Ductal carcinoma in situ of the breast: results of treatment by conservative surgery and definitive irradiation.

PURPOSE: To determine local control, survivorship, and cosmesis in women with ductal carcinoma in situ treated by conservative surgery and radiation therapy. METHODS AND MATERIALS: We retrospectively analyzed the results of treatment in 56 women with in situ carcinoma of the breast, treated between 1976 and 1990 by conservative surgery and irradiation. Two women had bilateral tumors, for a total of 58 breasts at risk. All patients underwent gross excision of the tumor followed by radiation to the entire breast and a sequential boost to the tumor bed. Eight of the 21 evaluable tumors (38%) had inadequate pathologic margins at the time of excision. Routine re-excision was not performed. The median dose to the whole breast and primary tumor site was 5000 cGy and 6940 cGy, respectively. Median follow-up was 61 months (range 27-191 months). RESULTS: Five patients (9%) failed in the breast for an 8-year actuarial local failure rate of 11%. Median time to failure was 34 months. All five patients with local recurrence underwent mastectomy and are alive, without evidence of disease at a mean of 40 months post mastectomy. The 8-year actuarial absolute and cause specific survivals were 89% and 100%, respectively. Cosmetic results were excellent or totally acceptable in 90% of patients. CONCLUSION: Patients with ductal carcinoma in situ treated by excision and irradiation achieved acceptable local control and excellent survival and cosmetic results. Because of the long time course associated with local failure, diligent and protracted follow-up is mandatory.

The infrequent use of office-based diagnostic tests for vaginitis.

OBJECTIVE: This study was undertaken to determine physician use of simple office-based tests in the evaluation of women with vulvovaginal symptoms. STUDY DESIGN: A medical record review of 52 women seeking care at a referral-based vaginitis clinic was performed. The evaluation performed and the care management were recorded for 150 previous physician-provided office visits. RESULTS: A microscopic assessment of vaginal fluid was not performed in 37% of office visits, and 42% of physicians did not perform microscopy as part of any evaluation of vaginitis. Whiff amine tests and measurement of vaginal pH were rarely performed (3% of office visits). Treatment without adequate evaluation of the etiology of the symptoms occurred in 54% of visits in which medication was prescribed. CONCLUSIONS: In our study population the evaluation and care provided to women presenting for evaluation of vulvovaginal symptoms were suboptimal. The use of simple inexpensive office-based tests can optimize the assessment of vaginal infections and should be encouraged.

The vaginal introitus: a novel site for Chlamydia trachomatis testing in women.

OBJECTIVE: We evaluated the vaginal introitus as a noninvasive sampling site for testing for Chlamydia trachomatis. STUDY DESIGN: Swabs from the vaginal introitus were obtained from 300 women attending a sexually transmitted diseases clinic and tested for the presence of Chlamydia trachomatis by polymerase chain reaction. Additionally, 200 of these women self-collected an additional introitus swab and submitted a urine sample for polymerase chain reaction testing. These samples were compared with polymerase chain reaction, culture, and enzyme immunoassay for Chlamydia trachomatis from endocervical samples and polymerase chain reaction and culture on urethral swabs. Patients were determined to be infected with Chlamydia trachomatis by a positive culture result from any site or a confirmed positive result by polymerase chain reaction with an alternate primer. RESULTS: The sensitivity of vaginal introitus swabs obtained by health care providers for the detection of urogenital Chlamydia trachomatis was 92% (95% confidence interval 83 to 100), greater than polymerase chain reaction, culture, or enzyme immunoassay of the cervix or urethra. The sensitivity by polymerase chain reaction of patient self-collected swabs was 81%. Sampling of the vaginal introitus, by both health care workers and the patient herself, performed as well as commonly used diagnostic tests that require vaginal speculum examination. The sensitivity of polymerase chain reaction testing of urine samples was 73%. CONCLUSION: The vaginal introitus represents a highly effective noninvasive specimen collection site for Chlamydia trachomatis testing by polymerase chain reaction. Self-collection of introitus specimens may revolutionize sexually transmitted disease testing by eliminating the need for a speculum examination by skilled health care personnel.