ABSTRACT
AIMS: The gold standard for detection of Sentinel Lymph Nodes (SLN) is a combined radioisotope and blue dye breast injection, using a gamma probe (GP). A new, non-radioactive method was developed, using a tracer (Sienna+(®)) of superparamagnetic iron oxide (SPIO) nanoparticles and a manual magnetometer (SentiMag(®)) (SM). The IMAGINE study was designed to show the non-inferiority of SM compared to GP, for the detection of SLN in breast cancer patients with SLN biopsy indication. METHODS: From November 2013 to June 2014, 181 patients were recruited, and 321 nodes were excised and assessed ex-vivo. Readings from both SM and GP devices were recorded during transcutaneous, intraoperative, and ex-vivo detection attempts. RESULTS: At the patient level, ex-vivo detection rates (primary variable) with SM and GP were 97.8% and 98.3% (concordance rate 99.4%). Transcutaneous and intraoperative detection rates were 95.5% vs 97.2%, and 97.2% vs 97.8% for SM and GP respectively (concordance rates > 97%). At the node level, intraoperative and ex-vivo detection rates were 92.5% vs 89.3% and 91.0% vs 86.3% for SM and GP respectively. In all cases the non-inferiority of SM compared to SM was shown by ruling out a predefined non-inferiority margin of 5%. CONCLUSIONS: Our study showed the non-inferiority of SM as compared to GP. Moreover, the ex-vivo and intraoperative detection rates at the node level were slightly higher with SM.
Subject(s)
Breast Neoplasms/diagnosis , Ferrosoferric Oxide , Lymph Nodes/pathology , Sentinel Lymph Node Biopsy/methods , Adult , Aged , Aged, 80 and over , Axilla , Breast Neoplasms/metabolism , Breast Neoplasms/secondary , Female , Ferrosoferric Oxide/pharmacokinetics , Humans , Lymph Nodes/metabolism , Lymphatic Metastasis , Middle Aged , Retrospective StudiesSubject(s)
Anal Canal/surgery , Anus Neoplasms/surgery , Myocutaneous Flap , Rectus Abdominis/surgery , Salvage Therapy/methods , Female , HumansABSTRACT
BACKGROUND: There is no evidence that supports the recommendation of sentinel lymph node biopsy (SLNB) in patients with breast cancer who have treated with neoadjuvant chemotherapy (NAC) to downsize tumors in order to allow breast conservation surgery, because NAC induces anatomical alterations of the lymphatic drainage. We evaluated the effectiveness of SLNB using intraoperative one-step nucleic acid amplification (OSNA) method to detect microscopic metastases or isolated tumor cells after NAC in patients with clinically negative axillary nodes at initial presentation. PATIENTS AND METHODS: We evaluated in patients with breast cancer and clinically negative axilla at presentation, the effectiveness of SLNB by OSNA after NAC (71 patients) or prior to NAC (40 patients). RESULTS: The rate of SLN identification was 100% in both groups. 17 women with SLNB prior to systemic treatment showed positive nodes (14 macrometastases and 3 micrometastases), and positive SLNB were detected in 15 women with SLNB after NAC, which were 14 macrometastases and 1 micrometastase. The negative predictive value of ultrasonography was 57.5% in patients with SLNB prior to neoadjuvant therapy and 78.9% in patients with chemotherapy followed by SLNB. CONCLUSIONS: Intraoperative SLNB using OSNA in women with clinically negative axillary lymph nodes at initial presentation who received NAC could predict axillary status with high accuracy. Also it allows us to take decisions about the indication or not to perform an axillary dissection at the moment, thus avoiding delay in the administration of chemotherapy and benefiting the patients from a single surgical procedure.
Subject(s)
Breast Neoplasms/drug therapy , Breast Neoplasms/surgery , Lymph Nodes/surgery , Neoadjuvant Therapy , Sentinel Lymph Node Biopsy/methods , Adult , Aged , Axilla , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Case-Control Studies , Chi-Square Distribution , Cohort Studies , Disease-Free Survival , Female , Humans , Intraoperative Care/methods , Lymph Node Excision/methods , Lymph Nodes/pathology , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Staging , Nucleic Acid Amplification Techniques , Predictive Value of Tests , Prognosis , Risk Assessment , Statistics, Nonparametric , Survival Analysis , Treatment OutcomeABSTRACT
La sepsis meningocóccica se asocia con un alto índice de mortalidad. Los pacientes afectados pueden mostrar signos de coagulación intravascular diseminada (CID) y necrosis de partes blandas debidas a baja perfusión tisular. Los procedimientos quirúrgicos precoces suelen demorarse en estos casos, pues inicialmente es difícil determinar el grado de la lesión. Una vez que el paciente está estable, es esencial el desbridamiento de todo tejido necrótico, teniendo como objetivo el preservar la máxima cantidad de tejido posible, especialmente las articulaciones. Muchos niños sobreviven a esta patología, pero sufren gran morbilidad: amputación de una o varias extremidades y otras complicaciones derivadas como exposiciones óseas. Existen pocas publicaciones que hagan referencia al tratamiento no quirúrgico de este tipo de lesiones. Presentamos un caso de aplicación del sistema de terapia depresión negativa VAC ® en paciente en edad pediátrica tras pérdida de sustancia como resultado de una púrpura fulminans secundaria a meningococcemia (AU)
Meningococcal sepsis is associated with a high mortality rate. These patients may show severe disseminated intravascular coagulation (DIC) and skin, subcutaneous tissue and muscle necrosis due to poor tissue perfusion. It is rare that early surgical intervention be required, as it is relatively difficult to determine the degree of tissue loss early on. Once the patient is stable, debridement of all necrotic tissue is essential, and the goals are still to preserve as much tissue as possible, specially the joints. Many children survive the disease, but suffer major morbidities such as extremities amputation, which may result of complications like bone exposure. There is very little published experience regarding the non-surgical treatment of this complication. We report anew possible application of the vacuum-assisted closure system (VAC®) in very young patients with loss of tissue as a result of purpura fulminans secondary to meningococcemia (AU)
Subject(s)
Humans , Female , Infant , /methods , Purpura Fulminans/complications , Skin Ulcer/surgery , Skin Ulcer/complications , Amputation, Surgical/methods , Neisseria meningitidis/pathogenicity , Ischemia/complicationsABSTRACT
Muchos métodos han sido utilizados para facilitar la desepidermización en mamoplastias de reducción. Uno de los aspectos más importantes es proporcionar una adecuada tensión para hacer dicha tarea fácil y sin muchas dificultades. Sin duda, esa es la parte más tediosa de la reducción mamaria porque se necesita una buena tensión durante un tiempo. Por tanto, cualquier maniobra que facilite esta tarea, es bienvenida. Presentamos la aplicación de una brida de polipropileno con objeto de proporcionar tensión y desepidermización adecuadas en mamoplastias de reducción. Esta maniobra de retracción hace más fácil y rápido este paso de la intervención (AU)
Many methods have been used to make easy skin deepithelization in reduction mammaplasty. The most important is to provide a good tension in order to harvest the skin quickly, easier and without difficulties. Surely, this is the most tedious part of breast reduction, because you need a very good breast tension, so anything that can be done to hasten this step is welcome. We report the application of a polypropilene strap to improve breast tension and deepithelization in breast reduction. This retraction maneuver makes this step of the operation quicker and easier (AU)
