Iodine seed localisation of non-palpable lesions in breast surgery first experience.

Surgical therapy of non-palpable malignant breast lesions requires precise preoperative localisation. Recently, radioactive iodine seed localisation has excelled among the number of localisation methods. We present our first experience with this method at our department. We describe the structure of the radioactive iodine seed, the principles of preoperative localisation and peroperative detection of the seed, the specimen transport process, histopathological examination, storage and disposal of the seed, as well as aspects of radiation protection.

The importance of sentinel lymph node biopsy following neoadjuvant chemotherapy in patients with breast cancer: prospective multicentre trial.

INTRODUCTION: The role of sentinel lymph node biopsy (SLNB) in patients with breast cancer after neoadjuvant chemotherapy (NAC) is currently under discussion. The aim of our study was to determine the false negativity rate (FNR) of SLNB, the accuracy of ultrasound examination in the evaluation of the status of lymph nodes and the accuracy of perioperative cryobiopsy of the sentinel lymph node (SLN). METHODS: Prospective multicentre study, which took place in years 20182020 at three centres in the Czech Republic. A total of 59 patients were evaluated. RESULTS: The FNR of SLNB in the group of patients with cN1 before NAC and ycN0 after NAC was 12.5%. The FNR of perioperative histological examination of the SLN was 38.5%. The FNR of ultrasound examination of axillary lymph nodes in patients after NAC was 35.5%, and the false positivity rate was 16.7%. The incidence of inflammatory complications in our cohort was 3.3%. CONCLUSION: The FNR of SLNB in the group of patients with cN1 before NAC and ycN0 after NAC exceeds the tolerable limit of 10%. The FNR of perioperative histological examination of the SLN is high; definitive histological examination of the SLN may change the original diagnostic-therapeutic plan. Ultrasound examination of the axillary lymph nodes in patients after NAC is a method with high false negativity and positivity and may not correspond with the perioperative finding. The incidence of inflammatory complications in our cohort in patients after NAC is comparable to literature data on the frequency of complications in patients without NAC.

Pagets disease of the breast - observational retrospective study of the past 20 years.

INTRODUCTION: Pagets disease of the breast (PD) is a rare type of carcinoma that affects the skin of the nipple-areolar complex. Unresolved issues exist regarding its diagnosis and therapy. The aim of the study was to gather data on how the therapy of the disease is approached in clinical practice, and to formulate current diagnostic and therapeutic recommendations. METHODS: Retrospective evaluation of data from medical records of patients with PD who underwent surgery at our department between 2001 and 2020. The data was evaluated using basic statistical methods. RESULTS: Sixty four female patients with the mean age of 62.5 years. In 58 women, PD was confirmed before surgery, with the median of 20 weeks from initial symptoms to diagnosis. Forty seven of the patients were operated for presumed isolated PD; in 38 cases, histopathological evaluation of the specimen revealed an associated malignancy in the mammary gland. Primary breast-conserving surgery (BCS) was performed in 46 patients; surgical revision was indicated in 17 cases. In 6 patients with PD associated with non-invasive breast cancer treated by BCS without radiotherapy (RT), a local recurrence appeared in 3 cases, which is significantly more compared to the group of patients undergoing total mastectomies (p=0.032). No local recurrence appeared in 9 cases of isolated PD treated by BCS, including 6 patients without RT. The tumors associated with PD were mostly ER-negative (44/57) and HER2-positive (22/25). CONCLUSION: In cases where PD is suspected, careful clinical examination and the use of available diagnostic imaging techniques including MRI are appropriate. BCS without RT is not an adequate oncological therapy where an associated malignancy of the breast is found.

Surgical solution of the extensive post-radiation defect developped 33 years after radiotherapy for breast carcinoma case report.

INTRODUCTION: Damage of the skin and its underlying structures is a common side effect of radiotherapy. These conditions limit further treatment and dealing with these complications is a routine practice of clinical oncologist. The majority of the complications are immediate, with a perspective of healing ad integrum within a few weeks. Less frequently, but sometimes with severe manifestations, chronic toxicity occurs belatedly after months, or even many years after irradiation, in form of post-radiation ulcer, for instance with potential of secondary malignant transformation. Regarding surgery, it might be one of the most challenging chronic wounds to treat. In extreme cases, extensive resection of the entire affected area is needed, inevitably ending with demanding reconstruction of the resulting defect. CASE REPORT: This case report presents a female patient with rapidly progressive post-radiation chest wall defect 33 years after the irradiation, when relatively insignificant skin injury occured. Prior to this sudden deterioration, only long-term, non-progressive changes, without a cutaneous defect, were described during the dispensarisation. After a protracted outpatient treatment with unsatisfactory results, when the patient repeatedly refused mastectomy, the condition inevitably led to the complex surgical procedure with necessary cooperation of breast, plastic and thoracic surgeons. CONCLUSION: Although changes of the similar severity rarely occur even after many years following the treatment, we havent found such a dramatic change of the patients condition three decades after the therapy with urgency of this type of complex,  surgical intervention in current literature.

Phyllodes tumours - a retrospective review of 83 clinical cases.

INTRODUCTION: Phyllodes tumours are rare, accounting for 0.3-1.0% of all primary breast tumours. According to biological behaviour, they are divided into three categories: benign, borderline and malignant. Due to the rare incidence, the requirements for the radicality of surgical treatment are not well known. According to respected foreign recommendations, resection with a free margin of 10 mm or more is desirable. METHODS: A retrospective review of patients, who underwent surgical treatment due to phyllodes tumour in the Masaryk Memorial Cancer lnstitute in 2003-2014. RESULTS: 83 patients were evaluated with a median follow-up of 68.0 months. Benign tumours accounted for 62.3%, borderline tumours accounted for 16.9% and malignant accounted for 20.8% of all tumours. Malignant phyllodes tumours reached a bigger average size (84.9 mm) than borderline (41.4 mm) and benign tumours (33.3 mm) and occurred in older patients (mean 56.4 years) than benign (mean 42.5 years). Results from preoperative core-cut biopsy were often inaccurate. In 70 cases, the primary resection was breast preserving, but the free margin above 1 mm was achieved only in 13 cases. The width of the resection edge never exceeded the recommended 10 mm. Nevertheless, there was a relapse in benign tumours in two cases and in the borderline tumours only in one case. Malignant tumours recurred more frequently, even after total mastectomy. Four patients with malignant tumours experienced distant metastases. There has never been a death caused by benign or borderline tumour. CONCLUSION: The 10 mm resection margin is unachievable in our conditions. However, it seems that such radicality is not necessary in benign tumours, because they rarely recur even with close margins. Conversely, neither total mastectomy of the malignant phyllodes tumours will protect against local progression or distant metastasis.

Venous access in cancer patients.

The most commonly used permanent venous access devices in cancer patients are the port, PICC port and PICC catheter (peripherally inserted central catheter). It is always necessary to consider the type of venous access needed for each individual cancer patient. Implantation should be performed using modern instruments to minimize the risk of early and late complications and thereby a delay in oncological treatment. The use of ultrasound is recommended at all stages of introduction. Precise tip placement of the central catheter in the sinoatrial junction region further reduces the number of thromboses arising in the catheter. A trend towards the treatment of catheter infections is certainly to maintain the venous access without compromising the patients health. Permanent venous access devices allow the application of chemotherapy and repeated blood sample collections with minimal impact on the quality of life in cancer patients.

Targeted axillary dissection and sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy - a retrospective study.

INTRODUCTION: No consensus exists as yet regarding the optimal extent of surgery on the lymph nodes in breast cancer patients after neoadjuvant treatment. In addition to axillary dissection and sentinel lymph node biopsy (SLNB), a new approach called Targeted Axillary Dissection (TAD) was introduced. It requires the marking of metastatic nodes before the neoadjuvant treatment. METHOD: A retrospective observational study on patients with breast cancer and neoadjuvant chemotherapy treated surgically at a single institution in 2017. RESULTS: The analysis included 121 cancers in 120 patients. Clinical regression of lymphadenopathy occurred in 29 out of 74 cases. Axillary dissection was performed 34x, SLNB 52x and TAD 35x. In TAD procedures, the marked lymph node was found 30x and was among the sentinel nodes in 19 cases. No case occurred in which the marked node was assessed as negative with a metastasis found in the other nodes. On the contrary, there were 3 cases with negative sentinel nodes whereas the marked node was positive. Out of 74 cases with initially pathologic nodes, 23 patients were spared axillary dissection. CONCLUSION: Clinical assessment of the lymph node status is rather inaccurate. In cases with initially pathologic nodes we recommend marking of the most explicit metastatic node to enable TAD. The marked node is likely to reflect the status of the lymph nodes after neoadjuvant treatment more accurately than common sentinel nodes. A considerable proportion of patients can be spared axillary dissection in this way. However, the long-term oncologic safety of TAD still needs to be verified. Key words: breast cancer - neoadjuvant treatment - axillary dissection - sentinel lymph node biopsy - targeted axillary dissection.

[Magnetic resonance imaging in preoperative diagnosis of invasive lobular carcinomas of the breast - analysis of 230 cases]. / Magnetická rezonance v predoperacní diagnostice invazivních lobulárních karcinomu prsu - analýza 230 prípadu.

INTRODUCTION: In breast cancer patients, magnetic resonance imaging (MRI) is a supportive method characterized by high sensitivity. Its indications in the preoperative assessment are not clearly defined. More likely to benefit from preoperative MRI are younger women, women with a dense breast on mammography and patients with invasive lobular carcinoma (ILC). The aim of this study was to assess utilization of MRI and resulting benefits in preoperative tumour staging of ILC in patients treated in our institution. METHODS: A retrospective evaluation of medical records of all patients with bioptically proven and primarily surgically treated ILC through the years 20142016. RESULTS: Overall, 230 patients were evaluated, among them 131 (57.0%) underwent MRI. These patients were significantly younger than patients without MRI. The results of MRI were as follows: in 28.2% a small unicentric lesion, in 41.2% large infiltration or multifocality, and in 30.5% suspicion of multicentricity. The proportion of conservative surgeries and re-resections did not differ between the patients with and without MRI. The subgroup of patients with a small unicentric lesion on MRI showed a higher proportion of conservative surgeries and fewer re-resections compared to the other subgroups. In 41 women (31.3%) the MRI finding resulted in further assessments; in 29 (22.1%) an additional biopsy was done, with a malignant result in the ipsilateral breast in 8 cases and in the contralateral breast in 3 cases. The MRI finding had a substantial impact on surgery in 35 patients (26.7%) of whom it was evaluated as clinically beneficial in 23 (65.7%) cases. CONCLUSION: At our institution, more than a half of patients with ILC undergo MRI preoperatively. The finding has an impact on the scope of the surgery in approximately one fourth of the cases, being clinically beneficial in most of them. However, a high frequency of additional imaging assessments and biopsies should be taken into account. Due to the low specificity of MRI, every suspicious lesion has to be bioptically verified to avoid inappropriate surgery and patient harm.Key words: breast cancer - invasive lobular carcinoma - magnetic resonance imaging - occult lesion - biopsy.

[Lymphoedema Following Regional Lymph Node Surgery for Breast Cancer]. / Lymfedém po operacích na spádových lymfatických uzlinách pro karcinom prsu.

BACKGROUND: The treatment of breast cancer is based on the multimodal principle and surgery of regional lymph nodes is an inseparable part of this. Indication criteria are changing constantly folowing advances in other modalities. It is necessary to consider not only the diagnostic or therapeutic benefit but also to take into account adverse effects. Previous studies have demonstrated that axillary dissection (ALND) is burdened by a high frequency of chronic lymphoedema of the arm or chest wall; however, a considerable percentage of patients may also suffer from lymphoedema after sentinel lymph node biopsy (SLNB). AIM: This paper focuses on the pathophysiology of lymphoedema, its potential predictive factors, and its complications. Furthermore, it presents an overview of published studies comparing the incidences of lymphoedema after current axillary surgery for breast cancer together with current trends designed to radically reduce the number of these operations. It also briefly refers to the possibilities of implementing preventive or therapeutic operations for lymphoedema. CONCLUSIONS: Both ALND and SLNB are burdened by a clinically significant risk of lymphoedema. This risk is more serious after ALND. In the medium term, approximately 7-59% of operated patients suffer from lymphoedema. The incidence of lymphoedema after SLNB, considered a very gentle method, is also not negligible (0-14%). As the number of patients surviving breast cancer treatment continues to increase, monitoring the undesirable effects of axillary surgery over the long term will become more important. The results of published studies support research into treatment methods that have the potential to reduce the radicality of axillary surgery while preserving or improving total medical effectiveness.Key words: breast neoplasms - sentinel lymph node biopsy - axillary dissection - adverse effects - breast cancer lymphedemaThis work was supported by the grants MEYS - NPS I - LO1413 and MH CZ - DRO (MMCI, 00209- 805).The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 7. 11. 2016Accepted: 5. 12. 2016.

INTRAOPERATIVE FAT GRAFTING INTO THE PECTORALIS AND LATISSIMUS DORSI MUSCLES-NOVEL MODIFICATION OF AUTOLOGOUS BREAST RECONSTRUCTION WITH EXTENDED LATISSIMUS DORSI FLAP.

BACKGROUND: The latissimus dorsi flap is a reliable and one of the most commonly used methods of both immediate and delayed breast reconstruction. Its disadvantage is the limited volume of transferred tissue. The authors present their experience with the use of extended latissimus dorsi flap associated with immediate fat grafting into the pectoralis and latissimus dorsi muscles for secondary breast reconstruction. METHODS: From 2013 to 2016, 14 patients underwent secondary unilateral total breast reconstruction with extended latissimus dorsi flap associated with primary fat grafting into the pectoralis major and latissimus dorsi muscles. Fat was injected under visual control between muscle fibers. Fat injected into the pectoralis muscle formed an apparent bulging - autoprosthesis. RESULTS: Mean patient age was 48.2 years (range, 34 to 64 years). Mean injected fat volume was 86.4 ml (range, 50 to 160 ml) and majority of this volume was injected into the pectoralis muscle. All flaps healed uneventfully and no fat grafting-related complications were observed. The most common complication was donor site seroma, which occurred in 57.1%. Results of postoperative ultrasound examination were evaluated. Incidence and the size of oil cysts and fat necroses were significantly lower in muscular layer in comparison with the subcutaneous layer of the reconstructed breast. CONCLUSIONS: Immediate fat transfer into the pectoralis and latissimus dorsi muscle increases the breast volume during the reconstruction with extended latissimus dorsi flap avoiding implant-related complications when abdominal tissue is not available. Pectoralis and latissimus dorsi muscles were shown as reliable and safe recipients for fat grafting.

[The possibility of eliminating axillary dissection in breast cancer patients using neoadjuvant treatment]. / Moznost eliminace axilárních disekcí u pacientek s karcinomem prsu pomocí neoadjuvantní lécby.

INTRODUCTION: Neoadjuvant systemic treatment in breast cancer was initially utilized for patients with locally advanced tumors to achieve resectability. Later on it moved to earlier cancer stages, thus allowing more breast conservations. Current explorations seek to find out whether its effect on axillary metastases could eliminate axillary dissection in treatment responders. Three large prospective trials have studied the accuracy of sentinel lymph node biopsy (SLNB) after clinical regression of nodal metastases in the axilla. METHODS: As shown by the results, false negativity of SLNB exceeds 10%, which is considered as unacceptably high. The false negativity can be reduced by using the dual tracer technique and/or by removing three nodes at the minimum. An even more promising approach consists in marking the initially metastatic node to ensure its surgical removal along with the regular sentinel nodes. This procedure has been described as "TAD" (Targeted Axillary Dissection), and extirpation of the marked node is now recommended in NCCN guidelines. However, the appropriate surgical procedure to be used to stage the axilla after clinical regression of nodal metastases still remains a matter of debate. Above all, safety of the conservative approach with respect to local regional control and overall survival is yet unknown. RESULTS: Longer follow-up is needed to assess this issue. Despite that, the use of neoadjuvant systemic treatment to reduce axillary dissections seems promising from the current perspective.Key words: breast cancer - neoadjuvant treatment - sentinel lymph node biopsy - axillary dissection - false negativity.

[SentiMag--the magnetic detection system of sentinel lymph nodes in breast cancer]. / Magnetická detekce sentinelových uzlin u karcinomu prsu metodou SentiMag.

INTRODUCTION: The aim of this study was to assess the feasibility of the new detection system of sentinel lymph nodes in breast cancer (SentiMag) and to compare its use to the standard method of detection with a radioisotope and a gamma-probe. METHODS: Twenty breast cancer patients scheduled for sentinel lymph node biopsy underwent standard lymphatic mapping with a radioisotope and also with the Sienna+ tracer. During the surgery, sentinel lymph nodes were identified preferably with the SentiMag system. The gamma-probe was used only at the end of the surgery to verify whether all sentinel lymph nodes had been harvested. RESULTS: The sentinel lymph node was detected in all cases. Both methods agreed in 18 cases, i.e. the lymph node with the highest magnetic value ex vivo was the same node as the one with the highest radioactivity. A metastasis in the sentinel lymph node was found in three patients. It is very likely that with the sole use of the SentiMag system, the results would have been identical to those of using the standard method with a radioisotope and the gamma-probe. CONCLUSION: The new magnetic detection method of sentinel lymph nodes (SentiMag) is feasible and clinically comparable to the gold standard method of detection with a radioisotope and the gamma-probe in patients with breast cancer. The new method could find its use not only in hospitals where the department of nuclear medicine is not available but in all hospitals performing sentinel lymph node biopsies in breast cancer and possibly other types of cancer.

[Failed preoperative lymphoscintigraphy for sentinel lymph node biopsy in breast cancer, possible causes and implications for the surgery - the analysis of 3014 procedures]. / Neúspesná lymfoscintigrafie pred sentinelovou biopsií u karcinomu prsu, mozné príciny a dusledky pro chirurgický výkon - analýza výsledku 3014 vysetrení

INTRODUCTION: The aim of the study was to review the cases of sentinel lymph node biopsy for breast cancer in which preoperative lymphoscintigraphy had shown no axillary hot spot; to assess the frequency of failed examinations and possible causes of the failure; to analyze subsequent surgical procedures and hence to provide a general recommendation on what to do in such a situation. METHODS: A retrospective overview of 3014 lymphoscintigraphy examinations at the Masaryk Memorial Cancer Institute from 2001 to 2011 with a more detailed analysis of the cases with axillary hot spot visualization failure. RESULTS: The axillary hot spot was not shown in 71 examinations (2.4%). The frequency of failed lymphoscintigraphy during the time period did not change substantially. The possible risk factors of failed lymphoscintigraphy include: previous surgery on the breast or the axilla, obturation of the lymphatic drainage with the cancer, and the absence of the tracer injection site massage. The most common surgical procedures to respond to a failed examination were: the application of patent blue and surgical exploration of the axilla, no axillary surgery, or axillary dissection. CONCLUSION: When repeated scanning with the gamma camera through the first several hours is performed, the frequency of failed lymphoscintigraphy procedures remains very low (2.4%). If there is no axillary hot spot shown, patent blue is to be injected and the axilla should be surgically explored. This solution will be successful in most patients. If the sentinel lymph node cannot be detected even using the combined method, the surgical procedure needs to be selected with regard to the individual clinical context.Key words: breast cancer - sentinel lymph node - sentinel lymph node biopsy - lymphoscintigraphy - failed detection.

[Breast cancer patient satisfaction with immediate two-stage implant-based breast reconstruction]. / Spokojenost onkologických pacientek s okamzitou dvoudobou aloplastickou rekonstrukcí prsu.

BACKGROUND: For most breast cancer patients in the Czech Republic, breast reconstruction is available only in a delayed manner. In the Masaryk Memorial Cancer Institute (MMCI), suitable candidates are offered immediate breast reconstruction using tissue expander with later exchange to a permanent silicone implant. The aim of this study was to assess patient satisfaction with this type of reconstruction. PATIENTS AND METHODS: Sixty-two women who had undergone surgery at the MMCI from 2007 through 2013 were sent a simple questionnaire developed by our working team. Fifty-seven patients completed the questionnaire. The data were evaluated by description methods and statistical tests. RESULTS: Patient response was 92%. The absolute majority of patients (56/57) would opt for this method again. The vast majority of patients (48/57) are generally satisfied with their reconstruction. Most women (8/14) younger than 50 years after the unilateral surgery would prefer synchronous contralateral prophylactic mastectomy and bilateral reconstruction if they could choose again. After bilateral surgery, reconstructed breasts are more often regarded as a part of the patients body. Dressed women rate their look substantially better than when they are undressed. As for self-esteem, these women are feeling excellent or good. Their psychosocial well-being in common situations is predominantly excellent. Their sexual well-being is significantly worse, and almost half of these women indicate occasional pain in their reconstructed breasts. The patients emphasize the need for appropriate information before the surgery. CONCLUSION: Immediate two-stage implant-based breast reconstruction is a suitable option for some breast cancer patients. With regard to the less natural cosmetic result and feeling of the implant-reconstructed breast, appropriate selection of women for this type of surgery is necessary and potential candidates must be thoroughly informed in the preoperative setting.

[The number of removed axillary sentinel lymph nodes and its impact on the diagnostic accuracy of sentinel lymph node biopsy in breast cancer]. / Pocet odebíraných axilárních sentinelových uzlin a jeho vliv na diagnostickou presnost sentinelové biopsie u karcinomu prsu.

INTRODUCTION: The number of lymph nodes removed during the sentinel lymph node biopsy in patients with breast cancer usually ranges from 1 to 3. In some cases, multiple nodes are identified and removed, which could be associated with increased risk of postoperative morbidity. The objective of the study was to assess the number of sentinel lymph nodes removed in patients treated in our hospital, to analyze factors that may influence the amount of the removed nodes, and to find if there is an upper threshold number of lymph nodes that should be removed without sacrificing the diagnostic accuracy of the sentinel lymph node biopsy. MATERIAL AND METHODS: Clinical data of four hundred and forty (440) breast cancer patients who underwent sentinel lymph node biopsy in Masaryk Memorial Cancer Institute during the year 2011 were retrospectively collected and analyzed. RESULTS: The number of sentinel lymph nodes ranged from 0 to 9 (average 1.7, median 1). The number of sentinel lymph nodes was significantly influenced by the age of the patient, the operating surgeon and the laterality of the surgery. In 275 cases the sentinel lymph nodes were negative, in the other cases macrometastases (n = 101), micrometastases (n = 46) or isolated tumor cells (n = 17) were found. In all the cases, but one, the staging of the axilla was determined by the status of the first three sentinel lymph nodes removed. Only in one case the first detected macrometastasis was present in the fifth node. CONCLUSION: In the vast majority of cases, the first three sentinel lymph nodes are sufficient to accurately assess the axillary status. However, with respect to the described case of first detected metastasis in the fifth node, to the present literary data and to the variability of clinical situations, we generally recommend to remove all lymph nodes meeting the criteria of the surgical definition of sentinel lymph node.

[Positive sentinel node in breast cancer - when and why also opt for axillary dissection?]. / Pozitivní sentinelová uzlina u karcinomu prsu - kdy a proc doplnovat axilární disekci?

One of the central concerns of contemporary mammary surgery is to verify the actual need for axillary dissection (AD) in patients with early breast cancer and positive sentinel lymph node biopsy. Several studies have addressed this issue (ASOCOG Z0011, IBCSG 23-01, MIRROR, EORTC AMAROS). So far, the preliminary results of the ASOCOG Z0011 trial with a median follow-up of 6.3 years and the results of the IBCSG 23-01 trial with a median follow-up of 5 years have been published. The conclusions of both randomized studies have implied that under specific circumstances, there is no significant difference in the local or regional recurrence between patients who had undergone completion AD compared to the patients in whom AD had been omitted. This article summarizes the current knowledge regarding indications for AD in patients with positive sentinel nodes. Key words: breast cancer - sentinel lymph node biopsy - axillary lymph node dissection - ACOSOG Z0011 trial.

[Surgical prevention of breast carcinoma in patients with hereditary risk]. / Chirurgická prevence karcinomu prsu u pacientek s dedicným rizikem.

BACKGROUND: Women with BRCA1 gene mutation have 85% risk of breast cancer; the risk for BRCA2 carriers is 45%. The aim of the study was to verify if prophylactic mastectomy with immediate breast reconstruction can prevent breast cancer in BRCA positive patients. MATERIAL: There were 100 BRCA positive women in which prophylactic mastectomy with immediate reconstruction, 75 dieps, 25 with implants, performed in period 2000-2011. Group A was composed of healthy, non-affected 41 patients, group B of 59 patients in remission after breast cancer treatment. These groups were compared to group C that consisted of 219 healthy carriers of BRCA1/2, non-operated, from registry of genetic department of the Masaryk Memorial Cancer in Brno, from 2000-2011. METHOD: Follow-up for oncology status was done in September 2011 for all 3 groups. RESULTS: Average follow-up of 21 months revealed that in group A there was no breast cancer, in group B 4 patients died and 2 had treatment for metastases. In group C, there were 16 new cases of breast cancer. CONCLUSION: Bilateral prophylactic mastectomy with immediate reconstruction can be an effective way in breast cancer prevention in healthy carriers of BRCA1/2 mutation. In BRCA positive patients treated for breast cancer, the effect of prophylactic mastectomy is unclear. Their survival is more influenced by their previous disease than by a new tumor in the breast.

[What patients need to know before their breast cancer surgery]. / Co pacientky potrebují vedet pred operací mamárního karcinomu.

BACKGROUNDS: The quality of health care depends not only on physicians' medical skills but also on proper patient education. The aim of the study was to ascertain the types of information required by women before they start their breast cancer treatment. PATIENTS AND METHODS: Before a surgery, 254 patients with early breast cancer treated primarily by surgery obtained an originally developed questionnaire containing information topics assumed to be important. The patients were asked to indicate the information they had been provided and the information they required. RESULTS: The majority of patients (more than 70%) knew that their disease was malignant, that they needed the surgery and what would be the extent of the resection of their breast. Markedly less patients (47.1%) knew about the planned extent of their regional lymph nodes surgery. More than 80% patients required information about their long-term expectations, such as the overall length of cancer treatment, length and extent of their anticipated physical impairment and their chances for cure. The majority of younger women (76.2%) recommended for total mastectomy required information about breast reconstruction options. A substantial proportion of older women (about 60%) were interested to learn about an anticipated cosmetic outcome and possibilities for correction of their potential defect. CONCLUSION: Multimodal breast cancer treatment is generally managed by clinical oncologists. However, a surgeon should be enabled to discuss with the patient their cancer treatment, what it involves and how it will affect the patient's future life. It is advisable to clarify the extent of the surgery on regional lymph nodes and to engage in discussions on cosmetic outcomes of the surgery. With respect to a proper patient education, breast cancer patients should be treated by surgeons specialized in the treatment of this disease.

[Accuracy of preoperative establishment of invasive breast carcinoma size using ultrasound and mammography]. / Presnost predoperacního stanovení velikosti invazivního mamárního karcinomu ultrasonografií a mamografií.

INTRODUCTION: Accurate preoperative assessment of breast cancer size is important for choosing appropriate surgical treatment. Mammography and ultrasonography are the most widely used breast imaging techniques. The aim of this study was to compare the tumour size measured by these two modalities with the pathological size of native specimen. METHODS AND SUBJECTS: From 2001 to 2007, a retrospective review was conducted of 299 patients operated on at Masaryk Memorial Cancer Institute for the diagnosis of invasive breast carcinoma detected on ultrasonography or mammography as a nucleus shadow lesion where the preoperative size was estimated. Pearson's correlation to pathological size was tested and the mean deviation was analysed in the whole group of patients as well as in subgroups defined by pathological size (pT), histogical type and grading. RESULTS: Ultrasonography was accurate in determination of the tumour size (i.e. within the deviation of 5mm) in 195 patients (74%), it underestimated in 45 cases (17%) and overestimated in 24 cases (9%). Pearson's correlation coefficient (r) was 0.610 and mean deviation minus 0.115 cm. Mammography estimated accurate results in 162 patients (81%), the size was underestimated in 14 cases (7%) and overestimated in 25 (12%). Pearson's correlation coefficient (r) was 0,645 and mean deviation 0.08 cm. Generally lower accuracy in assessing the size was noted in lobular carcinomas. CONCLUSIONS: Despite some limitations of our study, we can resume that in most cases (approximately 75%) the size assessment of invasive tumour lesion by both ultrasound and mammography is relatively reliable within the deviation of 5mm from the pathological size. But there's still been some portion of cases remaining where the estimation is not accurate, therefore we are not completely able to avoid redundant removal of tissue or, on contrary, demand of consecutive operations due to positive resection margins.

[Male breast cancer--our experience]. / Karcminom prsu u muzu--nase zkusenosti.

INTRODUCTION AND AIM: Male breast cancer (MBC) is a rare disease which represents only about 0.2% of all cancers. The ratio of female to male breast cancer is approximately 100:1. In this study, we review our experience with diagnosis, surgical treatment, and overall management of patients with MBC. METHODS: Overall, 5384 breast cancer patients underwent surgery in Masaryk Memorial Cancer Institute, Brno, Czech Republic during the period of 2001 to 2009. Among these, seventeen were men. In these patients, data on incidence, clinical symptoms, diagnostic procedures, types of surgical resection, histopathology, adjuvant systematic therapy, genetic investigation and therapeutic results were retrospectively reviewed from their medical records. RESULTS: None of the patients have distant metastases at the time of surgery. In sixteen cases an invasive cancer was histopathologically diagnosed, one patient had ductal carcinoma in situ (DCIS). Eight patients exhibited locally advanced stage of the disease (IIIB). All patients were primarily treated surgically; in no case neoadjuvant therapy was recommended. From the five patients operated primarily elsewhere, four underwent completion of modified radical mastectomy (RAME) at our institution and one patient underwent subcutaneous (nipple-sparing) mastectomy without the surgery on lymph nodes. Twelve patients were primarily diagnosed and operated at our institution. Ten of these were scheduled for RAME, one patient was recommended total mastectomy with sentinel lymph node biopsy, and one patient underwent total mastectomy without surgery on regional lymph nodes. Adjuvant therapy overall comprised radiotherapy, chemotherapy, hormonal therapy, and biological therapy. Investigation of BRCA genes was suggested in nine patients, but the results of only four of them are available to date. Two patients exhibited a mutation in BRCA genes. One mutation is explicitly pathogenic; another case represents variation with unknown clinical effect. Twelve patients of the cohort are in complete remission, two are alive with distant metastases and three died (two on cancer, one on cardiovascular disease). CONCLUSION: Our study should point out a rare form of mammary tumors--male breast cancer. There are some particular differences between male and female breast cancer though the overall clinical management of both is generally similar. There is a necessity of appropriate health education to prevent late diagnosis of breast cancer in men. Genetic testing should be recommended to every male patient with this disease.