Prognostic significance of number of lymph node metastasis on survival in patients with pathological T3 esophageal carcinoma.

The aim of this study was to evaluate the impact of the number of metastatic lymph nodes (MLN) and other risk factors on survival in patients with pathological T3 (pT3) esophageal carcinoma who were treated by esophagectomy. We analyzed 70 patients who received primary curative resection for pT3 esophageal cancer from 1997 to 2011. The prognostic role of age, gender, tumor location, cell type, pathological lymph node status (pN), number of MLNs (<3 vs ≥3), metastatic lymph node ratio (MLR), type of resection, local recurrence, and distant metastasis on overall survival (OS) were examined by univariate and multivariate analyses. Survival curves were calculated using Kaplan-Meier method and survival differences were assessed by log-rank test. A receiver operating characteristic analysis was used to determine the optimum cut-off point for the MLR. The median follow-up time was 42 (range, 8-128) months, and the 1-, 3- and 5-year OS rates were 78.6%, 38.1%, and 22.5%, respectively. Tumor location, pN, the number of MLNs, local recurrence, and distant metastasis had a significant effect on OS in the univariate analysis. In the multivariate model, the number of MLNs (p=0.02; hazard ratio (HR), 2.1; 95% confidence interval (CI), 1.1-4.1) and distant metastasis (p=0.007; HR, 5.1; 95% CI, 1.5-16.8) were independent risk factors for OS. Patients with pT3 esophageal cancer who have 3 or more MLNs and distant metastasis have a poor OS, and this result can be used as a factor for better estimation of prognosis.

Breast cancer subtypes can be a predictor of pathologic complete response and survival in the neoadjuvant setting for T4 noninflammatory breast cancer.

BACKGROUND: The aim of this study is to identify whether the breast cancer subtypes are predictors of pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) and survival in patients with T4 noninflammatory breast cancer. METHODS: The records of 181 patients treated with anthracycline +/- taxane based NAC followed by mastectomy and radiation therapy +/- hormonotherapy were evaluated. The role of intrinsic subtypes of the tumor including luminal A, luminal B, HER2, and triple-negative on pCR and survival were analyzed. RESULTS: The median follow-up was 44 months (range: 16-82 months). All patients received a median four cycles of NAC. Twenty-three patients (12.7%) were found to have pCR. In the univariate analysis, the intrinsic subtypes of the tumor had significant effect on pCR (p < 0.01). Also, intrinsic subtypes were significant predictors of pCR to NAC in the multivariate analysis (p < 0.01; hazard ratio, 2.4; 95% confidence interval, 1.1-6.8). While patients with triple-negative tumors had the highest rate of pCR (29%), this rate was the lowest in patients with HER2 tumors (4.2%). Five-year DFS was also significantly lower in patients with triple-negative (24%) and HER2 (21%) tumors compared to luminal A (61%) subtype (p < 0.0001). Likewise, 5-year OS was poorer in patients with triple-negative tumors (30%) and HER2 tumors (%31) compared to both luminal A (70%) and luminal B (68%) subtypes (p < 0.0001). CONCLUSIONS: It can be concluded that breast cancer subtyping defines the extent of response to NAC and has a significant effect on survival in patients with T4 noninflammatory breast cancer.

Is there any venous gradient in serum thyroglobulin levels in patients with differentiated thyroid cancer?

Some patients with differentiated thyroid cancer (DTC) have high serum thyroglobulin (Tg) levels although no evidence of disease can be detected on radioiodine scanning or other imaging methods. The aim of this study is to determine whether a gradient exists between the Tg levels of venous samples adjacent to primary tumour and systemic circulation. Twenty-six patients underwent thyroidectomy and/or lymph node dissection for primary and recurrent DTC. To detect Tg levels, blood samples were concurrently collected via venipuncture from the internal jugular vein adjacent to the tumor and ipsilateral antecubital vein. Serum Tg level was measured by a chemiluminescence assay. Tg levels were significantly higher in the adjacent internal jugular vein compared to the ipsilateral antecubital vein (p=0.001). The ratio of mean Tg values was higher 2.4-fold in the internal jugular vein than antecubital vein (median Tg ratio: 2.0:1; range, 0.7-29.6). Documentation of a venous gradient in Tg levels in patients with DTC is a new investigational topic. According to the results of this prospective study, venous sampling for Tg may be a useful tool to localize recurrent or perhaps persistent DTC in the neck for patients who have no detectable disease on radioiodine scans or other imaging studies.

Prediction of occult nipple-areola complex involvement in breast cancer patients.

The aim of this study was to evaluate predictive factors for the nipple-areola complex (NAC) involvement, and to define a subgroup of patients who may benefit from skin-sparing mastectomy with the NAC preservation in breast cancer patients. Univariate and multivariate analyses were carried out in the retrospective data of 397 eligible patients. The NAC involvement was histopathologically proved in 58 (14.6%) of the patients. In the multivariate logistic regression analysis showed that tumor location (central vs peripheral; p<0.0001; hazard ratio [HR], 7.5; 95% confidence interval [CI], 3.4-14.6), number of positive axillary lymph nodes (> or = 10 vs <10; p<0.005; HR, 2.9; CI, 1.3-6.1), and lymphatic vascular invasion (yes vs no; p<0.0001; HR, 3.5; CI, 1.7-7.1) were the most important prognostic factors. Whereas patients with 2 or 3 risk factors were accepted as high-risk group for the NAC involvement, those with no or 1 risk factor was defined as low-risk group. These groups had a 50.0% NAC involvement rate and a 8.1% NAC involvement rate, respectively (p<0.0001). In conclusion, this study showed that patients with 2 or 3 predictive factors had a high risk of the NAC involvement. These risk factors should be taken into consideration in patient selection for skin-sparing mastectomy with the NAC preservation. Key words: nipple-areola complex; involvement; breast cancer; mastectomy.

Prognostic factors in stage-i (T1N0) breast carcinoma patients: who needs adjuvant systemic treatment?

There is no consensus about the need of adjuvant therapy in T(1)N(0) breast carcinoma patients. To select a subgroup of these patients who may benefit from adjuvant systemic therapy, prognostic factor analyses were carried out using chi-square test and Cox regression analysis in 187 patients data in this retrospective study. Primary endpoint was distant metastasis (DM). The multivariate Cox analysis showed that age group (35 years, p=0.01; Hazard Ratio [HR], 15.4; 95% Confidence Interval [CI], 1.8-133.0), tumor size (>1 cm vs

Local recurrence in breast carcinoma patients with T(1-2) and 1-3 positive nodes: indications for radiotherapy.

AIMS: To investigate the relationship between local recurrence (LR) and distant recurrence (DR) and to determine a subgroup of patients who could benefit from radiotherapy among breast carcinoma patients with T(1-2) and N(1a). METHODS: Univariate and multivariate Cox regression analyses were carried out in the retrospective data of 326 eligible patients. RESULTS: Fourteen (4.3%) patients had LR and 46 (14.1%) patients suffered DR, in their follow-up periods. The multivariate time-dependent Cox model for DR showed that ratio of positive nodes (PN) (p=0.004; hazard ratio (HR), 1.05; 95% confidence interval (CI), 1.02-1.09) and LR (p=0.05; HR, dependent on time) were strongly associated with DR. In the multivariate Cox analysis for LR, age (35 years; p<0.0001; HR, 6.8; CI, 2.3-19.9), lymphatic vascular invasion (LVI) (yes vs no; p=0.03; HR, 3.3; CI, 1.2-9.8), and a ratio of PN (>15% vs

The effect of mechanical bowel preparation on colonic anastomotic healing: an experimental study.

PURPOSE: Although bowel preparation is traditionally used in elective colorectal surgery, its value is debatable. The aim of this study was to evaluate the influence of mechanical bowel preparation on healing of colonic anastomoses. MATERIAL AND METHODS: Twenty-seven rats were divided into three groups, each of nine animals. All rats had left colonic resection and anastomosis. Group 1 and group 2 were the control and sham group, respectively. Group 3 had colonic lavage before resection and anastomosis. On the fourth postoperative day, animals were killed; bursting pressure and tissue hydroxyproline concentrations were measured and compared. RESULTS: The median bursting pressure values were 87 (range 4-135) mmHg in group 1, 88 (range 78-136) mmHg in group 2 and 76.0 (range 57.0-125) mmHg in group 3. The differences between bursting pressure values of the groups were not statistically significant (p= 0.07). The median tissue hydroxyproline concentrations were 3.25 (range 2.63-5.16) mg/mg in group 1, 4.15 (range 1.54-5.72) mg/mg in group 2 and 3.52 (range 2.04-5.27) mg/mg in group 3. The differences between tissue hydroxyproline concentrations of the groups were not statistically significant (p = 0.7). CONCLUSION: Mechanical bowel preparation is not necessary for enhancing colonic anastomotic integrity in the rat.

Prevention of wound edge necrosis by local application of dimethylsulfoxide.

BACKGROUND: Surgical flap necrosis is one of the most common problems after procedures such as mastectomies and regional lymph node dissections. In this prospective randomized study, the effect of topical dimethylsulfoxide (DMSO) on skin flap viability was analyzed. MATERIAL AND METHODS: Sixty-six consecutive patients with breast cancer who had skin flaps created during mastectomy were randomized into two groups. Topical DMSO was applied on surgical flaps of the patients in Group-1, topical saline was applied for those in Group-2. Necrotic flap edges were recorded during the follow-up period for each patient, then excised and weighted in a blind manner. RESULTS: The mean weight of flap edge necrosis was 23.48 +/- 9.5 (mean +/- sem) microg in DMSO group and 126.27 +/- 44.8 microg in control group (p = 0.03). The hospitalization period was 9.6 +/- 0.5 days and 11.8 +/- 0.8 days in DMSO group and control group respectively (p = 0.02). There were no side effects due to DMSO. CONCLUSION: The application of DMSO reduced skin flap necrosis and improved outcome of surgical flaps.

The surgical management of incidental gallbladder carcinoma.

AIMS: To report the surgical management of carcinoma of the gallbladder. METHODS: A retrospective study in 65 patients who underwent simple (SC) or extended (EC) cholecystectomy for gallbladder carcinoma. RESULTS: 28 patients underwent extended cholecystectomy (EC) and 37 had simple cholecystectomy (SC). The multivariate analysis showed that lymph-node status (positive vs negative, p=0.001, Hazard Ratio [HR]:14.2, 95% Confidence Interval [CI]:3.1-62.8) and type of surgery (SC vs EC, p=0.01, HR:10.2, 95% CI:1.7-62.8) were the most important prognostic factors related to death. This analysis indicated that EC in those with pT(2) or pT(3) was associated with a reduce hazard of death by 90% in the follow-up period. CONCLUSIONS: In gallbladder cancer patients who diagnose after simple cholecystectomy, those with pT(1) with clear margins need no further surgery. In patients with pT(2) or pT(3) incidental carcinoma, the completion radical re-operation is the only chance for long-term survival.

Serum levels of tumor necrosis factor alpha correlate with response to neoadjuvant chemotherapy in locally advanced breast cancer.

It has been shown that serum levels of tumor necrosis factor alpha (TNF-alpha) are increased in breast cancer patients. There are few data available on the reduction of serum levels of this cytokine following chemotherapy. The aim of this study was to determine the effect of neoadjuvant chemotherapy on serum concentrations of TNF-alpha and the relation to response rates in locally advanced breast cancer. Twenty consecutive patients with non-inflammatory stage III-B breast cancer achieving a partial or complete clinical response to three courses of neoadjuvant chemotherapy followed by modified radical mastectomy were prospectively included in the study and evaluated. Sera were collected before the start and after the termination of chemotherapy. Serum concentrations of TNF-alpha were measured by an ELISA method. The pathological response rates were also evaluated and recorded. The control group consisted of 12 healthy age-matched women. The mean pre-treatment TNF-alpha value of breast cancer patients was 15.9 +/- 0.9 pg/mL while it was 5.8 +/- 1.7 pg/mL in the control group; the difference was statistically significant (p < 0.0001). The serum levels of TNF-alpha were markedly decreased in patients with partial and complete responses compared to pre-treatment values (p < 0.0001). There was also a difference in TNF-alpha levels in patients with partial vs complete responses (p < 0.0001). The relative change between pre- and post-treatment values correlated significantly with the type of response (p = 0.004). These results suggest that the serum concentration of TNF-alpha can be an indicator of response and could be used in clinical decision-making for patients with locally advanced breast cancer.

Correlation of vascular endothelial growth factor (VEGF) and CEA with clinicopathological variables in colorectal cancer patients.

The aim of the presented study is to analyze VEGF levels and its correlation with the clinicopathological characteristics of patients with colorectal carcinoma. Thirty-three patients with colorectal adenocarcinoma and 10 healthy controls were evaluated by estimation of VEGF and CEA levels and correlation with clinicopathological features. The serum VEGF and CEA concentrations of colorectal patients were higher than the healthy controls (p<0.05). Patients in advanced stage had high levels of both markers but these differences were not statistically significant. There was a positive correlation between both markers and, tumor size and peritumoral vascular invasion (PVI) but when compared VEGF with CEA, VEGF had a stronger correlation. Diagnostic sensitivity of VEGF for colorectal carcinoma was higher than the sensitivity of CEA and combining both markers the sensitivity to predict colorectal carcinoma was higher than of each marker alone. Our study indicated that VEGF compared to CEA had a higher diagnostic sensitivity for colorectal carcinoma and might provide even additional information about tumor features.

[A seroprevalence study of Coxiella burnetii in Antalya, Diyarbakir and Samsun provinces]. / Antalya, Diyarbakir ve Samsun illerinde Coxiella burnetii seroprevalans çalismasi.

The aim of this study was to demonstrate the presence of Q fever infection in three selected provinces, located in South Anatolia, Southeast Anatolia and Black Sea regions of Turkey. Specimens of 339 healthy subjects (114 from Antalya, 116 from Diyarbakir, and 109 from Samsun) were randomly selected from serum samples that are stored in National Serum Bank, Refik Saydam National Hygiene Center, and tested for the presence of IgG antibodies against Coxiella burnetii phase II antigen by using indirect immunofluorescent antibody (IFA) test with a commercial kit (Vircell, SL Granada, Spain). IgG antibodies were accepted positive in case of > or = 1:64 titers, and negative in case of < 1:64 titer, according to the test guidelines. IgG seropositivity rates were found 13.2% (n: 15), 6% (n: 7) and 1.8% (n: 2), in Antalya, Diyarbakir and Samsun provinces, respectively, with an overall rate of 7.1% (n: 24). By logistic regression analysis on the positive IgG antibodies, no significant differences were shown in terms of age, gender and residence in all the three selected provinces, but seropositivity rate was significantly higher in Antalya (OR=8.21, %95 GA=1.82-36.96). The study results showed that Q fever exists in Turkey, and it is necessary to take control measures against this disease.

Factors influencing outcome of surgery for stage I rectal cancer.

Stage I rectal cancer (T1N0M0, T2N0M0) carries excellent prognosis with up to 90% of long term survival rates and complete cure can be expected with curative surgery. However 10 to 15% of these patients show local recurrence and mortality seen in five years. The aim of this study is to analyze the prognostic factors that influence the overall and disease free survival in patients with stage I rectal cancer. Eighty-five patients with stage I (T1N0M0, T2N0M0) rectal cancer that had potentially curative surgery were entered into the study. The patients were evaluated according to age, sex, preoperative carcinoembryonic antigen (CEA) level, type of surgical procedure, tumor distance from anal verge, tumor size, depth of invasion, histological differentiation, presence of tumor ulceration, peritumoral vascular invasion, peritumoral lymphatic invasion and peritumoral perineural invasion. Five year overall and disease free survival rates for the patients were 88% and 74%, respectively. Multivariate analysis showed that independent predictors of recurrence were differentiation and peritumoral vascular invasion, and independent predictor of overall survival was only differentiation. Stage I rectal cancer patients with poor differentiation and peritumoral vascular invasion are at high risk for recurrence and should be evaluated for adjuvant therapies.

Is invasive lobular carcinoma different from invasive ductal carcinoma?

AIMS: The purpose of this study is to determine whether the histopathologic features and outcome in invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) are different, and whether the histologic type is a prognostic factor for outcome. METHODS: A retrospective cohort study was conducted in consecutive 510 stage I/II breast carcinoma patients who underwent modified radical mastectomy. The features of 65 patients with ILC were compared with those of 445 patients with IDC. In patients with median follow-up period of 44 months, univariate and multivariate prognostic factor analyses for cancer-specific death and relapse were carried out. RESULTS: The median ages in patients with ILC and those with IDC were 52 and 41 (P=0.04). Tumor size, estrogen receptor positive expression and nodal positivity were not significantly different between the histologic types. Patients with ILC had more frequently (81.5%) low grade tumors and less lymphatic vascular invasion (9.3%) in primary tumor than those with IDC (P<0.05). Whereas the rates of 5-year overall survival were 94% in ILC and 90% in IDC, the rates of 5-year event-free survival were 71 and 67%, respectively (P=NS). Multivariate analyses in all patients demonstrated that tumor size, pathologic lymph node status and age at diagnosis were the most important prognostic factors for overall and event-free survival. Histologic type was not statistically significant for both outcomes. CONCLUSIONS: Although patients with ILC had older age, low grade tumor and less lymphatic vascular invasion, they had no survival advantage comparing with their counterparts. Histologic type was not an independent prognostic factor for outcome.

The prognostic significance of total lymph node number in patients with axillary lymph node-negative breast cancer.

AIM: In node-negative breast cancer patients, several factors for survival have been evaluated and currently, some of them are accepted for their prognostic and/or predictive values after validation in the separate data sets. The prognostic significance of increases in the number of pathologically detectable axillary lymph nodes in the node-negative patients could not been established clearly. To address this question, we have reviewed our patients' records. METHODS: A retrospective cohort study was conducted in pathologically node-negative patients who underwent modified radical mastectomy for stage I and II breast cancer. Survival and multivariate prognostic factor analyses were carried out to determine whether the number of tumour-free lymph nodes in complete axillary dissection material in addition to known factors was significant for the outcomes. RESULTS: Two hundred and seventy consecutive patients were eligible to enter the trial. The median observation time and the median number of tumour-free lymph nodes were 61 (from 30 to 120) months and 18 (from 10 to 44), respectively. The cohort was divided into the groups according to the number of nodes. The 5-year event-free and overall survivals were 92.5 and 98.3% for patients who had 18 lymph nodes or less, and 70 and 86.7% for those who had more than 18 negative nodes, respectively (P < 0.00001). Multivariate analysis for event-free survival demonstrated that the number of lymph nodes (Relative risk: 3.2 and 95% confidence interval: 1.7 to 5.9) in addition to the pathological tumour size and age was the most important independent prognosticator. In similar, multivariate analysis for overall survival showed that the number of lymph nodes together with the tumour size was the significant indicator (RR of cancer-specific dying in patients who had more than 18 nodes: 3.1 and 95% CI: 1.2 to 8.5). CONCLUSION: The increases in number of tumour-free lymph nodes are clinically important and this parameter should be taken into consideration in the breast cancer patients without metastatic lymph nodes.

Is suprahyoid dissection a diagnostic operation in lower lip carcinoma?

Carcinoma of the lower lip can be treated primarily by surgical procedures. One of the most prominent characteristics of the tumor is that it can metastasize to submental and submandibular lymph nodes. For that reason, bilateral suprahyoid dissection with surgical treatment of the primary lesion is a diagnostic approach for some investigators and therapeutic for others. We evaluated whether bilateral suprahyoid dissection is a diagnostic approach in lower lip cancer or not. Prophylactic suprahyoid dissection had been performed in 53 patients who had been operated for squamous cell carcinoma of the lower lip in Ankara Oncology Hospital. Four of the cases were female and 49 male. The median age was 62. Forty-five out of 53 cases had T2 lesions and in the remaining 8 had T3 lesions. All patients were clinically node negative. In the dissection material, lymph node metastasis were present in 8 out of the 45 cases who had T2 tumors (17,7 %) and in 2 out of the 8 cases who had T3 tumors (25%). Three of the 10 cases who had regional lymph node metastasis underwent radiotherapy after surgery. Seven of them did not receive radiotherapy. Thirty-nine patients had regular follow-up for a median of 4.5 years. During this period, none of the patients had regional recurrence in cervical lymph nodes. According to these data, we conclude that bilateral suprahyoid dissection is both a diagnostic and a therapeutic approach in T2, T3 and clinically N0 lower lip tumors.

Lymphatic mapping and sentinel lymph node biopsy in squamous cell carcinoma of the lower lip.

AIMS: The risk of metastases to the submandibular and submental lymph nodes in squamous cell carcinoma (SCC) of the lower lip is closely related to the primary tumour size and the differentiation of the tumour. In order to determine the feasibility of the technique and the possible metastatic lymph nodes in SCC of the lower lip, intraoperative lymphatic mapping and sentinel lymph node biopsy was performed in patients with tumour size greater than 2 cm (T2) and clinically non-palpable regional lymph nodes (N0). METHODS: Intraoperative lymphatic mapping with patent blue dye was performed in 20 patients with SCC of the lower lip. The stained lymph node (sentinel) was identified in each patient and sent for frozen section analysis in order to verify tumour metastasis. All patients had undergone bilateral suprahyoid neck dissection at the same stage. RESULTS: Three of the patients were female and 17 were male. The median age was 66. Sentinel lymph nodes were identified in 18 of the patients (90%). Intraoperative or post-operative histopathologic examination of the sentinel lymph node showed tumour metastasis in three of the patients (16.6%). The histopathologic examination of the remaining 15 patients whose sentinel lymph nodes were free of metastasis, showed no metastasis in the non-sentinel lymph nodes. In two of the three patients with metastatic sentinel lymph nodes, non-sentinel lymph nodes were free of metastases. There were no false negative results and no local or systemic complications of the technique were seen among the patients. CONCLUSIONS: Intraoperative lymphatic mapping and sentinel lymph node biopsy is feasible in patients with SCC of the lower lip who have large tumour size and non-palpable regional lymph nodes. The technique may help to avoid neck dissection when the patient has negative sentinel lymph node and when positive provides useful information for more effective radical treatment.

The Turkish experience with curative gastrectomies for gastric carcinoma: is D2 dissection worthwhile?

BACKGROUND: The only possible curative treatment in gastric carcinoma is surgery, and there is still controversy surrounding the value of extended lymph node dissection. STUDY DESIGN: A retrospective cohort study was conducted in patients who underwent curative D1 or D2 resection for operable gastric carcinoma. Survival and multivariate prognostic factor analyses were carried out to determine whether dissection type was significant for outcomes, and which subgroup of patients would benefit from D2 dissection. RESULTS: Three hundred one patients who had potentially curative treatment were eligible to enter the trial. Although mortality rates were 3.1% in the D1 group and 4.3% in the D2 group (p = NS), morbidity rates in the D1 and D2 groups were 6.2% and 27.9%, respectively (p<0.05). Multivariate analysis showed that lymph node dissection type, Borrmann type of tumor, number of metastatic lymph nodes, and depth of wall invasion were the most important independent prognosticators. Five-year disease-free and overall survival rates were 19% and 36% in D1, and 49% and 54% in D2, respectively (p<0.05). After stratifying for pT and pN, the significant survival advantage with D2 was observed in subgroups of pT2, pT3 and pN1, pN2. The subset analysis showed a significant prognostic benefit with D2 dissection in patients in stages II and III-A. CONCLUSIONS: D2 dissections can be carried out with low mortality rates, but they have high morbidity rates and a survival advantage over D1 dissection of only 18%. In principle, a survival benefit with D2 is obtained especially when the tumor invades muscularis propria, penetrates serosa without invasion of adjacent structures, or metastasizes to fewer than fifteen regional lymph nodes. Data in this homogeneous population support the use of extended lymphadenectomy for selected group of patients with gastric carcinoma.

Prognostic significance of young age in breast cancer.

BACKGROUND: Breast carcinoma is relatively uncommon in younger women and whether or not young age at diagnosis is an adverse prognostic factor in this disease has been controversial. Our aim in this report is to determine whether the histopathologic features and outcome in young and old are different, and whether age is a prognostic factor for relapse. METHODS: A retrospective study of consecutive 281 stage I or II breast carcinoma patients who had modified radical mastectomy was carried out. The patients with a median follow-up period of 45 months were divided two groups according to their ages. The histopathological features and survival of Group 1 and Group 2 were compared with each other. Univariate and multivariate prognostic factor analysis for relapse were carried out. RESULTS: The patients in Group 1 (younger than 35 years of age) had the worst histopathological features related to the prognosis than those in Group 2 and the difference between the two groups was statistically significant. Whereas the rates of 5-year overall survival were 65% in Group 1 and 98% in Group 2 (P < 0.05), the rates of 5-year relapse-free survival were 40% and 80%, respectively (P < 0.05). In univariate analysis of all patients, pathologic tumour size, pathologic axillary status, number of metastatic lymph nodes, pathologic stage, age, lymphatic vascular invasion were statistically significant factors associated with relapse. Multivariate analysis demonstrated that number of metastatic nodes (risk ratio RR:4.3 in more than three nodes) and age (RR:3.6 in Group 1) were the most important independent prognostic factors for relapse. In the patients without axillary involvement, both of univariate and multivariate analysis revealed that pathologic tumour size (RR:5.1 in pT(2)) and age (RR:4 in Group 1) were the independent prognosticators for relapse. CONCLUSIONS: Young patients with breast cancer had the worst histopathological features and the worst survival than their older counterparts. Age was an independent significant prognostic factor for relapse.

Lymphatic mapping and sentinel lymphadenectomy in early stage breast carcinoma.

The rate of axillary lymph node metastases is low in early stage breast carcinoma and axillary lymph node dissection is controversial in the treatment of these patients. Intraoperative lymphatic mapping technique is suggested for the identification of metastatic lymph nodes. Intraoperative lymphatic mapping was performed on 60 clinical stage I and II patients who were treated at Ankara Oncology Hospital between 1996-1998. Patent blue dye was injected in all cases, as the tumor was totally excised before mastectomy, into the surrounding breast tissue at four different quadrants. Presence of metastases were examined on stained lymph nodes (sentinel lymph node: SLN) by frozen-section. Modified radical mastectomy was performed including level I, II, III lymph node dissection. Metastases were evaluated on the remnants of frozen-section tissues and unstained lymph nodes (nonsentinel lymph node: nSLN) in axilla on hematoxyline-eosin stained slides and by immunohistochemistry. Forty-nine (81.6%) SLNs were identified among 60 cases. In 18 (36.7%) of these 49 patients, metastases were detected in SLNs by frozen section. In one case micrometastasis was detected in the remnants of frozen-section by immunohistochemistry though it was negative with hematoxyline-eosin. There were no metastases in nSLNs of 27 cases whose SLNs's frozen-sections were tumor free. In 3 cases SLNs were negative but metastases were detected in nSLNs (false negative: 6.1%). There were no local or systemic complications due to injections of dye. Selective lymph node dissections can be performed on early stage breast cancer patients by means of lymphatic mapping. This minimally invasive technique identifies metastatic axillary lymph nodes with a high degree of accuracy, so we can suggest that, non-metastatic patients can be treated without axillary dissection.