Use of intraoperative stereomicroscopy for preventing loss of metastases during frozen sectioning of sentinel lymph nodes in breast cancer.

AIMS: Optimal detection of metastases in sentinel lymph nodes (SLN) remains controversial. To determine the reliability of intraoperative frozen sections, SLN protocol with one frozen section was compared with macroscopic SLN evaluation with consecutive complete SLN embedding. METHODS AND RESULTS: SLN from 135 consecutive breast cancer patients were analysed under a sereomicroscope. Frozen sections were performed in suspicious or clearly involved SLN on cut surface. One control group (n = 143) underwent one intraoperative frozen section on each SLN. The second control group (n = 90) was subjected to stereomicroscopy and one intraoperative frozen section on each SLN. A conventional SLN protocol with cytokeratin immunohistochemistry was performed postoperatively in all cases. All groups were statistically comparable. In the study group metastases were suspected in 21 SLN (16%) under the stereomicroscope and all were confirmed histologically. The negative SLN rate was significantly lower in the study group than in the main control group (47% versus 64%, P = 0.008), suggesting loss of metastases during frozen sections. More macrometastases were detected in the study group (30% versus 15%, P = 0.006); there were no differences in isolated tumour cells or micrometastases. The false-negative rate was significantly lower in the control groups (29% versus 13% and 12%, P = 0.001). CONCLUSIONS: Frozen sections potentially lead to loss or reduced size of metastatic deposits in SLN. Avoiding intraoperative frozen sections on grossly inconspicuous SLN may therefore be justified.

[Loss of metastatic deposits in breast sentinel lymph nodes during intra-operative frozen section analysis]. / Potentieller Verlust von Metastasen in Sentinel Lymphknoten während der Schnellschnitt Untersuchung.

The intraoperative evaluation of sentinel lymph nodes is an ongoing debated issue. In this review we discuss different approaches to sentinel lymph node processing in an intra operative setting and in the consecutive embedding in paraffin. We propose a method, which uses routine intra operative examination of lymph nodes with stereo microscopy with selected frozen section analysis. We demonstrate preliminary data on a larger patient collective along with data on a control group. We could show in our study that a higher rate of metastates can be achieved avoiding intra operative frozen sections on grossly inconspicuous sentinel lymph nodes.

[Conservative treatment of puerperal breast abscesses with repeated sonographically guided aspirations and oral antibiotic administrations]. / Behandlung puerperaler Mammaabszesse durch wiederholte ultraschallgezielte Punktionen und perorale Antibiotikagabe.

BACKGROUND: Breast abscesses have usually been treated by incision and drainage. During the past 10 years conservative treatment with repeated ultrasound-guided drainage to evacuate the abscess combined with antibiotic treatment has become a valuable alternative. PATIENTS AND METHODS: From 1991 to 2003 the authors treated 17 patients with puerperal abscess with this method. Under local anesthesia with ultrasound guidance a thick needle (preferably a Venflon) is introduced into the cavity. The procedure is repeated every two or three days until the ultrasound image demonstrates a diameter of the cavity of 1.5 cm or less. The oral antibiotic treatment lasts for 6 to 10 days. RESULTS: In 7 cases only one puncture was needed, 5 cases needed 2 punctures while 4 women needed 3 or more punctures (up to 5). In 16 cases an open drainage could be avoided. One patient wanted to discontinue the conservative treatment after the first puncture and requested the surgical drainage. CONCLUSIONS: Conservative therapy with ultrasound-guided drainage of puerperal breast abscesses can therefore be recommended as a standard treatment.

[Postpartum footdrop due to compression of the lumbosacral trunk]. / Geburtstraumatische Fussheberpareseinfolge einer pelvinen Nervenschädigung.

We report on a rare peripartal neuropathy of the leg caused by pro longed difficult labor in which forceps were used or caesarean sec tion was performed. Immediately after delivery, the 2 patients corn plained of a unilateral footdrop and numbness in the leg. The foot drop was most likely due to a compression of the lumbosacral trunl exposed to the fetal head. This trunk contains fibres from the lumba roots L4 and L5 and connects the lumbar with the sacral plexus. The outcome was favourable in both patients. If subsequent pregnancies occur, caesarean section may be indicated.

[Postpartum footdrop]. / Postpartaler Fallfuss.

We report on a rare peripartal neuropathy of the leg caused by prolonged difficult labour. Immediately after delivery two patients complained of unilateral footdrop and numbness in the leg. The footdrop was most probably due to compression of the lumbosacral trunk exposed to the foetal head. This trunk contains fibres from lumbar roots L4 and L5 and connects the lumbar with the sacral plexus. The outcome was favourable in both patients. If subsequent pregnancies occur, caesarean section may be indicated.

Premature contractions: possible influence of sonographic measurement of cervical length on clinical management.

In a retrospective case control study with historical controls, the influence of the introduction of vaginal sonographic cervical length measurement on the utilization of hospital services and pregnancy outcome of gravid women at risk of preterm delivery was examined. Prior to the introduction of vaginal ultrasonography to measure cervical length, we registered 76 hospitalizations totalling 1827 hospitalization days due to premature cervical ripening and/or premature labor in 1991 and 1992. In 1994 and 1995, after vaginal ultrasonography was introduced and intravenous tocolysis was limited to cases with cervical shortening to less than 3 cm, there were 64 admissions resulting in just 869 hospitalization days. Long-term hospitalizations (over 10 days) were reduced from 55 to 25 cases (p < 0.0001) and the median length of hospital stay decreased from 18 to 8 days (p < 0.0001). The number of preterm births (< or = 37 weeks) remained stable: 12 cases in 1991-1992 and 13 cases in 1994-1995. In conclusion, vaginal sonographic measurement of cervical length provides an objective criterion for cervical shortening with premature labor. The method could therefore be a suitable means of reducing unnecessary therapeutic interventions in gravid women with premature contractions and/or cervical dilatation. A prospective randomized trial to confirm these findings is suggested.

[Does breast self-examination affect the stage of breast carcinoma?]. / Beeinflusst die Selbstkontrolle der Brust das Stadium des Mammakarzinoms?

The regular self-examination of the breast is one of the possibilities to detect breast cancer early. Our aim was to test the sensitivity of the method on rural, poorly informed patients. Almost one fourth of the 90 cancer patients belonged to the self-examination group. 52% of these women had a stage-I tumor. 58% of the women who didn't examine themselves entered hospital with stage-III or stage-IV tumor. In the self-examination group, in 71% of the lymph nodes were negative. This cohort showed also a better result concerning tumor extension. The average size was 1.9 cm compared to 3.8 cm in the 'non-analyser group'. We summarize that women controlling themselves have a better prognosis. Therefore, self-examination, combined with mammography and clinical control, is one of the best methods for early detection of mammary-cancer.