腔镜腋窝淋巴结清扫在早期乳腺癌保乳手术中的应用

目的:探讨腔镜腋窝淋巴结清扫治疗早期乳腺癌保乳手术的可行性及临床效果。方法:回顾分析98例早期乳腺癌行保乳手术的临床资料,其中41例行腔镜腋窝淋巴结清扫术(腔镜组),57例行常规腋窝淋巴结清扫术(常规组),比较两组手术时间、出血量、清扫淋巴结个数、阳性淋巴结数及并发症、预后等。结果:两组均完成手术。腔镜组与常规组平均手术时间分别为99.5 min与61.5 min(P<0.05),平均清扫出腋窝淋巴结数分别为17.6枚与18.6枚(P>0.05),平均阳性淋巴结数分别为2.1枚与2.4枚(P>0.05),平均手术出血量分别为35.4 mL与61.5 mL(P<0.05)。随访1～4年,腔镜组无复发及转移病例,未出现术后并发症。常规组1例出现患侧上肢水肿,1例乳房皮肤瘢痕愈合不良;1例乳房局部复发,1例肺转移,1例胫骨转移。两组均无死亡病例。结论:腔镜腋窝淋巴结清扫术与开放腋窝淋巴结清扫术同样能彻底完成腋窝淋巴结清扫,具有并发症少,美学效果好的优势。     

乳腺癌患者腋中组转移性淋巴结的声像学特征分析

目的：利用高频超声探讨乳腺癌患者腋中组转移性淋巴结的声像学特征。方法2008年1月至2013年10月在中山大学肿瘤防治中心行超声检查,并发现腋中组存在淋巴结病例共89例,均为女性乳腺癌患者,其中66例为乳腺癌首诊患者,23例为乳腺癌术后复查患者。观察腋中组淋巴结的数量、最大径、纵横比及是否存在淋巴门、血流情况。统计学分析出有意义的参数,并计算其敏感度、特异度、阳性预测值及阴性预测值。结果超声检查发现腋中组淋巴结数量≥3个,诊断淋巴结良恶性的敏感度为56.8%,特异度为89.7%,准确性为71.9%,阳性预测值和阴性预测值分别为87.9%和61.4%;若腋中组有一个淋巴结最大径≥10 mm,则诊断淋巴结良恶性的敏感度为58.0%,特异度为79.5%,准确性为67.4%,阳性预测值和阴性预测值分别为78.4%和59.6%;如果同时存在两个声像学特征,则可明显提高诊断的敏感度（87.8%）和准确性（78.6%）,特异度为60.0%,阳性预测值为72.3%,阴性预测值为80.0%。结论腋中组淋巴结的数量和大小是判断淋巴结良恶性有意义的声像图指征。     

Breast MRI for evaluating patients with metastatic axillary lymph node and initially negative mammography and sonography.

OBJECTIVE: We wanted to investigate the ability of breast MR imaging to identify the primary malignancy in patients with axillary lymph node metastases and initially negative mammography and sonography, and we correlated those results with the conventional imaging. MATERIALS AND METHODS: From September 2001 to April 2006, 12 patients with axillary lymph node metastases and initially negative mammography and sonography underwent breast MR imaging to identify occult breast carcinoma. We analyzed the findings of the MR imaging, the MR-correlated mammography and the second-look sonography. We followed up both the MR-positive and MR-negative patients. RESULTS: MR imaging detected occult breast carcinoma in 10 of 12 (83%) patients. Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively). In nine out of 10 patients, the MR-correlated mammography and second-look sonography localized lesions that were not detected on the initial exam. All the non-MR-correlated sonographic abnormalities were benign. CONCLUSION: Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes. Localization of the lesions through MR-correlated mammography and second-look sonography is practically feasible in most cases.     

Randomisierte,plazebokontrollierte klinische Doppelblindstudie zur Wirksamkeit und Verträglichkeit der oralen Therapie mit Methantheliniumbromid (Vagantin®) bei fokaler Hyperhidrose

Background: Methanthelinium bromide is a quaternary ammonium derivate with anticholinergic activity. Since 1951 it has been used to treat patients with hyperhidrosis. However, all efficacy data has so far been limited to case reports and case series. We here report on the results of the first randomised clinical controlled trial on the efficacy and safety of methanthelinium bromide. Patients and methods: A total of 41 patients with a mean age (± standard deviation) of 28 ± 9.8 years (Range 18.7 – 54.8) were included, 31 (76 %) of them were females. Main inclusion criteria were are focal hyperhidrosis of a one year or longer duration and a gravimetrically assessed sweat production of ≥ 50 mg/min. Patients were treated with 2 × 50 mg methanthelinium bromide or placebo orally daily for 4 weeks. The therapeutic effect was determined by repeated gravimetric measurement of sweat production and by recording the patients' degree of satisfaction. Results: The efficacy was most pronounced for patients with an axillary hyperhidrosis of ≥ 50 mg/min (p = 0.02, χ²‐test, two‐sided). For the total group the main axillary sweat production decreased in the verum‐treated arm from a mean value of 89.2 ± 73.4 mg/min prior to therapy to 53.3 ± 48.7 mg/min during therapy (p = 0.02, Wilcoxon test, two‐sided). In contrast, no difference was detected in the placebo arm with 60.7 ± 42.8 mg/min prior to and 59.1 ± 40.6 mg/min during therapy (p = 0.92, Wilcoxon test, two‐sided). For the palmar sweat production no difference between the verum‐ and the placebo‐treated group was found. No serious adverse events were reported. As expected, dryness of the mouth, a known adverse reaction of anticholinergics, was reported significantly more frequently in the verum‐treated arm. Conclusions: Methanthelinium bromide has been considered for many years as a therapeutic option for the treatment of focal hyperhidrosis. However, its efficacy and safety have not previously been investigated in controlled randomised studies. We demonstrated both a decline in axillary sweat production and good tolerance. Therefore, the treatment of axillary hyperhidrosis with methanthelinium bromide in a regimen of 50 mg twice daily can be recommended, especially in those cases which are refractory to topical treatment with for example aluminium chloride hexahydrate solution. In contrast, we found no evidence for a clinically relevant diminution of palmar sweating.     

Pilonidal sinus on the axilla in young females

Summary Two cases of pilonidal sinus of the axilla, which are thought to be the third and fourth described in the literature, are reported. Both patients were young females aged 21 and 22 years, respectively. In Case 1, an elliptical incision was performed, resulting in a moderate degree of hypertrophic scar formation. In Case 2, two incisions parallel to the wrinkle lines were used to prevent postoperative scarring. Macroscopically, four hairs growing from the proximal to the distal sinus were seen in Case 1. Meanwhile, one hair was in the track in Case 2, directing from the proximal to the distal sinus. Growth forces, and assorted factors such as shaving, minor infection, friction and maceration seemed to be the most probable causal mechanism of the pilonidal sinuses.     

Adjuvant radiation therapy after axillary lymphadenectomy for metastatic melanoma: Toxicity and local control

Background: Certain patients with locally advanced melanoma have a high risk of regional recurrence after surgical excision and lymphadenectomy alone. Growing evidence suggests that radiation therapy may improve local control with acceptable morbidity for patients with melanoma in some sites. There is no information regarding the safety or efficacy of this treatment when applied to the axilla for regional metastasis of cutaneous melanoma. Methods: We conducted a retrospective evaluation of patients who received postoperative radiation therapy to the axillary lymphatics for malignant melanoma at the M. D. Anderson Cancer Center between 1980 and 1992. Twenty-eight patients were identified who had undergone a formal axillary lymph node dissection followed by postoperative irradiation to the full axilla and supraclavicular fossa. Twenty-two patients were irradiated using a hypofractionated treatment regimen (4–7 Gy/fraction), generally to 30 Gy in five fractions. Results: Sixteen patients are currently alive. Actuarial survival at 5 years is 50.1%. Local tumor recurred or persisted in five patients, four of whom had clinically palpable tumor when they were irradiated. Conclusions: Postoperative irradiation of the axilla for malignant melanoma has acceptable toxicity, even in those with extensive axillary dissection. In this group, patients treated for subclinical disease had a low rate of recurrence (1 of 21, [5%]).Results of this study were presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

Cost-effectiveness of MRI and PET imaging for the evaluation of axillary lymph node metastases in early stage breast cancer

Background

UK guidelines for breast cancer recommend axillary nodal assessment via surgical methods such as sentinel lymph node biopsy (SLNB). However, these procedures are associated with adverse effects such as lymphoedema. Magnetic resonance imaging (MRI) and positron emission tomography (PET) are non-invasive imaging techniques. The aim of this study is to evaluate the cost-effectiveness of MRI and PET compared with SLNB for assessment of axillary lymph node metastases in newly-diagnosed early stage breast cancer patients in the UK.

Methods

An individual patient discrete-event simulation model was developed in SIMUL8^® to estimate the lifetime costs and benefits of replacing SLNB with MRI or PET, or adding MRI or PET before SLNB. Effectiveness outcomes were derived from a recent systematic review; patient utilities and resource use data were sourced from the literature.

Results

Based on our analysis the baseline SLNB strategy is dominated by the strategies of replacing SLNB with either MRI or PET. The strategy of replacing SLNB with MRI has the highest total quality-adjusted life years (QALYs) and lowest total costs. However, clinical evidence for MRI is based on a limited number of small studies and replacing SLNB with MRI or PET leads to more false-positive and false-negative cases. The strategy of adding MRI before SLNB is cost-effective, but subject to greater uncertainty.

Conclusions

Based on this analysis the most cost-effective strategy is to replace SLNB with MRI. However, further large studies using up-to-date techniques are required to obtain more accurate data on the sensitivity and specificity of MRI.