Mammographic determination of breast volume by elliptical cone estimation.

BACKGROUND: We propose a new breast volume calculation method, treating the breast as an elliptical cone on craniocaudal and medial-lateral-oblique mammograms. This study aims to compare the accuracy and reproducibility of this proposed calculation method to the old Katariya method, which calculates breast volume as a circular cone on the craniocaudal mammogram only. MATERIALS AND METHODS: From January 2005 to December 2006, 83 mastectomy patients with recorded breast weight and available preoperative mammographic films were included in the present study. Two surgeons independently measured breast height and width on the preoperative craniocaudal and medial-lateral-oblique mammograms. Breast volume was calculated as a circular cone in the craniocaudal view, and as an elliptical cone in both the craniocaudal and the medial-lateral-oblique mammograms. The accuracy of each method was determined and compared by linear regression analyses. Interobserver variability was assessed by bivariate correlation. RESULTS: The most accurate formula for calculating breast volume was the one that assumed the elliptical cone projection. The mean error of estimated breast volume using the elliptical cone (EC) formula is 3.8 cm(3) (standard deviation [SD] = 133 cm(3)). The mean error of traditional circular cone (CC) formula is -51.3 cm(3) (SD = 182 cm(3)). From a linear regression model, the correlation coefficient of estimated breast volume using EC formula measured 0.977, whereas that using the CC formula measured 0.952 (Fig. 1). Measurements were reproducible between the two independent observers; the Pearson correlation for the EC formula is 0.93 (p < 0.001), and that for the CC formula is 0.95 (p < 0.001). CONCLUSIONS: Breast volume can be accurately determined from measurements made on mammograms. The proposed EC formula calculating breast volume on both the craniocaudal and the medial-lateral-oblique mammograms may be more accurate, as the horizontal and vertical dimensions of the breast are not always the same. In addition, height measurement on the medial-lateral-oblique film can eliminate the compression error as the craniocaudal film may miss the base of the breast and underestimate the breast volume. Taking both mammogram views for measurement is comparably reproducible to the traditional method. Reproducibility of measurement can be further enhanced by better defining the point of measurements.

Laparoscopic resection for colorectal cancer in octogenarians: results in a decade.

OBJECTIVES: This study was designed to evaluate the results of laparoscopic resection for colorectal cancer in octogenarians. METHODS: Patients aged 80 years or older who underwent elective laparoscopic resection for colorectal cancer from July 1, 1996 to June 30, 2006 were recruited for analysis, with the following exceptions: 1) patients who did not give informed consent; 2) unfit for operative treatment; 3) presented as surgical emergencies; 4) multiple previous abdominal operations; or 5) locally advanced tumors. Operating time, blood loss, length of hospital stay, mortality and morbidities, including anastomotic dehiscence, pulmonary and wound sepsis, disease recurrence, and patient survival were used to measure outcome. RESULTS: During a ten-year period, laparoscopic colorectal cancer resection was attempted in 101 octogenarians. The median age was 83 (range, 80-95) years and 45 patients were males. The median operating time was 110 (range, 60-245) minutes, with a median blood loss of 50 (range, 0-1,000) ml. Conversion was required in only one case with a leakage rate of 3.3 percent. The overall morbidity and operative mortality rate were 17 and 3 percent, respectively. With a median follow-up of 24 (range, 0-102) months, 22 patients developed recurrence, with 8 of those still surviving. The overall five-year survival is 51 percent. CONCLUSIONS: Our experience confirms that laparoscopic colorectal cancer resection in selected octogenarians is safe and feasible. Aside from the obvious short-term benefits, the long-term oncologic outcomes are favorable.