of malignancy for the associated definite breast mass was statistically significant. Therefore, to eradicate the bleeding and establish a pathological diagnosis, all patients should be treated surgically regardless of the results of investigations. And those who have an associated definite breast mass should be considered to have a malignant growth until proved otherwise.