Effects of COVID-19 pandemic in a breast unit: Is it possible to avoid delays in surgical treatment?

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has caused fear all around the world. With people avoiding hospitals, there has been a significant decrease in outpatient clinics. In this study, we aimed to compare and explore the first peak of the pandemic period by studying its effects on patient applications, new diagnoses and treatment approaches in a non-infected hospital. METHODS: We collected data from the first peak of the pandemic period in Turkey, from the pandemic declaration (11 March 2020) to social normalization (1 June 2020), and compared it with the data from a pre-pandemic period with a similar length of time. We analyzed the data of breast cancer patients from application to surgery. RESULTS: The data of 34 577 patients were analyzed for this study. The number of patients who applied to outpatient clinics decreased significantly during the pandemic period. After excluding control patients and benign disorders, a figure was reached for the number of patients who had a new diagnosis of breast cancer (146 vs. 250), were referred to neoadjuvant treatment (18 vs. 34), and were treated with surgery (121 vs. 229). All numbers decreased during the pandemic period, except for surgeries after neoadjuvant treatment (21 vs. 25). Surgical treatment approaches also changed. However, the rate of newly diagnosed breast cancer patients treated with surgery was similar in both periods. None of these patients were diagnosed with COVID-19 or died during the pandemic. CONCLUSION: This study shows that non-infected hospitals can be useful in avoiding delays in the surgical treatment of cancer patients.

Can preoperative axillary ultrasound and biopsy of suspicious lymph nodes be an alternative to sentinel lymph node biopsy in clinical node negative early breast cancer?

AIM: The aim of this study was to assess the efficacy of preoperative axillary ultrasonography (AUS) and preoperative axillary fine-needle aspiration biopsy (FNAB) from suspicious lymph nodes in clinically node-negative breast cancer to compare with radiologically positive and sentinel lymph node biopsy (SLNB) positive involvement. METHOD: Clinically node-negative early-stage breast cancer patients were included in the study. These patients underwent preoperative AUS examination, suspicious lymph nodes were evaluated with FNAB. AUS-FNAB results were compared with those of SLNB or axillary dissection. RESULTS: Of 181 patients undergoing AUS, 32 were reported to have axillary metastasis, 25 suspicious, and 124 benign nodes. The suspicious group underwent FNAB examination and metastasis was found in 9 of them. The sensitivity of AUS-FNAB was found to be 64.06%, specificity 100%, positive predictive value 100%, and negative predictive value (NPV) 83.5%. The false negativity rate (FN) of this method was 16,4%. Lymphovascular invasion and tumour size were found statistically significant factors for false negativity. CONCLUSION: It was concluded that axillary AUS-FNAB with its high NPV, low FN rate, may be a clinical alternative to SLNB for early-stage breast cancer patients.

Preoperative neutrophil-to-lymphocyte ratio as a predictive factor for survival in nonmetastatic colorectal cancer.

BACKGROUND: The pretreatment ratio of neutrophils to lymphocytes (NLR) has been suggested as an indicator of poor outcome in various cancers. This study aimed to determine whether the preoperative NLR may be a predictor of survival in patients who underwent curative resection for colorectal cancer (CRC). MATERIALS AND METHODS: The records of 219 CRC patients underwent curative resection between 2008 and 2014 were retrospectively evaluated. NLR was calculated by preoperative complete blood counts. The effects of age, gender, anatomic location, histologic grade, lymphovascular invasion, pathological T, pathological N, and tumor-node-metastasis stages and NLR on disease-free survival (DFS) and overall survival (OS) were analyzed using univariate and multivariate analyses. The optimal cutoff value for NLR was determined using receiver operating characteristic curve analysis. RESULTS: The best cutoff value of NLR was 2.8. Multivariate analysis showed that NLR was not a predictor of DFS. However, NLR was found as an independent prognostic factor for OS (Hazard ratio, 5.4; 95% confidence interval, 2.3-12.5; P = 0.0001). CONCLUSION: A preoperative NLR of more than 2.8 might be an independent predictor for OS in patients with CRC. This simple and routinely available laboratory parameter may be used as a useful marker for identifying patients with a worse prognosis.