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Targeted axillary dissection with preoperative tattooing of biopsied positive axillary lymph nodes in breast cancer. Neoplasma 2020; 67:1329-1334. [PMID: 32749847 DOI: 10.4149/neo_2020_191228n1344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/24/2020] [Indexed: 11/08/2022]
Abstract
Sentinel lymph node biopsy (SLNB) has emerged as an alternative to axillary lymph node dissection during breast cancer surgery during the last 2 decades. However, there are several controversies regarding the indication of the sentinel node biopsy after neoadjuvant chemotherapy which can convert positive lymph nodes to negative. The false-negative rate after neoadjuvant chemotherapy is unacceptably high. This high false-negative rate can be decreased by marking of the positive lymph nodes and removal during sentinel lymph node biopsy procedure in addition to the sentinel lymph nodes. The aim of this study was to investigate the possibility of carbon tattooing of the positive sentinel lymph nodes before neoadjuvant chemotherapy. In 2016, a prospective protocol was launched investigating the black carbon tattooing procedure of the suspective and positive axillary lymph nodes by injecting 0.1-0.5 carbon ink in normal saline under ultrasound guidance. All patients underwent black carbon tattooing of the suspected or positive axillary lymph nodes before the chemotherapy or one week before the primary surgery when chemotherapy was not indicated in the neoadjuvant setting. Sentinel lymph nodes together with lymph nodes marked by the black carbon ink were removed and histologically evaluated. So far 27 patients were treated under this protocol. Breast saving surgery was performed in 22 cases and mastectomy in 5 cases. All patients had invasive ductal carcinoma. In 20 patients neoadjuvant chemotherapy was indicated and in 7 patients primary surgery was performed. All lymph nodes marked by black carbon ink were successfully identified and removed. Sentinel lymph node biopsy was performed in 8 cases and sentinel lymph node biopsy followed by axillary dissection in 15 cases. Axillary dissection alone was performed in 4 cases. In 19 cases, the black carbon ink was present in the sentinel lymph node at the same time and in 4 cases carbon dye was present in other lymph nodes than the lymph node identified during SLNB, which corresponds to 17.4%. In the group of patients undergoing primary surgery, in one case from six, the sentinel lymph node was negative and the lymph node marked with carbon ink positive which represents false-negative lymph node and failure of the SLNB procedure. After neoadjuvant chemotherapy, there was no false-negative lymph node identified, but the conversion of the positive lymph nodes to negative was present in 10 cases (50%). There were no complications attributed to carbon ink tattooing. The results of positive sentinel lymph nodes tattooing have confirmed that this method is safe and allows a decrease in the false negativity rate during the sentinel node biopsy procedure.
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Reply to Dr. Charalampos Seretis. JOURNAL OF B.U.ON. : OFFICIAL JOURNAL OF THE BALKAN UNION OF ONCOLOGY 2013; 18:804. [PMID: 24065509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Significance of the resection margin and risk factors for close or positive resection margin in patients undergoing breast-conserving surgery. JOURNAL OF B.U.ON. : OFFICIAL JOURNAL OF THE BALKAN UNION OF ONCOLOGY 2012; 17:452-456. [PMID: 23033280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE While positive resection margin (RM) in women undergoing breast-conserving surgery (BCS) represents a clear indication for re-resection, there is no unequivocal recommendation regarding the extent of the clear RM. The aim of this study was to define the optimal extent of the RM and the risk factors for close or positive RM. METHODS Patients scheduled for BCS had diagnosis confirmed before BCS (lumpectomy and quadrantectomy) by core biopsy. Sentinel lymph node biopsy followed BCS, and in case of positive findings axillary lymph node dissection followed. According to RM patients were categorized into 4 groups: 1) Patients with positive RM; 2) Clear RM < 2 mm; 3) Clear RM of 2-5 mm; and 4) RM > 5 mm. In the first 3 groups where re-resection was indicated, the presence of tumor cells in the re-resection specimen was determined. All patients were followed for local recurrence. RESULTS 330 patients undergoing BCS were studied. Median follow up was 39.6 months (range 12-70). Lumpectomy was performed in 111 cases and quadrantectomy in 219. In 19 cases the final procedure was mastectomy due to the impossibility to achieve negative RM. In 78 cases re-resection followed the primary procedure due to close or positive RM. Clear RM was < 2 mm in 12 cases (15%), 2-5 mm in 56 (72%) and positive margin in 10 (13%). Positive re-resection specimen was detected in 31 cases (39.7%) (in 10 cases with positive RM after primary procedure, in 3 with negative margin < 2 mm and in 18 with 2-5 mm margin). The re-resection rate according to the location of the primary tumor was 77% (n=60) in the upper outer quadrant, 8% (n=6) in the lower outer quadrant, 6% (n=5) in the upper inner quadrant, 4% (n=3) in the lower inner quadrant, and 5% (n=4) in centrally located tumors. Multicentric/ multifocal tumor was diagnosed in 16 cases from which re-resection was indicated in 12 cases (75%). The number of re-resection according to tumor size was as follows: Tis 8 cases (30.7%), T1a none, T1b 14 (20.2%), T1c 34 (22.5%), T2 22 (28%). Re-resection was performed in 8 cases (31%) of ductal carcinoma in situ (DCIS), in 53 (22%) of ductal carcinoma, in 10 (37%) of lobular carcinoma, and in 7 (15%) of other histology. Five cases with local relapse were detected during follow up. CONCLUSION The generally recommended clear RM of 1-5 mm is not sufficient because of the high number of positive specimens in the case of clear RM of 2-5 mm. The risk factors for close or positive RM are multicentric tumors and upper outer location of the primary tumor. Longer follow up will be needed to analyze local relapse rate according to RM status.
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Sentinel node biopsy and neoadjuvant chemotherapy in the treatment of breast cancer. JOURNAL OF B.U.ON. : OFFICIAL JOURNAL OF THE BALKAN UNION OF ONCOLOGY 2012; 17:265-270. [PMID: 22740204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE Sentinel lymph node biopsy (SLNB) has become a safe and accurate alternative to axillary lymph node dissection (ALND) in the surgical management of early breast cancer. The aim of this study was to determine the false negative rate of SLNB in patients with advanced breast cancer after neoadjuvant chemotherapy. METHODS Forty-eight patients with 49 advanced breast cancers (one patient had bilateral disease) underwent neoadjuvant chemotherapy. All of them had SLNB, followed by standard level I/II ALND. SLNs were identified in 47 out of 49 tumors (detection rate 95.9%). RESULTS Axillary nodal metastases were detected in 28 patients; SLNs were positive only in 14 patients. Four sentinel internal mammary nodes were removed in 4 patients, while one of them was positive with micrometastasis but axillary nodes were negative. False-negative results occurred in 2 (7.14%) patients. The results of our study confirm that SLNB in patients with advanced breast cancer is not significantly altered by the preoperative chemotherapy. Biopsy results were very similar to those without any neoadjuvant chemotherapy. CONCLUSION ALND, known for its serious complications, can be replaced in some cases by SLNB.
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[Surgery of breast carcinoma--tactics and surgical technic]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2012; 91:172-180. [PMID: 22893925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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[Predictive factors for non-sentinel lymph nodes affection in breast carcinoma--outcomes of a Czech multicenter study of sentinel lymph nodes]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2011; 90:348-351. [PMID: 22026102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The aim of the study was to assess positivity nonsentinel lymph nodes in patients with macro, micro and submicrometastases in sentinel lymph nodes and find predictive factors of positivity nonsentinel lymph nodes. Study was conducted at the Department of Surgery in Pardubice, Pilsen, Ostrava and Zlín. MATERIAL AND METHODS Sentinel lymph nodes were assessed based on standards of Czech Pathological Society. Detection of sentinel lymph nodes was performed based on radionavigation or combination of radionavigation and blue dye method. RESULTS In group N1 (macrometastases) there was found positivity of nonsentinel lymph nodes in 50% (45 from 90 patients). In group N1 Mi (micrometastases) there was found positivity of nonsentinel lymph nodes in 26.7% (16 from 60 patients). In group NO I+ (sub-micrometastases) there was found positivity of nonsentinel lymph nodes in 6.7% (1 from 15 patients). Predictive factors were size of metastasis, number of positive sentinel lymph nodes and grading. Size of tumor was not found to be a predictive factor of positivity nonsentinel lymph nodes. DISCUSSION High positivity of nonsentinel lymph nodes in pacients with macro and micrometastases in sentinel lymph nodes advocates to perform axillary lymph nodes dissection. Due to small number of patients with submicrometastases it is not possible to assess if axillary dissection is necessary or not. Predictive factors of positivity of nonsentinel lymph nodes are size of metastasis in sentinel lymph nodes, number of positive sentinel lymph nodes and grading. Size of tumor was not found to be a predictive factor due to small tumors in the study. In spite of this it is necessary to consider it like a predictive factor of positivity nonsentinel lymph nodes. CONCLUSION In patients with macro and micrometastases it is necessary to perform axillary dissection. In patients with submicrometastases in sentinel lymph nodes it is necessary to consider predictive factors.
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[Minimal node affection in gastric carcinoma--pilote multicentric study results]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2011; 90:333-338. [PMID: 22026099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Lymphadenectomy is an essential part of surgical treatment of gastric cancer. In the part of hematoxylin-eosin negative nodes, small foci of tumour cells (micrometastastasis and isolated tumour cells) can be found using immunostaing or RT-PCR. The aim of this study is to asses clinical and prognostic relevance of these findings. MATERIAL AND METHODS Multicenter, prospective, non-randomised clinical trial running in four Czech centres. All lymphatic nodes from patients after radical resection are stained using standard hematoxylin-eosin technique, all negative nodes are further processed with immunostaining employing cytokeratin antibody. RESULTS In the period of two years (1st January 2009 - 31st December 2010), 73 patients (100%) were included into the study from four Czech centers. All patients underwent radical resection for gastric cancer. Subtotal resection was performed in 33 patients (45%), total gastrectomy in the remaining 40 patients (55%). Total number of acquired lymphatic nodes (LN) reached 1245, average number of nodes per one patient was 17.3. H-E metastasis were disclosed in 364 LN (29%). All H-E negative nodes were further processed using immunohistochemical staining. Lymph node micrometastasis (MM) were discovered in 35 LN (3%), isolated tumour cells (ITC) in another 72 LN (6%). Clinical and prognostic relevance of lymph node MM and ITC was assessed based on the patients' survival data. CONCLUSION Preliminary results of this study indicate that presence of the lymph node MM and ITC in gastric cancer patients is not linked to worse oncological outcome. Based on our results we can conclude, that expensive, time consuming and technically demanding immunostaining technique could not yet be recommended as a routine part of histological investigation of lymphatic nodes.
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[Lymphatic mapping and biopsy of sentinel lymph nodes using combined methodology of in vivo application of Patentblue and radionuclide and ex vivo detection of metastatic affection of lymph nodes in colorectal carcinoma]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2010; 89:695-701. [PMID: 21409805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM OF THE STUDY to check the new technique of lymphatic mapping and sentinel node biopsy by colorectal cancer surgery and to improve the lymphatic staging. METHOD combined technique of lymphatic mapping via Patentblue and the radiocolloid in vivo applied in the rectal cancer surgery. The lymphatic-mapping technique with Patentblue in the colon cancer surgery. Radically or palliative tumour resection. Ex vivo detection of sentinel and non-sentinel lymph nodes in the specimen and their division into peritumoral, intermedial and central level. Serial sectioning examination and immunohistochemistry examination of detected lymph nodes. Statistic process. RESULTS The methods were used for 107 patients. 1985 lymph nodes were examined, out of which 208 was with metastasis. Positive nodes were detected in 56 patients. In average there were 18.5 nodes per patient. 966 sentinel nodes were detected by colouring and radiocolloid marking. Sentinel nodes showed in 97 patients. In 10 patients, the method failed. In 44 patients, sentinel nodes were positive; 117 positive nodes in total. Skip metastases were detected in 6 percent of the patients. The upstaging of metastatic detection was in 3.7 percent. CONCLUSION The technique of lymphatic mapping and sentinel node detection significantly increases the number of detected nodes and selects the marks the sentinel ones for further examination. The greatest amount of findings of nodal metastases is in the area closest to the tumour, therefore, when sentinel nodes are negative there, these can be examined more closely, by the method of serial insections or immunohistochemically, and staging of the disease can be made more accurate.
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[Locoregional recurrences after conservative surgery in early breast cancer]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2010; 89:604-611. [PMID: 21374943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Conservative surgery is considered as standard and alternative mastectomy in early stage breast cancer but number of local recurrence is higher. Aim of the study was to detect number of local recurrences after conservative surgery and to identify risk factors of local recurrence especially importance of resection margins. MATERIALS AND METHODS Local recurrences were evaluated in patients after conservative surgery in early breast cancer at department of surgery Atlas hospital in Zlin between January 2004 and December 2008. T1-2 (only one T3) breast cancers were included in study. Diagnostic biopsy, lumpectomy and quadrantectomy were performed. In all patients axillary nodes were examined. Study guidelines required microscopic distance between resection line and tumor margin 5mm. Specimen after surgery was marked with black ink and from June 2006 with six colors ink. Radiotherapy and chemotherapy in additions to character of cancer followed surgery. RESULTS Conservative surgery was performed in 330 patients. Mean age was 59 years. Follow-up was 39.6 month. Stage of the tumor: 0 19x, I 101x, IIA 163x, IIB 33x, IIIA 5, IIIB 0, IIIC 9. Lumpectomy was made 11 lx including 11 diagnostic biopsies and quadrantectomy 219x. Final conservative surgery was 331x and mastectomy 19x. Positive axillary nodes were 98x. In breast local recurrence appeared in 5 (3.6%) patients and one had regional recurrence without in breast recurrence. Distant metastases were 8x (2.4%) and ten patient died on primary disease without locoregional recurrence. CONCLUSION Local recurrence appeared only 5x. Clear margins after breast conserving surgery are very important factor in prevention local recurrence. We recommend keeping 5 mm resection distance.
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[Lymphadenectomy in papillary thyroid cancer]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2010; 89:443-447. [PMID: 21121153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Papillary carcinoma is the most frequent malign tumour of the thyroid with rising incidence and metastasising in lymphatic veins. AIM Diagnosing our patients and comparing the TNM stages to metastases found in lymphatic nodes. MATERIALS, METHODS A retrospective study of 1,353 patients treated at our department between 2005 and 2008. RESULTS 220 (16.3%) malign thyroid tumours have been found among 1,353 patients. Papillary carcinoma has been found in 180 cases, according to the TNM classification T1 mic 80x (44.4%), T1 58x (32.2%), T2 29x (16.1%), T3 8x (4.4%), T4 5x (2.8%). Multifocal incidence of papillary carcinoma has been observed in 42 patients (23.3%). Lymphadenectomy cervicocentral 18x, ipsicervicolateral 52x, contracervicolateral 1x. In total, 351 nodes were removed and 113 nodes had metastasis of papillary carcinoma. 2 patients had permanent paresis of the NLR (1.11%), nerve at risk 0.56%, transitory paresis 5.56%. CONCLUSION The basic surgical treatment of the thyroid with papillary carcinoma is total thyroidectomy with cervicocentral lymphadenectomy. Ipsilateral lympadenectomy is indicated in the case of nodes found sonographically or tumour size T2.
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[Breast cancer surgery in the Czech Republic]. KLINICKA ONKOLOGIE : CASOPIS CESKE A SLOVENSKE ONKOLOGICKE SPOLECNOSTI 2009; 22:294-295. [PMID: 20099750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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[Initial results of the bipolar RFITT coagulation in advanced stages of hemorrhoidal disorder study]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2008; 87:576-579. [PMID: 19209509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM OF THE STUDY The aim is to verify a new methodology of radiofrequency bipolar coagulation for treatment of hemorrhoids in practice. USED METHODS: The method of bipolar radiofrequency-induced thermotherapy of internal and external hemorrhoids using the Olympus Celon apparatus. Radiofrequency bipolar electrode was applied to perform coagulation of internal and external hemorrhoids under visual control and feedback. RF energy was applied, on average, at 12 sites above the dentate line to treat internal, stage III hemorroids. In stage IV hemorrhoids, based on the prolapse extent, it was applied to external hemorrhoids, as well. In four subjects, the method was used in combination with a standard Parks management to perform excision of perianal fibromas. RESULTS From September 2007 to June 2008, the method was used in 18 patients with stage III and IV hemorrhoids. 15 patients underwent a per- protocol follow up on postoperative Day 7 and Day 21. Then, the first 5 subjects were checked in a 6- month interval and will be re-assessed in 12 months. The average duration of the procedure was 20 minutes and duration of hospitalization was 24 hours. Postoperative bleeding lasted for average 0-10 days. Major postoperative edema occured in 2 subjects. The average pain intensity (on 0-10 scale) was 1.5 on Day 7; 0.46 on Day 21. The postoperative complications included anal fissures with increased pain intensity in 2 subjects with a preoperative history of anal procedures. Transient edema of external hemorrhoids occured upon management of the stage IV hemorrhoidal disorder. CONCLUSION Bipolar radiofrequency-induced thermotherapy of hemorrhoids is a new, semiinvasive method of the management of hemorrhoids. It is safe, with minimal rates of early postoperative complications. It is well-tolerated and evaluated by patients. Long-term results will be published further.
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[Sentinel lymph node biopsy in the breast carcinoma in clinical practice]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2008; 87:180-185. [PMID: 18646656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM In the management of early breast carcinoma, biopsy of sentinel lymph nodes has gradually replaced dissection of Level I and II axillary nodes. The aim of the study is to assess feasability and reliability of the method in our conditions. METHOD From June 1998 to June 2007, a total of 458 sentinel node biopsies (SLNB) were performed. Originally, patent blue sentinel node mapping was used. Since 2000, a combination of radiocolloid application and a gamma- probe (detector), as well as the patent blue, has been used. Originally, SLNBs were followed by axillary dissections, however, in 2002, the procedure was waived in cases of negative sentinel nodes findings. RESULTS Out of the total of 458 SLNB patients, 382 female patients were included in the study. SLNB, without concomitant axillary dissection, was performed in 170 subjects. In 70 subjects, the sentinel node was positive and they were indicated for axillary dissections. Positive non-sentinel nodes were detected 17 times. In total, 899 sentinel nodes were examined in the study group of 382 biopsies. The mean was 2.35. False negative nodes were recorded in three cases in female patients with SLNB and axillary dissection (4.6%). No local relapses in the axilla were recorded in negative sentinel node findings without subsequent axillary dissections. CONCLUSION Sentinel node biopsy is a safe alternative to axillary dissection in the surgical management of early breast carcinoma.
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[Local recurrences after conservative surgery in breast carcinoma]. KLINICKA ONKOLOGIE : CASOPIS CESKE A SLOVENSKE ONKOLOGICKE SPOLECNOSTI 2008; 21:169-173. [PMID: 19102224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Local recurrences in breast after conservative surgery are failure of primary therapy. The aim of the study was monitoring of local recurrences after conservative surgery and also relationships of local recurrences with disease free interval and survival. MATERIALS AND METHODS Between 1.12.1998 and 30.06.2004, 143 patients with breast carcinoma were treated at Department of Surgery Atlas Hospital Zlin by conservative surgery. All patients received radiotherapy and boost in breast. Macroscopic free margins were 10 mm and reexcision were done in all patients with free margins less than 5 mm. Dose of the radiotherapy whole breast and cavity were 50 Gy, interval 5-6 weeks, daily 2Gy. Brachytherapy received all patients, combination of chemotherapy and hormonal therapy were 56x, only chemotherapy 31x, only hormonal therapy 31x and without adjuvant therapy 25x. RESULTS Median follow-up was 32 month. Tumor size according to TNM classification: TIS 10, pT1a 1x, pTb 28x, pTc 55x, pT2 44x, pT3 5x. Stage: 0 1x, I 58x, IIA 56x, IIB 24x, IIIA 4x. Local recurrences in breast were 5x, (3.49%), distant metastases 6x, (4.1%) and 3x (2.09%) appeared distant metastases and death at breast carcinoma without local recurrence. Only in one patient local recurrence were followed by distant metastases and death. Interval from local recurrence and death was 12 month. Size of the original tumor with local recurrences was from 10mm to 45 mm. Interval from the time of initial treatment to local recurrences was from 12 to 42 month. Surgical treatment of local recurrences included mastectomy 4x and conservative surgery 1x. CONCLUSION Number of local recurrences is in correspondence with international guideline and results of modern multimodal therapy.
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[Endoluminal radiofrequency ablation of varices]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2007; 86:582-586. [PMID: 18214143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Chronic venous insufficiency affects a considerable proportion of the population and, commonly, is not considered a disease, but a disease process presenting as a wide range of clinical findings. The commonest findings include stages C2 and C3 according to the CEAP classification. Recently, modern miniinvasive surgical methods have come forth. AIM The aim is to present the authors intitial experience with endoluminal bipolar radiofrequency thermotherapy of varices (RFITT). MATERIAL, METHODOLOGY 48 extremities operated in 35 subjects from January to June 2007. VSM (Vena saphaena magna) was operated in 47 cases and VSP (Vena saphaena parva) in a single case. Where terminal VSM valve insufficiency was detected, additional crossectomy was performed. In all subjects, the procedure was followed by mimiphlebectomy and foam sclerotherapy. RESULTS Obliteration of the operated vein using RFITT immediately after the procedure rated 100%. Subsequent recanalization was performed in a single subject after Day 140. Complications included irritation of the saphenous nerve in three subjects, in one case following miniphlegectomy and in the other two cases following RFITT. In all the subjects, the clinical findings recovered spontaneously within 14 days. Duration of their hospitalization was 5-24 hours. CONCLUSION RFITT is a safe and effective miniinvasive surgical technique in the varicose veins management. It can be considered another alternative to other miinvasive procedures, such as laser endoluminal photocoagulation or conventional procedures, including stripping.
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[Assessment of sentinel nodes in breast cancer by rapid peroperative biopsy and immunohistochemistry in serial sectioning]. CESKOSLOVENSKA PATOLOGIE 2007; 43:13-7. [PMID: 17370471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Results of histological examinations of sentinel lymphatic nodes (SLN) obtained by rapid peroperative biopsy (RPB) are presented. Our first experience with 77 patients undergoing localized excision of axillary sentinel nodes is reported. Negative nodes were subsequently examined by means of immunohistochemistry of serial sectioned blocks. The aim of the study was to verify the percentage of identified metastases, and thus define the reliability of the RPB. At the same time we tried to determine the ratio of the negative biopsies of SLN, which were found positive subsequent to immunohistochemistry examination of serial sections, to the total amount of peroperative negative findings or a "false negativity". Our results were compared with those recently published. Particular demands and possibilities of the method used are briefly discussed. In the group of 77 patients with breast cancer, the total number of 193 SLN were examined (average 2.5, in a patient ranging from 1 to 7). Out of all examined SLN, 45 patients (58.4%) were negative. Metastases were identified in 32 patients (41.6%). By rapid preoperative biopsy alone, metastases were found in 24%, which represents 75% sensitivity. The specificity was 100%. The following examination of serial sectioned specimens with or without immunohistochemistry showed 8 more patients with metastases, which represents the false negativity of 15.1%. The metastases found in all 8 patients were small micrometastases, isolated tumour cells or clusters of cells.
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[Crossectomy--the most important step in varices surgery]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2006; 85:446-9. [PMID: 17323768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The authors present ethiology and aethilogy-based surgical techniques of the disorder on a group of 3458 patients operated for varices of lower extremities. Crossectomy is flashed out as a key moment of the procedure in cases of sapheno-phemoral junction insufficiencies. The results are presented on two patient groups comparing relaps rates of the disorder following completion of partial selective and radical complete crossectomies. A subject of neovascularization and its relation to the procedure and relapses is discussed.
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[Distribution of metastatic affection in colorectal carcinoma using lymphatic mapping and radiation-navigated biopsy of the sentinel lymph node]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2006; 85:463-8. [PMID: 17323771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
AIM The aim is to define distribution of the lymphonode metastatic affection in colorectal carcinoma and to evaluate a new methodology of lymphatic mapping and the sentinel lymphonode detection during colorectal carcinoma procedures in practice. USED METHODS: A method of peroperative lymphatic mapping using a Patentblue method in vivo. Rectoscopic peritumoral application of a radiocoloid in a two-day or a single-day protocol, scintigraphy, peroperative quants of radioactivity detection using a gamma probe. Radical or paliative tumor resection. Detection of the sentinel and non-sentinel nodes on a preparation ex vivo, divided according to levels. The metastatic affection distribution is assessed in three levels, marked U1 - U3, a S1 - S3. Histopathological examination of the nodes on series sections and, event, immunohistochemistry. RESULTS The methods were used in 66 patients. A total of 970 nodes have been examined, with an average of 14.6 nodes/ patient. The metastases quantity decreases with distance from the tumor. The peritumoral levels (U1a S1) record the highest rates of metastases. In our patient group, 92% of the metastases were recorded in the S1 level, 4% in the S2 level and 4 % in the S3 level. CONCLUSIONS The highest rate of metastases was recorded in the levels, closest to the tumor, therefore, in case of negative findings of sentinel nodes in the S1 level, the nodes from this level may be closely examined (using the method of series sections and immunhistochemistry) and the staging be established more precisely.
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[Cavernous haemangioma of the small intestine leading to haemoperitoneum]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2006; 85:390-3. [PMID: 17144120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The authors present a case-review of a cavernous haemangioma of the small intestine as a cause of haemoperitoneum in a young female. The authors discuss the patient's history, completed examinations and surgical management of the case including a detailed histological examination of the intestinal resecate with cavernous haemangioma. Discussion includes literature data of the published case-reviews.
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Comparative analysis of thymidylate synthase, thymidine phosphorylase and dihydropyrimidine dehydrogenase expression in colorectal cancer and surrounding normal tissue. Neoplasma 2005; 52:208-10. [PMID: 15875081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Thymidylate synthase [TS], thymidine phosphorylase [TP] and dihydropyrimidine dehydrogenase [DPD] play the essential role in the activation and catabolism of the fluoropyrimidines used in cancer therapy. Its expression may influence the antitumor activity or toxicity of these drugs. We studied the expression levels of selected enzymes in colorectal tumors and adjacent normal mucosa. The analysis of TS, TP and DPD gene expression was performed using quantitative Real time PCR technique (Roche) in 15 (TS), 64 (TP) and 12 (DPD) of 64 colorectal cancer patients. The mean gene expression of TS, TP and DPD was found to be 3.29; 3.79 and 8.24 in tumors and 1.88; 3.80 and 19.69 in normal mucosa. The corresponding median gene expression was 1.87; 2.32 and 4.50 for tumors and 2.14; 2.63 and 11.64 for normal tissue. We did not find any significant differences in TS, TP and DPD gene expression between colorectal tumor and surrounding mucosa.
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[Surgical therapy of the ductal carcinoma in situ]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2004; 83:597-603. [PMID: 15736388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
AIM Rates of the newly-detected DCIS reach up to 20% in developed countries. There is no unified therapeutic scheme to deal with the disorder. The aim of this work is to assess the author's own therapeutic results. METHODOLOGY From 1999 until 2003, 11 female patients suffering from the DCIS were treated and 2 DCIS female patients were treated using microinvasion. The diagnosis was established 5x by the core-cut and 8x by the surgical excision. RESULTS The size of the tumors varied from 0.5 cm to 6.0 cm. Conservative procedures were performed 11 times, a simple mastectomy once and a mastectomy with reconstruction once, as well. The sentinel lymphonodes were examined in all cases and once the examination was accompanied by the axilla dissection. The number of the sentinel lymphonodes was 29. All of the lymphonodes were negative. Seven female patients were given a complementary therapy. All female patients have had no local relapse in the breast and have had no signs of the disease process since. The average follow-up time is 13.5 months. CONCLUSION The conservative procedures sufficiently provide treatment of early forms of the DCIS of the breast. The sentinel lymphonode biopsy is a patient- kind method, giving exact information on the status of the axillary lymphonodes and it is considered a suitable part of the DCIS therapy.
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