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  • 1
    Electronic Resource
    Electronic Resource
    The Department of Defense Experience in Perioperative Testing for Metastatic Disease in Patients with Breast Cancer (1998)
    Oxford, UK : Blackwell Publishing Ltd
    The @breast journal 4 (1998), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: Although multiple tests are often performed prior to surgery for the primary treatment of breast cancer, the role of perioperative testing has yet to be clearly defined. The purpose of this study was to examine the use of perioperative testing in the Department of Defense (DOD) health care system.Records from all patients who received an operation for breast cancer between April 1, 1990 and March 1, 1992 in the DOD health care system were reviewed. The results of bone scans (BS), abdominal CT scans, brain scans (CT, MRI), chest radiographs (CXR), blood tests, and specified parameters from the history and physical examination were analyzed. Chi-square statistics were performed.2,364 women underwent surgery for breast cancer during this period. The percentage of patients that received each test (A) and the percentage of the tests that were suggestive of metastatic disease (B) are as follows ([A%], [B%]): CXR (94%, 1.3%); BS (23%, 8%); abdominal CT (4%, 9%); and brain scans (1%, 11%). There were more abnormal BS in patients with an elevated alkaline phosphates than in those with a test that was normal or never performed (20% vs. 4.8%, p 〈 0.001). Elevated liver function tests or central nervous system signs or symptoms were not associated with abnormal studies.In the past, patients with breast cancer underwent an extensive array of blood tests, CXR, and scans of bones, liver, and brain in the attempt to detect occult metastatic disease prior to surgery. In a large and diverse system such as the DOD, however, a perioperative metastatic work-up, which includes a BS, brain scan, and abdominal CT scan is not routinely performed, suggesting that clinicians selectively perform specific tests during this period. Despite this tendency, when tests are performed on breast cancer patients in the perioperative period, they are infrequently suggestive of metastatic disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-4741.1998.420084.x
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  • 2
    Electronic Resource
    Electronic Resource
    Guidelines for the Safe Use of Radioactive Materials During Localization and Resection of the Sentinel Lymph Node (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 75-82 
    Details
    ISSN: 1534-4681
    Keywords: Radiation ; Technetium ; Lymph node ; Breast cancer ; Melanoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Several reports have demonstrated accurate prediction of nodal metastasis with radiolocalization and selective resection of the radiolocalized sentinel lymph node (SLN) in patients with breast cancer and melanoma. As reliance on this technique grows, its use by those without experience in radiation safety will increase. Methods: Tissue obtained during radioguided SLN biopsies was examined for residual radioactivity. Specimens with a specific activity greater than the radiologic control level (RCL) of 0.002μCi/g were considered radioactive. Radiation exposure to the surgical team was measured. Results: A total of 24 primary tissue specimens and 318 lymph nodes were obtained during 57 operations (37 for breast cancer, 20 for melanoma). All 24 (100%) of the specimens injected with radiopharmaceutical and 89 of 98 (91%) of the localized nodes were radioactive after surgery. Activity fell below the RCL 71 ± 3.6 hours in primary tissue specimens, 46 ± 1.7 hours in nodes from melanoma patients, and 33 ± 3.5 hours in nodes from breast cancer patients (P = .037). The hands of the surgical team (n = 22 cases) were exposed to 9.4 ± 3.6 mrem/case. Conclusion: Although low levels of radiation exposure are associated with radiolocalization and resection of the SLN, the presented guidelines ensure conformity to existing regulations and allow timely pathologic analysis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0075-7
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  • 3
    Electronic Resource
    Electronic Resource
    Contributions from surgeons to clinical trials and research on the management of soft tissue sarcoma (1998)
    Springer
    Annals of surgical oncology 5 (1998), S. 437-441 
    Details
    ISSN: 1534-4681
    Keywords: Soft tissue sarcoma ; Surgery ; Clinical research ; Prospective randomized trial
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Surgical resection is the primary treatment for soft tissue sarcoma. Surgeons are in a position to develop and define appropriate treatment strategies for this disease. In an effort to define the contributions of surgeons to the management of sarcoma, the surgical and clinical oncology literature from January 1983 through June 1996 was reviewed. Methods: A computerized literature search of the Cancerlit database for January 1983 to June 1996 was performed. The search was limited to the topic of soft tissue sarcoma and was further confined to 15 journals that publish articles relevant to surgical management. These studies were then categorized by multiple parameters and analyzed. Results: The Cancerlit file contained 4478 articles in which sarcoma was the primary topic. When the search was limited to 15 journals frequently read by surgeons, 479 references (11%) were retrieved. Within the surgical literature, 95 of the 479 articles (20%) described prospective studies, of which 33 were prospective and randomized. These studies represent all but three of the prospective randomized trials within the literature during the time period reviewed. The management of patients with sarcoma was evaluated in 26 of the prospective randomized trials; of these, 13 trials evaluated adjuvant chemotherapy, three evaluated adjuvant radiotherapy, and ten evaluated the chemotherapeutic treatment of metastatic disease. Surgical oncologists were the first or senior author on 10 of the 16 prospective randomized studies regarding adjuvant radiation or chemotherapy. Four of the 16 trials evaluating adjuvant therapy contained more than 100 patients, and three of those four were from cooperative group efforts. All but one of the studies of adjuvant therapy with less than 100 patients were from single institutional trials. Conclusions: Although the surgical and clinical oncology literature on soft tissue sarcoma is composed primarily of retrospective reviews, the prospective randomized trials reported represent almost all of the randomized trials in the literature and have significant contributions from surgeons. Surgeons can guide and design clinical trials, but overall patient accrual as represented by soft tissue sarcoma is low, and may be improved through cooperative group efforts.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303862
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  • 4
    Electronic Resource
    Electronic Resource
    Ultrasonographically guided injection improves localization of the radiolabeled sentinel lymph node in breast cancer (1998)
    Springer
    Annals of surgical oncology 5 (1998), S. 315-321 
    Details
    ISSN: 1534-4681
    Keywords: Gamma probe ; Lymph node ; Breast cancer ; Ultrasound ; Technetium
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Several reports have demonstrated the accurate prediction of axillary nodal status (ANS) with radiolocalization and selective resection of sentinel lymph nodes (SLN) in breast cancer. To date, no technique has proven to be superior in localizing the SLN. Methods: 1.0 mCi of clear unfiltered99mtechnetium sulfur colloid was injected under ultraso-nographic (US) guidance around the perimeter of the breast lesion (palpable and nonpalpable) or previous biopsy site. Resection of the radiolocalized nodes was performed, followed by complete axillary lymph node dissection (AXLND). Results: Forty-two breast cancer patients underwent SLN biopsy after US-guided radiopharmaceutical injection. The SLN was localized in 41 patients (98%). The type of previously performed diagnostic biopsy did not influence the ability to localize the sentinel lymph node. Pathology revealed nodal metastasis in 7 of the 41 evaluable patients (17%). ANS was accurately predicted in 40 of 41 patients (98%). Conclusions: Early experience with radiologicalization and selective resection of SLN in breast cancer remains promising. Use of US-guided injection facilitates localization of the SLN, perhaps as a result of more accurate placement of the radionuclide marker. Use of this technique allowed for effective management of patients regardless of tumor size or the extent of prior biopsy, thereby expanding the potential number of eligible patients for SLN biopsy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303494
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  • 5
    Electronic Resource
    Electronic Resource
    Suture granuloma masquerading as malignancy of the biliary tract (1990)
    Springer
    Digestive diseases and sciences 35 (1990), S. 1176-1179 
    Details
    ISSN: 1573-2568
    Keywords: suture ; granuloma ; cholangiocarcinoma ; biliary stricture
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Eighteen years after having a duodenal leiomyosarcoma resected, a patient presented with weight loss, pruritus, and abdominal pain. ERCP was consistent with a cholangiocarcinoma with proximal hepatic duct stricture and nonfilling of the cystic duct. CAT scan revealed no extrinsic masses compressing the gallbladder or biliary tract. At surgical exploration, the patient was found to have a suture granuloma with surrounding fibrosis within the common bile duct. There was no evidence of malignancy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01537593
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