Prerequisites for histopathological evaluation of reduction mammoplasty specimens: Recommendations based on an audit in a tertiary care hospital

Objective: To recommend prerequisites for the histo-pathological evaluation of reduction mammoplasty [RM] specimens based on an audit in a tertiary care hospital

Methods: All reduction mammoplasty specimens received at department of pathology, in a tertiary care hospital over a 3 years period were re-evaluated retrospectively. Medical records were checked for age, family history of breast cancer, indication for surgery and radiological evaluation. Pathology reports were reviewed for number of blocks sampled and diagnosis. A prerequisites protocol was developed based upon deficiencies and impediments noted

Results: We received a total of 26 cases of reduction mammoplasty. Only 2 [7.69%] specimens were from males. The age of the patients ranged from 26 to 50 years. Indication for surgery was provided in all [100%] of cases, with macromastia being most prevalent indication. Family history of breast carcinoma and radiological evidence was absent or not provided in all cases. The number of blocks prepared were in range of <4 in 17 [73.91%], 5-8 blocks in 5 [19.23%] and 8-12 blocks in 4 cases [15.38%]. The main histopathological finding was fibrocystic change, [n = 12, 46.15%]. Specimen radiography was not conducted in any case

Conclusion: There is a need to stratify RM cases as high, moderate and low risk of breast cancer based on family history of breast carcinoma, clinical and radiological evaluation. The high risk cases should be oriented, with margins inked and extensive sampling done. Specimen radiography should be carried out in younger patients in which mammography is not recommended

Recurrent laryngeal nerve injury in thyroid surgery

Vocal cord paresis or paralysis due to iatrogenic injury of the recurrent laryngeal nerve [RLNI] is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerve injury, still the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The aim of the present study is to assess the risk factors of recurrent laryngeal nerve injury during thyroid surgery. Patients who had thyroid surgery between 1990 and 2005 and were admitted to the surgical department of King Fahd hospital of the University, Al-Khobar, Saudi Arabia were enrolled for this retrospective review, Factors predisposing to recurrent laryngeal nerve injury were evaluated such as pathology of the lesions and the type of operations and identification of recurrent laryngeal nerve intra-operatively. Preoperative and postoperative indirect laryngoscopic examinations were performed for all patients. 340 patients were included in this study. Transient unilateral vocal cord problems occurred in 11 [3.2%] cases, and in 1 [0.3%] case, it became permanent [post Rt. Hemithyroidectomy]. Bilateral vocal cord problems occurred in 2 cases [0.58%], but none became permanent. There were significant increases in the incidence of recurrent laryngeal nerve injury in secondary operation [21.7% in secondary vs. 2.8% in primary, p=0.001], total/near total thyroidectomy [7.2% in total vs. 1.9% in subtotal, p=0.024], non-identification of RLN during surgery [7.6% in non-identification vs. 2.6% in identification, p=0.039] and in malignant disease [12.8% in malignant vs. 2.9% in benign, p=0.004]. However, there was no significant difference in the incidence of recurrent laryngeal nerve injury with regards to gender [4.1% in male vs 3.8% in female, p=0.849]. The present study showed that thyroid carcinoma, re-operation for recurrent goiter, non-identification of RLN and total thyroidectomy were associated with a significantly increased risk of operative recurrent laryngeal nerve injury