Lymph node metastasis in breast carcinoma: clinicopathologic correlations in 3747 patients

Histological axillary node involvement [ANI] evaluated by axillary dissection remains the most accurate predictive factor for patients with invasive breast cancer. Axillary node involvement implies the necessity of systemic adjuvant treatment and locoregional irradiation. Is to detect the relative frequency of node positivity in relation to histopathology through studying a large mastectomy series. This study included 3747 mastectomy specimens performed al NCI Cairo in the period 1993-2003. In each case we assesed the age at time of diagnosis. pathologic tumor size and number, histologic subtype [including grade], tumor location, number of lymph nodes dissected and number of positive nodes [burden of node positivity]. Females constituted 96.8% of cases, 60.7% of them were premenopausal. The mean age was 47.1 +/- 10.5 years. Tumor size ranged from 0.5 to 20 cm. The global ANI rate in the entire cohort was 70.6%. In univariate analysis. five variables were significantly correlated to ANI, these were laterality, multiplicity, tumor size, histologic subtype and grade, while multiplicity, tumor size, histologic subtype and grade correlated significantly with metastatic burden, Multivariate analysis showed that older women [40-60 and> 60 years] have at least half the risk of developing LN metastasis compared to those < 40 years with the odds of 0.51[0.35-0.73] and 0.31[0.18-0.55], respectively. Tumor size >2cm put the women with breast cancer at 3 [if 2-5cm] to 9 [if> 5cm] folds of developing lymph node [LN] metastasis. Tumor size> 5 cm increases the likelihood of higher metastatic burden [> 3 +ve nodes] with odds of 1.5 [1.24-1.9]. Unfavorable histology also, increases the liklihood of more positive nodes to the double when compared to favourable histology. The results of this study reflected the unfortunate presentation of breast cancer patients. In addition, some factors could be used as useful guidlines in the management of those patients. These factors include age, tumor size and histologic type of the tumor

Immunophenotyping, MIB-1, p53 and mast cell tryptase in large cell non-Hodgkin's lymphoma

The aim of the present study was to explore by immunohistochemical methods, on lymph node and infiltrated bone marrow bioposies. the potential value of MIB-l proliferation rate. p53 overexpression and Mast cell tryptase [MCT] as possible prognostic fators for large cell lymphomas on 69 adult patients for whom paraffin blocks, clinical data and survival information were available. In the reviewed series, large cell lymphoma included: 84.1% large B-cell lymphoma. 11.6% peripheral T-cell lymphoma and 4.3% anaplastic large cell lymphoma. MIB-1 labeling was quantitated by image analysis and cases were classified as either of low or high proliferation rate taking MIB-l count of 50% as a cutoff value. For p53, nuclear immunoreactivity equal to or more than 20% were considered overexpression or positive. As for MCT, presence of> 5 mast cells/hpf was recorded as high count while counts <5 mast cells/hpf were considered low counts. In the L.N. biopsies examined the mean MIB-l labeling rate was 48.5%. p53 positive tumors contributed 33.3% of cases while high MCT counts were detected in 43.5% of cases. High MIB-l rate, p53 positivity and MCT counts showed a statistically significant relation to high lPl and were associated ".ith poor response to therapy and unfavorable 2-year overall survival and hence were considered risk factors. Additionally, high MCT count was found to show a strong relation with T-cell phenotype and extranodal forms. Bone marrow biopsies were examined to detect infiltrated cases. B.M. infiltration was detected in 15 cases whose levels of MIB-l and p53were in accordance to the corresponding L.N. values.MCT counts in B.M. biopsies were within the high count group but were lower than corresponding L.N. values and were strongly related to T-cell phenotype. It is concluded that MIB- 1. p53 and MCT are valuable prognostic factors which could serve as a guideline for treatment by identifying unfavorable cases for more intensive therapy

Endovaginal ultrasonographic cervical measurements after prophylactic cerclage as predictor of obstetric outcome

The purpose of this study was to determine which if any of the post elective cervical cerclage measurements was predicitive of pregnancy outcome. A prospective observational study including 30 patients with singleton pregnancies diagnosed as having cervical incompetence was done. They underwent MacDonald cerclage and the cervix was assessed perioperatively using transvaginal ultrasound. Zagazig University Hospital. Obstetrics and Gynecology department. A negative correlation was noted between funnel length, funnel width, cervical index and the pregnancy prolongation after cerclage operation. The initial cervical length can no longer be used as a predictive of pregnancy prolongation after cerclage instead other measurements as funnel length or cervical index was noted to be more useful for patient counseling

Comparative study between trans vaginal sonography, saline infusion sonography and hysterosalpingography in diagnosis of uterine cavity diseases as compared to diagnostic hysteroscopy in infertile women

The purpose of this study was to evaluate the diagnostic accuracy of hysterosalpingography, saline infusion sonography and transvaginal sonography as compared to hysteroscopy in diagnosis of uterine cavity abnormalities in infertile women of more than one year. This study included 60 infertile patients with no malefactor, all patients were subjected to hysterosalpingography, saline infusion sonography, transvaginal sonography and hysteroscopic examinations post-mentsturally to evaluate the uterine cavity. Zagazig University Hospital and Cytogenetic unit. Eight patients were excluded from this study due to different causes and only 52 patients continued in this study. As regard to the polypoid lesions, hysterosalpingography [HSG] showed low diagnostic value 51% sensitivity with 28.7% positive predictive value [ppv], transvaginal sonography had intermediate diagnostic accuracy, sensitivity 75.3% and ppv was 75.3%, while saline infusion sonography had sensitivity and PPV of 100% .In cases with intrauterine adhesions poor results were obtained with transvaginal sonography, however the best results were obtained by saline infusion sonography as the sensitivity and ppv were 76.1% and 43.2% respectively. As Regard to uterine malformation, hysterosalpingography had low sensitivity 43.3% and high specificity 96.2%, while transvaginal sonography and saline infusion sonography demonstrated 100% specificity and 100% ppv. Saline infusion sonography had a diagnostic accuracy of 100% for endometrial hyperplasia while HSG had a poor value. Transvaginal sonoogaphy had sensitivity of 67.6% with PPV of 67.1% in diagnosis of endometrial hyperplasia. Saline infusion sonography was the most accurate diagnostic method for polypoid lesions and endometrial hyperplasia as compared to hysterosalpingography and transvaginal sonography. Its diagnostic accuracy was the same as that of hysteroscopy, but with limitted value in diagnosis of intrauterine adhesions

Magnetic resonance cholangiogaphy versus endoscopic retrograde cholangiography in diagnosis of obstructive jaundice

Until the early 1990 endoscopic retrograde Cholangiography [ERC] was considered the investigation of first choice in patients with evidence of cholestasis, offering also therapeutic intervention. With the innovation of magnetic resonance techniques, imaging of the biliary tree without either invasive intervention or dye complications became possible. This study correlates MRCP with ERCP findings in order to determine the efficacy of MRCP in visualizing and diagnosing diseases of the pancreatic and biliary ducts. Twenty consecutive patients [10 males and 10 females] diagnosed as obstructive jaundice cases by demonstration of dilatation of any portion of biliary tree by abdominal ultrasound], in the period from September 1998 till November 1999, were included in this study. The age ranged between 34 years and 71 years, with mean of 42 years. All 20 patients were divided into two groups based on laboratory results and abdominal ultrasonographic findings, as follows: Group [A] was subjected to ERCP. This group included 10 patients [50%]. Group [B] was subjected to MRCP. This group included 10 patients [50%]. As regarding group A, ERCP was attempted in 10 patients of this group, ERCP was done successfully in 9 [90%], while failure of cannulation of the papilla occurred in one case [10%], because of having the papillary orifice in a diverticulum. In all 9 patients, endoscopic sphincterotomy was done at the same endoscopic session. As regarding group B, MRCP was attempted in 10 patients of this group. Five patients [50%] of this group diagnosed to have choledocholithiasis. Five [50%] cases of MRC group diagnosed to have malignant obstruction: Two cases [20%] diagnosed as carcinoma of the head of pancreas, one case [10%] ampullary carcinoma, one case as cholangiocarcinoma [10%], and one case [10%] as hilar carcinoma. Although, the diagnostic outcome of both modalities is fairly comparable in the present study, ERCP still offers the therapeutic, minimally invasive potential over MRC

Role of percutaneous transhepatic cholangiography and drainage [PTC and D] in cases of inaccessible endoscopic retrograde cholangiopancreatography [ERCP]

Endoscopic retrograde Cholangiopancreatography [ERCP] represents an important diagnostic and therapeutic tool in management of obstructive biliary lesions. Yet, the level of obstruction contributes to failure of this technique and represents hindering limitations. The purpose of this study was to evaluate the feasibility and role of percutaneous transhepatic Cholangiography and drainage [PTC and D] in management of inaccessible ERCP. Out of 318 obstructive jaundice patients scheduled for ERCP, 22 [6.9%] failed cases formed the subject of this study. ERCP trial failed due to advanced tumor infiltrating the papilla or the lower end of the common bile duct in 14/22 [63.6%] cases whereas in the remaining 8 cases, the distal end of CBD showed filling with non visualization of the rest of biliary tree. These cases were subjected to PTC and D using ultrasonography guided technique in16/22 [72,7%] cases and the blind technique in 6/22 [27.3%] patients. The obstructive jaundice proved to be due to advanced cancer head of pancreas in 8/22 cases, peri-ampullary carcinoma in 6/22 cases, advanced cholangiocarcinoma in 2/22 patients, hilar stricture in 2/22 cases, iatrogenic ligation of the CBD in 2/22cases and extra-hepatic sclerosing cholangitis in 2/22 cases. Further operative biliary reconstruction or palliative bypass were done in 10/22 cases. Two patients [0.9%] had complications in form of leak around the tube with subcutaneous collection in one case and slipped tube in the other. Two unrelated hospital deaths were reported. There was no biliary peritonitis, peritoneal hemorrhage, subdiaghragmatic collection nor failed case. This study highlights PTC and D as safe and applicable procedure resort to visualize and decompress the biliary tree in inaccessible ERCP cases