Double-blinded, placebo-controlled, prospective randomized trial evaluating the efficacy of paravertebral block with and without continuous paravertebral block analgesia in outpatient breast cancer surgery.

BACKGROUND: Paravertebral block (PVB) is an effective alternative to general anesthesia for breast cancer surgery. Continuous paravertebral block (CPVB) anesthesia may extend postoperative analgesia at home and improve quality of early postoperative recovery of breast cancer patients. PURPOSE: This double-blinded randomized trial was conducted to compare degree of pain, nausea, mood, level of symptom distress, and time to return to normal daily activity between PVB and PVB + CPVB in patients undergoing outpatient breast cancer surgery. PATIENTS AND METHODS: Between July 2003 and April 2008 we randomly assigned 94 (73 evaluable) patients in a 1:1:1 ratio with early breast cancer to single injection PVB followed by CPVB infusion of 0.1% or 0.2% ropivacaine vs placebo (saline) for 48 hours postoperatively for unilateral breast cancer surgery without reconstruction. The primary study endpoint was the degree of pain, nausea, mood state, level of symptom distress, and recovery time. RESULTS: Of the 468 patients assessed for eligibility, 94 consented and 21 with incomplete data or follow-up were excluded, leaving 73 subjects for analysis. There was no clinically significant difference in degree of postoperative pain, nausea, mood state, level of symptom distress, or return to normal activity among the three study groups. CONCLUSION: The current study does not support the routine use of continuous paravertebral catheter anesthesia in patients undergoing operative treatment for breast cancer.

Sentinel node mapping for breast cancer: the operative experience of a breast surgeon in a rural community.

Sentinel lymph node biopsy has become an accepted procedure for staging the axilla in early stage breast cancer. Our objectives were to review our practice of sentinel lymph node (SLN) mapping in breast cancer, to determine the impact of frozen section (FS) analysis of the SLN on patient management, and to compare our results to national data. We retrospectively reviewed the medical records of our patients with breast cancer who underwent SLN mapping with or without axillary lymph node dissection (ALND) between 1999 and 2006. During this period, 478 patients were treated for breast cancer, with 227 patients undergoing SLN mapping. The SLN was identified in 201 patients, with a positive SLN found in 52 patients (25.9%). There was a discrepancy between the intraoperative analysis (FS/touch prep) and final pathology in 20 patients (11.3%). Nineteen of those patients had a negative FS with positive final pathology. Six of these patients underwent completion ALND. One patient had a false-positive FS with a negative ALND. No axillary recurrences were observed. Eight patients (3.5%) developed postoperative complications. Our practice has been to use intraoperative evaluation of the SLN to reduce the number of patients requiring a secondary ALND. In our study, six patients returned to the operating room for a completion ALND. Our complication rate and axillary recurrence rates were similar to national data.

Therapeutic options for occult breast cancer: a survey of the American Society of Breast Surgeons and review of the literature.

BACKGROUND: Axillary presentation of occult breast cancer (OBC) is uncommon, and continues to be a diagnostic and therapeutic challenge to physicians. After our recent experience with a similar patient, a survey of the American Society of Breast Surgeons (ASBS) was conducted to assess the Society's member's opinions on treatment. METHODS: A survey was sent by mail to 1837 members of the ASBS. The survey consisted of a brief case presentation after which the surgeon's preference for management of the breast was sought. The choices included "mastectomy," "whole breast radiation" or "other." RESULTS: A total of 776 (42%) responses were received. The majority of respondents, 338 or 43%, preferred "mastectomy," while 285 or 37% opted for "whole breast radiation." Twenty percent of respondents (153 responses) chose "other," of which 46 physicians (6% of total) indicated they would observe the patient. CONCLUSIONS: Although recent literature supports the use of whole breast radiation, these results demonstrate that a small majority of physicians still prefer mastectomy. The appropriate treatment of the breast after an axillary presentation of OBC continues to be a controversial issue.

Breast cancer in a patient with Poland's syndrome.

Poland's syndrome is a congenital anomaly that occurs in 1 of every 32,000 live births. Only two published cases of breast cancer in patients with this congenital anomaly have been previously reported. We describe a case of breast cancer in a 71 year-old female with a clinical diagnosis of Poland's syndrome. A detailed description of the clinical manifestations is provided.

Papillary carcinoma of the breast: characteristics and classification.

Papillary carcinoma is a rare but perplexing entity. The varied histopathological appearances make accurately diagnosing this tumor a difficult task. This review is a brief overview of the basic findings and a general classification of papillary carcinoma of the breast. Through an extensive literature review we have attempted to put forth a basic scheme of how papillary carcinoma is categorized with accepted treatment guidelines and protocol. A working knowledge of this tumor will facilitate a better understanding of its diagnosis and treatment with a reduction in overall morbidity.

Angiosarcoma of the breast: A case report and literature review.

PURPOSE: Primary angiosarcoma of the breast is a rare occurrence. METHODS: We report a case of a 35- year-old woman who presented with a highly vascular mass that had nearly replaced her right breast. RESULTS: Initial diagnosis reported the tumor as benign. However, permanent sections were sent to the Mayo Clinic, where the diagnosis of angiosarcoma of the breast was confirmed. The mass was removed via a total mastectomy. Adjuvant chemotherapy was also prescribed. A review of the literature suggested that the benefits of adjuvant chemotherapy were not well defined, but in the case described, adjuvant chemotherapy appeared to offer the best prognosis. CONCLUSIONS: Preoperative radiography is generally not indicated for angiosarcoma. Primary angiosarcoma of the breast is difficult to diagnose, with no pathognomonic features radiographically. We concluded that solid-appearing breast tumors, which are also highly vascular, should be considered malignant until proven otherwise. Surgical removal followed by adjuvant chemotherapy appears to afford the best prognosis.