Relationship between preoperative serum markers CA 15-3 and CEA and relapse of the disease in elderly (>65 years) women with breast cancer.

This study investigated whether preoperative carcinoma-associated antigen (CA) 15-3 and carcinoembryonic antigen (CEA) serum levels are predictive markers of reduced disease-free (DF) survival in women with breast cancer (BC) who have undergone curative surgery A series of 363 consecutive postmenopausal women (median age 63 years, range 47-89 years) with pT1-2, N0-1 and M0 BC who underwent curative surgery and were followed-up for at least 36 months after lumpectomy or mastectomy were reviewed retrospectively. Two groups of patients were considered: Group 1 (age 47-64 years), 203 (55.9%) patients; Group 2 (age >64 years), 160 (44.1%) patients. None of the parameters (age, size of the tumour, CA 15-3 and CEA baseline serum levels, ER and PgR rate, MIB-1 labelling index) differed between the groups. During follow-up (36-60 months) 62 (17.1%) patients developed relapse (DR) of the disease (41 and 21 among Groups 1 and 2, respectively), while 301 (82.9%) were DF. The differences were as follows (DF vs. DR): Group 1: CA 15-3 (25.0+/-11.4 vs. 31.4+/-14.6 U/l; p=0.003) and CEA serum levels (5.7+/-4.8 vs. 7.4+/-6.4 ng/ml; p=0.048). Group 2: CA 15-3 (27.9+/-13.2 vs. 20.4+/-6.5 U/l; p=0.012) and CEA serum levels (6.6+/-5.2 vs. 3.7+/-2.5 ng/ml; p=0.013). Surprisingly, in the subgroup of patients aged >65 years who developed relapse, both CA 15-3 and CEA baseline serum levels were lower than in the subgroup of DF patients. In conclusion, although serum tumour markers levels may be useful during follow-up, their baseline levels are not useful in predicting relapse in elderly patients with BC.

Incidence of arm lymphoedema following sentinel node biopsy, axillary sampling and axillary dissection in patients with breast cancer.

The aim of this study was to compare the incidence of lymphoedema after different treatments of the axilla in patients with breast cancer (BC). Medical records of 205 women (median age 61 years, range 26-72 years) who underwent curative surgery for primary BC were reviewed. According to the treatment of the axilla, the study population was divided into four age- and stage-matched groups of patients: Group A (N=54 patients), sentinel node biopsy (SLNB) alone; Group B (N=48 patients), SLNB followed by axillary node (AN) sampling using ultrasound scissors (harmonic scalpel); Group C (N=53 patients), AN dissection using ultrasound scissors; Group D (N=50 patients), traditional AN dissection. The median follow-up was 22 months (range 18-28 months). The intraoperative frozen section of SLNB (Groups A and B) showed 32 out of 102 (31.4%) patients with metastasis to AN, while final pathology showed AN metastases in 20, 17, 16 and 17 patients of groups A, B, C and D, respectively (p=NS). The sensitivity of SLNB alone was 80% and that of SLNB followed by AN sampling was 95% (p=NS). At follow-up patients with lymphoedema were 2 (3.7%), 2 (4.2%), 3 (5.6%) and 8 (16%) in groups A, B, C and D, respectively (p=NS). In conclusion, AN sampling is a sensitive and low-morbidity procedure which, in conjunction with the use of harmonic scalpel, may reduce the onset of arm lymphoedema.

Adrenal incidentalomas: indications for surgery.

Adrenalectomy represents the gold standard treatment for hyperfunctioning adrenal incidentaloma. In cases of silent adrenal masses, on the other hand, the surgical removal of an adrenocortical cancer entails the sacrifice of a large number of safe benign masses, and in most cases surgery is therefore unjustified. The aim of this paper was to clarify the surgical indications for adrenal incidentaloma by reviewing our experience in comparison with the main reference literature. Over the period from 1995 to 2001 we managed 40 cases of incidentaloma. US and CT abdominal scans, adrenal scintigraphy and biochemical tests were performed on an outpatient basis. Seven pre-Cushing syndromes were removed. Ten incidentalomas measured 4 cm or more in diameter: 5 of these were operated on and in 5 cases surgery was not feasible or was refused. Only one malignant mass was detected (an angiosarcoma). Four postoperative minimal complications (18.7%) were observed. The follow-up (median: 48 months) was uneventful. The surgical approach was traditional in 11 cases and laparoscopic in 1 case. Surgery should be considered mandatory in cases of hyperfunctioning adrenal masses in the presence of suspect radiological evidence, in cases of discordant CT and scintigraphy findings and when the maximum diameter is 4 cm or more.

Adrenal angiosarcoma: report of a case.

Adrenal epithelioid angiosarcoma is an extremely rare tumor. Even if such tumors are very aggressive, a long survival may occasionally be observed after an adrenal ectomy. A 70-year-old woman suffering from persistent right flank pain showed a 5-cm right adrenal mass plus a 2-cm liver mass at the radiologic workup, and both were suspected of being malignant. No adrenal hypersecretion was demonstrated. During an explorative median laparotomy the right adrenal gland with the whole periadrenal tissue and locoregional lymph nodes was removed. A histological examination revealed an adrenal angiosarcoma. The resection margin was tumor-free with no lymph node infiltration. The liver mass turned out to be a cistobiliary adenoma. Since no distant metastases were observed, no adjuvant chemotherapy was performed. After an 18-month follow-up the patient is still well with no sign of a relapse. When this rare adrenal tumor is encountered and curative treatment is attempted initially extensive surgical procedures are essential.