Applicability of Radioguided Occult Lesion Localization for NonPalpable Benign Breast Lesions, Comparison with Wire Localization, a Clinical Trial.

BACKGROUND: This study was designed to compare radioguided versus routine wire localization of non palpable nonmalignant breast lesions in terms of efficacy for complete excision, ease of use, time saving, and cosmetic outcome. MATERIALS AND METHODS: Patients with nonpalpable breast masses and nonmalignant core biopsy results who were candidates for complete surgical lumpectomy were enrolled and randomly assigned to radioguided or wire localization groups. Radiologic, surgical, and pathologic data were collected and analyzed to determine the difficulty and duration of each procedure, ease of use, accuracy, and cosmetic outcomes. RESULTS: This prospective randomized study included 60 patients, randomly divided into wire guided localization (WGL) or radioguided occult lesion localization (ROLL) groups. The mean duration of localization under ultrasound guidance was shorter in the ROLL group (14.4 min) than in the WGL group (16.5 min) (p<0.001). The ROLL method was significantly easier for radiologists (p=0.0001). The mean duration of the surgical procedure was 22.6 min (±10.3 min) for ROLL and 23.6 min (± 9.6 min) for WGL (p=0.6), a nonsignificant difference. Radiography of the surgical specimens showed 100% lesion excision with clear margins, as proved by pathologic examination, with both techniques. The surgical specimens were slightly heavier in the ROLL group, but the difference was not significant (p=0.06). CONCLUSIONS: The ROLL technique provides effective, fast, and simple localization and excision of nonpalpable nonmalignant breast lesions.

Breast Necrosis after Chemotherapy for Recurrent Ovarian Cancer: Report of a Case and Review of the Literature.

Breast necrosis is a rare event due to abundant blood supply of the breast. We present an unusual case of partial breast necrosis after chemotherapy for recurrent ovarian cancer. Necrotic tissue sloughed with conservative management and the wound was repaired surgically. We believe that this is the first case report of breast necrosis as a systemic complication of chemotherapy.

Clinicopathologic features predicting involvement of non- sentinel axillary lymph nodes in Iranian women with breast cancer.

BACKGROUND: Almost half of the breast cancer patients with positive sentinel lymph nodes have no additional disease in the remaining axillary lymph nodes. This group of patients do not benefit from complete axillary lymph node dissection. This study was designed to assess the clinicopathologic factors that predict non-sentinel lymph node metastasis in Iranian breast cancer patients with positive sentinel lymph nodes. MATERIALS AND METHODS: The records of patients who underwent sentinel lymph node biopsy, between 2003 and 2012, were reviewed. Patients with at least one positive sentinel lymph node who underwent completion axillary lymph node dissection were enrolled in the present study. Demographic and clinicopathologic characteristics including age, primary tumor size, histological and nuclear grade, lymphovascular invasion, perineural invasion, extracapsular invasion, and number of harvested lymph nodes, were evaluated. RESULTS: The data of 167 patients were analyzed. A total of 92 (55.1%) had non-sentinel lymph node metastasis. Univariate analysis of data revealed that age, primary tumor size, histological grade, lymphovascular invasion, perineural invasion, extracapsular invasion, and the number of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes ratio, were associated with non-sentinel lymph node metastasis. After logistic regression analysis, age (OR=0.13; 95% CI, 0.02-0.8), primary tumor size (OR=7.7; 95% CI, 1.4-42.2), lymphovascular invasion (OR=19.4; 95% CI, 1.4- 268.6), extracapsular invasion (OR=13.3; 95% CI, 2.3-76), and the number of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes ratio (OR=20.2; 95% CI, 3.4-121.9), were significantly associated with non-sentinel lymph node metastasis. CONCLUSIONS: According to this study, age, primary tumor size, lymphovascular invasion, extracapsular invasion, and the ratio of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes, were found to be independent predictors of non-sentinel lymph node metastasis.

Papillary serous carcinoma arising in abdominal wall endometriosis treated with neoadjuvant chemotherapy and surgery.

OBJECTIVE: To report a case of malignant transformation of abdominal wall endometriosis. DESIGN: Case report. SETTING: Private practice. PATIENT(S): A 59-year-old woman with a rapidly growing abdominal wall mass. INTERVENTION(S): Neoadjuvant chemotherapy and surgical resection of the mass. MAIN OUTCOME MEASURE(S): Shrinkage of the tumor after neoadjuvant chemotherapy and wide excision and reconstruction of abdominal wall. RESULT(S): A 59-year-old woman had a history of laparotomy performed for uterine perforation due to dilatation and curettage 20 years ago. She noticed a mass in her abdominal wall shortly after the operation, which changed in size with menstrual cycles. The mass showed a rapid growth in the last 6 months before presentation. Incisional biopsy revealed papillary serous carcinoma. Owing to the large size of the mass, the patient received neoadjuvant chemotherapy and underwent surgery after shrinkage of the mass. CONCLUSION(S): Malignant transformation of endometriosis is a rare event. In case of huge tumors, neoadjuvant chemotherapy might facilitate surgery by shrinking the tumor.

Comparison of carbon dioxide laser and scalpel for breast lumpectomy: a randomized controlled trial.

OBJECTIVE: To investigate whether the CO2 laser is superior to conventional surgical techniques for minor breast surgery in a randomized clinical trial. BACKGROUND DATA: It has been suggested in the literature that application of CO2 laser in breast surgery might be superior to conventional surgery in some aspects. PATIENTS AND METHODS: Sixty women whose breast masses were suitable for excisional biopsy were randomly allocated to laser and control (conventional surgical technique with scalpel) groups. Perioperative and postoperative variables were recorded and analyzed. RESULTS: The patients' ages ranged from 16-63 y. There were no significant differences between the two groups in total operative time (17.4 min with laser and 17.5 min with scalpel). There was a significant decrease in the required dose of lidocaine in the laser group (9.3 mL) compared to the scalpel group (12.4 mL; p = 0.01). In addition, hemorrhage was significantly lower in the laser group (6.6 mL) compared to the control group (11.9 mL; p = 0.006). There was no difference in the grade of the scar or postoperative pain between the two groups. CONCLUSION: Use of the CO2 laser in breast mass biopsy has some advantages, including a lower requirement for local anesthetic and a lower rate of intraoperative bleeding. Furthermore, using the laser does not prolong the operative time.

The accuracy of midwives' clinical breast examination in detection of breast lumps.

BACKGROUND: Screen-detected breast cancers are usually diagnosed at earlier stages. Therefore, countries with limited resources are recommended to implement clinical breast examination (CBE) as a screening method in conjunction with mammography. Since there are so many limitations to performance of CBE by surgeons in the health system and CBE by midwives is more feasible, this study was conducted to test the agreement of CBE by midwives and surgeons. METHODS: One thousand and twenty seven patients with no personal history of breast cancer received breast physical examination by both a midwife and a surgeon and designed forms including patients' general information, cause of referral and abnormal physical findings were completed for each patient. RESULTS: The inter-observer agreement (kappa) for mass detection was 36 % (95% CI= 31% to 41%), indicating a "fair" agreement exists between the midwife's and the surgeon's physical examination. Sensitivity, specificity, positive and negative predictive values of "midwife's physical examination" to detect abnormal breast masses in comparison to "surgeon's physical examination" as the gold standard were 75, 67, 48, and 87 percent respectively. CONCLUSIONS: The results of this study do not justify the replacement of general surgeons by midwives in the health care system as the first examiner for clinical breast screening. Decisions about this issue need more comprehensive studies considering cost-effectiveness and training procedures.

Breast conserving surgery versus mastectomy: cancer practice by general surgeons in Iran.

BACKGROUND: There appear to be geographical differences in decisions to perform mastectomy or breast conserving surgery for early-stage breast cancer. This study was carried out to evaluate general surgeons' preferences in breast cancer surgery and to assess the factors predicting cancer practice in Iran. METHODS: A structured questionnaire was mailed to 235 general surgeons chosen from the address list of the Iranian Medical Council. The questionnaire elicited information about the general surgeons' characteristics and about their work experience, posts they have held, number of breast cancer operations performed per year, preferences for mastectomy or breast conserving surgery, and the reasons for these preferences. RESULTS: In all, 83 surgeons returned the completed questionnaire. The results indicated that only 19% of the surgeons routinely performed breast conserving surgery (BCS) and this was significantly associated with their breast cancer case load (P < 0.01). There were no associations between BCS practice and the other variables studied. The most frequent reasons for not performing BCS were uncertainty about conservative therapy results (46%), uncertainty about the quality of available radiotherapy services (32%), and the probability of patients' non-compliance in radiotherapy (32%). CONCLUSION: The findings indicate that Iranian surgeons do not routinely perform BCS as the first and the best treatment modality. Further research is recommended to evaluate patients' outcomes after BCS treatment in Iran, with regard to available radiotherapy facilities and cultural factors (patients' compliance).