The use of indocyanine green as the only tracer for the identification of the sentinel lymph node in breast cancer: safety and feasibility.

Background: Sentinel lymph node biopsy (SLNB) is now considered the "gold standard" for axillary staging in the treatment of breast cancer. Most of the lymph node mapping experiences have been performed with a radioisotope (albumin-Tc99m) associated or not with the intraoperative injection of a dye, such as Patent-Blue V. Recent studies have shown how the use of indocyanine green (ICG; a drug used for diagnostic use for many years in other sectors) as a fluorescent tracer, allows to obtain alone detection rate of the sentinel lymph node similar or even better, without the risks related to radioactivity and with better use of resources. Methods: From March 2020 to February 2021, 184 patients with breast cancer cN0, candidate for SLNB were enrolled at the Complex Operative Unit (UOC) of Breast Surgery, Breast Unit of the Hospital of Verona. The ICG was injected into the periareolar site and was used the NOVADAQ SPY Elite system (Stryker®) for transcutaneous intraoperative observation of fluorescence. The primary objective of the study is the evaluation of the feasibility of the technique and its sensitivity in the identification of sentinel lymph node; among the secondary endpoints the recognition of predictive factors on the identification (t1-t0) and extraction (t2-t1) times of the sentinel lymph node, and on the number of lymph node uptake pathways. Finally, was analyse the safety of the technique. Results: The sentinel lymph node was detected and removed in 98.3%. The average number of sentinel lymph nodes extracted is 1.527, while the average number of total lymph nodes (TLNs) extracted is 3.375. The sensitivity of the sentinel lymph node detection technique with ICG, turns out to be 100%. Finally, in the literature, lymphatic function decreases with increasing age, reducing the identification rate of the SLN; this is not confirmed in our study. Conclusions: Our study confirms the use of the only ICG tracer for SLNB in cN0 breast cancer, demonstrating that it is a safe, effective and sensitive technique, which also allows to reduce costs, risks and organizational efforts.

Laparoscopic Complete Mesocolic Excision for Right-Sided Colon Cancer: Analysis of Feasibility and Safety from a Single Western Center.

BACKGROUND: Colectomies performed according to complete mesocolic excision (CME) principles have demonstrated an improvement in the quality of surgical specimen and a potential improvement of long-term results. Laparoscopic CME right hemicolectomy is considered a demanding procedure and adopted in few centers from the West. The main purpose of this paper is to present a video showing our technique for laparoscopic CME right hemicolectomy and to analyze our short-term results to prove its safety. METHODS: Data from 38 patients operated on at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust, between September 2014 and February 2017, were included in the study. RESULTS: In the present series, 37% of patients were ≥75 years old, 32% of patients were ASA class 3, 46% of patients had ≥2 comorbidities, 30% of patients had BMI >28 and 17% of patients had ≥2 previous abdominal surgeries. Despite these unfavorable clinic characteristics, no mortality was observed, Clavien-Dindo ≥3 complications occurred in 13.1% and redo surgery in 5.3%. Good quality specimens were obtained with a mean (SD) length of 34.5±7.5 cm, a proximal margin of 16.8±9.2 cm and a distal margin of 14.3±6.4 cm. The mean (SD) number of harvested lymph nodes was 24.3 (8.3). CONCLUSIONS: When implemented in a Western center, laparoscopic CME right hemicolectomy is feasible and safe and allows obtaining good quality specimens.

Estrogen therapy and risk of breast cancer in postmenopausal women: a case-control study and results of a multivariate analysis.

OBJECTIVE: Several randomized trials and observational studies show that the use of hormone therapy (HT) increases the risk of breast cancer (BC). The aim of this study was to assess the effects of exposure to both HT and oral contraceptives (OCs) on BC risk in postmenopausal women, all residing in the same metropolitan area. METHODS: Data regarding a series of 238 consecutive postmenopausal women with infiltrating ductal carcinoma (cases) and 255 randomly selected age-matched healthy women (controls) were reviewed. Odds ratios for no breast-feeding and HT and OC use were 1.82 (95% CI, 1.20-2.77), 2.49 (95% CI, 1.73-3.58), and 2.06 (95% CI 1.14-3.70), respectively. RESULTS: Four independent variables (years between menarche and menopause, breast-feeding, OC use, and HT use) were included in the final multivariate analysis using logistic regression. The cumulative odds ratio calculated from the observed versus predicted values, obtained using the logistic regression function, was 4.55 (95% CI, 2.13-9.71), whereas the cumulative risk of common exposure to both OCs and HT was 2.77 (95% CI, 1.44-5.32). The logistic model correctly classified 67.5% (95% CI, 63.2-71.5) of cases. The receiver operating characteristic (ROC) curve of the complete logistic function showed a fair area of accuracy (0.77; 95% CI, 0.72-0.81). CONCLUSIONS: Our results show that the risk of common exposure to both OCs and HT increases in women with other risk factors. However, several parameters traditionally considered in epidemiological studies do not have the same weight in each local community, suggesting the need to create different models to correctly select the high-risk population.

Changes of bone formation markers osteocalcin and bone-specific alkaline phosphatase in postmenopausal women with osteoporosis.

The relationship between bone formation markers osteocalcin (OC) and bone-specific alkaline phosphatase (bALP) and age in postmenopausal women was investigated. Forty-eight osteoporotic women (median age 62, range 49-76 years) were enrolled in the study. There were 17 (35%) patients aged 49-59 years (Group A), and 31 (65%) patients aged over 59 years (Group B). Parathyroid hormone, calcium, and creatinine serum levels did not differ significantly between groups. Compared with Group A, patients in Group B had higher levels of both OC (28.5 +/- 17.8 versus 46.2 +/- 19.3 ng/mL; P= 0.003) and bALP (57.3 +/- 12.4 versus 66.4 +/- 8.7 U/L; P= 0.005). A significant relationship between age and both OC (R= 0.49, P= 0.002) and bALP (R= 0.41, P= 0.009) was found only in Group B, but there was no relationship with bone mineral density. In conclusion, in postmenopausal women the increase of bone formation markers later in life may be an expression of increased bone turnover, which is partially the cause of osteoporosis.

Bone mineral density, osteocalcin, and bone-specific alkaline phosphatase in patients with insulin-dependent diabetes mellitus.

The aims of this study were to evaluate the prevalence of osteopenia and the relationships between osteocalcin (OC), bone alkaline phosphatase (bALP), and bone mineral density (BMD) in patients with insulin-dependent diabetes mellitus (IDDM). A group of 18 patients (median age 47, range 36-51) with uncomplicated IDDM (Group A) were matched by sex, age, and body mass index with 21 healthy control volunteers (Group B). All subjects underwent osteodensitometry with measurement of BMD at the lumbar spine and femoral neck. Osteopenia was present in 11 (61.1%) and 2 (9.5%) of Group A and B patients (P= 0.01), respectively. Both OC (28.4 +/- 16.4 versus 41.2 +/- 14.6 ng/mL; P= 0.005) and bALP (51.3 +/- 11.8 versus 61.7 +/- 10.6 U/L; P= 0.006) serum levels were significantly lower in patients with IDDM. BMD did not correlate with either OC or bALP. In conclusion, osteopenia is common among patients with IDDM, but the relationship between bone formation markers and BMD is still unclear.

Relationship between oral contraceptive therapy and estrogen receptor status in patients with breast cancer.

BACKGROUND: Breast cancer (BC) is the most common cancer in women, and the hormone receptor status is one of the most important prognostic factors in patients with BC. The aim of this study was to establish whether a relationship exists between the hormone receptor rate and the main classic risk factors in patients with BC. PATIENTS AND METHODS: The data regarding a series of 351 consecutive women (median age 57 years, range 26-85 years) who had undergone curative surgery for primary BC was retrospectively reviewed. Eighty-seven (24.8%) patients used oral contraceptives. According to the duration of OC therapy, the patients were dichotomized into two Groups. Group A: less than 22 months (47 patients, 54%) and Group B: 22 months or more (40 patients, 46%). RESULTS: Final pathology showed 15 (4.3%) pT1a, 62 (17.7%) pT1b, 133 (37.9%) pT1c, 125 (35.6%) pT2, and 16 (4.5%) pT3 BC. There were 286 (81.5%) infiltrating ductal, and 24 (6.8%) infiltrating lobular breast carcinomas. The average estrogen receptor (ER) and progesterone receptor (PgR) rate was 59.7 +/- 32.8 and 54.2 +/- 33.9, respectively. There was no relationship (p = NS) between either ER or PgR and the age of the patients, age at menarche and menopause, number of pregnancies, age at first pregnancy, number of spontaneous abortions, months of breastfeeding and the use of estrogen replacement therapy. As expected, ER and PgR rates correlated significantly (R = 0.78, p < 0.01). The ER rates of groups A and B were 51.7 +/- 35.6% and 68.2 +/- 23.6%, respectively (p = 0.014). No other differences (p = NS) between the groups were found. CONCLUSION: The prolonged use of oral contraceptives may increase the ER rate within the tumor tissue, and thus such therapy should be considered an indirect positive prognostic factor in patients with BC.