Tumour size as a predictor of axillary node metastases in patients with breast cancer.

BACKGROUND: The ability to predict the behaviour of breast cancer from its dimensions allows the clinician to inform a woman about the absolute benefits of adjuvant therapies or further surgery to control her disease. Tumour size and grade are independent predictors of nodal disease. This study aims to generate a tool, using Australian data, allowing surgeons to calculate the probability of axillary lymph node involvement in a preoperative setting. METHODS: The histological reports of patients with breast cancer treated in 1995 in New South Wales were examined and tumour size, grade and nodal status recorded. Univariate and multivariate analyses identified predictors of node positivity and, using linear regression analysis, a simple formula to predict nodal involvement was derived. RESULTS: In a 6-month period, 754 women had non-metastatic, unifocal breast cancer treated with surgery and complete axillary dissection and 283 (37.5%) had positive nodes. Tumour size remained an independent predictor of node positivity and the probability (%), y, of nodal involvement may be predicted by the formula y = 1.5 x tumour size (mm) + 7, r = 0.939 and P = 0.001. CONCLUSIONS: This paper shows the need to assess the axilla in every patient because even patients with small tumours (0-5 mm) have the possibility of axillary involvement (7-14.5%). Use of this simple formula allows clinicians and patients to make informed decisions about the possible need for a full axillary dissection to reduce the chance of understaging and potentially undertreating a woman's breast cancer.

Patient preference for bra or binder after breast surgery.

BACKGROUND: No data are currently available to assess the relative merits of breast binder or bra following breast surgery. METHODS: A randomized controlled study was undertaken to compare a breast binder with a bra postoperatively for patients undergoing lumpectomies, partial mastectomies and total mastectomies. RESULTS: Fifty-eight patients were included in the study. Six different parameters were compared and the bra was found better on all criteria; a small group of patients who initially used a binder and then, for a second procedure, used a bra, found the bra more comfortable. CONCLUSION: Postoperative discomfort can be decreased by using a well-fitting bra rather than a breast binder.

Protocol-based approach to suspected appendicitis, incorporating the Alvarado score and outpatient antibiotics.

BACKGROUND: There is evidence that antibiotics can be used as primary treatment for appendicitis, however, delayed surgical treatment might still be associated with perforation. Most patients at risk of perforation have high Alvarado scores. We designed a protocol-based approach to suspected appendicitis, in which the Alvarado score was used to select patients for early treatment with surgery or outpatient antibiotics. METHODS: Patients included in the present study were adults and children referred to the surgical service at John Hunter Hospital (Newcastle, Australia) with suspected appendicitis in the 12 months from July 2000. Treatment groups: no treatment (Alvarado score 1-4); antibiotics alone (Alvarado 5-7); early surgery (Alvarado 8-10). OUTCOME MEASURES: time to operation; duration of hospital stay; non-therapeutic operations; delayed treatment in association with perforation; recurrent appendicitis (for those treated with antibiotics). Comparison group: 142 patients managed with 'best clinical practice' as part of an earlier trial. RESULTS: One hundred and twenty-two patients were enrolled. Median time to operation was 3.9 h (comparison group 7.3 h, P = 0.014). Median length of stay was 38.5 h (comparison group 44.2 h, P = 0.041). There were two cases of delayed treatment in association with perforation (2/122 = 1.6%, comparison group 2/142 = 1.4%, P = 0.88) and 10 non-therapeutic operations (10/122 = 8.1%, comparison group 15/142 = 10.6%, P = 0.51). Of those whose initial illness was treated successfully with antibiotics, 2/42 (4.8%) subsequently required appendicectomy. CONCLUSIONS: This protocol-based approach to suspected appendicitis is feasible. A prospective controlled study would be required to confirm potential benefits (in terms of short hospital stay) and to confirm that there is not an increase in adverse outcomes.