relation between tumor marker Ca 15-3 and metastases in interpectoral lymph nodes in breast cancer patients

We aimed at analyzing the metastatic involvement in interpectoral [Rotter's] lymph nodes [RLN] in relation to tumor marker CA 15-3. The study included 177 female patients undergoing surgery for primary breast cancer at the University Hospital for Tumors, Zagreb, Croatia from November 2001 to March 2004. In addition to the standard surgical procedure, interpectoral RLNs were removed in all of the patients Levels of the serum tumor marker CA 15-3 was determined prior to surgery. Rotter's lymph nodes were identified in 66.2% of the patients, with metastatic involvement revealed in 18.6% of the RLNs. Metastatic involvement of RLNs in patients with negative axillary lymph nodes was 2.8% and positive in 34.6%. Elevated serum levels of tumor marker CA 15-3 had 22 [12.4%] patients. of 33 Rotter's node-positive patients, 27.3% had elevated serum levels of tumor marker CA 15-3 and in Rotter's node-negative patients only 9% had elevated serum levels of tumor marker CA 15-3, with the level statistically significantly higher in Rotter's positive patients compared to those with negative [or absent] RLNs [chi 2=8.22,P=0.004. Tumor marker CA 15-3 is more frequently elevated in patients with positive RLNs. Elevated values of tumor marker CA 15-3 could be warning for possible positive interpectoral nodes. The removal of the RLNs may be beneficial for patients with [massive] axillary nodal involvement. For axillary node negative patients, sentinel node biopsy could avoid the unnecessary removal of the RLNs.

Sentinel node localization in breast carcinoma

To determine the success rate of sentinel node dissection and the sensitivity of sentinel node to determine the presence of axillary node metastasis in women with clinically node negative breast cancer. Case series. Place and Duration of Study: The study was conducted at Department of General Surgery Pakistan Institute of Medical Sciences, Islamabad [PIMS] and Nuclear Oncology and Radiotherapy Institute, Islamabad [NORI] from January 2002 to December 2003. A total of 15 patients of early carcinoma breast were recruited in the study. Five patients were injected with radiocolloid and later with isosulfan blue in the subareolar region. Ten patients were given isosulfan blue only. All the patients were subjected to standard axillary clearance after sentinel node biopsy through separate incisions. Sentinel node was examined by intra-operative frozen section and all of the dissected lymph nodes were examined histopathologically for tumour deposits. Sentinel lymph node was successfully excised in all the cases 15/15 [100%]. In 14 of the patients the sentinel node pathology was truly predictive of axillary nodal status. Sensitivity of the test was 93.33% and the positive predictive value was 100%. Sentinel node biopsy should be followed by standard axillary lymph adenectomy until the results of multiple prospective randomized trials define the role of this technique in the management of carcinoma breast

Comparative study to evaluate the safety and efficacy of high dose tamoxifen and dexamethasone versus dexamethasone alone in the management of recurrent malignant gliomas

This study included 19 [15 males and 4 females] evaluable patients with recurrent malignant gliomas who failed treatment with external radiotherapy, they were randomly assigned into two arms [A and B] by a simple toss test. Arm A included ten patients [eight males and two females] treated with tamoxifen in an escalating dose to reach the target dose of 160 mg/day in the third week of treatment and dexamethasone in a dose of 12 mg/day. Arm B included nine patients [seven males and two females] treated with dexamethasone only in the same dose. In arm A, a clinical improvement was detected in three patients and radiological improvement was detected in one of them and two patients had a stable disease. The remaining five patients had a rapid progressive disease despite of treatment. In arm B, two patients had clinical improvement of a short duration and one patient had a stationary course and no radiological improvement was detected in any patients. The remaining six patients deteriorated rapidly. No major side effects were reported in both arms apart from one patient in arm A who developed deep venous thrombosis [DVT] and responded to medical treatment