Radioguided occult lesion localization versus wire-guided localization for non-palpable breast lesions: randomized controlled trial

AIM: This prospective randomized clinical study was conducted to compare radioguided occult lesion localization (ROLL) with wire-guided localization to evaluate optimum localization techniques for non-palpable breast lesions. METHODS: A total of 108 patients who were undergoing an excisional biopsy for non-palpable breast lesions requiring pathologic diagnosis were randomly assigned to the ROLL group (n = 56) and wire-guided localization group (n = 52). In the study, patients' characteristics, radiological abnormalities, radiological technique of localization, localization time, operation time, weight of the excised specimen, clearance margins, pathological diagnosis and perioperative complications were assessed. RESULTS: There were no differences between the two groups in terms of age, radiological abnormalities and localization technique (p = non-significant for all). ROLL techniques resulted in 100 percent retrieval of the lesions; for the wire-guided localization technique, 98 percent. Both localization time and operation time were significantly reduced with the ROLL technique (p = significant for all). The weight of the specimen was significantly lower in the ROLL group than in the wire-guided localization group (p = significant). The overall complication rate and pathological diagnosis were similar for both groups (p = non-significant for all). Clear margins were achieved in 91 percent of ROLL patients and in 53 percent of wire-guided localization patients, and the difference was significant. CONCLUSIONS: The present study indicated that the ROLL technique is as effective as wire-guided localization for the excision of non-palpable breast lesions. In addition, ROLL improved the outcomes by reducing localization and operation time, preventing healthy tissue excision and achieving clearer margins.

Can spirometry, pulse oximetry and dyspnea scoring reflect respiratory failure in patients with chronic obstructive pulmonary disease exacerbation?

To evaluate the extent to which oximetry, spirometry and dyspnea scoring can reflect hypoxemia and hypercapnia among patients admitted to the emergency department [ED] with acute exacerbations of chronic obstructive pulmonary disease. Spirometry, oxygen saturation by pulse oximetry [SpO[2]], arterial blood gas analysis and dyspnea scoring assessments were made in the ED. Correlations of these parameters were evaluated by means of Pearson's test. Pulse oximetry cutoff values to express hypoxemia were demonstrated by receiver operating characteristic [ROC] curves. 76 patients with a mean age of 68.0 years were included in the study. Mean spirometric values, expressed as percentages of predicted values, were forced expiratory volume in 1 s [FEV[1]] = 23.1 +/- 9%; forced vital capacity [FVC] = 32.8 +/- 11%, and mean FEV1/FVC = 72.4 +/- 21.6%. While there was a positive correlation between the SpO[2],SaO[2] and PaO[2] values [r = 0.91 and 0.80, respectively], a negative correlation [r = -0.74] was observed between PaCO[2]and SpO[2]. In determining hypoxemia, both SpO[2] and FEV1 were sensitive [83.9 and 90.3%, respectively] while dyspnea scoring was the most sensitive [93.5%]. In the evaluation by means of an ROC curve, a saturation of 88.5% for the pulse oximeter was the best cutoff value to reflect hypoxemia [sensitivity 95.6%, specificity 80.6%]. SpO[2] alone appears to be as highly specific as a combination of other tests in the evaluation of hypoxemia. A cutoff value for SpO2 of