National patterns of care for pancreatic cancer. Results of a survey by the Commission on Cancer.

BACKGROUND: The Commission on Cancer of the American College of Surgeons conducted a large, national survey to assess methods of diagnosis, American Joint Commission on Cancer staging, treatment, and outcome of patients with adenocarcinoma of the pancreas. STUDY DESIGN: The survey questionnaire contained 160 questions and covered two study periods, 1983 to 1985 and 1990, for time-trend analysis. Nine hundred seventy-eight institutions throughout the United States voluntarily participated, contributing 8917 case reports for 1983 to 1985 and 8025 reports for 1990, resulting in a total of 16,942 patient reports. Most, but not all, of the participating hospitals maintain approval status with the Commission on Cancer of the American College of Surgeons. RESULTS: The ratio of male-to-female cases was 1:1. Patient characteristics including age, ethnicity, neighborhood income, type of insurance coverage, and hospital characteristics--including annual caseload and type of facility (e.g., teaching, community)--appeared to influence surgical multimodality treatment patterns. The most common presenting symptom was abdominal pain. The reported history of smoking for these patients with pancreatic cancer was higher than U.S. population averages. The frequency of using abdominal computed tomography scans, endoscopic retrograde cholangiopancreatography, carcinoembryonic antigen, and CA 19-9 during patient evaluation all increased. Time trends toward lower operative mortality and more extirpative surgery were reported, as was a slightly higher survival for those patients who were resected surgically. CONCLUSIONS: Pancreatic cancer continues to be a disease of older patients. There were slight improvements in operative mortality. For a highly selective category of patients, cancer-directed surgery offers a chance for cure with excellent operative mortality and acceptable complication rates, especially when performed in institutions that have a 20 or greater case per year experience.

Initial 300 consecutive stereotactic core-needle breast biopsies by a surgical group.

BACKGROUND: Stereotactic localization and breast biopsy by fine needle and 14-gauge core needle is a new technique for diagnosing nonpalpable breast lesions. The procedure employs a device that affords extremely accurate localization and sampling of nonpalpable breast abnormalities. METHODS: We are a 5-man surgical group reporting on the experience of our initial 300 consecutive stereotactic core-needle biopsies (SCNB). RESULTS: The procedures, conducted over a 13-month period, revealed 37 cancers, for a malignancy rate of 12%. Seven percent were infiltrating ductal carcinoma and 4% ductal carcinoma in situ. There were 2 cases of adenocarcinoma, and 1 case of mucinous carcinoma. Benign microscopic diagnoses included 193 categorized as "fibrocystic change," 34 "fibroadenomas," 19 "benign breast tissue," and 5 lesions that were suspected of being malignant but were proven to be benign. There were 12 "others." CONCLUSION: We conclude that SCNB is an essentially painless, short outpatient procedure with a reduced cost compared to open biopsy. It can be easily mastered by surgeons. Results are comparable to controlled series in the literature, and rates of malignant diagnosis are similar to our group's experience in previous years.