[Micrometastasis in the sentinel node and axillary lymph node macro-metastasis in breast cancer]. / Micrometástasis en el ganglio centinela y macrometástasis ganglionares axilares en el cáncer de mama.

AIM: The study of the sentinel node has made it possible to obtain more comprehensive knowledge about the extent of axillary involvement in breast cancer. It has also decreased the surgical morbidity associated to the surgical examination of the axilla. The systematic use of immunohistochemical staining and molecular biology techniques improves the ability to detect the presence of micrometastasis or isolated tumor cells in a significant number of cases when this is the only sign of the lymph node extension of the disease. The possibility of avoiding complete axillary lymphadenectomy in those patients who are only affected by micrometastasis is proposed because of the low incidence of further involvement of the remaining lymph nodes. MATERIAL AND METHOD: 159 patients diagnosed of stage T1 or T2 breast cancer, in which the sentinel node had been identified by scintigraphy and intraoperative localization, were included in the study. Complete axillary lymphadenectomy was performed when micro- or macrometastases were found in the sentinel node, in order to determine the degree of axillary involvement. RESULTS: A total of 40 patients (25%) showed infiltration of the sentinel node. This infiltration was only by micrometastasis in 17 of them (10.7%). Of these 17 patients, only 2 (11.8%) showed macro-metastasis in the lymphadenectomy. In the remaining subjects, the final staging reached after the sentinel node study was not modified. CONCLUSION: It is possible to speculate that, in the future, axillary dissection can be avoided in those patients diagnosed of micrometastasis in the sentinel node, pending the conclusions of the on-going multicenter studies.

[Patient satisfaction as quality indicator in a nuclear medicine department]. / La satisfacción del usuario como indicador de calidad en un servicio de Medicina Nuclear.

OBJECTIVE: To assess patient satisfaction and dissatisfaction with a Nuclear Medicine department. MATERIAL AND METHODS: A questionnaire was designed with 9 closed questions, 1 with a numerical scale (1-10) and 1 with an open question for suggestions. The questions included different quality dimensions of the department related with waiting time for the scan, information, facilities, attention manner with department staff and global satisfaction (numerical scale, 1-10). Dissatisfaction was determined by analyzing the written complaints for the last 6 years. RESULTS: A total of 671 questionnaires were obtained, 58 % of those surveyed being women. The mean age of patients was 56.5 (+/- 16.26). The information provided was correct in 81.7 % of cases. Equipment and facilities were correct for 74.5 % of patients. Waiting list and waiting time were correct for 70 % and 66.4 % respectively. The attention manner of the department staff was the most satisfactory dimension (98.7 %). Global satisfaction was positive (> or = 7 out of 10) in 82.8 % of the patients. 29 complaints were received. Most of them were based on waiting list (12) and disagreement with assistance (9). CONCLUSIONS: Global satisfaction was high in most of patients. Waiting time was the dimension with the lowest level of satisfaction and subsidiary of improvement plans. The primary spontaneous complain by our patients was due to the waiting list.