Incidence of invasive versus non-invasive carcinoma in comparing palpable and non-palpable solid breast lesions.

A retrospective study was done of all patients with a suspicious mammographic breast lesion surgically biopsied in our institution within the last 5 years. Incidence of invasive versus non-invasive carcinoma and stage at presentation (according to TNM classification system) of palpable and non-palpable lesions were compared. We found a significant difference of non-invasive carcinoma in non-palpable and palpable cancers: 42.2% versus 4.3% (p < 0.001). Patients with a non-palpable invasive carcinoma presenting at stage I (i.e. pT1 with no axillary metastasis) rated significantly higher compared to those with palpable lesions 51.8% versus 9.4% (p < 0.001). The true positive biopsy rate is 30%. As low as 10% has been considered reasonable. We have a total of 56% carcinomas detected on all biopsies: 30% for non-palpable lesions and 66.8% for palpable lesions. A more aggressive approach towards screening and biopsy of breast lesions might increase early detection of carcinoma and so improve survival.

Thoracoscopic removal of a leiomyoma of the oesophagus: a case report.

A case of an oesophageal leiomyoma is presented. The technical aspects and benefits of thoracoscopic enucleation and closure of the muscular layer are discussed.

Laparoscopic-assisted surgery of the spleen: clinical experience in expanding indications.

Between January 1993 and November 1995 laparoscopic surgery was used in 21 patients with a variety of splenic diseases, namely idiopathic thrombocytopenic purpura, congenital spherocytosis, lymphoma, leukemic infiltrative disease, splenic infarction, trauma, or splenic cyst. Total splenectomy was carried out laparoscopically in 16 patients. Conversion to open splenectomy was necessary in two other patients because of intractable bleeding. Two patients with a splenic cyst underwent laparoscopic unroofing of the cyst. Conservative hemostasis of a spleen injury grade II was carried out in a child after blunt trauma. The total mean duration of the laparoscopic procedures was 158 min and the mean blood loss volume was 350 ml, both conversions being excluded. Postsurgical recovery was excellent and the average hospital stay was 5 days, including the patients with conversion. There were no significant postoperative complications. Our observations indicate that an increasing number of surgical diseases of the spleen can be managed adequately by a less invasive laparoscopic approach. However, the criteria for using this procedure are in an expanding phase and are still mainly dependent on the surgeon's technical experience.