Precise application of sentinel lymph node biopsy in patients with ductal carcinoma in situ: A systematic review and meta-analysis of real-world data

PurposeAlthough ductal carcinoma in situ (DCIS) seldom involves lymph nodes, some patients may upstage to invasive disease, thus requiring a second surgery for sentinel lymph node (SLN) biopsy (SLNB). However, the indications of SLNB remain inconclusive and clinical trials are rarely available. Our aim is to systematically review the real-world data to evaluate whether SLNB is precisely applied in patients with a high risk of upstaging from DCIS to invasive carcinoma.MethodsPubMed, EMBASE, and Cochrane library databases were searched. Prospective and retrospective cohort studies that evaluated the pathological outcomes of SLNB and the upstaging rate in women with DCIS were included. The primary outcomes were the upstaging and SLN-positive rates of patients initially diagnosed as having DCIS. We analyzed factors, namely biopsy methods, clinical presentations, histological patterns, and hormone receptor status, that potentially indicate nodal involvement risk.ResultsWe retrieved 43 prospective and 69 retrospective studies including 44,001 patients. The pooled estimates of upstaging and SLN-positive rates were 25.8% (95% confidence interval [CI]: 0.230–0.286) and 4.9% (95% CI: 0.042–0.055), respectively. In subgroup analysis, the upstaging rate was significantly higher in patients with estrogen receptor-negative status, palpable mass, tumor size >2 cm on imaging, and high-nuclear grade and those who received a preoperative diagnosis through core needle biopsy.ConclusionThe upstaging and SLN-positive rates of DCIS were 25.8% and 4.9%, respectively. By selecting patients with high risk DCIS, surgeons may increase the precision of and reduce the excess and incomplete treatment rates of SLNB.     

Extent of gastrectomy and lymphadenectomy for gastric adenocarcinoma

Gastric adenocarcinoma is one of the most common and lethal cancers worldwide and is associated with a high frequency of nodal metastasis. The value of multimodality therapy is well-established, but gastric resection and locoregional lymph node dissection are important mainstays in potentially curative therapy. However, there has been considerable regional variation in surgical approach and debate regarding the ideal extent of gastric resection, gastric reconstruction, and extent of lymphadenectomy. This chapter outlines the current evidence in the surgical management of gastric adenocarcinoma. The advent of minimally invasive approaches to gastric operations is also discussed.     

The role,yield and cost of paediatric faecal elastase-1 testing

ObjectiveFaecal elastase-1 (FE1) is a sensitive marker for exocrine pancreatic enzyme insufficiency. Pancreatic insufficiency (EPI) leads to maldigestion and subsequent poor weight gain. Thus, FE1 is performed as work-up for children with failure to thrive (FTT). However, EPI in the paediatric population outside of cystic fibrosis (CF) is rare. This study aimed to identify the indications for FE1 testing and their diagnostic yield in children. The secondary aim was to evaluate the cost per case of EPI detected for the various indications.DesignAll FE1 tests performed on children (0–18 years) at a tertiary paediatric hospital in Sydney, Australia between 2010 and 2013 (inclusive) were identified. A retrospective chart audit was performed to identify the indication for testing FE1. The diagnostic yield based on FE1 cut-offs <200 and < 100 μg/g were assessed.ResultsThe most common indication for testing FE1 was “FTT only” (71/216, 32.9%), however, in this cohort of patients, FE1 was least likely to be positive with only 2 out of the 71 (2.8%) patients returning a positive result. In comparison, CF was the second most common indication for testing (60/216, 27.8%), but nearly half (48.8%) of tests returned a positive result in this cohort. The cost per case detected (FE1 <200 μg/g) reflected the test yield with an average cost per positive test of $262.50 (AUD2015) for FTT with short-gut syndrome and $420.00 (AUD2015) for CF-related indications.ConclusionOur study shows that for patients with isolated failure to thrive, FE1 testing is low yield and costly.     

启东市2001-2007年膀胱癌生存率分析

目的分析启东市2001-2007年全人群膀胱癌登记病例生存率,为预后评价提供依据。方法 426例膀胱癌登记病例的生存(死亡)情况随访截止于2009年12月31日。用SURV3.01软件计算观察生存率(OS)及相对生存率(RS),应用Hakulinen等人似然比检验法进行χ2检验,P<0.05为差异有统计学意义。结果启东膀胱癌1、3、5年OS分别为67.14%、52.17%和47.16%,1、3、5年RS分别为72.02%、64.04%和66.10%。其中男性1、3、5年RS分别为71.71%、63.28%、64.78%,女性1、3、5年RS分别为73.30%、67.19%、71.90%,男女性生存率差异无统计学意义(P>0.05)。35～44岁、45～54岁、55～64岁、65～74岁及75岁以上各年龄组的5年RS分别为61.28%、77.31%、61.07%、61.78%及72.76%。本资料与启东20世纪70年代以来各时期资料相比,5年相对生存率有了较大的提高。结论启东市全人群膀胱癌生存率呈上升趋势,但与国外发达国家尚有较大差异,膀胱癌诊治水平亟待提高。