Intraoperative ultrasound guidance for excision of non-palpable invasive breast cancer: a hospital-based series and an overview of the literature.

Intraoperative ultrasound (IOUS) can be used in the operation theatre for localization of non-palpable breast cancers. In this prospective cohort study, we compared the yield of IOUS to guidewire localization (GWL). A total of 258 consecutive patients with non-palpable invasive breast cancer underwent breast conserving surgery between 1999 and 2010. GWL was performed in 138 (54 %) and IOUS in 120 (46 %) patients. Tumor dimensions, resection volume, margin status and re-excision rates were compared by means of multivariate regression analysis. The groups were similar in terms of age, histological subtype and presence of DCIS. Lesions in the IOUS group were larger (1.24 vs. 0.98 cm, P < 0.001), while microcalcifications were more common in the GWL group (19 vs. 3 %, P < 0.001). Even after stratification for tumor diameter, presence of DCIS and findings on mammography, resection volumes were similar in both groups. Tumor-free resection margins were obtained in >93 % of patients (93.5 % with GWL vs. 93.3 % with IOUS, P = 0.958) and re-excision was performed in 11 % of patients undergoing GWL and 12.5 % of patients undergoing IOUS (P = 0.684). For localization of non-palpable breast cancer, IOUS is a reliable alternative to GWL, as it achieves similar results in terms of complete tumor removal, re-excision rate and excised volume.

Prognostic value of micrometastases in sentinel lymph nodes of patients with breast carcinoma: a cohort study.

BACKGROUND: The prognostic meaning and thus indication for adjuvant therapy of lymphogenic micrometastases in breast cancer patients is still under debate. PATIENTS AND METHODS: From 1999 to 2007, 703 patients with (c)T(1-2)N(0) breast cancer underwent surgery including sentinel lymph node biopsy. Examination of sentinel lymph nodes consisted of hematoxylin and eosin and immunohistochemistry staining following serial sectioning of the sentinel node. Patients were divided into four groups: (p)N(0) (n=423), (p)N(1micro) (n=81), (p)N(1a) (n=130) and (p)N(>or=1b) (n=69). Median follow-up was 40 months. RESULTS: At the end of follow-up, 53 patients had died and 64 had recurrent disease. Compared with (p)N(0) and following adjustment for possible confounders, including adjuvant systemic treatment, overall survival was not significantly different for (p)N(1micro) while significantly worse for (p)N(1a) and (p)N(>or=1b) {hazard ratio (HR) [95% confidence interval (CI)]: 0.59 [0.14-2.58], 4.31 [1.85-10.01], 10.66 [4.04-28.14], respectively}. Likewise, disease-free survival was not significantly different for (p)N(1micro) and worse for (p)N(1a) and (p)N(>or=1b) (HR [95% CI]: 1.43 [0.67-3.02], 2.79 [1.37-5.66], 7.13 [3.27-15.54], respectively). Distant metastases were more commonly observed in the (p)N(1micro) than in the (p)N(0) group, but still not as common as in the (p)N(1a) or (p)N(>or=1b) group (HR [95% CI]: 4.85 [1.79-13.18], 10.34 [3.82-28.00], 23.25 [7.88-68.56], respectively). CONCLUSION: Although the risk of distant metastases was higher in patients in the (p)N(1micro) than in the (p)N(0) group, no statistically significant differences were observed in overall or disease-free survival between (p)N(0) and (p)N(1micro). Micrometastatic lymph node involvement in itself should not be an indication for adjuvant chemotherapy in breast cancer patients.

The value of ultrasound in the evaluation of palpable breast tumours: a prospective study of 400 cases.

In a prospective study, 400 palpable breast tumours were examined to establish the value of ultrasound. 174 Carcinomas were diagnosed by histological examination. The sensitivity of ultrasound examination in detecting malignancy was 96.6%, the specificity 94.2%. Ultrasound examination of a palpable breast tumour is reliable in differentiating between benign and malignant tumours.

Locating and marking non-palpable, mammographically suspicious breast lesions with the aid of ultrasound.

Most non-palpable, mammographically suspicious breast lesions can be located by ultrasound (47 of 58 lesions in our series). We found that it was possible in 26 of 28 cases to mark these lesions prior to operation under ultrasound guidance thus simplifying the operating procedure.

Technetium-99m-sestamibi uptake in axillary lymph node metastases in breast cancer patients.

In a prospective study the value of technetium-99m-sestamibi scintigraphy (MIBI scintigraphy) in staging axillary lymph node involvement in breast cancer patients was established. The study comprised 36 cases. The results of the staging were compared with physical and histological examination. MIBI scintigraphy had a sensitivity of 91% and a total accuracy of 81%. These percentages demonstrate the potential value of this technique; larger series will be needed to confirm our results.

[Little extra information with ultrasonic studies of the axillary glands in patients with breast carcinoma]. / Weinig extra informatie door echografisch onderzoek van de okselklieren bij patiënten met een mammacarcinoom.

In order to establish the value of ultrasound examination of the axillary lymph nodes on the presence of lymph node metastases of carcinoma of the breast a prospective survey was carried out in 100 consecutive patients with a carcinoma of the breast on which a lymph node dissection was performed. In the survey the results of the ultrasound examination were compared with the results of the physical and pathological examinations. Although the sensitivity of the ultrasound examination was higher (60%) than that of the physical examination (33%) the ultrasound examination proved insufficiently reliable.

[Mondor's disease]. / De ziekte van Mondor.

Mondor's disease, a harmless superficial thrombophlebitis of mainly thoracic veins, was diagnosed in four patients. Two of them were initially suspected of carcinoma of the breast, while the two others were thought to have a helminthic infection. Symptoms, signs, pathology and aetiology of this disease are discussed.

[Ultrasonographic study of the palpable breast tumor is very useful]. / Echografisch onderzoek van de palpabele mammatumor zeer waardevol.

OBJECTIVE: To determine the value of ultrasonographic examination in the assessment of palpable breast tumours, with special reference to the distinction between benign and malignant tumours. DESIGN: Prospective ultrasonographic study; the results of the ultrasonographic examination were compared retrospectively with those of mammographic examination. SETTING: Diakonessenhuis, Utrecht. METHOD: In 282 successive patients, 300 palpable breast tumours were examined ultrasonographically in the period from December 1989 to May 1992 and the findings were compared with those of morbid-anatomical examination (histological examination in solid tumours, cytological examination in cysts). The results of ultrasonographic and mammographic examination of 241 tumours were compared. RESULTS: Of the 300 palpable tumours examined ultrasonographically, 297 were included in the study (122 carcinomas and 175 benign lesions). The sensitivity of ultrasonography was 97.5%, its specificity 92.6%. The predictive value of a positive test result was 90.2%. When the results of ultrasonography and mammography were compared for 204 tumours, the sensitivity of ultrasonography proved to be 97.4% and its specificity 91.0%; for mammography, these figures were 91.3% and 75.3%, respectively. CONCLUSION: Ultrasonography of palpable breast tumours can be a highly reliable diagnostic method, particularly with a view to distinguishing between malignant and benign lesions.

The non-palpable, radiographically suspicious breast lesion: an analysis of 101 cases.

Analysis of 94 patients with 101 non-palpable, radiographically suspicious, breast lesions revealed 46 malignancies (46%). Comparison of the malignant lesions with 225 palpable carcinomas (221 patients) removed surgically during the same period, showed a higher incidence of carcinoma in situ. Contrary, lymph-node metastases and distant metastases were, at the time of operation, distinctly less than in the patients with non-palpable malignant lesions. A breast-conserving therapy was more often feasible in patients with nonpalpable malignant lesions.