The accuracy of combination ultrasound and fine needle aspiration biopsy in confirming malignancy in patients with clinically malignant breast masses seen at the breast center of Vicente Sotto Memorial Medical Center

Objectives: To determine if ultrasound can increase the accuracy of fine needle aspiration biopsy in confirming malignancy in clinically malignant breast masses. Methods: Clinically malignant breast masses underwent ultrasound, fine needle aspiration biopsy/cytology, and tissue biopsy. Accuracy of each test and in combination were calculated using histopathology as gold standard. Results: The accuracy of ultrasound alone was only 67.5% sensitivity of 90.0%, specificity of 33.3%, positive predictive value of 67.2% and negative predictive value of 68.8%, while FNAB alone has an accuracy of 89.2%, sensitivity of 90.0%, specificity of 87.9%, postive predictive value of 91.8%, and negative predictive value of 85.3%. With concordant findings in ultrasound and FNAB, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value are 94.3%, 97.6%, 81.8%, 95.3%, and 90%, respectively. Conclusion: With concordant findings in ultrasound and FNAB, accuracy in confirming malignancy is 94.3%. Key words: breast cancer, breast ultrasonography, fine needle aspiration biopsy/cytology

Treatment outcome of implementing "pain as the 5th vital sign" in the standard of care of pain management among patients admitted in the Department of General Surgery, Vicente Sotto Memorial Medical Center

OBJECTIVE: To determine the impact of monitoring pain as the 5th vital sign and the utilization of a protocolized analgesic regimen on pain treatment outcome among patients admitted in the Department of General Surgery. METHODS: Eight hundred fifty (850)admitted patients were included in the study. These were patients who underwent surgery (either trauma or non-trauma cases) and may or may not have had any complaint of pain magnitude. The Department's post operative analgesic regimen protocol (composed of tramadol and ketorolac combination)was followed. Pain scores were monitored every eight hours throughout the patient's hospitalization up to discharge and were documented on the new monitoring sheet of Vicente Sotto Memorial Medical Center. RESULTS: Of the 850 patients, 629 patients (74 percent) were non-trauma cases and 221 patients (26 percent) were trauma cases. On admission, 313 (51 percent) non-trauma patients and 171 (81 percent) trauma patients experienced severe pain. upon discharge, only 1 (0.6 percent) non-trauma patient continued to be suffering from severe pain and non from trauma cases. Five hundred five (80 percent) non-trauma patients and 140 (63 percent) trauma patients had mild pain, 114 (18 percent) non-trauma patients and 81 (37 percent) trauma patients were totally pain free. CONCLUSION: There was a significant reduction to pain from admission to discharge because patients were intervened appropriately of their respective symptoms by using proactive pain monitoring and providing analgesia using a protocolized analgesic regimen.

Clinical analysis of 1,393 females with mastalgia

To determine the clinical profile of benign and malignant mastalgia in terms of age distribution, geographic location, laterality, pain severity and pattern.METHOD: This is a 3-year (April 1,2001 until March 31, 2004) retrospective chart review of female patients presenting with mastalgia in a hospital-based government breast center at Vicente Sotto Memorial Medical Center, Cebu City. Malignant mastalgia was diagnosed based on histopathologic findings. Pain severity assessment was based on a numeric scale of 0 to 10. Exclusion criteria include patients without mastalgia as chief complaint, no histopathologic confirmation of malignancy and males. All statistical computations were done using Chi square test with a = 0.05.RESULTS: A total of 1237 patients (89 percent) had benign mastalgia with an average age of 29.72 +/- 10.96 years and 156 (11 percent) had malignant mastalgia with an average of 48.92 +/- 11.96 years. Patients less than 60 years of age had a statistically significant probability that their mastalgia is due to benign pathology (p CONCLUSION: Age above 60 years, right-sidedness and non-cyclical pain pattern are the only significant factors for differentiating whether the mastalgia is due to a benign or malignant etiology.

Clinical and demographic profile of male breast patients seen at Vicente Sotto Memorial Medical Center (VSMMC)

INTRODUCTION: Palpable breast tissue is so prevalent in studies of men and boys that some authors suggest differentiating it from clinically important gynecomastia. Understanding male breast problems present a great challenge to many physicians especially when there is no specific guidelines developed for men.OBJECTIVES: This study aims to determine the demographic and clinical profile of male patients with breast problems consulting at Vicente Sotto Memorial Medical Center.METHODOLOGY: This study is a review of 77 male patients seen at the breast center of Vicente Sotto Memorial Medical Center from April 1, 2001 to March 31, 2004. The clinical profile included the age, geographic origin, chief complaint, family history of breast cancer, clinical breast examination findings, attributes of the clinically palpable breast mass like number, size, consistency, laterality, location, associated breast pain and pain score, clinical diagnosis and final histopathologic report.RESULTS: Within this time period, there were 2,669 consultations seen at the breast clinic. A total of 77 male patients, comprising 2.9 percent were seen at the clinic. The mean age of occurrence was 36.2 years old. The frequency distribution of breast problem is highest between the ages of 20 to 29 years old at 40.3 percent. In all of the 69 patients (89.61 percent) with clinically palpable mass, 66 patients (95.65 percent) only had a solitary mass while 3 patients (4.35 percent) had two masses. Forty-three (59.7 percent) of the masses were less than 2 centimeters in diameter. Only 1 (1.4 percent) of the 72 masses was fixed to the chest wall which turned out to be a soft tissue sarcoma while the rest (98.6 percent) were freely movable. Based on the final histopathologic results, gynecomastia was the most common diagnosis among patients subjected to fine needle aspiration biopsy and excisional biopsy.CONCLUSION: Male breast problems are common in the third decade of life and among patients living the urban area like Metro Cebu. Male patients sought consultation due to problems of unilateral firm breast mass less than 2 centimeters in diameter located in the nipple-areola complex. The most common clinical diagnosis is that of gynecomastia which is supported by the final histopathologic result of the same condition.