Relationship between preoperative serum markers CA 15-3 and CEA and relapse of the disease in elderly (>65 years) women with breast cancer.

This study investigated whether preoperative carcinoma-associated antigen (CA) 15-3 and carcinoembryonic antigen (CEA) serum levels are predictive markers of reduced disease-free (DF) survival in women with breast cancer (BC) who have undergone curative surgery A series of 363 consecutive postmenopausal women (median age 63 years, range 47-89 years) with pT1-2, N0-1 and M0 BC who underwent curative surgery and were followed-up for at least 36 months after lumpectomy or mastectomy were reviewed retrospectively. Two groups of patients were considered: Group 1 (age 47-64 years), 203 (55.9%) patients; Group 2 (age >64 years), 160 (44.1%) patients. None of the parameters (age, size of the tumour, CA 15-3 and CEA baseline serum levels, ER and PgR rate, MIB-1 labelling index) differed between the groups. During follow-up (36-60 months) 62 (17.1%) patients developed relapse (DR) of the disease (41 and 21 among Groups 1 and 2, respectively), while 301 (82.9%) were DF. The differences were as follows (DF vs. DR): Group 1: CA 15-3 (25.0+/-11.4 vs. 31.4+/-14.6 U/l; p=0.003) and CEA serum levels (5.7+/-4.8 vs. 7.4+/-6.4 ng/ml; p=0.048). Group 2: CA 15-3 (27.9+/-13.2 vs. 20.4+/-6.5 U/l; p=0.012) and CEA serum levels (6.6+/-5.2 vs. 3.7+/-2.5 ng/ml; p=0.013). Surprisingly, in the subgroup of patients aged >65 years who developed relapse, both CA 15-3 and CEA baseline serum levels were lower than in the subgroup of DF patients. In conclusion, although serum tumour markers levels may be useful during follow-up, their baseline levels are not useful in predicting relapse in elderly patients with BC.

Incidence of arm lymphoedema following sentinel node biopsy, axillary sampling and axillary dissection in patients with breast cancer.

The aim of this study was to compare the incidence of lymphoedema after different treatments of the axilla in patients with breast cancer (BC). Medical records of 205 women (median age 61 years, range 26-72 years) who underwent curative surgery for primary BC were reviewed. According to the treatment of the axilla, the study population was divided into four age- and stage-matched groups of patients: Group A (N=54 patients), sentinel node biopsy (SLNB) alone; Group B (N=48 patients), SLNB followed by axillary node (AN) sampling using ultrasound scissors (harmonic scalpel); Group C (N=53 patients), AN dissection using ultrasound scissors; Group D (N=50 patients), traditional AN dissection. The median follow-up was 22 months (range 18-28 months). The intraoperative frozen section of SLNB (Groups A and B) showed 32 out of 102 (31.4%) patients with metastasis to AN, while final pathology showed AN metastases in 20, 17, 16 and 17 patients of groups A, B, C and D, respectively (p=NS). The sensitivity of SLNB alone was 80% and that of SLNB followed by AN sampling was 95% (p=NS). At follow-up patients with lymphoedema were 2 (3.7%), 2 (4.2%), 3 (5.6%) and 8 (16%) in groups A, B, C and D, respectively (p=NS). In conclusion, AN sampling is a sensitive and low-morbidity procedure which, in conjunction with the use of harmonic scalpel, may reduce the onset of arm lymphoedema.