Blue dye is sufficient for sentinel lymph node biopsy in breast cancer.

BACKGROUND: Most previous studies have reported superior results when blue dye and radiocolloids were used together for sentinel lymph node (SLN) biopsy in early breast cancer. Blue dye was reported to perform poorly when used alone, although more recent studies have found otherwise. This study reviewed the authors' practice of performing SLN biopsy with blue dye alone. METHODS: This was a retrospective review of patients who underwent SLN biopsy using blue dye alone from 2001 to 2005, when SLN biopsy was performed selectively and always followed by axillary lymph node dissection (ALND), and from 2006 to 2010, when SLN biopsy was offered to all suitable patients and ALND done only when the SLN was not identified or positive for metastasis. RESULTS: Between 2001 and 2005, 170 patients underwent SLN biopsy with blue dye alone. The overall SLN non-identification rate was 8·4 per cent. The overall false-negative rate was 34 per cent, but decreased with each subsequent year to 13 per cent in 2005. From 2006 to 2010, 610 patients underwent SLN biopsy with blue dye alone. The SLN was not identified in 12 patients (2·0 per cent) and no significant contributing factor was identified. A median of 2 (range 1-11) SLNs were identified. A non-SLN was found to be positive for metastasis in two patients with negative SLNs. Axillary nodal recurrence developed in one patient; none developed internal mammary nodal recurrence. Anaphylaxis occurred in one patient. CONCLUSION: Blue dye performed well as a single modality for SLN biopsy. Non-identification, axillary nodal recurrence and serious allergic reactions were uncommon.

Locally advanced and metastatic breast cancer in a tertiary hospital.

INTRODUCTION: The breast cancer incidence among Singapore women has risen through the years and is now the highest in Asia. Despite efforts to promote a greater awareness of breast cancer among the public, a significant number of patients still present with locally advanced or metastatic breast cancer. Our study aims to evaluate the clinical and pathological characteristics between patients presenting with locally advanced (LABC) and metastatic breast cancer (MBC) and those presenting with early breast cancer (EBC), to identify factors that predict for advanced disease. MATERIALS AND METHODS: We reviewed 622 patients who were newly diagnosed with invasive breast cancer in our department over a 4-year period from January 2000 to December 2003. Patient and tumour characteristics including age, parity, family history, tumour size and histology, grade and hormonal receptor status were analysed. Comparisons were made between those with EBC and those with LABC and MBC, as well as between Malay women and women of other ethnic groups. RESULTS: One hundred and thirty-four patients (21.5%) presented with either LABC or MBC. Adjusted analysis found that these patients were older and more likely to be nulliparous than those with EBC. Older patients tend to have larger tumours, but otherwise, age and parity did not correlate with tumour histology, grade or hormonal status. It was noted that Malay women, who were more likely to present with LABC or MBC, were more likely to have oestrogen receptor- and progesterone receptor-negative tumours. CONCLUSIONS: Older women and those who were nulliparous were found more likely to present with LABC and MBC. However, age and parity did not appear to be related to tumour histology, grade and hormonal status. Given that tumour size and stage have the greatest impact on overall survival, efforts to raise public awareness of the benefits of early detection and treatment should be continued, and possibly directed towards these groups of women who appear to be at an increased risk of presenting late.

Breast conservation surgery--the surgeon's factor.

Breast-conserving surgery (BCS) is a well-established treatment for early breast cancer. However, rates of BCS differ in different countries and institutions. This study attempts to find the factors affecting BCS in a local acute care hospital. To this end, 389 patients with early breast cancers treated between 2000 and 2002 were enrolled. Indications for mastectomy were more likely to be documented by breast surgeons (45%) than by other surgeons (30.6%) (P = 0.052). Univariate analysis showed that patients who had smaller tumours, were operated on in 2002 and were operated on by breast specialists were more likely to have undergone BCS. Multivariate analysis, after exclusion of patients with compelling indications for mastectomy, showed that the year of operation (p < 0.001) and the surgeon's subspecialty (p = 0.003) remained independent predictors of BCS. Thus, the surgeon has a crucial role in increasing the BCS rate in the treatment of early breast cancer.

Alvarado score: an admission criterion in patients with right iliac fossa pain.

Appendicitis is an important differential diagnosis in patients with right iliac fossa pain. The diagnosis in patients with equivocal signs can be difficult. Many patients with suspected appendicitis are admitted for observation. We studied the Alvarado scores of 175 patients who presented to the emergency department with right iliac fossa pain and found that patients with scores of 4 or less did not have appendicitis. We also present an algorithm incorporating the Alvarado score for patients with suspected appendicitis.