ABSTRACT
BACKGROUND: The purpose of the present study was to assess the impact of inadequate fine-needle aspiration cytology (FNAC) breast specimens on the outcome of patients with a palpable breast lesion. METHODS: A retrospective review was carried out of inadequate FNAC specimens from the Department of General Surgery, Singapore General Hospital in 1997. RESULTS: One hundred and thirty-eight (16.6%) of 831 FNAC specimens were reported inadequate, and these form the study group. Outcome analysis was divided into benign on excision biopsy (n = 38; 29.4%); benign on repeat FNAC or trucut biopsy (n = 6; 4.7%); benign on follow up (n = 46; 35.7%); malignant on histology (n = 11; 8.5%); and lost to follow up (n = 28; 21.7%). The 11 cases with breast cancer were further analysed. The mean time to treatment was 88.3 days for three patients whose tumours were not clinically suspicious of malignancy versus 20 days for six patients who were diagnosed with cancer clinically from the onset. One patient with cancer refused treatment and one absconded from treatment only to return 7 months later. CONCLUSION: Breast cancer was present in 8.5% of the inadequate FNAC specimens. When clinical suspicion of malignancy is high, an excision biopsy is advised in patients with inadequate FNAC specimens. If properly managed with triple tests and good clinical judgement, the inadequate FNAC specimens do not delay treatment in patients with breast cancer.
Subject(s)
Biopsy, Needle/standards , Breast Neoplasms/pathology , Breast/cytology , Diagnostic Errors , Adult , Aged , Breast/pathology , Breast Neoplasms/diagnosis , Breast Neoplasms/mortality , Breast Neoplasms/surgery , Disease-Free Survival , Female , Humans , Middle Aged , Prognosis , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Transabdominal duplex Doppler ultrasonography (TDDU) is commonly used for measuring hepatic blood flow (HBF) in clinical practice. Flow velocity and the cross-sectional area (CSA) of vessels are obtained separately and used to compute blood flow. Respiration and changes in portal pressure are known to cause variations in the CSA of the portal vein, but the impact of these parameters on TDDU measurement of portal blood flow is unclear. Eight Yorkshire pigs (20.7-25.1 kg) were used for the study. TDDU determination of portal blood flow was carried out using CSA of the portal vein obtained at inspiration (maximal) and at expiration (minimal) for computation, and the differences obtained were compared. Determination of HBF was carried out simultaneously on the same animals using diisopropyliminodiacetic acid (DISIDA) clearance. A physiological increase in portal pressure was then created by 50% hepatectomy and TDDU measurement similarly carried out on the second postoperative day. Computing portal blood flow in the intact liver using maximal and minimal CSA gave rise to a mean difference of 7.0 ml kg(-1) min(-1) (P < 0.001). A significant correlation was obtained between HBF and portal flow computed from maximal CSA (Pearson's correlation = 0.85, P < 0.033). The respiratory index of the portal vein (maximal CSA/minimal CSA) decreased from 1.5 to 1.2 after hepatectomy, which also caused a 90% increase in portal pressure. Respiration and portal pressure thus significantly impact on TDDU determination of HBF, and in this porcine model, computation using maximal CS more accurately reflects HBF.
Subject(s)
Portal System/diagnostic imaging , Portal System/physiology , Respiration , Ultrasonography, Doppler, Duplex , Animals , Portal Vein/diagnostic imaging , Radiopharmaceuticals , Regional Blood Flow , Swine , Technetium Tc 99m DisofeninABSTRACT
A prospective, comparative study was made between 371 patients undergoing laparoscopic cholecystectomy and 100 patients undergoing conventional cholecystectomy. Post-operative pain was assessed subjectively by a single observer using a visual analog score and objectively by assessment of parenteral analgesic used. Patients who underwent laparoscopic cholecystectomy required significantly less analgesia (46.7 mg vs 223.9mg mean pethidine dose, p < 0.01) and were observed to have mobilised earlier and had a shorter mean post-operative stay (3.5 days vs 5.9 days, p < 0.01). Laparoscopic cholecystectomy objectively reduces post-operative pain significantly and should be the new standard for treatment of gallstones.
