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NCI CANCERLIT^® Search: Surgery for Breast Cancer - October 2002

National Cancer Institute^®
Last Modified: October 1, 2002

Impact of boost irradiation with surgically placed radiopaque clips on local control in breast-conserving therapy.
Breast-conserving therapy versus modified radical mastectomy in the treatment of early breast cancer in Japan.
Results of questionnaires concerning breast cancer surgery in Japan: an update in 2000.
Breast-conserving treatment after neoadjuvant chemotherapy in large breast cancer.
Short stay surgery for breast cancer: an audit of an experience in a regional cancer centre in northern India.
Breast-conservation treatment for bilateral breast cancer in five Japanese women.
Secretory carcinoma of the male breast.
[Breast cancer]
Minimal sentinel node procedure for staging early breast cancer.
Day-surgical management of ductal carcinoma in situ (DCIS) of the breast using wide local excision with sentinel node biopsy.
Sentinel lymph node biopsy in breast cancer: the GIVOM experience in Veneto, Italy.
Intraoperative sentinel node detection by an innovative imaging probe.
Axillary dissection for breast cancer.
Oophorectomy and tamoxifen adjuvant therapy in premenopausal Vietnamese and Chinese women with operable breast cancer.
Reduced use of drains following axillary lymphadenectomy for breast cancer.
[Leiomyoma of the nipple]
Primary leiomyosarcoma of the breast: report of a case.
A comparative study of modified radical mastectomy using harmonic scalpel and electrocautery.
Radiofrequency ablation of early-stage invasive breast tumors: an overview.
Breast cancer treatment and chemoprevention.
Comparative examination of complaints of patients with breast-cancer with and without silicone implants.
Angiosarcomas--clinical profile, pathology and management.
Survival of women after breast conserving surgery for early stage breast cancer.
Indications and complications of latissimus dorsi myocutaneous flaps in oncologic breast surgery.
Erosive adenomatosis of the nipple: Conservation of nipple by Mohs micrographic surgery.
[Breast cancer in pregnant women]
The time has come to change the algorithm for the surgical management of early breast cancer.
Sentinel lymph node biopsy performed with local anesthesia in patients with early-stage breast carcinoma.
Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life.
Variation in breast cancer surgery in Ontario.
Temporal trends in breast cancer surgery in Ontario: can one randomized trial make a difference?
Involving surgeons in discussions of breast cancer surgery.
The simultaneous combination of implants and tram flaps for an aesthetically pleasing breast.
The use of breast conserving surgery: linking insurance claims with tumor registry data.
Chestwall resection: a new and simple method for stabilization of extended defects.
The analgesic effect of gabapentin and mexiletine after breast surgery for cancer.
Racial differences in treatment and survival from early-stage breast carcinoma.
Radiotherapy and breast reconstruction: complications and cosmesis with TRAM versus tissue expander/implant.
[Conservative treatment of wound infection after breast cancer surgery]
A surgical subculture. The use of mastectomy to treat breast cancer.
Radical choices in mastectomy.

1
UI - 11668244
AU - Kokubo M; Mitsumori M; Yamamoto C; Fujishiro S; Mise K; Kodama H; Nagata
TI - Y; Hiraoka M Impact of boost irradiation with surgically placed radiopaque clips on local control in breast-conserving therapy.
SO - Breast Cancer 2001;8(3):222-8
AD - Department of Therapeutic Radiology and Oncology, Graduate School of Medicine, Kyoto University, Japan.
BACKGROUND:The purpose of this study was to determine whether boost irradiation relying on radiopaque clips placed surgically around the resected margin of breast cancer contributes to increasing the local control rate in patients with close or positive margins in breast-conserving therapy (BCT). METHODS: Among 837 patients with breast patients with close or positive surgical margins received boost irradiation following conventional tangential whole breast irradiation. Since 1994, four radiopaque clips were surgically placed around the resected margin of the breast cancer in 155 patients treated with wide excision. The four clips were clearly and accurately identified with a CT-simulator (CT-S). The boost irradiation field was automatically determined with a safety margin of 3 cm according to one-to-one correspondence of radiopaque clips to pathologically close or positive surgical margins. In the remaining 26 patients treated before 1994, the boost irradiation field was determined according to the skin tattoo of the primary tumor. RESULTS: The median follow-up period of the 155 patients receiving the radiopaque clips was 42 months (range: 19 to 78), and that of the 26 patients without the clips was 87 months. Local recurrence was observed in two of the 155 patients who underwent boost irradiation using the radiopaque clips 39 and 54 months after the surgery, while 4 of the 26 patients developed local recurrence 14, 23, 51, and 76 months after BCT. In three of the four patients without the clips developing local recurrences, local recurrences were observed at the margin of the boost irradiation field. The 5-year local recurrence-free survival rate of patients who received boost irradiation with the radiopaque clips was 97%, and that of patients without the clips was 88%. The difference of local recurrence-free survival rates between the patients with and without the clips was significant (p<0.05). CONCLUSION: Surgically placed radiopaque clips appear to be useful for determining adequate boost field in the BCT using the CT-S and help increase the local control rate.

3
UI - 12196713
AU - Anonymous
TI - Results of questionnaires concerning breast cancer surgery in Japan: an update in 2000.
SO - Breast Cancer 2002;9(1):1

4
UI - 12196717
AU - Inaji H; Komoike Y; Motomura K; Kasugai T; Sawai Y; Koizumi M; Nose T;
TI - Koyama H Breast-conserving treatment after neoadjuvant chemotherapy in large breast cancer.
SO - Breast Cancer 2002;9(1):20-5
AD - Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Japan.
Several recent trials have demonstrated that neoadjuvant chemotherapy can allow more patients to successfully undergo breast-conserving treatment (BCT), and does not confer a survival disadvantage compared with standard adjuvant chemotherapy. In addition, the pathological response of primary breast tumors to neoadjuvant chemotherapy appears to be a surrogate marker for patient outcome. In our series, during the 3.1 and 6.0 cm in diameter received epirubicin-based neoadjuvant chemotherapy. There were 55 (64.0%) responders and ultimately 64 patients (74.4%) were treated with BCT. The margin positive rate was 14.1%(9/64), similar to the rate after BCT for early-stage breast cancers, the largest diameter of which was smaller than 3 cm. At a median follow-up of 30 months, only 3 patients in the BCT group have developed local recurrence; the local recurrence rate appears to be comparable to that after BCT for early stage breast cancers. Long term follow-up is required, however, to establish whether this procedure is a safe alternative to mastectomy for patients with large breast cancers.

5
UI - 9315063
AU - Deo SV; Shukla NK; Goel AK; Kishore J
TI - Short stay surgery for breast cancer: an audit of an experience in a regional cancer centre in northern India.
SO - Eur J Surg Oncol 1997 Aug;23(4):335-8
AD - Institute Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences (AIIMS), New Delhi, India.
At the Institute Rotary Cancer Hospital, AIIMS, New Delhi, 246 patients suitable patients were discharged within 48 h (short stay surgery, SSS) after surgery and 164 were discharged after 48 h (conventional stay surgery, CSS). After discharge, patients of both groups were followed in the outpatient clinic until the removal of sutures and drains. There was no mortality or readmission for a complication in either group. Mean post-operative hospital stay was 1.5 days in the SSS group, and 3.3 days in the CSS group. There was no statistically significant difference in the incidence of post-operative complications like wound infection (4.8% vs 4.2%), flap necrosis (6% vs 5.4%), seroma (14% vs 19%), and the average number of hospital visits (3.42 vs 3.2) in SSS and CSS groups, respectively. Patient acceptance of early discharge was good except in the day care group. The study supports the safety and feasibility of short stay surgery for breast cancer in certain circumstances for properly selected patients.

7
UI - 12167580
AU - de Bree E; Askoxylakis J; Giannikaki E; Chroniaris N; Sanidas E;
TI - Tsiftsis DD Secretory carcinoma of the male breast.
SO - Ann Surg Oncol 2002 Aug;9(7):663-7
AD - Department of Surgical Oncology, University Hospital, Medical School of Crete, 711 10 Herakleion, Greece. debree@edu.uch.gr
BACKGROUND: Secretory carcinoma is a distinctive and rare variant of breast carcinoma with a favorable prognosis because these tumors usually behave in an indolent manner. The occurrence of this type of breast cancer in males was studied. METHODS: An extensive literature survey concerning secretory breast cancer in males was performed. Data of one case treated in our institute were added. RESULTS: A total of 14 cases were identified, and our case was added to this series. The median age was 17 years. The duration of symptoms varied from 1 month to 21 years, and the tumor size was 1.2 to 4 cm. Surgical treatment varied from local excision only to modified radical mastectomy. Three patients received adjuvant treatment. Lymph nodes were involved in 3 of the 10 cases undergoing axillary lymph node dissection. The primary tumor was only 1.5 cm in diameter in two of those cases. None of the patients presented with systemic metastases. Only one male was reported to develop recurrence and consequently died of systemic disease. CONCLUSIONS: Secretory breast cancer is very rare in males and seems to occur at a younger age in males than in females. A sufficient number of female cases have been reported with recurrence after local excision. Although in females lymph node metastases are rarely observed in secretory breast carcinoma smaller than 2 cm, in male patients nodal metastases might occur more frequently in smaller tumors. Therefore, mastectomy with sentinel lymph node biopsy or axillary lymph node dissection is recommended in any male case. Biological behavior seems to be similarly favorable in either sex.

8
UI - 12355936
AU - Ikeda T; Jinno H; Matsui A; Mitsui Y; Asaga S; Muto T; Wada M; Kitajima
TI - M [Breast cancer]
SO - Gan To Kagaku Ryoho 2002 Sep;29(9):1509-15
AD - Department of Surgery, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Adjuvant chemo-endocrine therapy for breast cancer (ACETBC) trial has been the first large scaled clinical trial performed in Japan. Several prospective randomized trials have been performed in Japan since ACETBC-1 trial started in 1985. The effect of oral 5-FU agents had been tested in prospective randomized trials and the statistically marginal effect of oral 5-FU agents in adjuvant settings has been reported. Several trials having CMF as a control arm started in 1996 when CMF combination chemotherapy was approved by the government. The results of these trials have not been published. To perform good clinical trials, it is imperative to construct infrastructures including clinical research coordinator, and abolish governmental regulation of the dose of anticancer agents.

9
UI - 12365388
AU - Mariotti S; Buonomo O; Guadagni F; Spila A; Schiaroli S; Cipriani C;
TI - Simonetti G; Felici A; Granal AV; Bellotti A; Cabassi A; Casciani CU; Roselli M Minimal sentinel node procedure for staging early breast cancer.
SO - Tumori 2002 May-Jun;88(3):S45-7
AD - Division of Medical Oncology, University of Rome Tor Vergata, Italy.
AIMS AND BACKGROUND: Sentinel lymph node dissection (SLND) has recently been evaluated as a new staging technique for early breast cancer. To minimize the extent of surgery, the feasibility of eradicating primary breast lesions and the relative sentinel lymph nodes (SLN) under regional anesthesia was evaluated in this study. METHODS AND STUDY DESIGN: A selected population of 76 patients with suspected operable breast cancer and no clinically palpable lymph nodes was enrolled in the study. Intra- and perilesional administration of a radiotracer was performed. Lymphoscintigraphy was carried out to confirm the drainage pathway and locate the SLN. The following day, after inducing a nervous block induction of the ipsilateral intercostal nerves, we performed the surgical procedure with the help of a hand-held gamma-detecting probe. In case the primary lesion was diagnosed as invasive carcinoma by frozen section, the SLN and the remaining axillary lymph nodes (non-SLNs) were removed. The status of SLN and non-SLNs was compared. RESULTS: The primary breast lesion was located and excised in all cases (identification rate: 100%). Lymphoscintigraphy positively identified SLNs in 40/45 (89%) patients; in five patients no lymphatic drainage was detected. In 38 cases an average of 1.5 SLNs and 14 non-SLNs per patient were removed and pathologically analyzed; the remaining two patients showed SLNs in the internal mammary chain, which were not excised. Twenty-nine percent of the patients showed metastatic disease in the lymph nodes examined. Of all patients with affected nodes, 55% had cancer cells only in the SLN. No false negatives (skip metastases) were found. No immediate or long-term anesthesia-related complications (e.g., pleural lesions, intravascular injection) were observed. CONCLUSIONS: Our data confirm the feasibility of single radiotracer administration for both occult lesion and SLN localization as well as the usefulness of SLND in staging early breast cancer. Regional anesthesia resulted in easy management and good patient compliance. This time-saving procedure allowed the completion of the whole surgical plan, reducing the recovery time without modifying the effectiveness of surgery.

10
UI - 12365390
AU - Buonomo O; Granai AV; Felici A; Piccirillo R; De Liguori Carino N;
TI - Guadagni F; Polzoni M; Mariotti S; Cipriani C; Simonetti G; Cossu E; Schiaroli S; Altomare V; Cabassi A; Pernazza E; Casciani CU; Roselli M Day-surgical management of ductal carcinoma in situ (DCIS) of the breast using wide local excision with sentinel node biopsy.
SO - Tumori 2002 May-Jun;88(3):S48-9
AD - Department of Surgery, University of Tor Vergata, Rome, Italy. o.buonomo@inwind.it

11
UI - 12369554
AU - Zavagno G; Meggiolaro F; Bozza F; Scalco G; Racano C; Rubello D;
TI - Pescarini L; De Salvo G; Lise M Sentinel lymph node biopsy in breast cancer: the GIVOM experience in Veneto, Italy.
SO - Tumori 2002 May-Jun;88(3):S52-4
AD - Clinica Chirurgica II, Universita di Padova, Italy. giorgio.zavagno@unipd.it

12
UI - 12369557
AU - Campisi C; Soluri A; Stella S; Valenti G; Scopinaro F
TI - Intraoperative sentinel node detection by an innovative imaging probe.
SO - Tumori 2002 May-Jun;88(3):S56-8
AD - Institute of Biomedical Technologies, National Research Council, Rome. campisi@itbm.rm.cnr.it
Intraoperative tumor detection has been used in many applications, and today the sentinel node technique is a widely employed surgical procedure in breast cancer. Different detector systems are employed but several problems have been reported in clinical practice, in particular the difficulty to accurately detect the sentinel node within the axillary soft tissue. The problem is even greater for abdominal and thoracic tumors. We propose an innovative Imaging Probe (IP) able to visualize on a monitor the primary tumor and secondary lesions if appropriately radiolabeled. The IP can be optimally applied for minimally invasive surgery in breast cancer treatment, and a preliminary experience related to 15 patients and 20 sentinel nodes is reported here. We compared the results obtained with the IP to those obtained with an Anger camera and a traditional scintillation detector, and found them to be very promising. In particular the surgeon's work is greatly facilitated by direct visual guidance instead of a generic acoustic signal.

13
UI - 11939573
AU - Olszewski WL
TI - Axillary dissection for breast cancer.
SO - Lymphology 2002 Mar;35(1):41-2

14
UI - 12011136
AU - Love RR; Duc NB; Allred DC; Binh NC; Dinh NV; Kha NN; Thuan TV; Mohsin
TI - SK; Roanh le D; Khang HX; Tran TL; Quy TT; Thuy NV; The PN; Cau TT; Tung ND; Huong DT; Quang le M; Hien NN; Thuong L; Shen TZ; Xin Y; Zhang Q; Havighurst TC; Yang YF; Hillner BE; DeMets DL Oophorectomy and tamoxifen adjuvant therapy in premenopausal Vietnamese and Chinese women with operable breast cancer.
SO - J Clin Oncol 2002 May 15;20(10):2559-66
AD - University of Wisconsin Comprehensive Cancer Center, 610 Walnut Street, Madison, WI 53705-2397, USA. rrlove@facstaff.wisc.edu
PURPOSE: In 1992, the Early Breast Cancer Trialists' Collaborative Group reported that a meta-analysis of six randomized trials in European and North American women begun from 1948 to 1972 demonstrated disease-free and overall survival benefit from adjuvant ovarian ablation. Approximately 350,000 new cases of breast cancer are diagnosed annually in premenopausal Asian women who have lower levels of estrogen than western women. PATIENTS AND METHODS: From 1993 to 1999, we recruited 709 premenopausal women with operable breast cancer (652 from Vietnam, 47 from China) to a randomized clinical trial of adjuvant oophorectomy and tamoxifen (20 mg orally every day) for 5 years or observation and this combined hormonal treatment on recurrence. At later dates estrogen- and progesterone-receptor protein assays by immunohistochemistry were performed for 470 of the cases (66%). RESULTS: Treatment arms were well balanced. With a median follow-up of 3.6 years, there have been 84 events and 69 deaths in the adjuvant treatment group and 127 events and 91 deaths in the observation group, with 5-year disease-free survival rates of 75% and 58% (P =.0003 unadjusted; P =.0075 adjusted), and overall survival rates of 78% and 70% (P =.041 unadjusted) for the adjuvant and observation groups, respectively. Only patients with hormone receptor-positive tumors benefited from the adjuvant treatment. In Vietnam, for women unselected for hormone receptor status, a cost-effectiveness analysis suggests that this intervention costs $350 per year of life saved. CONCLUSION: Vietnamese and Chinese women with hormone receptor-positive operable breast cancer benefit from adjuvant treatment with surgical oophorectomy and tamoxifen.

15
UI - 12123509
AU - Talbot ML; Magarey CJ
TI - Reduced use of drains following axillary lymphadenectomy for breast cancer.
SO - ANZ J Surg 2002 Jul;72(7):488-90
AD - The St George Hospital, Kogarah, New South Wales, Australia. mltalbot64@hotmail.com
BACKGROUND: Axillary dissection is frequently performed during the treatment of operable breast cancer, and is associated with certain morbidities. Accumulation of axillary fluid, otherwise known as a seroma, is a frequent complication that appears to be related to the degree of dissection. Based on empirical evidence, surgeons have attempted to reduce the occurrence and duration of seromas by using suction drainage, but this concept has been challenged by several authors. OBJECTIVES: To determine if the natural history of seroma fluid accumulation after axillary surgery is altered by the duration of suction drainage or non-placement of a drain. METHODS: Ninety consecutive patients having axillary dissection for breast cancer had either prolonged suction drainage (mean 9.6 days), short duration drainage (2 days), or had no drain placed. Seromas were aspirated and the time to cessation of fluid accumulation determined, as well as any other wound complications. RESULTS: There was no difference in the number of wound complications or the duration of fluid accumulation between the three groups, being 26.6, 25.7, and 27.9 days, respectively. Patients having no drains placed required more frequent aspirations. CONCLUSIONS: The duration of seroma fluid accumulation is not altered by the placement of a suction drain following axillary lymphadenectomy.

16
UI - 12148427
AU - Di Vita G; Barresi E; Raimondo D; Matranga S
TI - [Leiomyoma of the nipple]
SO - Ann Ital Chir 2002 Jan-Feb;73(1):81-3
AD - Dipartimento di Discipline Chirurgiche Anatomiche ed Oncologiche I Divisione di Chirurgia Generale, Scuola di zzazione in Chirurgia Generale, Universita degli Studi di Palermo.
A case of 28 years woman with nipple's leiomyoma we report. Only 38 cases are reported in the literature. This neoplasm presents a difficult differential diagnosis with the remaining flogistic and neoplasm breast and nipple disease.

17
UI - 12181723
AU - Shinto O; Yashiro M; Yamada N; Matsuoka T; Ohira M; Ishikawa T; Nishino
TI - H; Hirakawa K Primary leiomyosarcoma of the breast: report of a case.
SO - Surg Today 2002;32(8):716-9
AD - Department of Surgical Oncology (First Department of Surgery), Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Japan.
We describe herein a case of primary leiomyosarcoma of the breast in a 59-year-old woman. Preoperative clinical examination and cytology findings indicated a benign breast tumor, but intraoperative histopathological examination of the tumor revealed malignant spindle cells, and a modified radical mastectomy was performed. Immunohistochemical analysis subsequently confirmed a diagnosis of leiomyosarcoma. Primary leiomyosarcoma of the breast is extremely rare and difficult to diagnose before surgery because of the need for mitotic figures and immunohistochemical staining to confirm the diagnosis. When pre- and intraoperative examinations indicate the possibility of a leiomyosarcoma, an extended excision with sufficient margins should be performed to remove all of the affected tissue. A review of the literature on this unusual tumor of the breast is presented.

18
UI - 12188072
AU - Deo SV; Shukla NK; Asthana S; Niranjan B; Srinivas G
TI - A comparative study of modified radical mastectomy using harmonic scalpel and electrocautery.
SO - Singapore Med J 2002 May;43(5):226-8
AD - Department of Surgical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi.
AIM: The harmonic scalpel is recently emerging as an alternative surgical tool for dissection and haemostasis and has been extensively used in the field of minimally invasive surgery.We studied the utility and advantages of this instrument over electrocautery for performing modified radical mastectomy. METHODS: The operative and morbidity details of twenty-three breast cancer patients who underwent modified radical mastectomy using the harmonic scalpel were compared with 23 matched controls operated with electrocautery by the same surgical team. RESULTS: There was no significant difference in the operating time between the harmonic scalpel and electrocautery group (104 and 100 mins, p > 0.05).The blood loss (60 +/- 35 ml and 294 +/- 155, p < 0.001) and drainage volume (590 +/- 430 ml and 1,085 +/- 690 ml, p < 0.001) were significantly lower in the harmonic scalpel group.There was a significant reduction of drain days in harmonic scalpel group (mean five and nine days, p < 0.05). There was no significant difference in the seroma rate between two groups (16% and 22%). CONCLUSION: Modified radical mastectomy using harmonic scalpel is feasible and learning curve is short. Harmonic scalpel significantly reduces the blood loss and duration of drainage as compared to electrocautery.

19
UI - 11999950
AU - Singlelary SE; Fornage BD; Sneige N; Ross MI; Simmons R; Giuliano A;
TI - Hansen N; Kuerer HM; Newman LA; Ames FC; Babiera G; Meric F; Hunt KK; Edeiken B; Mirza AN Radiofrequency ablation of early-stage invasive breast tumors: an overview.
SO - Cancer J 2002 Mar-Apr;8(2):177-80
AD - Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
As the management of breast cancer evolves toward less invasive treatments, the next step is the possibility of removing the primary tumor without surgery. The most promising of the noninvasive ablation techniques is radiofrequency ablation, which uses frictional heating that is caused when ions in the tissue attempt to follow the changing directions of a high-frequency alternating current. Three pilot studies, including an ongoing study at M.D. Anderson Cancer Center, have demonstrated that radiofrequency ablation is effective for the destruction of small primary breast cancers. The most important factorfor successful radiofrequency ablation is accuracy of the ultrasound evaluation, which is used to estimate tumor size, localize the tumor for treatment, and monitor the progress of the ablation. A study in preparation at M.D. Anderson will determine whether the use of radiofrequency ablation alone for the local treatment of primary breast cancer will result in outcomes equivalent to those obtained with breast conservation therapy.

20
UI - 10463092
AU - Kotwall CA
TI - Breast cancer treatment and chemoprevention.
SO - Can Fam Physician 1999 Aug;45():1917-24
AD - Department of Surgery, University of North Carolina at Chapel Hill, USA. canuck@med.unc.edu
OBJECTIVE: To outline modern principles of surgery, radiation therapy, and systemic treatment of breast cancer, and to review preliminary data on breast cancer prevention. QUALITY OF EVIDENCE: A MEDLINE search was conducted from 1966 to the beginning of 1999; most of the studies reviewed are randomized clinical trials. MAIN MESSAGE: Breast conservation surgery should be offered to all women with early breast cancer because studies demonstrate survival rates equivalent to those with mastectomy. If mastectomy is chosen, breast reconstruction should be offered. Most women with breast cancer are treated systemically with either chemotherapy or tamoxifen, or both, and mortality is substantially reduced. Data indicating that tamoxifen prevents breast cancer are promising; more studies with both tamoxifen and raloxifene are under way. All women should be strongly encouraged to enter clinical trials. CONCLUSIONS: Because many issues face women recently diagnosed with breast cancer, they often seek out family physicians as advisors to help negotiate a complex treatment path. The possibility of preventing breast cancer will undoubtedly raise questions among family members of women with breast cancer that should appropriately be answered and referred, if necessary, by family physicians.

21
UI - 12039092
AU - Berner I; Gaubitz M; Jackisch C; Pfleiderer B
TI - Comparative examination of complaints of patients with breast-cancer with and without silicone implants.
SO - Eur J Obstet Gynecol Reprod Biol 2002 Apr 10;102(1):61-6
AD - Institute for Clinical Radiology, Universitat Munster, Albert-Schweitzer-Street 33, D-48129 Munster, Germany.
OBJECTIVE: To measure the relationship between silicone breast implants and various symptoms using a control group. STUDY DESIGN: A matched-pair-analysis of 96 women with breast-cancer (32 with silicone implants (K I); 64 without implants (K II)) was performed with help of a standardized questionnaire in respect to 50 single criteria. The condition of implants was monitored by MR-imaging. RESULTS: Athralgias and myalgias were not significantly more frequent in K I. Only six symptoms were reported significantly more often in patients with implants. Positive correlation with implant rupture was given only for the numb feeling/tingling sensation in extremities (P=0.02). There was no correlation between silicone implants and the symptoms of the "chronic-fatigue syndrome" nor any other described silicone-induced disease. CONCLUSIONS: According to our analysis many of the symptoms examined here are present in middle-aged women regardless of silicone implants and underlying disease.

22
UI - 12365113
AU - Sur RK; Nayler S; Ahmed SN; Donde B; Uijs RR; Cooper K; Giraud A
TI - Angiosarcomas--clinical profile, pathology and management.
SO - S Afr J Surg 2000 May;38(1):13-6
AD - Department of Radiation Oncology and Anatomical Pathology, University of the Witwatersrand, South African Institute for Medical Research, Johannesburg.
Files of 8 patients with primary angiosarcomas treated in the Department of Radiation Oncology at the University of the Witwatersrand from 1982 to 1995 were identified. None of these patients had received prior radiotherapy or chemotherapy which would have predisposed them to the formation of an angiosarcoma. Slides of 6 patients were reviewed. Five of the 6 were confirmed as having angiosarcomas, while 1 patient was found to have a peripheral neuro-epithelial tumour. Four patients had angiosarcomas of the breast, while there was 1 patient each with angiosarcoma of the skin, intestine and brain. Complete excision was the primary modality of management whenever possible. Postoperative radiotherapy was given in cases of incomplete excision, patient refusal of radical surgery or gross tumour. Four patients died within 4 months of diagnosis. Three patients are alive (2 with no evidence of disease) 22-96 months after diagnosis. In 1 patient follow-up details were not available as he did not return for treatment. Angiosarcomas are aggressive malignant tumours arising from the endothelial cells. Complete surgical excision is the treatment of choice in the management of this aggressive disease, which has a poor prognosis.

23
UI - 12000218
AU - Du Xianglin; Freeman JL; Nattinger AB; Goodwin JS
TI - Survival of women after breast conserving surgery for early stage breast cancer.
SO - Breast Cancer Res Treat 2002 Mar;72(1):23-31
AD - Department of Internal Medicine, Department of Preventive Medicine and Community Health, Sealy Center on Aging, University of Texas Medical Branch, Galveston 77555-0460, USA. xdu@utmb.edu
BACKGROUND: Increasing numbers of older women with breast cancer are receiving breast-conserving surgery (BCS). However, substantial numbers of them are not receiving either axillary dissection or adjuvant irradiation. OBJECTIVE: To determine whether failure to perform axillary dissection or irradiation is associated with decreased survival in women with early-stage breast cancer. METHOD: We studied 26,290 women aged > or = 25 in 1988-1993 from the surveillance, epidemiology, and end results (SEER) data and 5,328 women aged > or = 65 in 1991-1993 from SEER-Medicare linked data, who had early-stage breast cancer and received BCS. RESULTS: Twenty seven percent of women aged > or = 25 receiving BCS did not receive axillary dissection, most of whom (74%) were age > or = 65. Women receiving BCS with axillary dissection had lower 7-year breast cancer-specific mortality than did those without dissection (hazard ratio = 0.53, 95% confidence interval: 0.44-0.63). We found an interaction between receipt of axillary dissection and radiotherapy on survival of older women after BCS. Women who received either axillary dissection or radiotherapy experienced similar survivals to those who received both axillary dissection and radiation, while women who received neither treatment experienced poorer survival (hazard ratio = 1.76, 1.23-2.52), after controlling for demographics, tumor size and comorbidity. CONCLUSIONS: Women who receive neither axillary dissection nor radiation therapy after BCS experience an increased risk of death from breast cancer. The lack of improvement in the past two decades in survival of older women with breast cancer may be explained in part by the increasing use of treatments that do not address potential tumor in axillary nodes.

24
UI - 12209237
AU - Apffelstaedt J
TI - Indications and complications of latissimus dorsi myocutaneous flaps in oncologic breast surgery.
SO - World J Surg 2002 Sep;26(9):1088-93
AD - Breast Clinic, Department of Surgery, University of Stellenbosch, PO Box 19063, Tygerberg 7505, Cape Town, South Africa. jpa@.sun.ac.za
The use of the latissimus dorsi myocutaneous flap (LDMF) in reconstructive breast surgery is well documented. Few reports exist of its use in oncologic breast surgery. This series describes indications and complications of the LDMF in locally advanced cancer. The records of 83 patients were analysed for age and sex, menstrual status, stage, indication, margins of resection, chemotherapy, radiotherapy, complications, and survival. The indication was to cover defects caused by resection of locally advanced breast cancer (67 cases), recurrent breast cancer (13 cases), radiation damage (2 cases), and surgical complications (1 case). The mean age of the patients was 50.2 years; 52% were postmenopausal. The flaps had mean diameters of 32 by 14 cm. The donor site was skin grafted. Clear margins were achieved in 83%. At the LDMF insertion site, wound infection required drainage in 1 case; flap necrosis required reintervention in 7 cases. In 2 cases a second skin graft was done for the LDMF donor site. The proportions of wound infections and incomplete skin graft take were significantly greater in patients receiving preoperative cyclophosphamide/methotrexate/5-fluorouracil (CMF) versus cyclophosphamide/doxorubicin/5-fluorouracil (CAF) chemotherapy (p < 0.001 and p < 0.05, respectively). The late complication rate was 7.2%. The mean follow-up is 40.0 months. The complication rates for CMF versus CAF chemotherapy suggest an adverse effect of methotrexate, which warrants further investigation. The use of the LDMF made wide resection of locally advanced lesions and radionecrosis possible; major complications were rare. LDMF has its place in the armamentarium of the surgeon who regularly sees locally advanced breast cancer.

25
UI - 12271304
AU - Lee HJ; Chung KY
TI - Erosive adenomatosis of the nipple: Conservation of nipple by Mohs micrographic surgery.
SO - J Am Acad Dermatol 2002 Oct;47(4):578-80
AD - Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea.
Erosive adenomatosis of the nipple (EAN) is a rare, benign tumor that resembles Paget's disease and well-differentiated adenocarcinoma. Total excision of the nipple has been the usual treatment modality because of the high incidence of recurrence when removal is incomplete, and complete excision generally mandates a reconstructive procedure. We report a case of a 56-year-old woman with EAN treated with Mohs micrographic surgery (MMS). We suggest that MMS is the first choice of treatment for EAN because it can be effectively used to remove the tumor completely and at the same time preserve the nipple, if performed early enough, before the tumor is widely spread.

26
UI - 12152295
AU - Kniazewski B; Olejek A
TI - [Breast cancer in pregnant women]
SO - Ginekol Pol 2002 Apr;73(4):404-7
AD - Katedry i Oddzialu Klinicznego Poloznictwa i Ginekologii Sl. AM. w Bytomiu.
The problem of breast cancer during pregnancy was touched. Usually in pregnant women with breast cancer the prognosis is bad. Authors described 3 cases of pregnant patients with breast cancer. All those pregnancies were pre-term finished by cesarean section: 2 after induction of fetal lungs maturation with Mucosolvan (2 newborns in a good state) and 1 case in 19th week of pregnancy. In 2 cases during the cesarean section ovariectomy was performed. In all cases very dynamical progress of illness was described what is consistent with other reports. In one case we observed an inflammatory form of breast cancer. We suggest three breast examinations during pregnancy should be performed.

27
UI - 12361418
AU - Hansen NM; Grube BJ; Giuliano AE
TI - The time has come to change the algorithm for the surgical management of early breast cancer.
SO - Arch Surg 2002 Oct;137(10):1131-5
AD - Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute at St John's Health Center, Santa Monica, CA 90404, USA. HansenN@jwci.org
HYPOTHESIS: If the sentinel lymph nodes (SNs) draining a primary invasive breast cancer are free of tumor, then axillary lymph node dissection is not necessary for management of disease. DESIGN AND small cohort of patients who underwent axillary lymph node dissection only if their SNs were involved with metastases. We now report outcome data for all patients who underwent breast conservation and sentinel lymph node dissection without completion axillary lymph node dissection between October 1, 1995, and April 30, 1999. SETTING: Tertiary breast referral center. PATIENTS: Two hundred thirty-eight patients whose SN staining results were negative for tumor by both hematoxylin-eosin and imunohistochemical stains. Median age was 58.4 years. Most patients (85%) had a T1 tumor; 15% had a T2 tumor. Most (86%) had infiltrating ductal carcinoma with or without extensive ductal carcinoma in situ; 10% had invasive lobular cancer. RESULTS: At a median follow-up of 38.9 months (range, 6-69 months), we found no axillary recurrences, and 98.3% of patients are alive without evidence of disease. Three patients have died of causes not related to breast cancer. Four patients are alive with metastatic disease but have not developed axillary recurrences. CONCLUSIONS: Sentinel lymph node dissection is a safe and efficacious treatment option for patients with early breast cancer. It provides excellent regional control and is associated with excellent survival. A multicenter trial such as the American College of Surgeons Oncology Group Z0010 is needed to corroborate findings of this single-institution study.

28
UI - 12361425
AU - Luini A; Gatti G; Frasson A; Naninato P; Magalotti C; Arnone P; Viale G;
TI - Pruneri G; Galimberti V; De Cicco C; Veronesi U Sentinel lymph node biopsy performed with local anesthesia in patients with early-stage breast carcinoma.
SO - Arch Surg 2002 Oct;137(10):1157-60
AD - Senology Division, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy. alberto.luini@ieo.it
HYPOTHESIS: Sentinel lymph node (SN) biopsy performed with local anesthesia has a positive effect on patients' quality of life and on treatment management for early-stage breast carcinoma. This method represents an interesting development in breast-conserving surgery. DESIGN: We performed SN biopsy with local anesthesia in selected patients to test the feasibility of the technique and its impact on our organization and on patients' quality of life. PATIENTS AND METHODS: palpable breast tumor (maximum diameter, 2.5 cm). The axilla was clinically negative for metastasis in all cases. RESULTS: Forty-eight patients (41.7%) had SNs that were positive for metastasis. In 20 cases (17.4%), the SN was macrometastatic and in 28 cases (24.3%), it was micrometastatic (diameter <2 mm). The SN was negative for metastasis in 66 cases (57.4%). In 1 case, the histologic examination revealed the presence of a non-Hodgkin B-cell lymphoma. The complete axillary dissection performed in the subgroup of patients with macrometastatic SNs showed that in 9 cases (45%), the SN was the only positive node. In another 9 cases (45%), patients had fewer than 4 positive axillary lymph nodes; more than 4 axillary nodes were metastatic in 2 cases (10%). Among the 28 patients with SN micrometastasis, 21 received complete axillary dissection: 15 patients (53.6%) had no other metastasis to the axillary nodes and 6 patients (21.4%) had cancer cells in other axillary nodes. In case of micrometastasis, we suggested that patients enter the International Breast Cancer Study Group 2301 trial (15 of them accepted and signed the informed consent), which compared completion of axillary dissection with no further surgical treatment of the axilla. Based on randomization, 7 patients (25%) in the group with micrometastasis to the SN received no axillary dissection. Patients' tolerance to this kind of treatment was excellent. CONCLUSION: Our experience indicates that SN biopsy performed with local anesthesia can be a suitable alternative to standard intraoperative evaluation with general anesthesia in patients with unifocal, early-stage breast carcinoma.

29
UI - 12377968
AU - Kwan W; Jackson J; Weir LM; Dingee C; McGregor G; Olivotto IA
TI - Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life.
SO - J Clin Oncol 2002 Oct 15;20(20):4242-8
AD - Radiation Therapy Program, Surgical Oncology Program, and Breast Cancer Outcomes Unit of the British Columbia Cancer Agency-Fraser Valley Centre, Surrey, Canada. wkwan@bccancer.bc.ca
PURPOSE: To determine the prevalence of and contributing factors for chronic arm morbidity including lymphedema in breast cancer patients after treatment and to assess the impact of arm morbidity on quality of life (QOL). PATIENTS AND METHODS: A four-question screening questionnaire was developed and mailed to a random sample of 744 breast cancer patients treated curatively in two cancer centers from 1993 to 1997. Patients were without recurrence and at least 2 years from diagnosis. Respondents were classified as with or without arm-related symptoms on the basis of the survey. Stratified random samples from each group were then invited for a detailed assessment of their symptoms and signs, including the presence of lymphedema. Their QOL was assessed by the European Organization for Research and Treatment of Cancer QOL Questionnaire C-30 and by a detailed arm problem questionnaire that assessed various aspects of daily arm functioning. RESULTS: Approximately half of all screened patients were symptomatic and 12.5% of all assessed patients had lymphedema. Axillary dissection (AD) and axillary radiotherapy (RT) after dissection were statistically significantly related to the occurrence of arm symptoms (odds ratio for AD = 3.3, P <.001; odds ratio for RT = 3.1, P <.001). Symptomatic patients and patients with lymphedema both had impaired QOL compared with asymptomatic patients. CONCLUSION: Treatment for breast cancer is associated with considerable arm morbidity, which has a negative impact on QOL. Arm morbidity should be carefully monitored in future studies involving local treatment modalities for breast cancer.

30
UI - 8293375
AU - Iscoe NA; Goel V; Wu K; Fehringer G; Holowaty EJ; Naylor CD
TI - Variation in breast cancer surgery in Ontario.
SO - CMAJ 1994 Feb 1;150(3):345-52
AD - Toronto Bayview Regional Cancer Centre, Ont.
OBJECTIVES: To analyse the extent of variation by county and hospital in the use of breast-conserving surgery in the initial management of breast cancer and to assess some factors that might explain the observed variation. DESIGN: Population-based retrospective cohort study. SETTING: Ontario. PATIENTS: All women with breast cancer newly diagnosed from Jan. 1, 1989, to Dec. 31, 1991. MAIN OUTCOME MEASURE: Proportion of women undergoing unilateral breast cancer surgery who had breast-conserving surgery in each hospital and county. RESULTS: Of the 14,570 women with newly diagnosed breast cancer 12,815 (88.0%) underwent unilateral breast cancer surgery. The mean proportion of breast-conserving procedures by county was 52% and ranged from 11% to 84%. The proportion of breast-conserving procedures in individual hospitals with one or more cases of breast cancer per month ranged from 6% to 84%. The variations in the rates between hospitals was greater than that expected by chance alone (p < 0.0001). CONCLUSIONS: There was marked variation at the hospital and county level in the use of breast-conserving surgery in the initial management of breast cancer. This variation was strongly associated with the hospital where the surgery was performed.

31
UI - 8137191
AU - Iscoe NA; Naylor CD; Williams JI; DeBoer G; Morgan MW; Fehringer G;
TI - Holowaty E Temporal trends in breast cancer surgery in Ontario: can one randomized trial make a difference?
SO - CMAJ 1994 Apr 1;150(7):1109-15
AD - Toronto Bayview Regional Cancer Centre, Ontario Cancer Treatment and Research Foundation.
OBJECTIVE: To assess the effect of a single randomized clinical trial, the National Surgical Adjuvant Breast Project (NSABP) B-06, on the surgical management of breast cancer in women. DESIGN: Retrospective cohort study. SETTING: All hospitals in Ontario. PATIENTS: A consecutive sample of 37,447 women with breast cancer newly diagnosed from Jan. 1, 1980, to Dec. 31, 1989, linked to a surgical procedure record in the Ontario Cancer Registry. MAIN OUTCOME MEASURE: The most invasive surgical procedure used within 90 days of diagnosis. RESULTS: Unilateral breast-ablative surgery (BAS) was performed in 57.3% of the women and breast-conserving surgery (BCS) in 31.6%. The annual rate of BAS declined from 77.5% in 1980 to 44.2% in 1989 and the rate of BCS rose from 12.5% in 1980 to 43.5% in 1989. The decline was linear from 1980 to 1984 and then accelerated significantly in 1985 (p < 0.0001), after the results of the NSABP B-06 trial were published. CONCLUSION: One randomized clinical trial can have an immediate and profound effect on medical practice.

32
UI - 8087747
AU - Friesen RW
TI - Involving surgeons in discussions of breast cancer surgery.
SO - CMAJ 1994 Sep 15;151(6):732, 734, 736

33
UI - 12197427
AU - Chang KP; Lin SD; Lin TM; Tsai CC; Lai CS
TI - The simultaneous combination of implants and tram flaps for an aesthetically pleasing breast.
SO - Kaohsiung J Med Sci 2002 May;18(5):215-20
AD - Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. kapich@cc.kmu.edu.tw
In Taiwan, there have quite often been incidences when patients have had more abundant abdominal tissue to make a TRAM flap with a volume larger than the contralateral

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