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3.
Pathol Res Pract ; 233: 153805, 2022 May.
Article in English | MEDLINE | ID: covidwho-1829375

ABSTRACT

BACKGROUND: The diagnosis of nodal nevi (NN) is challenging as they mimic melanoma metastases (MM), with a detection rate mostly ranging between 1% and 11% in sentinel lymph node biopsy (SLNB). Herein, we assessed the incidence of NN and the association with the clinical-pathological features of primary melanoma, adopting the updated European Organisation for Research and Treatment of Cancer (EORTC) protocol for SLNB. METHODS: All cases of paired melanoma and SLNB were retrospectively evaluated (April 2019-May 2020). Appropriate statistical tests were adopted, with significant variables included in the logistic regression model. RESULTS: 81 patients and a total of 186 lymph nodes (LNs) were included. Eleven patients had only NN and 4 had both NN and MM (18.5%); 29 LNs (15.6%) showed at least one NN and 12 (6.5%) showed more than one NN (a total amount of 43 NN was detected). All NN and none MM stained for p16. NN were associated with age < 60 years (p: 0.042), no ulceration (p: 0.025) and nevus-associated melanoma (NAM) (p: 0.018), with this latter being the only predictor at the logistic regression model (p: 0.022). CONCLUSIONS: The updated EORTC protocol shows a high number of NN and highlights a strong association with NAM.


Subject(s)
Melanoma , Nevus , Skin Neoplasms , Humans , Lymph Nodes/pathology , Melanoma/pathology , Middle Aged , Nevus/diagnosis , Retrospective Studies , Sentinel Lymph Node Biopsy , Skin Neoplasms/pathology
4.
In Vivo ; 36(2): 1041-1046, 2022.
Article in English | MEDLINE | ID: covidwho-1732571

ABSTRACT

BACKGROUND/AIM: COVID-19 started to spread as a pandemic in December 2019 and COVID-19 vaccination has been initiated worldwide. The efficacy of vaccination has been scientifically proven, but it might cause axillary lymph node swelling. To diagnose patients with axillary lymph node swelling caused by COVID-19 vaccination, we herein reviewed existing literature on this symptom. CASE REPORT: We report the case of a 70-year-old woman with a breast tumour. She had undergone cecum cancer surgery and regular computed tomography (CT). During breast tumour follow-up, she received scheduled CT that indicated severe axillary lymph node swelling mimicking breast cancer metastasis. We performed aspiration biopsy cytology of that lymph node, and determined this was not cancer metastasis but an effect of the COVID-19 vaccine. We confirmed this diagnosis at one month after computed tomography showed that the lymph node swelling had improved. CONCLUSION: Axillary lymph node swelling can occur after COVID-19 vaccination. Therefore, it is important to consider the effect of the COVID-19 vaccination on axillary lymph node swelling when diagnosing breast tumours.


Subject(s)
Breast Neoplasms , COVID-19 , Aged , Axilla/pathology , Breast Neoplasms/pathology , COVID-19 Vaccines/adverse effects , Female , Humans , Japan , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , SARS-CoV-2 , Sentinel Lymph Node Biopsy , Vaccination
5.
Breast Dis ; 41(1): 1-3, 2022.
Article in English | MEDLINE | ID: covidwho-1604128

ABSTRACT

During the first hit of SARS-COVID pandemic, an important reorganization of Healthcare Services has been done, and new protocols and pathways to protect frail patients like oncological patients were designed. The second hit of pandemic had stressed these new pathways and suggests to health-workers some improvements for safer management of patents.We reported our experience in organizing the clinical pathway of neoadjuvant therapy candidate patients based on the execution of sentinel lympho-node biopsy and the placement of implantable venous access port in the same access to operating room before neoadjuvant chemotherapy suggesting a possible organizational model. In the period October-December 2020 we have included in this new type of path twelve patients and we have not registered any cases of COVID among the patients included. We think this new path, adopted amid the second hit, will be useful for all Breast Units that are facing the challenge of guaranteeing the highest standards of care in a historical moment where the health emergency occupies the efforts of health workers and the economic resources of health systems.


Subject(s)
Antineoplastic Agents/administration & dosage , Breast Neoplasms/drug therapy , COVID-19/prevention & control , Catheterization, Central Venous/methods , Infection Control/methods , Patient Safety , Sentinel Lymph Node Biopsy/methods , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Catheterization, Central Venous/instrumentation , Catheterization, Central Venous/standards , Central Venous Catheters , Chemotherapy, Adjuvant , Critical Pathways , Female , Humans , Infection Control/standards , Mastectomy , Middle Aged , Neoadjuvant Therapy , Neoplasm Staging , Sentinel Lymph Node Biopsy/standards
6.
Ann Surg Oncol ; 28(13): 8729-8739, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1317136

ABSTRACT

BACKGROUND: Randomized clinical trials support deescalation of axillary surgery in breast cancer patients with low-volume axillary disease treated with a surgery-first approach. However, few data exist to guide axillary surgery following neoadjuvant endocrine therapy (NET). Therefore, we evaluated the extent and outcomes of axillary surgery in a contemporary cohort of NET patients, a treatment approach that has become particularly relevant during the coronavirus disease-19 (COVID-19) pandemic. PATIENTS AND METHODS: We identified invasive breast cancer patients treated with NET between October 2008 and November 2019. Patients presenting with stage IV disease or recurrent disease were excluded. Statistical analyses were performed using chi-square, Fisher's exact, and Wilcoxon rank-sum tests. RESULTS: 194 invasive breast cancers in 186 patients (median age 66 years) were evaluated; 81 patients had breast-conserving surgery (BCS), while 113 underwent mastectomy. Eighty-four patients (43.3%) were biopsy-proven cN+ with 4/84 (4.8%) ypN0 following NET. Among cN+ patients, 14 (16.7%) had sentinel lymph node biopsy (SLNB) only, 27 (32.1%) had SLNB + axillary lymph node dissection (ALND), and 43 (51.2%) had ALND. Among 110 cN0 patients, 99 had axillary surgery with 28/99 (28.3%) ypN+: SLNB in 83 (75.5%), SLNB+ALND in 14 (12.7%), and ALND in 2 (1.8%). Among all ypN+ patients, 23/108 (21.3%) had SLNB alone: 18/43 (41.9%) of BCS and 5/65 (7.7%) mastectomy patients (p < 0.001). After median follow-up of 35 months, no regional recurrences were observed. CONCLUSIONS: Among biopsy-proven cN+ NET patients, we observed deescalation of axillary surgery in selected patients, despite a low nodal pathologic complete response (pCR) rate, without nodal recurrences. These data suggest that patients with low-volume axillary disease treated with NET may be managed similarly to patients treated with a surgery-first approach.


Subject(s)
Breast Neoplasms , COVID-19 , Aged , Axilla , Breast Neoplasms/drug therapy , Breast Neoplasms/surgery , Female , Humans , Lymph Node Excision , Mastectomy , Neoadjuvant Therapy , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/surgery , SARS-CoV-2 , Sentinel Lymph Node Biopsy
7.
Breast Cancer Res Treat ; 188(3): 825-826, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1279468

ABSTRACT

There have been recent reports in the breast imaging literature of unilateral axillary lymphadenopathy following COVID-19 vaccination. It is unclear whether the reactive lymphadenopathy may impact the sentinel lymph node biopsy procedure. In this article, we provide guidelines regarding the timing of the COVID-19 vaccine and breast cancer surgery which were formulated after a review of the available literature and in consultation with infectious disease specialists.


Subject(s)
Breast Neoplasms , COVID-19 , Axilla , Breast Neoplasms/surgery , COVID-19 Vaccines , Female , Humans , Lymph Node Excision , Lymph Nodes , SARS-CoV-2 , Sentinel Lymph Node Biopsy , Vaccination/adverse effects
8.
J Surg Oncol ; 124(4): 655-664, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1265393

ABSTRACT

BACKGROUND AND OBJECTIVES: Clinicopathologic characteristics have prognostic value in clinical stage IB-II patients with melanoma. Little is known about the prognostic value of obesity that has been associated with an increased risk for several cancer types and worsened prognosis after diagnosis. This study aims to examine effects of obesity on outcome in patients with clinical stage IB-II melanoma. METHODS: Prospectively recorded data of patients with clinical stage IB-II melanoma who underwent sentinel lymph node biopsy (SLNB) between 1995 and 2018 at the University Medical Center of Groningen were collected from medical files and retrospectively analyzed. Cox-regression analyses were used to determine associations between obesity (body mass index> 30), tumor (location, histology, Breslow-thickness, ulceration, mitotic rate, SLN-status) and patient-related variables (gender, age, and social-economic-status [SES]) and disease-free interval (DFI), melanoma-specific survival (MSS), and overall survival (OS). RESULTS: Of the 715 patients, 355 (49.7%) were women, median age was 55 (range 18.6-89) years, 149 (20.8%) were obese. Obesity did not significantly affect DFI (adjusted hazard ratio [HR] = 1.40; 95% confidence interval [CI] = 0.98-2.00; p = 0.06), MSS (adjusted HR = 1.48;95%CI = 0.97-2.25; p = 0.07), and OS (adjusted HR = 1.25; 95% CI = 0.85-1.85; p = 0.25). Increased age, arm location, increased Breslow-thickness, ulceration, increased mitotic rate, and positive SLN-status were significantly associated with decreased DFI, MSS, and OS. Histology, sex, and SES were not associated. CONCLUSION: Obesity was not associated with DFI, MSS, or OS in patients with clinical stage IB-II melanoma who underwent SLNB.


Subject(s)
Body Mass Index , Melanoma/mortality , Obesity/complications , Sentinel Lymph Node Biopsy/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Melanoma/etiology , Melanoma/pathology , Melanoma/surgery , Middle Aged , Prognosis , Prospective Studies , Retrospective Studies , Survival Rate , Young Adult
10.
J Plast Reconstr Aesthet Surg ; 74(10): 2776-2820, 2021 10.
Article in English | MEDLINE | ID: covidwho-1252517

ABSTRACT

INTRODUCTION: Axillary sentinel node biopsy for melanoma is routinely performed under general anaesthesia. Emerging evidence has shown general anaesthetics are associated with increased mortality in the context of the COVID-19 pandemic. In the interest of patient safety, we have designed a series of bespoke axillary regional blocks enabling surgeons to remove nodes up to and including level III without the need for a general anaesthetic. The aim of this study was to assess the feasibility of performing axillary sentinel node biopsy under such blocks. METHODS: Approval was granted by the Joint Study Review Committee on behalf of the Research and Ethics Department. Ten consecutive patients having axillary sentinel node biopsy for melanoma were included in this prospective study. Patients completed a Quality of Recovery-15 (QoR15) questionnaire preoperatively and 24 h postoperatively. DISCUSSION: One patient had a positive sentinel node, the remining were negative. A significant reduction in time spent in hospital post-operatively (p = 0.0008) was observed. QoR15 patient reported outcome measures demonstrated high levels of satisfaction evidenced by lack of statistical difference between pre and post-operative scores (p = 0.0118). 80% of patients were happy to have a regional block and 90% were happy to attend hospital during the pandemic. CONCLUSION: ASNB under regional block is safe, negates risks associated with performing GAs during the COVID-19 pandemic and facilitates quicker theatre turnover and discharge from hospital. Collaboration between anaesthetic and surgical teams has enabled this change in practice. There is a learning curve with both patient selection, education and development of technique.


Subject(s)
Anesthesia, Conduction/methods , COVID-19/epidemiology , Lymph Nodes/surgery , Melanoma/secondary , Sentinel Lymph Node Biopsy/methods , Skin Neoplasms/pathology , Axilla , Comorbidity , Global Health , Humans , Lymph Node Excision/methods , Lymphatic Metastasis , Melanoma/diagnosis , Melanoma/epidemiology , Pandemics , Skin Neoplasms/epidemiology
11.
Dermatol Ther ; 34(3): e14908, 2021 05.
Article in English | MEDLINE | ID: covidwho-1096758

ABSTRACT

Due to the COVID-19 crisis, many scheduled medical and surgical activities have been suspended. This interruption to the healthcare system can negatively affect the diagnosis and management of melanoma. Neglecting melanoma throughout the outbreak may be associated with increased rates of mortality, morbidity, and healthcare expenses. We performed a retrospective review of all dermatological and surgical activity performed in our Melanoma Skin Unit between 23 February 2020 and 21 May 2020 and compared these data with those from the same period in 2019. During the lockdown period, we observed a decrease in dermatologic follow-up (DFU) (-30.2%) and in surgical follow-up (SFU) (-37%), and no modification of melanoma diagnosis (-3%). Finally, surgical excisions (SE) (+ 31.7%) increased, but sentinel lymph node biopsy (SLNB) (-29%) and lymph node dissections(LND) (-64%) decreased compared to the same period in 2019. Our experience supports the continuation of surgical and diagnostic procedures in patients with melanoma during the COVID-19 pandemic. Surgical and follow-up procedures for the diagnosis and treatment of melanoma should not be postponed considering that the pandemic is lasting for an extended period.


Subject(s)
COVID-19 , Melanoma , Skin Neoplasms , Communicable Disease Control , Humans , Italy/epidemiology , Lymph Node Excision , Melanoma/diagnosis , Melanoma/epidemiology , Melanoma/surgery , Pandemics , Retrospective Studies , SARS-CoV-2 , Sentinel Lymph Node Biopsy , Skin Neoplasms/epidemiology , Skin Neoplasms/surgery
15.
Anticancer Res ; 40(12): 7119-7125, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-962745

ABSTRACT

BACKGROUND/AIM: Extraordinary restrictions aimed to limit Sars-CoV-2 spreading; they imposed a total reorganization of the health-system. Oncological treatments experienced a significant slowdown. The aim of our multicentric retrospective study was to evaluate screening suspension and surgical treatment delay during COVID-19 and the impact on breast cancer presentation. PATIENTS AND METHODS: All patients who underwent breast surgery from March 11, 2020 to May 30, 2020 were evaluated and considered as the Lockdown group. These patients were compared with similar patients of the previous year, the Pre-Lockdown group. RESULTS: A total of 432 patients were evaluated; n=223 and n=209 in the Lockdown and Pre-lockdown-groups, respectively. At univariate analysis, waiting times, lymph-nodes involvement and cancer grading, showed a statistically significant difference (p<0.05). Multivariate analysis identified waiting-time on list (OR=1.07) as a statistically significant predictive factor of lymph node involvement. CONCLUSION: Although we did not observe a clinically evident difference in breast cancer presentation, we reported an increase in lymph node involvement.


Subject(s)
Breast Neoplasms/epidemiology , COVID-19/epidemiology , Pandemics , SARS-CoV-2/pathogenicity , Adult , Aged , Aged, 80 and over , Axilla/pathology , Axilla/surgery , Breast Neoplasms/complications , Breast Neoplasms/surgery , Breast Neoplasms/virology , COVID-19/complications , COVID-19/virology , Female , Humans , Lymph Node Excision , Lymph Nodes , Lymphatic Metastasis , Mastectomy , Middle Aged , Retrospective Studies , Sentinel Lymph Node Biopsy
16.
Lymphat Res Biol ; 19(2): 134-140, 2021 04.
Article in English | MEDLINE | ID: covidwho-799806

ABSTRACT

Background: In the current study, we reported our experience on sentinel node mapping of breast cancer patients during the extreme shortage of Mo99-Tc99m generators using Tc-99m phytate. Methods and Results: During the period from March 7, 2019, to April 18, 2020, due to disruption of molybdenum supply chain, we used low specific activity Tc-99m pertechnetate elute (0.5-2 mCi of 99mTcO4 in 5 mL) for each kit preparation. Two or three intradermal periareolar injections were done for each patient (0.02-0.1 mCi/0.2 mL for each injection). Immediately following injection, dynamic lymphoscintigraphy was done. Surgery was done the same day of injection and the axillary sentinel node was sought using a gamma probe. Overall, 35 patients were included in the study. The specific activity of the Tc-99m elute (in 5 mL) used for kit preparation was 2 mCi/10 mg in four, 1.5 mCi/10 mg in eight, 1.25 mCi/10 mg in eight, 1 mCi/10 mg in three, 0.75 mCi/10 mg in five, and 0.5 mCi/10 mg of 99mTc-Phytate in seven patients. For the first four groups of patients, we used two 0.2 mL injections, while in the latter two groups, three 0.2 mL injections were used. At least one sentinel node was detected in all patients but three in whom axilla was involved. Conclusion: Sentinel node biopsy can be achieved with low specific activity of Tc-99m elute at the time of Mo99-Tc-99m generator shortage. If special personal protection is used, sentinel node mapping can be done in nuclear medicine departments with excellent results despite the COVID-19 pandemic and disruption of generator shipment.


Subject(s)
Breast Neoplasms/diagnostic imaging , COVID-19 , Lymph Nodes/diagnostic imaging , Molybdenum/supply & distribution , Organotechnetium Compounds/supply & distribution , Phytic Acid/supply & distribution , Radioisotopes/supply & distribution , Radiopharmaceuticals/supply & distribution , Sentinel Lymph Node Biopsy/methods , Adult , Aged , Axilla , Breast Neoplasms/pathology , Feasibility Studies , Female , Health Services Accessibility , Humans , Lymph Nodes/pathology , Lymphatic Metastasis , Middle Aged , Molybdenum/administration & dosage , Organotechnetium Compounds/administration & dosage , Phytic Acid/administration & dosage , Radioisotopes/administration & dosage , Radiopharmaceuticals/administration & dosage
17.
Breast Cancer ; 27(6): 1045-1047, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-778098

ABSTRACT

The COVID-19 pandemic poses current and future challenges in the maintenance of surgical operating capacity. In the United Kingdom surgery has continued-in a reduced capacity-through the establishment of regional 'cancer hubs' using independent sector facilities to treat public healthcare patients. It is essential that these scarce operating facilities available are optimally utilized and that logistical challenges that result from remote operating away from the surgeon's primary hospital site are considered. These issues are best addressed through the application of currently available medical technology and enhanced training in advanced oncoplastic techniques, which extend the limits of breast conservation.


Subject(s)
Breast Neoplasms/surgery , Coronavirus Infections , Mammaplasty , Mastectomy , Pandemics , Pneumonia, Viral , Sentinel Lymph Node Biopsy , Betacoronavirus , COVID-19 , Diagnostic Imaging , Health Services Accessibility , Humans , Mastectomy, Segmental , SARS-CoV-2 , Surgery, Computer-Assisted , Surgical Oncology/education , Surgical Oncology/methods
19.
Breast Cancer Res Treat ; 182(3): 679-688, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-608129

ABSTRACT

PURPOSE: As our hospitals conserve and re-allocate resources during the COVID-19 crisis, there is urgent need to determine how best to continue caring for breast cancer patients. During the time window before the COVID-19 critical peak and particularly thereafter, as hospitals are able to resume cancer operations, we anticipate that there will be great need to maximize efficiency to treat breast cancer. The goal of this study is to present a same-day protocol that minimizes resource utilization to enable hospitals to increase inpatient capacity, while providing care for breast cancer patients undergoing mastectomy and immediate breast reconstruction during the COVID-19 crisis. METHODS: IRB exempt patient quality improvement initiative was conducted to detail the operationalization of a novel same-day breast reconstruction protocol. Consecutive patients having undergone immediate breast reconstruction were prospectively enrolled between February and March of 2020 at Massachusetts General Hospital during the COVID-19 crisis. Peri-operative results and postoperative complications were summarized. RESULTS: Time interval from surgical closure to patient discharge was 5.02 ± 1.29 h. All patients were discharged home, with no re-admissions or emergency department visits. No postoperative complications were observed. CONCLUSION: This report provides an instruction manual to operationalize a same-day breast reconstruction protocol, to meet demands of providing appropriate cancer treatment during times of unprecedented resource limitations. Pre-pectoral implant-based breast reconstruction can be the definitive procedure or be used as a bridge to autologous reconstruction. Importantly, we hope this work will be helpful to our patients and community as we emerge from the COVID-19 pandemic.


Subject(s)
Ambulatory Surgical Procedures/methods , Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/surgery , Mammaplasty/methods , Mastectomy/methods , Quality Improvement , Adult , Aftercare , Anesthesiology , Betacoronavirus , Breast Implantation , Breast Implants , COVID-19 , Clinical Protocols , Coronavirus Infections/epidemiology , Efficiency , Emergency Service, Hospital , Female , Health Resources , Home Care Services , Humans , Length of Stay , Middle Aged , Pandemics , Patient Readmission , Perioperative Care/methods , Pneumonia, Viral/epidemiology , Prospective Studies , SARS-CoV-2 , Sentinel Lymph Node Biopsy , Surgery, Plastic , Surgical Oncology , Telemedicine , Tissue Expansion Devices
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