Preoperative ultrasound guided percutaneous axillary biopsy in breast cancer patients: fine needle aspiration cytology versus core biopsy.

AIM: The aim of this study is to compare the diagnostic accuracy in detecting axillary node metastases between preoperative ultrasound with percutaneous core biopsy or fine needle aspiration cytology, in patients with breast cancer. MATERIAL AND METHODS: All cases with newly diagnosed ipsilateral primary breast cancer that underwent axillary ultrasound guided biopsies in a 2 year period were reviewed and the biopsy outcome was compared to the final histopathology from sentinel lymph node biopsy or axillary node dissection. Comparison was also attempted in a subgroup including only patients who underwent one method and in a second subgroup of patients who had both techniques performed. RESULTS: Within the total population results are in favor of core biopsy which correlates statistically significantly with the final histology after excluding neoadjuvant related false negatives. Within the single modality subgroup results are again in favor of core biopsy which again correlates statistically significantly with the final histology. Within the combined modality subgroup results demonstrate equal diagnostics but neither method demonstrates statistically significant diagnostic success. DISCUSSION: The results of the study are generally in favour of core biopsy which tends currently to override fine needle aspiration cytology. Only few studies have directly compared the two methods and a great variability exists in the results of the different studies. CONCLUSIONS: A case-match cohort study is advised to accurately compare the diagnostic value of the two methods. Until then the decision will be based on the radiologist's experience. KEY WORDS: Breast cancer, Diagnostic accuracy, Percutaneous axillary biopsy.

Spontaneous acalculous gallbladder perforation.

An 86-year-old woman, 4 days post-operative following a right-sided Austin-Moore arthroplasty, reported abdominal pain around a known umbilical hernia and became increasingly confused. A diagnosis of incarcerated umbilical hernia was made. At surgery, on entering the peritoneal cavity, bile was immediately noted. The operation was converted to a laparotomy and a perforation was noted in the gallbladder. An open cholecystectomy was performed. Macroscopically the gallbladder was perforated in multiple places, was thin walled and did not contain gallstones. This case demonstrates the difficulty in diagnosing an apparently spontaneous gallbladder perforation in a cognitively frail patient.

Endoscopic breast surgery: where are we now and what might the future hold for video-assisted breast surgery?

Endoscopic surgery has been extensively used for many surgical conditions and has gained acceptance as an alternative and less invasive approach to open surgery. However, minimal access endoscopic techniques have yet to be translated into mainstream clinical practice in breast surgery. More recently, technical innovations have made it feasible to conduct endoscopic breast cancer resection, with or without breast reconstruction, through wounds inconspicuously hidden in the axilla and periareolar region. Several clinical trials have now been conducted to demonstrate technical feasibility, assess safety and provide follow up data regarding oncological success of endoscopic breast surgery. This primary aim was to critically evaluate the literature in order to determine the oncological and cosmetic efficacy of endoscopic breast surgery. A systematic review was conducted using Medline, Ovid and Embase to identify original data from studies of endoscopic breast surgery. Initial results have demonstrated that endoscopic breast surgery is safe and technically feasible. Early data suggests that it is possible to achieve disease control with high rates of overall survival and low rates of local relapse recurrence and/or distant metastases. However, the absence of level I randomised clinical evidence currently precludes a recommendation that endoscopic breast cancer surgery is capable of achieving equivalent oncological outcomes to open surgery.

Perforated sigmoid diverticulum mimicking acute appendicitis in a young patient: a case report.

Acute colonic diverticula are uncommon in patients <40 years of age, with an incidence between 2% and 10%. In such patients, the condition may be misdiagnosed in the acute setting, because it is often not considered and may be mistaken for acute appendicitis, particularly if there are predominantly right-sided signs. As a result, it may result in diagnostic delay and complications. We report a case of a young patient who presented with a perforated sigmoid diverticulum mimicking acute appendicitis, which was not diagnosed initially, and the resulting course of events.

A rare and unusual case of bilateral, axillary, metachronous apocrine carcinoma.

Apocrine carcinoma is a rare sweat gland neoplasm with very few cases reported in the published literature. We report a case of primary axillary apocrine carcinoma with later recurrences in both axillae. A 55-year-old man was clinically diagnosed with hydradenitis suppurativa in the right axilla, and after excision of lesion, histology showed metastatic adenocarcinoma of probable breast origin. However, no primary focus was found after extensive work-up except for metastatic lymph nodes in the ipsilateral axilla treated with axillary clearance. After 4 years, the patient developed metastatic lymph nodes in the contralateral axilla and had surgery. He had a further recurrence in the right axilla and was treated with surgery and radiotherapy. He continues to do well at this time, with no evidence of local or distant metastases.

Axillary gland involvement in breast carcinomas is not always metastatic: a case report.

We describe an unusual case of coexistence of carcinoma in the breast and an ipsilateral enlargement of axillary lymph nodes caused by tuberculosis. Accurate diagnosis has helped us in down staging the carcinoma in the breast and also identifying curable disease.