Intraoperative palpation of sentinel lymph nodes can accurately predict axilla in early breast cancer

Recent randomized trials have shown that completion axillary lymph node dissection (ALND) is not required in all patients with a positive sentinel lymph node (SLN) who will receive radiation therapy. Although routine intraoperative pathologic assessment (IPA) becomes unnecessary and less indicated by breast surgeons in the United States and some European countries, it is still widely used all around the world. In this prospective study, the feasibility of intraoperative nodal palpation (INP) as opposed to IPA of the SLN has been analyzed. Between March 2014 and June 2015, 305 patients with clinical T1‐2/N0 breast cancer from two different breast clinics (cohort A; [n = 225] and cohort B; [n = 80]) who underwent any breast surgery with sentinel lymph node biopsy (SLNB) were included in this study. Surgeons evaluated the SLNs by manual palpation before sending for IPA, and findings compared with the final pathology. The positive predictive values (PPV) of INP and IPA were 81.8% and 97.9%, respectively, whereas the negative predictive values (NPV) of INP and IPA were 83% and 92.4%. The accuracies of INP and IPA were 82.6% and 94.1%, respectively. If patients with SLNB including micrometastasis were also considered in the final pathologic assessment (FPA) (?) group that would not require a further axillary dissection, the revised NPV of INP and FPA were found to be 92.6% and 98.1%, respectively. The revised accuracy of INP also found to be increase to 86.9%. Our study, which is the only prospective one about palpation of dissected SLNs in the literature, suggests that INP can help to identify patients who do not need ALND, which encourages omitting IPA in cT1‐2 N0 breast cancer.     

Prognostic factors for overall survival in patients with metastatic colorectal carcinoma treated with vascular endothelial growth factor-targeting agents

Objective: Angiogenesis represents a key element in the pathogenesis of malignancy. There are no robust data on prognostic factors for overall survival (OS) in patients with metastatic colorectal cancer treated with vascular endothelial growth factor (VEGF)-targeted therapy. The present study was conducted to establish a prognostic model for patients using an oxaliplatin-based or irinotecan-based chemotherapy plus bevacizumab in metastatic colorectal cancer. Methods: Baseline characteristics and outcomes on 170 patients treated with FOLFIRI or XELOX plus anti-VEGF therapy-naïve metastatic colorectal cancer were collected from three Turkey cancer centers. Cox proportional hazards regression was used to identify independent prognostic factors for OS. Results: The median OS for the whole cohort was 19 months (95% CI, 14.3 to 23.6 months). Three of the seven adverse prognostic factors according to the Anatolian Society of Medical Oncology (ASMO) were independent predictors of short survival: serum lactate dehydrogenase (LDH) greater than the upper limit of normal (ULN; p<0.001); neutrophils greater than the ULN (p<0.0014); and progression free survival (PFS) less than 6 months (p =0.001). Conclusion: Serum LDH and neutrophil levels were the main prognostic factors in predicting survival, followed by PFS. This model validates incorporation of components of the ASMO model into patient care and clinical trials that use VEGF-targeting agents.     

Therapeutic efficiency of Atosiban, an oxytocin receptor blocking agent in the treatment of experimental endometriosis

Purpose

The current study investigated the potential therapeutic efficiency of atosiban, an oxytocin receptor antagonist, in an experimental endometriosis model.

Methods

Endometriosis was surgically induced in 35 female rats during estrus. Four weeks after this procedure, relaparotomy was performed. The viability and dimensions of the endometriosis foci were recorded. Rats were then randomly divided into three groups. In the first group (n?=?8), a daily dose of 0.2?ml 0.9?% NaCl was injected intraperitoneally (i.p.) (control cases). In the second and third groups (n?=?8 and n?=?8), 0.5?mg/kg/day i.p. atosiban and 1?mg/day i.p. diltiazem were given, respectively. At the end of the treatment, laparotomy was performed, and the dimensions of the endometriosis foci were recorded. The endometrial implants were processed for histological and immunohistochemical studies. The volumes of endometriotic implants were measured, and immunohistochemical analyses were performed, and compared between the groups.

Results

After the treatment with atosiban, volumes of endometriotic implants decreased significantly. Proliferating cell nuclear antigen expression levels were significantly reduced in the atosiban and diltiazem groups compared with the control group.

Conclusions

In a rat endometriosis model, atosiban, an agent used for the first time for the medical treatment of endometriosis, has shown significant therapeutic efficiency.     

Comparing the effectiveness of “plasma knife” tonsillectomy with two well-established tonsillectomy techniques: Cold dissection and bipolar electrocautery. A Prospective randomized Study

Objective

To evaluate the effectiveness of a new device “plasma knife” for tonsillectomy by comparing to two well-established tonsillectomy techniques: cold dissection, and bipolar electrocautery.

Methods

A prospective, randomized study conducted on 110 patients undergoing tonsillectomy. Subjects were randomized to plasma knife (PKT), cold dissection (CDT) and bipolar electrocautery (BET) groups. Operative time, intraoperative blood loss and postoperative complications were recorded. Pain/discomfort level of patients and healing time of the tonsillar fossae were assessed postoperatively. Data were recorded and statistically analyzed.

Results

Operative time with plasma knife and bipolar electrocautery were associated with a significant decrease in operative time compared to cold dissection (p < 0.05). Intraoperative blood loss was significantly decreased with plasma knife, compared to cold dissection and bipolar electrocautery (p < 0.05). Less postoperative pain was observed with plasma knife compared to bipolar electrocautery but more postoperative pain was observed with both compared to CDT (p < 0.05). Postoperative healing time was longer with plasma knife and bipolar electrocautery, compared to cold dissection (p < 0.05).

Conclusion

Plasma knife is a useful and safe device in tonsillectomy. Its use reduces intraoperative blood loss and provides a fast tonsillectomy with acceptable morbidity.     

Comparison of adenoidectomy methods: Examining with digital palpation vs. visualizing the placement of the curette

Objective

To evaluate the effectiveness of adenoidectomy by defining the remnant volume and localization in nasopharynx, following being satisfied with completeness of removal of the adenoid tissue with digital palpation.

Methods

A prospective study conducted on 99 patients undergoing adenoidectomy ± tonsillectomy. The main mass of the patient's adenoid tissue was removed with a sharp adenoid curette without visualization and the surgeon was allowed to palpate the adenoid bed and repeat the curettage until satisfied with completeness of removal. Then nasopharynx was visualized with a laryngeal mirror for defining the anatomical localization of the residual adenoid tissue and curettage completed under indirect mirror visualization. The volumes of the adenoid tissue excised at both stages were measured.

Results

By blunt curettage and digital palpation, only 20.2% of the patients (20) had no residual adenoid tissue. In patients who had residual adenoid tissue, the proportion of the median percentage of residual adenoid tissue to total adenoid tissue was 19.98% (range 3.22-50%). The anatomical localization of the residual adenoid tissue were, along the torus tubarius on either side of the nasopharynx in 9 (11.4%), on the pharyngeal roof near choanal openings in 64 (81%), along the torus tubarius on either side of the nasopharynx + on the pharyngeal roof near choanal openings in 5 (6.3%), and on the pharyngeal roof near choanal openings + on the posterior wall of nasopharynx in 1 (1.3%) patients. There was no difference found among surgeons in the percentage and the location of the residue left (p > 0.05).

Conclusion

Digital palpation is not a dependable technique and visualization of the nasopharynx is crucial for a complete adenoidectomy.