ABSTRACT
BACKGROUND: Upstaging from DCIS to invasive ductal carcinoma varies widely from 0 to 59%. We aim to identify risk factors associated with upstaging in all DCIS patients and based on specific surgical intervention. METHODS: Patients with a pre-operative diagnosis of DCIS undergoing BCT or mastectomy were reviewed. Multivariable analysis was performed to identify risk factors for upstaging. RESULTS: In total, 623 patients had a preoperative diagnosis of DCIS. Upstaging occurred in 74 patients (12%) overall. There was no difference in upstaging rates between mastectomy and BCT (11% v 14% pâ¯=â¯0.27). Sentinel lymph node biopsy was positive in 4/212 patients (1%). Multivariable analysis revealed suspicion of microinvasion (OR 5.7 95%CI2.2-14.9), surgeon suspicion of invasive disease (OR 2.7, 95% CI 1.2-6.4) and larger size/multicentric/extensive tumor (OR 1.9 95% CI 1.1-3.4) increase risk of upstaging. CONCLUSIONS: Suspicion of microinvasion, surgeon suspicion, and tumor size can be used to help guide the use of sentinel lymph node biopsy. For patients without these high risk characteristics, it is hard to justify the use of concurrent SLN biopsy for patients who undergo BCT.
Subject(s)
Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/pathology , Carcinoma, Intraductal, Noninfiltrating/pathology , Mastectomy, Radical , Mastectomy, Segmental , Adult , Aged , Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/diagnosis , Carcinoma, Ductal, Breast/surgery , Carcinoma, Intraductal, Noninfiltrating/diagnosis , Carcinoma, Intraductal, Noninfiltrating/surgery , Female , Humans , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Retrospective Studies , Risk Factors , Sentinel Lymph Node BiopsyABSTRACT
A simple, rapid, sensitive, and specific field test for marijuana and its products is described. The test employs an extracting-eluting ssolvent and an inert adsorbent microcolumn coated with Fast Blue B salt as the reagent. One milligram or less of the suspect material can be tested within 1 min. Of greater than nonmarijuana plant samples tested, only nutmeg and its mace responded similarly to marijuana initially. A differentiation was possible by careful evaluation of the colored microcolumn and the elution behavior of the colored products. The test also provides for a confirmatory step, based on spectrophotometric analysis of the colored eluates. The reagent microcolumn was very stable to environmental factors such as moisture, light, and air.
