Risk Factors Associated With Sentinel Lymph Node Metastasis in Clinically Node-Negative Breast Cancer.

Objective: Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in clinically node negative breast cancer. If predictive factors for sentinel lymph node (SLN) metastasis could be identified, it would allow selection of candidates for SLNB and omit axillary surgery in those with the lowest risk of axillary lymph node involvement. The aim of this study was to determine risk factors associated with SLN metastasis in breast cancer patients in Bahrain. Materials and Methods: Patients with clinically node-negative breast cancer who underwent SLNB at a single institution between 2016 and 2022 were identified from the pathology database. Patients who had failure of localization of SLN, those with bilateral cancers and those treated for a local recurrence were excluded. Results: A total of 160 breast cancer patients were retrospectively analyzed. Of these, 64.4% had a negative SLNB and 21.9% of all cases underwent axillary dissection. The following parameters emerged as predictors of SLN metastasis in univariate analysis: age; tumour grade; ER status; presence of lymphovascular invasion (LVI) and tumor size. On multivariate analysis, age was not independently associated with the incidence of SLN metastasis. Conclusion: This study showed that high tumour grades, presence of LVI and large tumour size were all risk factors related to axillary metastasis after SLNB in breast cancer. In the elderly, the incidence of SLN metastasis appeared to be relatively low, providing an opportunity to de-escalate axillary surgery in these patients. These findings may allow for the development of a nomogram to estimate the risk of SLN metastasis.

Male occult triple-negative breast cancer.

Male breast cancer is a rare but important condition accounting for only 1% of breast cancer worldwide and less than 1% of all male malignancies. Occult male breast cancer is an extremely rare type of male breast cancer that manifests as axillary metastases without an identifiable breast lesion. We report a case of triple-negative occult male breast cancer who underwent modified radical mastectomy.

Transverse colon volvulus in a patient with sickle cell disease.

Although colonic volvulus is a relatively rare cause of large bowel obstruction, accounting for up to 5% of all cases of intestinal obstruction, transverse colon volvulus is extremely uncommon compared with volvulus of the sigmoid colon or caecum and is responsible for only 3% of all reported cases. We report an unusual case of spontaneous volvulus of the transverse colon in a young man with sickle cell disease who underwent resection with primary anastamosis. Having a high index of suspicion and early operative intervention allowed for this patient to have an uneventful postoperative course.

Systematic Review and Meta-Analysis of Liver Resection for Colorectal Metastases in Elderly Patients.

BACKGROUND: This systematic review and meta-analysis evaluated the short- and long-term outcomes of liver resection for colorectal liver metastases (CRLM) in elderly patients. METHODS: A PubMed, EMBASE, and Cochrane Library search was performed from January 1995 to April 2017, for studies comparing both short- and long-term outcomes in younger and elderly patients undergoing liver resection for CRLM. RESULTS: Eleven studies comparing patients aged <70 years with patients aged >70 years and 4 studies comparing patients aged <75 years with patients aged >75 years were included. Postoperative morbidity was similar in patients aged >70 years (27 vs. 30%; p = 0.35) but higher in patients aged >75 years (21 vs. 32%; p = 0.001). Postoperative mortality was higher in both patients aged >70 years (2 vs. 4%; p = 0.01) and in patients aged >75 years (1 vs. 6%; p = 0.02). Mean 5-year overall survival was lower in patients aged >70 years (40 vs. 32%; p < 0.001) but equal in patients aged >75 years (42 vs. 32%; p = 0.06). CONCLUSION: Although postoperative morbidity and mortality were increased with higher age, liver resection for CRLM seems justified in selected elderly patients.