National Variations in the Work-Up,Investigation, and Surgical Management of Ductal Carcinoma In Situ of the Breast across Canadian Surgeons

Variation in the management of Ductal Carcinoma In Situ (DCIS) of the breast occur at both national and international levels. The aim of this study is to determine the degree of, and reasons behind, this variation in the workup and treatment of DCIS among Canadian surgeons. We developed a 35-question survey involving the pre-, peri, and post-operative management of DCIS using SurveyMonkey^®. The survey was sent out via email and responses were analyzed using SurveyMonkey^® and Microsoft Excel. 51/119 (43%) of the Canadian General Surgeons contacted participated in this study. Some variation was observed in the utilization of pre-operative imaging with 29/48 (60%) surgeons routinely using ultrasound. Perceived contraindications to breast conserving therapy also varied with multicentricity (54%) and the presence of diffuse microcalcifications (13%). Nearly all respondent’s (98%) patients had access to immediate breast reconstruction following a mastectomy but 14/48 (29%) of respondents’ patients were required to travel a mean distance of 300 km to undergo the procedure. Substantial variation was also seen during follow-up with half (52%) of surgeons following up patients for >1 month in their surgical clinic. There is considerable variation in the management of DCIS among Canadian Surgeons. The present study indicates the need for pan-Canadian, evidence-based guidelines to ensure a standardized management strategy for patients with DCIS.     

规范化腋窝淋巴结切除在乳腺癌外科治疗中的意义

目的　探讨规范化腋窝淋巴结切除的方法及其在乳腺癌外科治疗中的意义。方法　回顾性分析 3 83例因乳腺癌行标准腋窝淋巴结切除患者的临床资料。结果　 3 81例患者行腋窝淋巴结切除平均用时为 12min。术后病理证实平均切除腋窝淋巴结数目为 16 6个。 3例术后出现腋窝积液。 3例术后近期出现轻度水肿。 11例术后出现患肢上臂轻度麻木感。所有患者术后 1个月后患侧肢体功能良好。术后平均住院时间为 7.2d。结论　按正确方法对乳腺癌患者进行规范化腋窝淋巴结切除是安全的 ,其并发症是可以接受的     

SINODAR ONE,an ongoing randomized clinical trial to assess the role of axillary surgery in breast cancer patients with one or two macrometastatic sentinel nodes

Sentinel lymph node biopsy alone is the current surgical axillary treatment for early-stage breast cancer patients with a negative sentinel lymph node (SLN). The possibility to omit axillary dissection also in presence of positive SLNs has been promoted by the American College of Surgeons Oncology Group (ASOCOG) Z0011 randomized trial. Several limitations and evidences of potential selection bias made this trial fairly controversial. Stronger evidence than currently available is needed on the safety of foregoing axillary dissection in well-defined populations of patients with positive SLNs. The Italian multicentre SINODAR ONE randomized trial here presented was designed with this aim.     

超声联合钼靶对早期浸润性乳腺癌豁免前哨淋巴结活检的价值分析

目的 分析超声联合钼靶检查对肿瘤直径≤2 cm早期浸润性乳腺癌患者豁免前哨淋巴结活检(SLNB)的价值.方法 选取重庆医科大学附属第一医院2018-01～2019-06肿瘤直径≤2 cm且术中行SLNB的122例早期浸润性乳腺癌患者,对其临床资料进行回顾性分析,收集超声、钼靶、MRI及SLNB的结果,分别与术后腋窝淋巴...     

治疗前哨淋巴结阳性乳腺癌非前哨淋巴结状态的多因素分析

目的探讨影响前哨淋巴结阳性乳腺癌非前哨淋巴结状态的因素,建立判断有否转移的预测模型。方法回顾性分析我院自2003年-2010年共285例前哨淋巴结阳性乳腺癌患者临床病理资料。采用Logistic回归方法分析13种影响前哨淋巴结阳性乳腺癌非前哨淋巴结状态的因素,建立判断有否转移的预测模型,并验证模型的准确度、敏感度、特异性。结果单因素Logistic回归分析结果提示,有6个因素与NSLN转移具有密切相关性,分别为肿瘤大小（OR=1.45,P<0.01）、阳性SLN大小（OR=2 078.49,P<0.01）、阳性SLN数量(OR=2.44,P<0.01)、阴性SLN数量(OR=0.19,P<0.01)、脉管侵犯(OR=11.45,P<0.01)、阳性SLN包膜外扩散(OR=74.34,P<0.01)。Logistic多因素回归分析表明：肿瘤大小、脉管侵犯、阴性SLN数量、阳性SLN大小及阳性SLN包膜外扩散与NSLN转移密切相关(P<0.05)。Logistic回归模型预测前哨淋巴结阳性乳腺癌非前哨淋巴结状态的敏感度为 92.62%（138/149）,特异性为 89.15%（115/129）,总符合率91.01% (253/278)。结论Logistic回归预测模型能较好的判断前哨淋巴结阳性乳腺癌非前哨淋巴结的状态,[JP2]有助于乳腺肿瘤外科医师选择最佳治疗方案。     

乳腺癌前哨淋巴结活检指导腋窝淋巴结清扫

目的探讨前哨淋巴结活检（SLNB）对乳腺癌腋窝淋巴结（ALN）转移状态的预测价值,为指导乳腺癌患者是否行腋窝淋巴结清扫（ALND）提供科学依据。方法2005～2008年本院手术治疗的乳腺癌患者36例患者,采用术前2 h注射99M锝-右旋糖苷（99M Tc-dx）1 ml于肿瘤周围腺体内和术中1%亚甲蓝2 ml（总剂量）四点法注射于肿瘤覆盖皮肤之皮内,术中前哨淋巴结活检,随后行包括ALND的不同方式的根除术。所有前哨淋巴结（SLN）术中冷冻病理检查为单切片HE染色,所有SLN和非SLN均再行多层切片HE染色及免疫组织化学病理学检查。结果根据术中切片病理和术后腋窝淋巴结病理,SLN检出成功率为94.4%（34/36）;SLN预测ALN转移的准确性为94.1%（32/34）,灵敏度为85.7%（12/14）,特异性为100%（20/20）,假阴性率为14.3%（2/14）,总的阳性、阴性预测值分别为100%（12/12）和90.9%（20/22）。与单切片HE染色相比,多层切片HE染色和免疫组织化学检查使灵敏度提高至92.9%（13/14）,假阴性率降低至7.14%（1/14）。结论亚甲蓝法和放射性示踪法联合应用能准确检测出SLN,SLN能反映腋窝淋巴结的状态。术中多层切片HE染色可降低前哨淋巴结假阴性率。