Communication between breast cancer patients and their physicians about breast-related body image issues.

Breast cancer patients encounter body image changes throughout their diagnosis, treatment, and recovery from breast cancer. No prospective studies were identified investigating communication between physicians and breast cancer patients related to body image. This qualitative pilot study determines (1) how breast cancer patients prefer their physicians communicate regarding body image changes and (2) how comfortable physicians are in discussing body image issues with their patients. Data were collected from patients over 12 weeks through the breast evaluation questionnaire (BEQ), a valid and reliable instrument, and a qualitative questionnaire. Ten physicians completed a qualitative questionnaire. The data were analyzed using frequency analysis. Nearly 70% of the patients reported there was more the physician could do to improve patient comfort in discussing breast-related body image concerns. Honesty, openness, and directness were important to the patients. Thirty-three percent of the patients answered that their physicians should be honest, open, and direct while discussing these issues. On a five-point Likert scale (1 = very uncomfortable and 5 = very comfortable), the physicians most frequently answered a 4 when asked how comfortable they are speaking about breast-related body image issues; however, only four out of 10 always address the topic themselves during the patient's visit. These data suggest that patients want honesty, openness, and directness from their physicians during the discussion of breast-related body image issues. The physicians report they are comfortable speaking about breast-related body image issues; yet, they do not directly initiate the topic.

A contemporary, population-based study of lymphedema risk factors in older women with breast cancer.

BACKGROUND: We studied potential risk factors for lymphedema in a contemporary population of older breast cancer patients. METHODS: Telephone surveys were conducted among women (65-89 years) identified from Medicare claims as having initial breast cancer surgery in 2003. Lymphedema was classified by self-report. Surgery and pathology information was obtained from Medicare claims and the state cancer registries. RESULTS: Of 1,338 patients treated by 707 surgeons, 24% underwent sentinel lymph node biopsy (SLNB) and 57% axillary lymph node dissection (ALND). At a median of 48 months postoperatively, 193 (14.4%) had lymphedema. Lymphedema developed in 7% of the 319 patients who underwent SLNB and in 21% of the 759 patients who underwent ALND. When controlling for patient age, tumor size, type of breast cancer, type of breast and axillary surgery, receipt of radiation, chemotherapy, and hormonal therapy, and surgeon case volume, the independent predictors of lymphedema were removal of more than five lymph nodes [odds ratio (OR) 4.68-5.61, 95% confidence interval (CI) 1.36-19.74 for 6-15 nodes; OR 10.50, 95% CI 2.88-38.32 for >15 nodes] and presence of lymph node metastases (OR 1.98, 95% CI 1.21-3.24). CONCLUSIONS: Four years postoperatively, 14% of a contemporary, population-based cohort of elderly breast cancer survivors had self-reported lymphedema. In this group of predominantly community-based surgeons, the number of lymph nodes removed is more predictive of lymphedema rather than whether SLNB or ALND was performed. As more women with breast cancer undergo only SLNB, it is essential that they still be counseled on their risk for lymphedema.

Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27.

PURPOSE: Experience with sentinel node biopsy (SNB) after neoadjuvant chemotherapy is limited. We examined the feasibility and accuracy of this procedure within a randomized trial in patients treated with neoadjuvant chemotherapy. PATIENTS AND METHODS: During the conduct of National Surgical Adjuvant Breast and Bowel Project trial B-27, several participating surgeons attempted SNB before the required axillary dissection in 428 patients. All underwent lymphatic mapping and an attempt to identify and remove a sentinel node. Lymphatic mapping was performed with radioactive colloid (14.7%), with lymphazurin blue dye alone (29.9%), or with both (54.7%). RESULTS: Success rate for the identification and removal of a sentinel node was 84.8%. Success rate increased significantly with the use of radioisotope (87.6% to 88.9%) versus with the use of lymphazurin alone (78.1%, P = .03). There were no significant differences in success rate according to clinical tumor size, clinical nodal status, age, or calendar year of random assignment. Of 343 patients who had SNB and axillary dissection, the sentinel nodes were positive in 125 patients and were the only positive nodes in 70 patients (56.0%). Of the 218 patients with negative sentinel nodes, nonsentinel nodes were positive in 15 (false-negative rate, 10.7%; 15 of 140 patients). There were no significant differences in false-negative rate according to clinical patient and tumor characteristics, method of lymphatic mapping, or breast tumor response to chemotherapy. CONCLUSION: These results are comparable to those obtained from multicenter studies evaluating SNB before systemic therapy and suggest that the sentinel node concept is applicable following neoadjuvant chemotherapy.

Does breast tumor location influence success of sentinel lymph node biopsy?

BACKGROUND: Controversy exists regarding the influence of sentinel lymph node (SLN) mapping technique or patient variables on the success rate of SLN mapping. We undertook a prospective study in a single institution series to evaluate multiple variables that could adversely affect SLN identification rates. STUDY DESIGN: Data were collected on 174 patients who underwent 177 SLN mapping procedures followed by axillary dissection from October 1996 through January 2000. Patient demographics, body mass index (BMI), biopsy method, tumor size, palpability, and location were recorded. SLNs were identified by blue dye only (n = 31), Tc-99m sulfur colloid only (n = 34), or combined techniques (n = 112). Data were analyzed by logistic regression analysis and expressed as the probability of failure to map the SLN. RESULTS: SLNs were identified successfully in 150 of 177 procedures (85%) with a false negative rate of 3.7%. Mapping success reached 93% using combination blue dye and isotope. Variables found to adversely affect SLN mapping success and the odds ratio of failure (OR) included lower inner quadrant (LIQ) location (OR 35.6), blue dye only (OR 42.4), BMI >30 and upper outer quadrant (UOQ) location (OR 14.6), and nonpalpable UIQ location (OR 25). LIQ location adversely affects mapping success independent of technique, tumor size, or obesity. Obesity and nonpalpability were adverse factors when tumors were located in the UOQ and UIQ, respectively. Age, biopsy technique, and tumor diameter did not affect SLN mapping success. CONCLUSIONS: SLN mapping success is influenced by technique and tumor location, with best results achieved using combined techniques and for lesions located in quadrants other than the LIQ. Obesity and tumor palpability influence success in the context of tumor location.

Sequelae of cryotherapy in breast tissue.

Cryotherapy is a novel treatment for benign and malignant breast lesions that is under evaluation. We assessed the acute and subacute outcomes of breast cryotherapy in normal goat teats using physical, microscopic, and imaging modalities. Eight goats were subjected to two freeze-thaw cycles of breast tissue producing a 2cm iceball and sacrificed either 2 or 7 weeks later. Acute skin changes were minimal unless obvious tissue injury occurred during cryotherapy; however, depigmentation developed over several weeks in dark-skinned goats despite the presence of melanocytes. By histology, breast epithelial elements could not be identified at cryotherapy sites. There was no cystic degeneration, which is common at surgical excision sites. Neither calcifications nor prominent scarring could be attributed to cryotherapy on imaging studies after 2 or 7 weeks. When compared to standard breast surgery, the sequelae of cryotherapy using histologic, radiographic, and sonographic criteria were decreased. Our study suggests that cryotherapy, with technical modifications, is feasible within breast tissue and warrants further study.

Biometrial - associated infections in surgery: part I clinical application, etiology and pathogenesis

Nas ultimas decadas presenciamos um aumento consideravel em relacao ao numero e a variedade de biometrias disponiveis para o uso medico, sem que, no entanto, um correspondente aumento na seguridade de seu uso fosse observada. Considerada uma complicacao de rara ocorrencia, a infeccao esta geralmente associada a uma alta morbidade e suas consequencias podem ser catastroficas para o paciente. Sua incidencia esta diretamente relacionada a reacao tecidual, fatores relacionados ao microorganismo e as caracteristicas do biomaterial. Atualmente, as opcoes terapeuticas estao limitadas as medidas profilaticas, antibioticoterapia e a remocao da protese...