[Ultrasound-guided surgery for breast cancer]. / Echogeleid opereren bij mammacarcinoom.

Recent literature shows that perioperative ultrasound guidance of surgery for palpable and nonpalpable breast carcinoma results in improved surgical effectiveness. Ultrasound-guided surgery can easily lead to significant improvement of the number of radical resections and can decrease the need for additional surgery or extra radiotherapy. Ultrasound-guided surgery also contributes to a reduction in the amount of excessive breast tissue removal, which means the final cosmetic result is better. Ultrasound-guided surgery is cost-effective and easy to learn. Implementation of ultrasound-guided surgery has increased in recent years, albeit slowly. Surgeons as well as radiologists should become more aware of the improvement of primary and secondary outcome measures that can be achieved with ultrasound-guided surgery of breast cancer. In addition to radicality, the quantity of excised tissue - tumour tissue and healthy tissue - can be used as a quality indicator, given the impact on cosmetic outcome and quality of life for patients with breast cancer.

Localization of regional lymph nodes in melanomas of the head and neck.

OBJECTIVES: To study the efficacy of gamma-probe radiolocalization of the first draining (sentinel) lymph node (SLN) in stage N0 melanoma of the head and neck and to evaluate its potential role in the staging and treatment of this disease. DESIGN: Gamma-probe radiolocalization, a new alternative to blue-dye lymphatic mapping, uses a scintillation (gamma) probe to identify radiolabeled SLNs. In a consecutive sample clinical trial, gamma-probe radiolocalization of the SLN is compared with lymphoscintigraphy and blue-dye lymphatic mapping. Follow-ups ranged from 1.7 years to 4 years, with a mean follow-up of 2.5 years. SETTING: Tertiary and private care teaching hospital. PATIENTS: Between June 1993 and November 1995, 23 patients with stage N0 intermediate-thickness melanoma of the head and neck were enrolled in this volunteer sample. INTERVENTIONS: Twenty-four hours prior to surgery, a radioactive tracer was intradermally injected around the circumference of a primary melanoma. Twelve patients also had blue dye injected just prior to surgical resection. Using a handheld gamma probe, radiolabeled lymph nodes were identified and selectively removed with minimal dissection. In patients with nodes with histologic evidence of metastases, a regional lymphadenectomy was performed. MAIN OUTCOME MEASURES: The successful identification of radiolabeled SLNs, the correlation of SLN radiolabeling to lymphoscintigraphy and blue-dye mapping, and the long-term development of regional metastases. RESULTS: Surgeons successfully resected the radiolabeled SLNs in 22 (96%) of 23 patients. The success rate of blue-dye lymphatic mapping was 8 (75%) of 12 patients and lymphoscintigraphy was 20 (91%) of 22 patients. One hundred percent of blue-stained lymph nodes were radiolabeled. The one patient in whom no SLN could be identified developed regional disease at 17 months. CONCLUSIONS: Gamma-probe radiolocalization and resection of the radiolabeled SLN is a simple and reliable method of staging regional lymph nodes and determining the need for elective lymphadenectomy.

Impact of [18F]fluorodeoxyglucose positron emission tomography on surgical management of melanoma patients.

BACKGROUND: Several studies have shown adequate sensitivity and specificity of [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) for the detection of metastases from melanoma, but few have addressed its impact on treatment. The aim of this retrospective study was to assess the impact of FDG-PET on treatment of melanoma in three Dutch university medical centres. METHODS: The medical records of 257 patients were reviewed. The indications for FDG-PET and findings were recorded. Unexpected findings of suspected (pre)malignant tumours other than melanoma were assessed. Treatment plans before and after FDG-PET were recorded and analysed to evaluate changes in disease management. RESULTS: Most scans (71.2 per cent) were requested for staging, mainly to detect distant metastases in patients with stage III disease. Overall, 56 patients (21.8 per cent) were upstaged as a result of PET. In 44 patients (17.1 per cent) treatment was changed, usually from surgery to systemic treatment in patients with stage III disease. Unexpected tumours were detected (mainly colorectal) in 11 patients (4.3 per cent). CONCLUSION: FDG-PET is most valuable in patients with stage III melanoma for detection of distant metastases and identification of candidates for surgery and/or systemic treatment. Unexpected FDG-PET findings should not be disregarded, as (pre)malignant, clinically relevant, tumours may be identified.

Cisplatin: a review of clinical applications and renal toxicity.

In reviewing the literature about the clinical application of cis-diamminedichloroplatinum(II) (cisplatin) it can be concluded that the availability of cisplatin has been an important advance in cancer chemotherapy; especially in patients with disseminated testicular carcinoma and ovarian cancer cisplatin-based combinations are the first choice treatment. Our own investigations of the nature of the main form of toxicity of cisplatin, the nephrotoxicity, are mentioned and methods of its prevention are summarized.

Continent urostomy: a clinical experience in 20 patients.

Urinary diversion via a continent ileal reservoir (modified Kock's procedure) was performed in 20 patients. Primary continent urostomy construction was carried out in 6 patients. Previous urinary diversion was present in 12 patients. Two patients were referred to us because a previous attempt to construct a continent reservoir urostomy had failed. There was no operative mortality. Three early complications occurred in 3 patients. Leakage from a uretero-enteric anastomosis in one patient and necrosis of a continence-providing valve in another patient necessitated reoperation. Late complications causing malfunction of the nipple valves required revisional surgery in 2 patients. Stoma stricture developed in 1 patient after 5 months and could be corrected surgically. The functional results were excellent. Continence was achieved without reflux to the upper urinary tract. Instead of a Kock pouch, an S-pouch was used. The continence and antireflux-providing valves were stapled to the reservoir wall. Slippage of the nipple valves did not occur. All our patients had consistently positive urine cultures and were without complaints. In a few cases, stone formation was observed usually on the staples at the tip of the valve. The stones were removed by forceps during endoscopy of the reservoir.