Bacterial colonization of seromas after breast cancer surgery with and without local steroid prophylaxis.

BACKGROUND: Seroma formation is a frequent postoperative sequela after mastectomy for primary breast cancer. We investigated the role of bacterial colonization of seroma fluid with three different culture methods and the effect of intracavitary steroids. METHODS: The study group consisted of 212 patients scheduled for mastectomy from a previously performed double-blind randomized placebo-controlled intervention trial. The patients were allocated to a single dose of 80 mg of steroids (methylprednisolone) or saline, and the effect on seroma formation was investigated. From each aspiration, an equal volume of seroma fluid (10 mL) was distributed into one sterile transport tube (conventional method), one aerobic blood culture bottle and one anaerobic blood culture bottle. RESULTS: There was significant variation in the number of bacterial species detected in seroma samples among the three culture methods, ranging from 18 species with the conventional culture tubes to 40 species with aerobic blood culture bottles. Patients receiving prophylactic steroids had significantly more frequent colonization than those in the saline group. Nevertheless, the clinical surgical site infection rate of 7.0% was equal between the two groups. CONCLUSIONS: In general, data analysis of the entire set of case material did not succeed in demonstrating a relationship between a specific bacterial species or a combination of species and seroma formation. However, in the few patients with growth of a pathogenic species, both the duration of seroma formation and volume of seroma fluid were more pronounced. TRIAL REGISTRATION: Ethics Committee of Copenhagen (H-4-2009-137), (EudraCT number 2009-016650-40), the Danish Data Protection Agency (code J. no. F.750.75-2), and the Danish Health and Medicines Authority (sponsor protocol code number 23837). Start date November 2010.

Local injection of methylprednisolonacetat to prevent seroma formation after mastectomy.

INTRODUCTION: This study served the following three purposes: To evaluate the prophylactic effect against seroma of a single dose of steroid in the mastectomy cavity, to evaluate the thesis that there is a connection between subclinical bacterial colonization and seroma formation and to evaluate if a simple urine stix test can detect postmastectomy infection. MATERIAL AND METHODS: This was a double-blinded and randomized study of injection of methylprednisolonacetate versus saline in the mastectomy cavity at the time of drain removal. A total of 160 females were enrolled after mastectomy. The study parameters were as follows: seroma volume, number of seroma punctures, frequency of clinical infections, degree and type of subclinical colonization, complications and evaluation of the microbiological results of the stix test with automatically read glucose, ketones, blood, pH, protein, nitrite and leucocytes. The degree of inflammation was monitored by measurement of 15 cytokines in each sample of seroma fluid. The study was initiated in August 2010 and is expected to run for three years. DISCUSSION: Some reports have concluded that seroma formation forms part of postsurgical inflammation. Steroids are effective against inflammation and accumulation of fluid at the surgical site after several types of surgery and have also proved valuable in the treatment of seroma formation. In the present study, the prophylactic effect of steroids on seroma formation is investigated. CONCLUSION: As the incidence of postmastectomy seroma formation is 80%, there is a need for improvement in the prophylaxis and treatment of this condition. FUNDING: not relevant. TRIAL REGISTRATION: Medicines Agency The EudraCT number 2009-016650-40 has been issued for your Sponsor's Protocol Code Number 23837. Data protection agency J.no. F.750.75-2. The study is perfomed in collaboration with the GCP Unit, capital Region, Bispebjerg Hospital under the EudraCT number: 2009-016650-40.

No effect of steroids on seroma formation after mastectomy.

INTRODUCTION: Seroma formation is a common problem after breast surgery. Studies indicate that seroma formation is a result of the postoperative inflammatory process. Glucocorticoid inhibits the inflammatory response. MATERIAL AND METHODS: In a randomized pilot study, we measured the effect of glucocorticoid on drainage volume and seroma formation after breast surgery. A total of 42 patients with operable primary breast cancer scheduled for total mastectomy were randomized to either 125 mg methylprednisolone sodium succinate intravenously as a single bolus before the start of surgery or to a control group. RESULTS: There was no difference between the groups as to the number of patients having drains from day to day. The drainage volume was lower in the methylprednisolone sodium succinate group than in the control group; however, the difference was not significant (7,979 ml versus 9,267 ml). There was a tendency towards a higher seroma formation in the methylprednisolone sodium succinate group, but the tendency was not significant (15,803 versus 13,987 ml), and there was no significant difference in the number of seroma aspirations after surgery (92 versus 99). CONCLUSION: Injection of a bolus of 125 mg of methylprednisolone sodium succinate before mastectomy did not reduce drainage volume or seroma formation. If intravenous glucocorticoid did have an effect, the case material was too small to prove it.

Intraoperative immunohistochemistry staining of sentinel nodes in breast cancer: clinical and economical implications.

The study aimed to evaluate intraoperative immunohistochemistry (IHC) staining of sentinel nodes in primary breast cancer surgery. We analysed retrospectively 1209 consecutive sentinel node procedures and compared the rate of late positive metastases in sentinel node biopsy (SNB) and the duration of the surgical procedures before (n=706) and after (n=503) introducing intraoperative IHC on frozen section. We also did a cost analysis. Intraoperative IHC staining led to a lowering of the late positive SNB rate. Introducing IHC gave a decrease in the late positive rate from 93 to 52% (p<0.0001) for isolated tumour cell metastasis, from 56 to 36.4% (p<0.02) for micrometastasis, and from 16 to 5% (p<0.01) for macrometastasis. The surgical procedures were slightly prolonged for lumpectomies but not for mastectomies after introducing intraoperative IHC staining. The cost analysis showed an overall cost saving of approximately 40%. In conclusion, intraoperative IHC staining of the SNB lowered the late positive rate and gave an overall cost saving.

Estrogen receptor alpha polymorphism and risk of cardiovascular disease, cancer, and hip fracture: cross-sectional, cohort, and case-control studies and a meta-analysis.

BACKGROUND: We hypothesized that the estrogen receptor alpha (ESR1) IVS1-397T/C polymorphism affects high-density lipoprotein cholesterol response to hormone replacement therapy and risk of cardiovascular disease (CVD), cancer of reproductive organs, and hip fracture. METHODS AND RESULTS: We studied cross-sectionally 9244 individuals from the Danish general population and followed them up for 23 to 25 years. End points were CVD (ischemic heart disease, myocardial infarction, angina pectoris, ischemic cerebrovascular disease, ischemic stroke, other ischemic cerebrovascular disease, venous thromboembolism, deep vein thrombosis, and pulmonary embolism), cancer of reproductive organs (breasts, ovaries, uterus, and prostate), and hip fracture. We also studied patients with ischemic heart disease (n=2495), ischemic cerebrovascular disease (n=856), and breast cancer (n=1256) versus general population controls. The CC, CT, and TT genotypes had general population frequencies of 21%, 50%, and 29%, respectively. Cross-sectionally, genotype did not influence high-density lipoprotein cholesterol response to hormone replacement therapy. In the cohort study, there were no differences in risks of CVD, cancer of reproductive organs, or hip fracture between genotypes. In case-control studies, risk of CVD did not differ between genotypes; however, the odds ratio for breast cancer in women with TT versus CC genotypes was 1.4 (95% CI, 1.1 to 1.7). Meta-analysis in men of 6 previous and the present 2 studies, including 4799 cases and 12,190 controls, showed odds ratios in CC versus CT and TT genotypes for fatal and nonfatal myocardial infarction of 0.81 (95% CI, 0.59 to 1.12) and 1.08 (95% CI, 0.97 to 1.21). CONCLUSIONS: ESR1 IVS1-397T/C polymorphism does not influence high-density lipoprotein cholesterol response to hormone replacement therapy or risk of CVD, most cancers of reproductive organs, or hip fracture.

Increased risk of breast cancer associated with CHEK2*1100delC.

PURPOSE: CHEK2*1100delC heterozygosity has been associated with increased risk of breast, prostate, and colorectal cancer in case-control studies. We tested the hypothesis that CHEK2*1100delC heterozygosity in the general population increases the risk of cancer in general, and breast, prostate, and colorectal cancer in particular. PATIENTS AND METHODS: We performed a prospective study of 9,231 individuals from the Danish general population, who were observed for 34 years, and we performed a case-control study including 1,101 cases of breast cancer and 4,665 controls. RESULTS: Of the general population, 0.5% were heterozygotes and 99.5% were noncarriers. In the prospective study, multifactorially adjusted hazard ratios by CHEK2*1100delC heterozygosity versus noncarriers were 1.2 (95% CI, 0.7 to 2.1) for all cancers, 3.2 (95% CI, 1.0 to 9.9) for breast cancer, 2.3 (95% CI, 0.6 to 9.5) for prostate cancer, and 1.6 (95% CI, 0.4 to 6.5) for colorectal cancer. In the case-control study, age-matched odds ratio for breast cancer by CHEK2*1100delC heterozygosity versus noncarriers was 2.6 (95% CI, 1.3 to 5.4). The absolute 10-year risk of breast cancer in CHEK2*1100delC heterozygotes amounted to 24% in women older than 60 years undergoing hormone replacement therapy, with a body mass index of 25 kg/m2 or higher. CONCLUSION: CHEK2*1100delC heterozygosity is associated with a three-fold risk of breast cancer in women in the general population.

[Patients' experiences--indications for treatment quality in breast cancer surgery]. / Patientoplevelser--indikatorer for behandlingskvaliteten i brystkraeftkirurgien.

INTRODUCTION: After the establishment of a centralised unit for the surgical treatment of breast cancer in the county of Copenhagen, Denmark, a number of parameters concerning the quality of patients' in-hospital stay were established. A survey of patients' experiences was done via a questionnaire in which they described their satisfaction level. MATERIALS AND METHODS: Two questionnaires including 43 questions were sent to 400 women recently operated on for primary breast cancer. They were returned by 269 patients, who were included in the study. RESULTS: The patients indicated a high degree of satisfaction with the general aspects of their hospital stay, but problems and possible areas of future improvement were also identified. CONCLUSION: Even with a malignant diagnosis and a short hospital stay, patients may regard the treatment course positively if and when the course is firmly anchored in well-established quality goals.

[Treatment of breast abscess. An analysis of patient material and implementation of recommendations]. / Behandling af abscessus mammae. Gennemgang af et patientmateriale og fremsaettelse af rekommandationer.

INTRODUCTION: Several options for treatment of abscesses in the breast have appeared during the last two decades. No randomised studies comparing these options have been performed. MATERIAL AND METHODS: A retrospective study of the treatment of breast abscesses over a four-year-period. Incision or puncture was employed at the discretion of the responsible doctor. RESULTS: A total of 87 women with various types of breast abscesses were treated by means of incision (42 women equal to 48%) or aspiration of pus by puncture (45 women equal to 52%). After incision which was done in general anaesthesia in 38 women (90%) the patients were discharged after 2.9 days (mean), median 2.0 days, and 39 of 45 women treated by means of puncture were discharged after 2.1 days (mean), median 1.0 day, p = 0.001. In six women, puncture treatment was possible as outpatient procedure. Concerning puncture the majority of patients were treated in local analgesia or without any medication. Recurrent abscess formation was observed in eight women (19%) after incision and in nine women (20%) after puncture. DISCUSSION: The two treatment schedules are effective, but abscess treatment by means of puncture is preferred as the most convenient method for the patient and as a cost-effective treatment. Finally, recommendations for the future schedule of breast absess treatment are specified.