ABSTRACT
BACKGROUND: Pathologic evaluation of sentinel lymph node biopsy (SLNB) samples is crucial for axillary staging in patients newly diagnosed with breast cancer. Patients with pathologic evidence of nodal metastasis scheduled for upfront surgery typically also undergo axillary lymph node dissection (ALND). Although SLNB is the gold standard method for detecting nodal metastasis, axillary lymph node fine-needle aspiration biopsy (FNAB) utility has not been thoroughly explored. METHODS: Ultrasound-guided axillary lymph node FNAB samples along with concurrent ipsilateral breast tissue samples were searched and reviewed. The control group included histologic findings of axillary dissection or intraoperative SLNB results. RESULTS: A total of 354 axillary lymph node FNAB samples with matched histology were included. Of these, 187 (52.8%) were positive for metastatic carcinoma of breast origin; 143 (40.4%) were negative for metastasis; 12 (3.4%) showed atypical cells; six (1.7%) were suspicious for metastasis; and six (1.7%) were nondiagnostic because of a lack of lymphoid tissue and malignant cells. Of the 143 negative FNAB samples, 22 (15.4%) were positive on either intraoperative SLNB or ALND. When only the positive and negative FNAB samples were accounted for (n = 330; 93.2%), overall diagnostic sensitivity and specificity were 89.4% and 99.2%, respectively. CONCLUSIONS: Although axillary SLNB is the standard procedure for detecting nodal metastasis of breast origin, axillary lymph node FNAB appears to be a suitable alternative in a significant proportion of patients. A standard SLNB should be performed in cases of negative axillary lymph node FNAB findings, particularly nodes with abnormal imaging findings.
Subject(s)
Breast Neoplasms , Humans , Female , Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , Breast Neoplasms/pathology , Biopsy, Fine-Needle/methods , Neoplasm Staging , Lymphatic Metastasis/diagnosis , Lymphatic Metastasis/pathology , Lymph Nodes/diagnostic imaging , Lymph Nodes/surgery , Lymph Nodes/pathology , Sentinel Lymph Node Biopsy/methods , Lymph Node Excision , Axilla/pathologyABSTRACT
BACKGROUND: Congenital diaphragmatic eventration (CDE) is a rare congenital malformation that is well described in the pediatric literature. In contrast to congenital diaphragmatic hernia (CDH), there is no physical defect in the diaphragm with CDE. Prenatal differentiation of the two pathologies represents a diagnostic and prognostic challenge. CASE: A 26-year-old nulliparous woman was evaluated for a fetal thoracic mass. At 22 weeks, detailed morphology ultrasound revealed a multi-cystic structure in the left side of the thorax. Differential diagnosis included cystic congenital adenomatoid pulmonary malformation and CDH. Left diaphragmatic eventration was added to the differential diagnosis when serial ultrasound at 36 weeks showed the left hemidiaphragm as a thin membrane bulging into the fetal chest with the left kidney in a higher position underneath. The male infant was delivered vaginally at 373 weeks. CT imaging at 2 days of life showed findings consistent with left diaphragmatic eventration with protrusion of small bowel loops and the left kidney underneath. The infant was successfully extubated 3 days later and remained on nasal cannula until discharge on day 17 of life. At 6 months, the infant required operative repair owing to increasing shortness of breath. CONCLUSION: CDE is a rare and difficult diagnosis to consider prenatally. Probable associated features may aid diagnosis. Additional, larger case series are needed to improve prenatal differentiation of this condition.
Subject(s)
Diaphragmatic Eventration , Hernias, Diaphragmatic, Congenital , Adult , Child , Diaphragm , Diaphragmatic Eventration/diagnostic imaging , Female , Fetus , Hernias, Diaphragmatic, Congenital/diagnostic imaging , Humans , Infant , Male , Pregnancy , UltrasonographyABSTRACT
Introduction This study assessed the impact of a summer research training course on the knowledge levels and skills of medical and allied health students. Methods A one group pretest-posttest quasi-experiment study was conducted during a summer research course at King Fahad Medical City, Saudi Arabia. A self-administered questionnaire was distributed among course participants twice, on the first day (pretest) and the last day of the course (posttest). The questionnaire consisted of four sections: study design, literature review, formulation of a research question, and biostatistics. Results A total of 44 participants were included in the study, of whom 27 (61.4%) were medical students. The overall mean score of correct responses of the participants was 17.70±4.00 in the pretest compared to 22.18±6.64 in the posttest (p<0.001). The mean score of the correct responses of the participants in the "study design" pretest section was (4.23±1.51) compared to (10.23 ± 3.71) in the posttest, (p<0.001). While for the literature review section, the mean score of the correct responses in the pretest was (2.20±1.19) and (2.77±1.34) in the posttest, (p=0.027). Moreover, our results revealed that all participants (100%) were able to execute all the steps of a research project and 6 (13.64%) participants were able to submit papers for publication. Conclusions Our results showed that a research training program might enhance research knowledge and skills in terms of the successful accomplishment of relevant assessment tasks among medical and allied health students.
