Analysis of nipple-areolar complex [NAC] involvement with mastectomy: can the nipple be preserved in Egyptian patients receiving skin-sparing mastectomy?

The aim of the study is to determine the true incidence and associated risk factors for nipple and areolar complex involvement in mastectomy specimens obtained from Egyptian females with breast carcinoma. This study was divided into 2 phases: A retrospective phase, in which we studied at random 414 mastectomy specimens treated over the last 2 years, and a prospective phase, which included breast cancer cases fitted the inclusion criteria and agreed to join the study, which is ongoing. They were subjected to skin and nipple sparing mastectomy with immediate transverse rectus abdominus myocutaneous flap reconstruction in order to study the technical feasibility of such a procedure in Egyptian females. The results showed an overall incidence of nipple and areolar complex invasion with malignancy in 6.3% of cases. In the presence of clinically normal nipple and areola, this incidence dropped to 1.2%. There was a highly significant association between nipple and areola invasion and central [retroareolar] location of the primary breast tumour, of> 3cm in size, high grade and with skin involvement [p >/= 0.000]. Concerning the lymph nodes status, there was a trend toward higher involvement with > 3 positive axillary nodes. In conclusion it was found that nipple and areolar invasion with malignancy is a rare event in the presence of an early peripherally located tumour with clinically normal nipple and areolar complex. Skin and nipple sparing mastectomy is technically feasible in Egyptian females inspite of the relatively large size of the breast, with an excellent cosmetic result. Yet a prospective randomized study with a large number of cases [which is ongoing] is requird in order to determine the oncologic safety of the nipple preservation

[131]I percentage neck uptake as a determining factor for post-operative [131]I ablative dose quantification: validity and efficacy

This prospective study was executed to validate and evaluate the efficacy of the [131]I% neck uptake as a determining factor for postoperative [131]I ablative dose quantification for local thyroid remnant. 144 patients with well-differentiated thyroid carcinoma were the subject of this work. All of them were submitted to near-total or subtotal thyroidectomy, neck iiltrasonography, 48 hours[131]I whole body scan and%neck uptake prior to [131]I therapy dose. They were grouped into two groups according to the method of [131]I ablative dose quantification. Group 1: Included 65 patients receiving empirical [subjective] [131]I ablative dose. Group 2: included 79 patients receiving [131]I ablative dose according to the following protocol based on the 48 hours% neck uptake. Patients with% neck uptake <2%, 2-4%and >4% received 1.07 GBq 1.85 GBq and 3.7 GBq respectively. Follow-up [131]I scan and% neck uptake were done at least 3 months after [131]I therapy. Successful ablation was defined as the absence of visible uptake in the neck background. There were statistically significant correlations between% neck uptake and both thyroid residual volume and surface area[r=0.7 and 0.5 respectively, p <0.05]. The overall ablation rate in group 2 cases treated according to the proposed protocol was significantly higher than that of the empiric group [79.7%and 35.4% respectively, p<0.0001]. Also ablation rates per given dose of [131]I were significantly higher in group 2 than those of group I [p< 0.006]. Thirty [37.97%] out of 79 group 2 patients received 1.07 GBq as outpatients saving about 90 hospitalization days with 86.7% ablation rate. We concluded that [131]I% neck uptake is a simple, accurate, objective and effective method for [131]I dose quantification required for postoperative ablation of local thyroid remnant, allowing for a significant proportion of these cases to be treated on an outpatient basis while maintaining a high ablation rate