The role of prophylactic central compartment lymph node dissection in differentiated thyroid carcinoma

Background: Differentiated thyroid carcinoma, arising from thyroid follicular epithelial cells, accounts for the vast majority of thyroid carcinomas. Of the differentiated cancers, papillary cancer comprises about 85% of cases compared to about 12% that have follicular histology, including conventional and oncocytic (Hurthle cell) carcinomas, and <3% that are poorly differentiated tumors. In general, stage for stage, the prognoses of PTC and follicular cancer are similar. The aim of this study is to evaluate the benefit of central compartment lymph node dissection in accurate staging of the disease and plan radioiodine treatment and dosing. And also to assess the morbidity associated with central neck dissection. Materials and methods: This was a prospective clinical study conducted at MNJIO and RCC, Hyderabad. 20 patients with carcinoma thyroid who underwent total thyroidectomy and prophylactic central compartment lymph node dissection from December 2015 to December 2017 were included. The protocol was submitted to the ethics committee at Osmania Medical College and was approved. Results: We analyzed the number of patients of that age in whom the disease stage changed due to the presence of central nodal dissection. Prophylactic CND resulted in upstaging of tumour in 2/20 (10%) patients from stage I to stage II. Also in 4/20 (20%) patients, the evidence of node metastases influenced also the therapeutic strategy because these patients would not have been treated with 131-I if the prophylactic central neck dissection had not been performed. Thus a prophylactic CLND may play an even larger role in determining RAI use. A prophylactic CLND that demonstrates a lack of lymph node metastasis would strengthen the case not to use RAI treatment in a low-risk patient. Nived Rao, M. Muralidhar, M. Srinivasulu. The role of prophylactic central compartment lymph node dissection in differentiated thyroid carcinoma. IAIM, 2018; 5(9): 91-98. Page 92 Conclusion: With the available evidence, we advocate a selective approach to performing prophylactic CND and to be done in high volume centres. Routine prophylactic central lymph node dissection should be avoided in the absence of involved lymph nodes, reserving the procedure to “high-risk” patients as defined by ATA and European Society of Endocrine Surgeons, which include extremes of ages, large primary tumor size, and male gender, which were similar to high risk cases seen in our study.

A Study to Evaluate the Effect of Neo-adjuvant Chemotherapy on Hormonal and Her-2 Receptor Status in Carcinoma Breast

Background: The advances in diagnosis and treatment, in the management of breast cancer have led to excellent cure rates for tumors detected in early stage. Even patients with stage III disease have 5 years survival rates in the range of 50-70%. The search for predictive and prognostic factors in breast cancer represents a major challenge. It is important to distinguish prognostic factors from predictive factors. Aim: The aim of the surgery was to compare the immunohistochemical expression of estrogen, progesterone and Her-2 receptor status in breast cancer before and after neo-adjuvant chemotherapy. Materials and methods: In this study, the total of 50 cases of locally advanced breast cancers was included. Cases of carcinoma breast requiring preoperative chemotherapy from January 2015 to January 2017 were recruited in to the study after informed consent. Results: In this study, the total of 50 cases of locally advanced breast cancers was included. Among them most of the cases belonged to the age group of 40 to 60. The extremes of ages (<30 and >60) comprised of only 14 % of the cases. In total of 50 cases 32 patients were pre-menopausal which was accounting for 64% of cases, and remaining patients were post-menopausal. Out of 20 cases of triple negative in this study complete response was seen in 6 cases accounting for about 30%. In our study there were a total of 24 changes in the receptor status post chemotherapy altogether out of which 11 changes were seen in Her2neu group. Changes in the ER and PR group accounted for 8 and 5 cases respectively. Out of 14 cases of ER positive before chemotherapy, conversion was seen in 8 cases accounting for change in ER status of 57%. Similarly 5 changes were seen in PR receptor expression E. Rajesh Goud, M. Muralidhar, M. Srinivasulu. A Study to Evaluate the Effect of Neo-adjuvant Chemotherapy on Hormonal and Her-2 Receptor Status in Carcinoma Breast. IAIM, 2018; 5(9): 83-90. Page 84 accounting for 62% of change. All the changes found were loss of expression of receptor after NACT means receptor positive cases became receptor negative. Conclusion: Breast cancer subtypes are associated with the response to NACT. The response rates for the HE and TN subtypes were significantly higher than for the luminal subtypes. So it is mandatory for a patient with breast cancer who is scheduled for NACT should be assessed for the subtype of breast cancer before NACT, by using IHC, for planning treatment. This study also revealed that change in receptor status did occur after neo-adjuvant chemotherapy.

Correlation of clinical and sonological features in cases of mastalgia without a palpable lump

Background: Mastalgia is defined as pain, dull ache or heaviness in the breast. The most common cause of mastalgia is Aberration of Normal Development and Involution (ANDI) of breast tissue [1]. It can occur during adolescence, pregnancy and perimenopause. Materials and methods: Patients with complaints of breast pain in the age group 15-64 years with clinically no palpable mass attending to the surgical OPD in a tertiary care hospital between August2013- August 2015 (two years) were included in the study. Out of 700 patients who presented with pain in one or both breast, 482 (68%) had fibroadenoma, 78 (11%) were fibroadenosis with nodularity in breast followed by 50 (7%) cases had abscess and 40 (5.7%) had mastalgia without any palpable lesion which are included in this study. Detail history with particular reference to age, duration of symptoms, side of preponderance, menstruation, marital status, parity, lactation, nipple discharge and tenderness are recorded. Pain is recorded by subjective numerical pain intensity scale of 0-10. Clinical findings with particular reference to tenderness, quadrants involved are recorded. Ultrasound of the breast was done for all cases and findings recorded to correlate with clinical features. Results: Regarding age distribution, 18 (45%) patients belong to age group 26-35 years followed by 11 (27.5%) in age group of 36-45 years. 8 (20%) of patients were in the age group of 15-25 years. Remaining 3 (7.5%) were above 46 years. 20 (50%) had symptoms of < 1 month duration, 10 (25%) had duration of 1 - 6 months, 3 (7.5%) had symptoms for more than 6 months.13 (32.5%) had pain on right side, 16 (40%) had pain on left side, 11 (27.5%) had pain both sides. Severity of pain varied from 1 – 10 with an average of 5.4. 36 (90%) are married, 4 (10%) are unmarried. 35 (87.5%) had children, 5 (12.5%) were nulliparous. 32 (80%) women are having regular menstrual cycles and 8 Keerthi Sunil Kumar, Manga Muralidhar. Correlation of clinical and sonological features in cases of mastalgia without a palpable lump. IAIM, 2016; 3(8): 93-96. Page 94 (20%) were not menstruating due to either following hysterectomy or attained menopause apart from 3 (7.5%) patients were lactating mothers. Conclusion: The sonological findings of altered echogenisity and cystic changes can be the baseline while starting the treatment in patients with mastalgia without palpable lesion. These findings will also guide in assessing the response and follow-up of these patients.