Ultrasound accuracy in determining the tumor depth for boost field radiotherapy in breast cancer in comparison with CT scan plus clips

Background: There are miscellaneous methods of boost field determination with different levels of accuracy. One of the important parameters in boost field planning is the tumor bed depth, as it is important for determining electron energy

Objectives: The purpose of present research was the determination of ultrasound accuracy to estimate the appropriate depth for the tumor bed

Patients and Methods: Patients who were undergone breast conservative surgery with placing of 5 clips in the tumor bed [lower, upper, medial, lateral, and posterior] were included. The depth and location of the tumor bed were determined using ultrasonography. The optimum field boost was planned with an appropriate 2.5 cm margin. After putting the marker on the field boost, the CT simulation was done and then the obtained depth of the ultrasound report and that of the CT scan-clips were compared

Results: Twenty five patients were included. The average depth reported by the ultrasound was about 18 mm +/- 3 mm [range 10-26 mm], and the average obtained from the CT scan-clips was about 48 mm +/- 13 mm [range 24-80 mm], [P Value = 0.001]. In almost all cases, the depth obtained from the ultrasound was less than that obtained from the CT scan- clips

Conclusions: Ultrasound is not an accurate method to determine the appropriate depth and field for determination of breast field boost. Thus, it is better not to use ultrasound to estimate the tumor cavity depth; the CT scan images with surgical clips should be used instead

Role of capitonage and fibrin sealant in reducing seroma formation after breast conservation surgery: a randomized clinical trial

Seroma formation is a common complication after breast cancer surgery. Several techniques such as tube drainage, fibrin sealant and suturing methods have been employed to prevent or reduce seroma formation. Capitonnage, a suturing method widely used following hydatid cyst removal, has been used after breast surgery in limited studies. Our aim was to compare the effectiveness of tube drainage, fibrin sealant and capitonnage to prevent early complications. Eligible patients with breast cancer who were candidate for breast conserving surgery were enrolled and randomized into three different groups [tube drainage, capitonnage, capitonnage plus fibrin sealant]. Patients were visited on 5[th],12[th] and 19[th] days after surgery and were assessed for any probable complications. A total of 90 patients were enrolled. One patient developed seroma in tube drainage and capitonnage group, while no participant from capitonnage plus fibrin sealant group experienced the mentioned complication. Three patients developed skin necrosis, all of them were treated with capitonnage plus fibrin sealant protocol. Based on our observations, it seems that capitonnage alone or in combination with fibrin sealant do not lead to significant differences in frequency of complications after breast cancer surgery such as hematoma, seroma and surgical site infection

Religious, cultural, and social beliefs of Iranian rural women about breast cancer: a qualitative study

Background: The purpose of this study was to examine religious, cultural, and social beliefs of healthy women about breast cancer in rural settings in Iran. Methods: In the present study, 16 in-depth interviews with health care leaders, social and religious experts and 11 focus group discussions were conducted with 79 women in the rural areas near the capital city of Tehran, Iran. Grounded theory model was used to analyze the data. Results: Some women believed that religious customs and rituals, such as praying, taking a vow, or going on a pilgrimage to a holy place, might have healing effects if performed in addition to seeking medical care medical care. Many believed that God intervenes in the entire course of any illness, from occurrence to cure. Although few had fatalistic views toward cancer, the majority believed that patients could try to change their destiny. With respect to the relationship between moral behavior and disease, 4 types of opinions were identified; good people suffer, evil people get punished, evil people do not suffer, and everything has a scientific explanation. Participants believed that self-perception, their husbands, deficiencies in the health care system, and financial concerns influence breast cancer outcome. Conclusions: Our study showed that many participants were not aware of any available support in the healthcare system. They generally believed in the healing effect of prayers, only when it is sought in parallel with medical care

Predictors of sentinel node involvement in breast cancer

Background: Sentinel lymph node biopsy has shown to be a good alternative procedure for axillary lymph node dissection and to lead to lower frequency of morbidity, though this technique has its own side effects. It needs especial equipment and may not be available in some medical centers, especially in developing countries. This study aimed to identify a subgroup of patients with higher probability of metastasis to sentinel lymph node that can be excluded from indications of this procedure. Methods: In this cross-sectional study, the clinical data of 195 patients with breast cancer who underwent sentinel lymph node biopsy in Tehran, Iran, between 2009 and 2011 were reviewed. Whenever tumor features showed significant association with sentinel node metastasis in univariate analyses, logistic regression was used to identify independent predictors. Results: Univariate analyses revealed that tumor size and lymphovascular invasion have significant association with sentinel lymph node metastasis [P = 0.009 and P < 0.001, respectively]. Moreover, age had an significant association with positive sentinel lymph node biopsy [SLNB] [P = 0.004]. Other factors, including tumor grade, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2, were not associated with positive sentinel lymph node biopsy in univariate analysis. All factors that showed significant association in univariate analysis remained statistically significant predictors of positive SLB in multivariate analysis. Conclusions: It seems that young breast cancer patients, those who have tumors larger than 5 cm and those with lymphovascular invasion, are at an increased risk of sentinel lymph node metastasis

Variation of ATM gene expression in peripheral blood cells of sporadic breast carcinomas in Iranian patients

The ataxia telangiectasia mutated gene [ATM], candidate for breast cancer susceptibility gene, encode a 350-kDa protein belongs to the core components of DNA-damage response machinery. Female AT carriers have at least 5-fold increase risk for breast cancer. Reduction in ATM expression is shown in multiple studies in breast tissues. We aimed to perform a research to measure the ATM mRNA expression in peripheral blood cells in breast cancer patients. Peripheral blood sample from 40 newly diagnosed, histologically confirmed female breast cancer patients was collected before surgery. Total RNA was isolated from blood cells using the RNX-Plus solution and reverse transcribed into cDNA. Real-time PCR was performed using the 2-delta delta CT method to calculate relative changes in gene expression by REST software. The Relative Quantitation [RQ] mean was 1.27 with the min. and max. equal to 0.20 and 3.34, respectively. Calculation of patient frequencies in different groups revealed that 17.5% had reduced expression lower than two fold decreases and 15% high expression more than two fold increases, but according to REST software there was no up-regulation or down-regulation compared to normal females. The findings of multiple studies consistent with this study indicate that the ATM gene may play an important role in breast cancer development and progression, and ATM expression is down-regulated in breast cancer tissues. Although, some of the results do not support a suppressor role for ATM in the development of sporadic breast cancer, 17.5% of our patients had under expression of ATM mRNA less than two fold relative to control

[Ranking of Imam Khomeini educational hospital wards]

Objective: The aims of this study are scoring the educational wards of Imam Hospital complex, comparison of different wards according to educational, research and treatment scores and finally improvement of hospital's curriculum

Methods: For assessing the educational performance a questionnaire was filled by the wards' directors. Another questionnaire was filled by faculty members in order to evaluating the research situation of the ward. Customers' satisfaction was assessed through questionnaires which were filled by residents, interns, students and patients. Data were analyzed using SPSS-13

Results: In educational sector, pediatric ward has the first rank, infection ward the second rank. In the research sector infection ward the first and the pediatric ward have the second rank. Training customers have the most satisfaction of general ward and Patient had more satisfaction of surgery ward [3 and 4 surgery ward].With 47% score to training sector, 28% to research sector and 25%to satisfaction, the infection ward has the first rank, pediatric ward second rank and orthopedic ward the third rank of Imam Khomeini complex

Conclusion: In Imam Khomeini complex survey of wards ranking, the infection ward has the first rank pediatric ward second rank and orthopedic ward the third rank in overall survey