Subdermal laterocranial mapping of sentinel lymph nodes in breast cancer as an alternative to the peritumoral mapping.

PURPOSE: Peritumoral injection of blue dye is standard method of sentinel lymph nodes (SLN) biopsy in breast cancer. Applying the marker to different locations will be of great benefit in cases in which the peritumoral mapping is difficult to implement. The aim of this study was to demonstrate that the subdermal laterocranial (SLC) mapping with a dye has similar diagnostic reliability to the peritumoral mapping and is applicable for clinical use. PATIENTS AND METHODS: 254 patients with operable breast cancer (cT

[Mammary ductoscopy--diagnostic opportunites for the assessment of women with pathologic nipple discharge].

UNLABELLED: The aim of this study to analyse the diagnostic possibilities of mammary ductoscopy in the patients with pathologic nipple discharge. MATERIAL AND METHODS: The target of this prospective study are 29 patients who have been through ductal lavage and mammer ductoscopy. We used local anastetic to induct the lacrimal dilatators (dimeter from 0.35 to 1.00 mm from which we infuse and aspirate from 5 to 18 ml 1% Lidocain and 0.9% NaCl) through the openiting of the secreting cannal. After the ductal lavage follows ductoscopy with mammary ductoscope of Karl-Starz endoscope with outside diameter of 0.89 mm. RESULTS: The ductoscopy in which we visualized the ductal lumen was successful released on 23 of patients. A good correlasy was established between the macroscopic finding ductoscopy, the cytology study of ductal secret and the postoperative hystologic diagnosis. CONCLUSIONS: The mammar ductoscopy gives an important information which leads to target to approach for the assessment and treatment of women with pathologic nipple discharge.

[Breast lesions with moderate and high risk of invasive breast cancer--incidence and some particularities].

INTRODUCTION: According to the American College of Pathologists consensus statement proliferative lesions with atypia are benign breast conditions with moderately increased breast cancer risk. Ductal carcinoma in-situ and lobular carcinoma in-situ are described as conditions associated with high risk of invasive breast cancer. AIM: Aim of the following investigation was to analyze the incidence of moderate and high risk lesions leading to invasive breast cancer among the central-north Bulgaria women's population and to access by immunohistological method some of their phenotype biological characteristics. PATIENTS AND METHODS: Six hundred and twenty one clinical cases, histologically verified as benign breast disorders were reviewed in a retrospective study. In 18 of all revealed cases atypical hyperplasia was found. The remaining 591 patients were with benign breast lesions with non-increased and slightly increased risk of invasive breast cancer. Carcinoma in-situ was obtained in 12 cases for the studied period. CD34 and Ki-67 immunostaining was preformed and evaluated. RESULTS AND DISCUSSION: Incidence of benign breast lesions with moderate and high risk was 2.9%, lower than data in literature. Assessment of CD34 positive fibrocytes might play an important role in breast lesion differential diagnosis.

Clinical and surgical aspects of vulvar reconstruction with tensor fasciae latae flaps after en bloc radical vulvectomy.

PURPOSE: The aim of this study was to assess some clinico-surgical aspects of vulvar reconstruction with m. tensor fasciae latae flaps (TFL). PATIENTS AND METHODS: This retrospective study covers the period 1996-2002, and 51 patients with vulvar carcinoma were analyzed. Seven (13.7%) patients had undergone en bloc resection, followed by vulvar reconstruction with TFL., 28 (54.9%) radical vulvectomy with bilateral inguinofemoral lymph node dissection, and 12 (23.5%) patients simple vulvectomy. RESULTS: In 13 (25.5%) patients recurrences were found, that could not be statistically related to the type of surgical intervention (p=0.47). The overall 2-year survival was 82%. Factors contributing to prognosis included FIGO stage, the presence of recurrence and its type. Nine (17.6%) patients had died and the distribution by type of surgery in that group was as follows: en bloc resection with TFL reonstruction--14.3%, radical vulvectomy with lymph node dissection--17.9%, and simple vulvectomy--25%. The correlation was statistically nonsignificant (p=0.71). CONCLUSION: The comparison of the 3 surgical methods of treating primary vulvar carcinoma showed no influence on survival, mortality rate, and type and rate of recurrences. To obtain a reliable clinico-surgical assessment, a multicenter study is necessary.

[Breast cysts--diagnostic and therapeutic management and risk for subsequent development of breast carcinoma]. / Kisti na mlechnata zhleza--diagnostichno-lechebna taktika i riskove ot posledvashto razvitie na kartsinom na gurdata.

Cystic breast disease is a relatively widespread pathological condition in the female sex, it has an incidence of around 7% and predominantly affects women aged between 35 and 50 year old. The diagnosis is based on the standardised protocol including breast examination, mammography, fine-needle aspiration cytology and pneumocystography. While the majority of cysts can be managed by simple aspiration, a small percentage (0.3-1.4%) are malignant. The clinical and pathological features of 7 cases of intracystic carcinoma of the breast which are 0.73% of all cases of cystic breast disease between 1996-2001, are considered in the present article.

[Selection criteria for breast conservation in patients with early breast carcinoma]. / Kriterii za selektsiia za organosukhraniavashti operatsii pri ranen rak na mlechnata zhleza.

During the past two decades, breast-conserving therapy (excision of the tumor and axillary lymphadenectomy followed by irradiation) for early stage breast carcinoma has become firmly established as an equivalent treatment approach to mastectomy. The purpose of this review as to examine the risk factors for local recurrence after breast-conserving therapy. Better mammographic evaluation, better margin assessment, recognition of an extensive intraductal component and the use of adjuvant systemic therapy has improved the logo-regional control.

[The treatment of cyclic mastalgia--a comparative study between the preparations Bromocriptine and Geritamin]. / Lechenie na tsiklichna mastalgiia--srabnitelno prouchvane mezhdu preparatite Bromocriptin i Geritamin.

The aim of the prospective randomized study was to compare the reduction in cyclical breast pain after treatment with oral bromocriptine for 30 days (42 cases) and Geritamine for 40 days (44 cases). The overall response rate to first group was 78.5% and 64.0% to second group. Nine patients treated with bromocriptine and 15 cases with Geritamine have refractory cyclical mastalgia (not influence). The relapse rate after stopping bromocriptine was 30.3% and was 44.8%, with a mean follow-up of 5 months. The investigators indicate that these agents will be used for a twice per year.

[Reconstructive surgery after mastectomy--the anatomical prerequisites]. / Rekonstruktivna khirurgiia sled mastektomiia--anatomichni predpostavki.

Reconstructive surgery of the breast after mastectomy occupies an important place in the complex treatment of breast cancer. The aim of the present study is to determine the capacity of the dermo-muscular flaps and to study the anatomical premises for their use under breast reconstructions. On the base of putrid material are created operative models of reconstructions of the breast with myocutaneous flaps m. rectus abdominis, m. latissimus dorsi and m. gluteus maximus. A study of the anatomical parameters of 64 female individuals, at an age from 51 to 73 years, has been conducted. It was found out that the myocutaneous flap m. rectus abdominis has an average volume of 590 cc and is formed basically of dermo-subdermal tissue (more than 80%). The myocutaneous flap m. latissimus dorsi has an average volume of 290 cc and is formed basically of muscular tissue (85%). The myocutaneous flap m. gluteus maximus has an average volume of 650 cc and is formed of subdermal and muscular tissue in the correlation 65/35%. The most suitable for breast reconstructions turns out to be the myocutaneous flap from m. rectus abdominis, since it provides sufficient amount of new tissue and uncomplicated surgical technique.

[Grading intraductal breast carcinoma]. / Stepenuvane na intaduktalnite kartsinomi na mlechnata zhleza.

Mammographic screening has led to increased detection of intraductal carcinoma of the breast (IdC). IdC is y heterogeneous disorder with different clinical outcomes. The study was designed to confirm consensibility of the three-tiered classification, accepted by Thomas Jefferson University Consensus Conference since 1997. The study population comprised 30 patients with IdC including patients with T1 mic and T1a. Sixty percent of IdC were classified as II-nd grade, 27% were III-rd grade and 13% as I-st grade. 20% of IdC exhibited heterogenity of grade. The cases with cribriform and papillary architecture were 1-st or II-nd grades. The other cases with comedo and solid architecture we are II-nd or III-rd grades. The cases with invasive component (T1 mic u T1a) were 25%--I-st grade, 75%--II-nd grade and III-rd grade--87.5%. In conclusion, the grading of IdC could y prognostic factor in far long term prognosis of patients with those lesions.

[The TUNEL technic for demonstrating apoptosis on paraffin sections]. / TUNEL tekhnika za dokazvane na apoptoza na parafinovi srezi.

TUNEL technique, i.e. terminal deoxynucleotidil transferase-mediated dUTP nick end-labeling, has become a widely used staining method to assist in detection of apoptotic cells in tissue section for routine pathology and scientific investigation. Terminal deoxyribonucleotidyl transferase catalyzed the addition of biotinylated dUTP to free 3'OH ends of DNA fragments, with the synthesis of a polydeoxynucleodide polymer. The signal is amplified by avidin-(biotin)-peroxidase and diaminobenzidine is used as chromogen. We have used this technique to study apoptosis in a group of 9 patients with primary breast carcinoma, 4 of them treated with primary chemotherapy. In situ labeling technique identify apoptotic cells, including those with early nuclear chromatin margination. Necrotic cells have multiple random DNA breaks and stain less intensely. Using these technique will allow for the comparison of the quantitative rate of apoptosis in specific target cell types before and after therapy. Such comparison should enhance knowledge as to the role that apoptosis plays in process of cancer therapy.

[Sentinel lymph node biopsy. The possibilities for axial staging in early breast cancer and the results in 187 patients]. / Biopsiia na sentinelni limfni vuzli. Vuzmozhnosti za stadirane na aksialata pri ranen rak na mlechnata zhleza i rezultati pri 187 patsientki.

The authors studied the sentinel lymph node (SLN) identification rate and its accuracy in predicting axillary staging (N- or N+) in patients with early breast cancer. One hundred eighty seven mapping procedures were performed using a vital dye (Patent blue V, Drimaren Brilliant blue or Mitoxantrone) injected at the primary tumour site. The overall rate of identification of SLN was 81.3% (in 152 of 187 patients). The pathological status of the sentinel nodes was compared with that of the remaining axillary nodes. The accuracy of the sentinel biopsy was 89.5% (in 42 of 47 axillary positive patients). In 15 cases with lymph metastases, the SLN was the only site of disease. This experience indicates the sentinel lymphadenectomy should diminish staging morbidity and could improve surgical management of the axilla in women with early breast cancer.

[Regional lymphotropic chemotherapy in breast cancer--a new approach in the therapeutic procedure for the parasternal lymph nodes]. / Regionalna limfotropna khimioterapiia pri RMZh--nov podkhod v lechebnata taktika za parasternalnite limfni vuzli.

A method of regional lymphotropic chemotherapy in breast cancer is presented, aimed at attaining higher cytostatic concentration in the region of parasternal lymph nodes. In twenty-three women with centrally and medially situated tumors preoperatively 1 mg Mitoxantrone is applied around the 4 tumor poles each. In ten cases (IIb and IIIa stage) given 3 courses of nonadjuvant chemotherapy, part of the Cyclophosphamide dose is administered as regionally lymphotropic subxiphoid bilaterally. The clinical response, distribution of the Mitoxantrone blue stained regional lymph nodes and the morphological changes in the latter are analyzed. The early clinical observations indicate that the method proposed is technically easily executed, with a good local tolerance, and has a definite place in the complex treatment of breast cancer.

[Prognostic factors and the risk of axillary metastases in early breast cancer]. / Prognostichni faktori i risk ot aksilarni metastazi pri ranen rak na mlechnata zhleza.

The authors analyzed the clinical and pathomorphological of T tumors for their association with the likelihood of axillary metastases. Two hundred forty three patients with early breast cancer (T1N0M0 T1N1M0) were studied. All underwent complete lymph node dissection. The parameters of the primary tumor evaluated included size, histologic subtype, hystological grade, hormone receptor status, lymphatic/vascular invasion (LVI). Clinical parameters were age, menopausal status and clinical lymph node status. Sixty two (25.5%) on 243 axillary dissection contained metastases. Univariate analysis showed that nodal involvement were associated with tumors larger than 1 cm and presence of LVI. Decision for complete axillary dissection should be individualized based on prognostic factors for lymph node involvement.

[The triple diagnosis of breast diseases]. / Troina diagnostika na zaboliavaniiata na mlechnata zhleza.

The aim of the study is to assess the data of clinical, mammographic, cytological and triple diagnosis of breast diseases. 188 patients are included in the study. The hystological findings are as follow: 58 patients with carcinoma and 130 with benign diseases. The coincidence of the exams are: 1. clinical examination--109 benign and 46 with carcinoma 2. mammography--114 for the benign group and 51 with carcinoma 3. cytology of FNB--104 to 40 4. triple diagnosis--118 to 40 The best method of diagnosis, according to our study, is the triple method.

[The lymphotropic marking and biopsy of sentinel lymph nodes in T1 tumors--a new approach to the staging of axillary lymphatic metastasis in breast cancer]. / Limfotropno markirane i biopsiia na sentinelni limfni vuzli pri T1 tumori--nov podkhod za stadiirane na aksialnoto limfno metastazirane pri rak na mlechnata zhleza.

It is the purpose of the study to assay the possibility of demonstrating axillary lymph status through marking and biopsy of sentinel lymph nodes. Preoperative lymphotropic marking of sentinel lymph nodes is performed in 48 female patients presenting mammary gland carcinoma, measuring up to two centimeters. Drimaren 0.5 ml (in 18 cases), Mitoxantrone (17 cases) or Patent Blue (13 cases) each are perineoplastically injected in two points. Intraoperatively, in 34 patients blue stained lymph nodes (from Patent Blue and Mitoxantrone mainly) are identified, and compared with the results of axillary dissection. Metastases in sentinel nodes are documented in seven instances. In the remainder (30) which are histologically negative, lymph node metastasis II level is discovered in one case (false negative = 3.3 per cent). As shown by the initial observations perioperative marking of lymph nodes with Patent Blue and Mitoxantrone contribute to demonstrate sentinel nodes, and by biopsy study of the latter it is possible to judge about the pattern of lymph metastasizing of mammary gland carcinoma.

[Regional and systemic neoadjuvant chemotherapy in locally advanced carcinoma of the cervix uteri]. / Regionalna i sistemna neoadiuvantna khimioterapiia pri lokalno avansiral kartsinom na matochnata shiika.

Neoadjuvant chemotherapy with bleomycin and Cisplastin was administered on ten patients with cervical cancer (IIB, IIIA, IIIB). On three successive days, five minutes after deep bilateral subcutaneous application of 100E Hylase in the medical surface of the lower third of the shin, 20 mg/msq of bleomycin was introduced slowly. The chemotherapeutic drug was absorbed by the lymph capillaries predominantly, and then transferred to the pelvic lymph nodes. Cisplastin was administered intravenously, at a dose of 50 mg/msq. Treatment was applied three times, third week. Remission was observed in 5 out of the 10 cases.

[The adjuvant chemotherapy of N(-) patients with breast cancer--when is it indicated?]. / Adiuvantna khimioterapiia pri N(-) patsientki s rak na mlechnata zhleza--koga e inditsirana?

The object of this research is determination the necessity of leading of adjuvant chemotherapy with patients with breast cancer without metastases in axillary lymph nodes (N(-)), with disadvantages other prognostic factors (T > 20 mm, estrogen receptors (-), II and III stage grading). Post-operative with 52 women with high risk of recedives or metastases had been performed polychemotherapy (39-CMF and 13 FEC). Control group include 40 patients without adjuvant chemotherapy. Relapse are report with 6 of investigate and 8 of control group (pt > 0.05). The obtained results are discussed in connection with literature data.

[The treatment of slowly healing wounds with collagen and growth factors]. / Lechenie na bavno zazdraviavashti rani s kolagen i rastezhni faktori.

Experience had with the local application of collagen and autologous growth factors, isolated from platelets, in 35 patients presenting chronic, slowly healing wounds, treated with conventional methods, is discussed. In 24 cases of the series reviewed the wounds undergo epithelization within six weeks, and in the remainder (11)-within 10 weeks. As shown by the results, the healing process is quicker in wounds of patients treated with growth factors in combination with collagen, as compared to the control group--p(t) > 0.05.