Iatrogenic Breast Lesions: Various Ultrasound Findings
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The purpose of this study was to evaluate the occurrence of lymphatic drainage to non-axillary sentinel nodes and to determine the implications of this phenomenon. A total of 549 breast cancer patients underwent lymphoscintigraphy after intratumoural injection of 99mTc-nanocolloid. The sentinel node was intraoperatively identified with the aid of intratumoural administered patent blue dye and a gamma-ray detection probe. Histopathological examination of sentinel nodes included step-sectioning at six levels and immunohistochemical staining. A sentinel node outside level I or II of the axilla was found in 149 patients (27%): internal mammary sentinel nodes in 86 patients, other non-axillary sentinel nodes in 44 and both internal mammary and other non-axillary sentinel nodes in nineteen patients. The intra-operative identification rate was 80%. Internal mammary metastases were found in seventeen patients and metastases in other non-axillary sentinel nodes in ten patients. Staging improved in 13% of patients with non-axillary sentinel lymph nodes and their treatment strategy was changed in 17%. A small proportion of clinically node negative breast cancer patients can be staged more precisely by biopsy of sentinel nodes outside level I and II of the axilla, resulting in additional decision criteria for postoperative regional or systemic therapy.
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Sentinel node biopsy is a minimally invasive but accurate way of staging the axilla such that as many as 50% of women with primary breast cancer could avoid axillary clearance and the morbidity this carries with it. The methodology has yet to be perfected but identification of the sentinel node(s) with either dye or isotope, or with a combination of these, is a robust technique that is quick to learn and correctly predicts the status of the rest of the axilla in significantly more than 90% of patients. Improvements in the methodology and in patient selection will inevitably make sentinel node biopsy even more accurate. Studies to demonstrate the survival impact of replacing axillary clearance with sentinel node biopsy and selective axillary node treatment are required and are in their early stages.
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For the surgical treatment of osmidrosis with subdermal excision in adolescent patients, immobilization of the axilla after the surgery is very important to prevent hematoma. Skin necrosis may occur when hematoma develops in the axilla after subdermal shaving. However, in case of young patients, they cannot maintain immobilization of the axilla after surgery for a long time, so they are relatively vulnerable to skin necrosis of the axilla due to hematoma after surgery. We used Yogips(R) splint for the dressing in 21 patients from January, 2002 to December, 2002 in our institute to prevent hematoma. The control group was composed of 46 patients only with tie-over dressing after subdermal excision for the dressing. We compared the incidence of hematoma 5 days after the surgery with that of the control group. There was no evident hematoma observed in the patients with Yogips(R) splint, but in case of the control group, hematoma developed in 16 patients of total 46 patients(33%). In this 16 patients with hematoma, 12 patients(75%) were adolescents. In conclusion, the dressing with a Yogips(R) splint seems to be a good method for immobilization of axilla and preventing hematoma after subdermal excision in young patients with osmidrosis.
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SUMMARY Sentinel node biopsy is a minimally invasive but accurate way of staging the axilla such that as many as 50% of women with primary breast cancer could avoid axillary clearance and the morbidity this carries with it. The methodology has yet to be perfected but identification of the sentinel node(s) with either dye or isotope, or with a combination of these, is a robust technique that is quick to learn and correctly predicts the status of the rest of the axilla in significantly more than 90% of patients. Improvements in the methodology and in patient selection will inevitably make sentinel node biopsy even more accurate. Studies to demonstrate the survival impact of replacing axillary clearance with sentinel node biopsy and selective axillary node treatment are required and are in their early stages.
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To find out if the sentinel node can be detected in sufficient numbers of women with breast cancer to be useful as a prognostic sign, whether it reflects that state of the entire axilla, and whether it detects micrometastases that would otherwise be missed. Prospective study. 3 teaching hospitals, Sweden. 75 patients with breast cancer who were listed to have axillary dissection as well as resection of their tumour. Injection of 99Tc nanocolloid 0.4 ml and patent blue dye 1 ml around the tumour or under the skin above the tumour, followed by preoperative lymphoscintigraphy and then identification of the sentinel node during operation either because it had turned blue or with a gamma probe. Removal of the sentinel node and complete axillary dissection. Identification of the sentinel node and presence of metastatic nodes in the axilla. The sentinel node was identified in 69/75 (92%). It correctly predicted the state of the axilla in 66/69 (96%), and detected metastases in 24 of the 27 with invaded nodes in the axilla (89%). The false negative rate was 11%. In 14/27 with axillary metastases (52%) the sentinel node was the only involved node. In 3/24, metastases were detected by immunohistochemistry alone. Biopsy of the sentinel node predicted the presence or absence of axillary metastases with acceptable accuracy. However, before axillary node dissection is rejected in favour of sentinel node biopsy alone, large multicentre studies are needed to establish the true false negative rate.
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