The evaluation of the sentinel lymph nodes status in breast carcinoma using microscopic, immunohistochemical and cytomorphometric methods in order to establish new stadializations and therapeutic schemes.

The state of axillary lymph nodes represents the most important prognostic parameter in patients with breast carcinoma. The biopsy and examination of sentinel lymph nodes, the former one containing metastases originating in mammary carcinoma, allows a better stadialization of the tumor but also the avoiding of the extirpation of the axilla, associated with a series of complications and high costs of hospitalization. In establishing the tumoral prognosis, not only the diameter but also the localization of the metastasis in the lymph nodes is utterly important. The evaluation of the metastases was carried out through the serial examination of the sentinel lymph node correlated to immunohistochemical examinations with AE1/AE3. Of the 570 patients with breast carcinoma evaluated in this research, 250 had macrometastases, 93 micrometastases, only 23 had isolated tumor cells, and in the case of 204 no metastases were found. The technique of computerized cytomorphometry allowed a better evaluation of the diameter and localization of the metastases in the lymph nodes than the examination through optical microscope. The tumoral prognosis in the case of patients with macrometastases is poorer than that of patients with micrometastases. The patients in whom only the presence of isolated tumoral cells was demonstrated have a similar prognosis with those who do not have metastases. As far as the localization of micrometastases in the sentinel lymph nodes is concerned, those with a subcapsular localization are associated with a poorer prognosis than those with an intraparenchymatous localization. As well as this, the subcapsular localization of micrometastases was also associated with the diameter of the primary tumor extending between 2-5 centimeters, a high microscopic grade, the presence of lymph vascular emboli and microscopic type of the primary tumor associated with poor prognosis. On the other hand, the presence of isolated tumoral cells was associated with tumors of a small diameter lacking the presence of lymph vascular emboli and with a low microscopic grade. All these data are essential in establishing the therapeutic management of the patients with breast carcinoma; consequently, we recommend their inclusion in future stadializations of this lesion and the evaluation of tumoral prognosis.

The value of intraoperative diagnosis in breast lesions.

UNLABELLED: Frozen section examination is aimed at making a preoperative diagnosis, determining the benign or malignant nature of a breast lesion, but also the most suitable surgical procedure. The sensitivity and specificity of this method and the causes of discrepancies were analyzed in a retrospective study of 2 177 breast lesions. METHOD: 1,150 frozen sections from 2,177 breast lesions were performed in the interval 1999-2005. The sections made at the open door cryostat and measuring 5 microm were stained with rapid Hematoxylin-Eosin. The following terms were used for describing the intraoperative diagnosis: negative, positive, and await paraffin section. After the frozen section diagnosis was made, the frozen tissue was thawed to room temperature and fixed in formalin overnight for further paraffin processing. The remaining unfrozen tissue was processed into a paraffin section. RESULTS: The number of cases and the number of frozen sections increased from 1999 (341 cases, 87 frozen sections) to 2005 (441 cases, 220 frozen sections). Mean sensitivity (a/a+c) was 94%, and mean specificity (d/b+d) was 99%. The false positive cases accounted for 0.08%, while the false negative ones for 2.26%. In 7% of the cases the diagnosis could not be made on frozen section. CONCLUSIONS: Despite the raging popularity of aspiration cytology, frozen section still stands out as the method of choice for rapid diagnosis. Frozen section is not indicated to be performed on mammographically detected lesions, small lesions, papillary lesions, proliferating fibrocystic disease, or tubular carcinoma.

Study of the efficiency of the head-up tilt test with nitroglycerin challenge in the diagnosis of vasovagal syncope.

UNLABELLED: Syncope is defined as a transient, self-limited loss of consciousness. It is an important cause of morbidity in general population and the vasovagal syncope (VVS) is a common clinical problem which often leads to hospital admission, multiple office visits, and performing of many diagnostic tests. Head-up tilt table testing (HUTT) is a widely used diagnostic tool, with proved efficiency in diagnosing the many types of VVS. The aim of our study was to assess the efficacy of the HUTT with sublingual nitroglycerin (NTG) challenge for the diagnosis of vasovagal syncope. PATIENTS AND METHODS: The study groups consisted of 72 patients (37 women, 35 men), mean age (+/-SD) 38.5 +/- 15.7 years, referred to our clinic for syncope of unknown origin and 16 healthy volunteers as control subjects (9 women and 7 men) with a mean age 26 +/- 6.5 years and no history of syncope. The HUTT protocol was performed in the morning after an overnight fast, with a 15 minutes supine equilibration phase followed by a 30 minutes drug free tilt phase at an angle of 70 degrees. If no positive response was recorded, 400 micrograms of NTG spray were given sublingually and the HUTT continued for 20 minutes. RESULTS: The HUTT was positive in 58 patients (80.5%) and negative in 14 (19.5%) while in the control subjects 4 (25%) had positive HUTT response. The sensitivity of the HUTT protocol with nitroglycerin challenge used in our study was 81% and the specificity was 75% (p<0.0001). CONCLUSION: The described HUTT protocol appears to be a simple and efficient tool for the diagnosis of syncope associated with normal ECG and no signs of organic heart disease. The sublingual nitroglycerin challenge was safe to use and showed no side effects while keeping the sensitivity and specificity of the test to an accepted level.