The Comparison of Total Drain Volume In Post MRM Patient Using Songket Design And Tewart Design At Dr. Mohammad Hoesin Hospital Palembang

ABSTRACTBackground: In 2018, breast cancer was the most common malignancies in women. Which mainmodality for the management is surgery. The most frequently-used incision design is Stewartincision. Its disadvantages were difficult to access axillary, surgical scar, lateral ear dog and theloss of anterior axillary fold. Another design used is Songket design which consists of crescentincision, rule of half buried mixed mattress suture technique and axillary anker suture. This studyaims were to compare the total drain volume of post-MRM breast cancer patients between Songketand Stewart incision design.Method: Clinical randomized control trial (cRCT) research is the most robust design forevaluating the interventions used. Samples were all post-Modified Radical Mastectomy CaMammae patients with Songket and Stewart incision design who were hospitalized in theDepartment of Surgery at Dr. Mohammad Hoesin Hospital Palembang in the time of June -November 2019. The inclusion criteria were Ca Mammae patients who underwent the procedureand agreed to participate for this study. The patients who had post-operative wound dehiscence,under-documented drains, or the history of axillary lymph node surgery were excluded from this study.Results: Total drain volume for post-MRM using Stewart incision was 613.85 ± 215.93 ml, whileSongket Incision stood was 116.15 ± 139.95 ml. The mean age of the study subjects was 48.69 ±9.57. BMI was 23.65 ± 3.51 on average. Total drain volume of Stewart incision design was 497.7± 75.98 higher than Songket incision design.Conclusion: There was found significant difference in total drain volume between the two groupswith p value of <0.001.

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Comparison of the Effectiveness of Full Negative Pressure with Half Negative Pressure on Suction Drain in Reducing Post-Modified Radical Mastectomy Seroma

Sriwijaya Journal of Surgery ◽

10.37275/sjs.v2i2.18 ◽

2019 ◽

Vol 2 (2) ◽

pp. 24-31

Author(s):

Gulraj Singh ◽

Mulawan Umar ◽

Nur Qodir

Keyword(s):

Breast Cancer ◽

Negative Pressure ◽

Radical Mastectomy ◽

Control Group ◽

Breast Cancer Patients ◽

Modified Radical Mastectomy ◽

Pressure Groups ◽

Suction Drain ◽

Significant Difference ◽

June July

Abstract Introduction: Modified radical mastectomy (MRM) is a breast cancer treatment option that is still operable. One of the postoperative complications that can be found is the formation of seroma. High negative suction drain is done to treat seroma after surgery but it can contribute to increase the length of stay in hospital. Methods: This study was a clinical randomized control trial (cRCT) conducted on 30 breast cancer patients in June - July 2019 at Moehammad Hoesin Hospital in Palembang. This study divided the two sample groups, each group consisting of 15 patients. One group was given half negative pressure on suction drain (experimental group) and the other used full negative pressure on suction drain (control group). Results: There was a significant difference (p <0.005) between the full and half negative pressure groups where there were more seroma events in the full vacuum group in 9 (60%) cases and half vacuum in 2 (30%) but there were no significant differences in long period of stay (p> 0.005). Conclusion: Half negative pressure is more effective in treating seroma than full negative pressure.

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EARLY COMPLICATIONS AFTER RADICAL OPERATIONS IN BREAST CANCER PATIENTS

EUREKA Health Sciences ◽

10.21303/2504-5679.2020.001119 ◽

2020 ◽

Vol 1 ◽

pp. 3-9

Author(s):

Yuri Vinnyk ◽

Vadym Vlasenko ◽

Anna Baranova

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Wound Infection ◽

Cancer Patients ◽

Lymph Node Dissection ◽

Early Period ◽

Radical Mastectomy ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Node Dissection

Breast cancer is one of the most common malignancies in women. In many cases, a major component of complex treatment for breast cancer is surgery - radical mastectomy or radical breast resection. The aim of the work – to investigate the frequency and structure of complications after radical surgery with dissection of axillary lymph nodes in breast cancer patients. Material and methods. The baseline and surgical results of 147 women with breast cancer who underwent radical mastectomy or radical breast resection with lymph node dissection were analysed. Results. Complications in the early period after surgery for breast cancer were found in 76 (51.7 %), including postoperative extremity edema in 60 (40.8 %); lymphorrhea – in 37 (25.2 %), seroma – in 33 (22.4 %); wound infection in 18 (12.2 %), necrosis of the wound edges – in 15 (10.2 %) patients. Correlation of postoperative edema with almost all other complications was found, lymphorrhea and seroma were most associated with swelling and with each other; necrosis of edges with postoperative edema. Wound infection was significantly associated with lymphorrhea. Patients' age, stage of disease, and immunohistochemical type of tumour did not affect the development of complications. With increasing BMI, the incidence of complications increased significantly (χ2=9.530; p=0.009). The tendency to decrease the frequency of complications during reconstructive surgery was revealed (42.6 % versus 58.1 %, p=0.064), and adjuvant radiotherapy, on the contrary, contributed to the increase of complications (57.8 % versus 43.8 %, p=0.090). Conclusion. Radical operations with lymph node dissection in patients with breast cancer are characterized by a high frequency of early postoperative complications, mainly associated with disorders of lymphatic outflow, which indicates the need for a set of measures of preoperative preparation, improvement of surgical technique.

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Role of axillary reverse mapping in decreasing complications after axillary dissection in breast cancer

International Surgery Journal ◽

10.18203/2349-2902.isj20173204 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2397 ◽

Cited By ~ 1

Author(s):

Ahmed Gaber ◽

Ahmed Fawzy ◽

Ahmed Sabry ◽

Alaa El sisi

Keyword(s):

Breast Cancer ◽

Radical Mastectomy ◽

Controlled Study ◽

Blue Dye ◽

Axillary Lymph ◽

Axillary Reverse Mapping ◽

Significant Difference ◽

Complications Rate ◽

And Control ◽

Reverse Mapping

Background: Breast cancer is one of the most leading causes of cancer deaths in female. Surgical treatment is considered the corner stone in its management. Axillary lymph node dissection (ALND) is an integral step in most of surgeries done, however it has many morbidities like prolonged seroma and lymphedema. Axillary reverse mapping (ARM) procedure was first described in 2007 in a trial to map the axillary lymphatics of the arm and avoid its injury therefore lymph complications.Methods: A prospective, randomized, controlled study over 72 female patients who underwent modified radical mastectomy (MRM). Patients were divided and randomized into study and control groups, thirty-six patients for each. In study group the ARM procedure was done by injecting 2.5 ml of methylen blue dye intra-dermally and subcutaneously in the upper inner ipsilateral arm along the medial intramuscular groove before ALND. Operative and post-operative results were recorded. Follow up was 6 to 24 months.Results: ARM procedure and successful visualization of arm lymphatics was achieved in 31 patients (86.1%). Statistically there was no significant difference between the two groups regarding patient and tumour characteristics, operative time and number of excised L.Ns. There was significant difference favouring the ARM group in decreasing the incidence of seroma (p= 0.040), lymphedema (p= 0.031) and time passed till remove drains (p <0.001).Conclusions: ARM procedure facilitated arm lymphatics visualization. It is easy non-time-consuming procedure. It resulted in significant reduction in incidence of seroma and lymphedema, with considerable reduction in the overall complications rate.

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Dosimetric Comparison of Three Radiotherapy Techniques in Irradiation of Left-Sided Breast Cancer Patients after Radical Mastectomy

BioMed Research International ◽

10.1155/2020/7131590 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Jian Hu ◽

Guang Han ◽

Yu Lei ◽

Ximing Xu ◽

Wei Ge ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Volumetric Modulated Arc Therapy ◽

Intensity Modulated Radiation Therapy ◽

Radical Mastectomy ◽

Target Volume ◽

Conformity Index ◽

Breast Cancer Patients ◽

Ipsilateral Lung ◽

Significant Difference

Introduction. This study is aimed at evaluating the dosimetric differences among target segmented planning (TSP), conventional 9-field intensity modulated radiation therapy (9FIMRT) planning, and volumetric modulated arc therapy (VMAT) planning for postmastectomy radiotherapy of left-sided breast cancer patients. Material and Methods. Fifteen left-sided breast cancer patients who underwent radical mastectomy were enrolled. In TSP, the planning target volume (PTV) was divided into four regions (supra/infraclavicular, chest wall, external mammary region, and internal mammary region), and each individual PTV region was treated with respective fixed fields. Results. The VMAT plans showed superior to PTV dose conformity index (CI), homogeneity index (HI), protection of the ipsilateral lung, monitor units (MUs), and maximum dose (Dmax) to the contralateral breast compared with TSP and 9FIMRT plans. The TSP provided better protection for Dmean of the heart and left ventricle (p<0.05). A dose for left anterior descending artery from the three techniques had no significant difference. Compared with the 9FIMRT plans, the V5Gy (%) and V10Gy (%) for the ipsilateral lung were significantly reduced with TSP and VMAT (p<0.05). The V5Gy (%) and V10Gy (%) for the ipsilateral lung turned out to be similar between VMAT and TSP techniques. Conclusions. Our study indicates that VMAT should be a better choice of radiotherapy for left-sided breast cancer patients after radical mastectomy. If VMAT is unavailable, 9FIMRT can achieve better CI and HI values and be more MU-efficient compared with TSP; however, TSP can effectively reduce the low dose volume of the ipsilateral lungs and heart.

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Cytokeratin on Frozen Sections of Sentinel Node May Spare Breast Cancer Patients Secondary Axillary Surgery

Pathology Research International ◽

10.1155/2012/802184 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Elisabeth Specht Stovgaard ◽

Tove Filtenborg Tvedskov ◽

Anne Vibeke Lænkholm ◽

Eva Balslev

Keyword(s):

Breast Cancer ◽

Sentinel Node ◽

Predictive Value ◽

Frozen Section ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Frozen Sections ◽

Paraffin Sections ◽

Significant Difference ◽

Diagnostic Values

Background. The feasibility and accuracy of immunohistochemistry (IHC) on frozen sections, when assessing sentinel node (SN) status intraoperatively in breast cancer, is a matter of continuing discussion. In this study, we compared a center using IHC on frozen section with a center not using this method with focus on intraoperative diagnostic values. Material and Methods. Results from 336 patients from the centre using IHC intraoperatively were compared with 343 patients from the center not using IHC on frozen section. Final evaluation on paraffin sections with haematoxylin-eosin (HE) staining supplemented with cytokeratin staining was used as gold standard. Results. Significantly more SN with isolated tumor cells (ITCs) and micrometastases (MICs) were found intraoperatively when using IHC on frozen sections. There was no significant difference in the number of macrometastases (MACs) found intraoperatively. IHC increased the sensitivity, the negative predictive value, and the accuracy of the intraoperative evaluation of SN without decreasing the specificity and positive predictive value of SN evaluation. Conclusions. IHC on frozen section leads to the detection of more ITC and MIC intraoperatively. As axillary lymph node dissection (ALND) is performed routinely in some countries when ITC and MIC are found in the SN, IHC on frozen section provides valuable information that can lead to fewer secondary ALNDs.

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A decision tree to predict four or more positive axillary lymph nodes in breast cancer patients with positive sentinel node biopsy: Determining necessity for regional nodal irradiation in the absence of axillary dissection

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e11540 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e11540-e11540

Author(s):

R. A. Macrorie-Fairweather ◽

K. Albuquerque ◽

K. Yao ◽

J. Sinacore

Keyword(s):

Breast Cancer ◽

Decision Tree ◽

Lymph Nodes ◽

Cancer Patients ◽

Axillary Lymph Nodes ◽

P Value ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Regional Nodal Irradiation ◽

Interaction Detection

e11540 Background: Regional nodal irradiation (RNI) is indicated for breast cancer patients with ≥ 4 positive axillary lymph nodes (ALN). The need for RNI is unclear for women with T1–2 tumors and 1–3 positive sentinel lymph nodes (SLN) who don’t undergo axillary lymph node dissection (ALND). In an effort to guide clinician decision-making and potentially spare patients combined toxicities of ALND and radiation, the purpose of this study was to create a decision tree of clinicopathologic variables to predict patients with ≥ 4 positive ALN. Methods: We reviewed the records of 197 women with T1–2 tumors and 1–3 positive SLN. All patients underwent a complete ALND to determine the number of positive ALN. The patients were divided into 2 groups: < 4 or ≥ 4 positive ALN. Ten clinicopathologic predictive variables were identified for analysis: patient age, size of tumor, histological type, tumor grade, number of metastatic SLN, largest SLN metastasis size, detection method, estrogen receptor, Ki67 and lymphovascular invasion (LVI). The analysis used Chi-Square Automatic Interaction Detection (CHAID SPSS), a non-parametric, stepwise “regression tree” analysis, with Bonferroni adjusted p-values to create a decision tree. Results: 141 (72%) patients had < 4 and 56 (28%) had ≥ 4 positive ALN. Three variables were selected into the CHAID tree based upon maximum predictability: LVI, the number of metastatic SLNs, and largest SLN metastasis size. 100% of patients (N=42) had < 4 positive ALN if negative for LVI and had only 1 positive SLN with a metastasis size < 0.2cm (p-value < 0.0432). For patients with LVI (N=77), 13 of 14 (93%) had < 4 positive ALN if the SLN metastasis size was ≤ 0.2cm (p < .0014). The highest prevalence of ≥ 4 positive ALN were patients with LVI and a SLN metastasis size > 0.2cm. Conclusions: The CHAID analysis more accurately predicted patients with < 4 positive ALN compared to those with ≥4. The decision tree provides a new tool for the clinician to determine the necessity for RNI without ALND. No significant financial relationships to disclose.

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Prognostic significance of plasma osteopontin level in breast cancer patients

Forum of Clinical Oncology ◽

10.1515/fco-2015-0005 ◽

2015 ◽

Vol 6 (1) ◽

pp. 27-32

Author(s):

Hanan R. Nassar ◽

Alfred E. Namour ◽

Hanan E. Shafik ◽

Amr S. El Sayed ◽

Samar M. Kamel ◽

...

Keyword(s):

Breast Cancer ◽

Bone Metastasis ◽

Cancer Patients ◽

Biochemical Marker ◽

Menopausal Status ◽

P Value ◽

Breast Cancer Patients ◽

Pathological Type ◽

Significant Difference

Abstract Many studies have demonstrated that osteopontin (OPN) contributes functionally to aggressive behaviour in many tumours including breast cancer. This study aims to investigate its role as a simple biochemical marker easily measured in plasma of breast cancer patients to give an early signal for metastases and to detect its relationship to clinicopathological findings and survival. We measured plasma OPN, CA15.3 and serum alkaline phosphatase (ALP) activity in 55 patients, 28 with early stage breast cancer and 27 with bone metastasis out of whom 20 had metastasis in other sites. The median age at diagnosis for non-metastatic cases was 60 years (range 35-85) and for metastatic cases was 45.5 years (range 32-59). In the non-metastatic group, 78.57% of the patients were histologically graded as grades I and II and 21.43% as grade III tumours. In the metastatic group, 81.48% of the patients had grades I and II and 18.52% had grade III tumours; 54% of patients in the non-metastatic group were at stage II and 46% were at stage III at presentation. All patients of group II had bone metastasis, 33% had liver metastases, 25.9% had lung metastasis and 14.8% had lymph node metastasis. Patients with non-metastatic disease had a median OPN level of 55 ng/ml (range 54-150 ng/l), while those in the metastatic group had a median of 148.0 ng/l (range 56.0-156.0 ng/l), a difference which was statistically significant (P = 0.001). There was no statistically significant difference in the median levels of CA15.3 and ALP between both groups. The median OPN level was significantly higher with serum ALP level above 90, progesterone receptor (PR) status, bone and visceral metastasis. Median OPN was not affected significantly by menopausal status (P-value 0.3), tumour grade (P-value 0.3), estrogen receptor (ER) status (P-value 0.7), pathological type (P-value 0.42) or serum CA15.3 level (P-value 0.6). At the end of 12-year follow-up, 83% of the patients survived (92.3% in the non-metastatic versus 74.1% in the metastatic group). The estimated median survival for the whole study population at 12 years was 13 years (95% CI 8.144-17.856). The estimated median survival was 13 years (95% CI 0) and 12 years (95% CI 4.893-19.11) in patients with median OPN levels of <142 and ≥142, respectively, a difference which was not statistically significant (P = 0.343). No statistically significant difference in overall survival OS was noticed in relation to menopausal status (P = 0.7), pathological type (P = 0.4) and hormone receptor status (P = 0.3). At 6-year follow-up, it was found that OS was affected by the presence of visceral metastasis, tumour grade, serum plasma level of ALP and the serum level of CA15.3 (P = 0.0006, 0.007, 0.001 and 0.03, respectively). However, the presence of bone metastasis did not affect OS (P = 0.6). Osteopontin level can be a simple biochemical marker easily measured in plasma of breast cancer patients to give early signals for metastases, but not a prognostic factor for survival.

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Comparison of diagnostic validity between mitotic activity index and Ki-67 expression as predictor for breast cancer in distant metastasis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192154 ◽

2019 ◽

Vol 7 (6) ◽

pp. 2072

Author(s):

Andreasta Ginting ◽

I. Gede Budhi Setiawan ◽

I. Wayan Sudarsa ◽

I. Gede Raka Widiana

Keyword(s):

Breast Cancer ◽

Mitotic Activity ◽

Distant Metastasis ◽

Activity Index ◽

P Value ◽

Breast Cancer Patients ◽

Ki 67 ◽

Diagnostic Characteristics ◽

Significant Difference ◽

Mitotic Activity Index

Background: One particular cause of death from breast cancer is distant metastasis. In this study, we calculate and compare diagnostic value of Mitotic Activity Index (MAI) and Ki-67 expression in predicting distant metastasis.Methods: Study was conducted in Sanglah Hospital from January 2017 to February 2019. All histopathology results from open biopsy are examined, thus MAI and Ki-67 values were obtained. We divided this into 2 groups: MAI high (≥20/HPF), low (<20/HPF) and Ki-67 high (≥20%) and low (<20%). We compared with distant metastasis event as gold standard, obtained from radiology examination. We count all diagnostic characteristics (sensitivity, specificity, positive and negative predictive value, accuracy, and likelihood ratio). We compared these diagnostic validities from data area under curve (AUC) with p value <0.005 considered to be statistically significant.Results: A total of 173 breast cancer patients were participated in this study, 92 of them had distant metastasis (53.2%) and 81 patients didn’t have any distant metastasis (46.8%). MAI had relative high specificity (82.7%) and Ki-67 had fair sensitivity values (69.6%). There are 0.08 point AUC differences between these two variables. With p value higher than 0.05 (0.06), it can be summarized that these two variables are not different significantly and statistically.Conclusions: There is not any statistically significant difference between these two markers in predicting distant metastasis in breast cancer. We hope other researcher interest into exploring more about these markers and their function.

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Effects of BRCA Germline Mutations on Triple-Negative Breast Cancer Prognosis

Journal of Oncology ◽

10.1155/2020/8545643 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Katarzyna Pogoda ◽

Anna Niwińska ◽

Elżbieta Sarnowska ◽

Dorota Nowakowska ◽

Agnieszka Jagiełło-Gruszfeld ◽

...

Keyword(s):

Breast Cancer ◽

Ovarian Cancer ◽

Cancer Prognosis ◽

Entire Group ◽

Prognostic Impact ◽

Breast Cancer Patients ◽

Mutation Carriers ◽

Significant Difference ◽

History Of

Germline BRCA1 and BRCA2 mutations confer an increased lifetime risk for breast cancer and ovarian cancer. Several studies have investigated prognosis among BRCA1/2 mutation carriers and noncarriers, but the prognostic impact on outcomes of breast cancer patients has not been determined. The aim of this study was to determine the prognosis of TNBC patients with and without BRCA1/2 germline mutation. Among 502 patients diagnosed with TNBC between 2005 and 2008, 124 patients with a strong family history of breast cancer or ovarian cancer as well as TNBC patients diagnosed under 45 years were referred to the Genetic Counseling Unit for genetic counselling and genetic tests. In 30 (24%) of them, the BRCA1/2 mutation was detected (the most common 5382insC in 18 (60%) patients). The median follow-up of the entire group was 60 months. BRCA1/2 mutation carriers were statistically significantly younger at TNBC diagnosis compared with nonmutation patients (41 vs 47 years, respectively). Patients with the BRCA1/2 mutation had smaller tumors (stage I: 47% vs 24.5% in noncarriers), but there was no significant difference in the regional nodal status (58.5–63% with cN0). Contralateral breast cancer developed in 26.5% of BRCA1/2 mutation carriers and in 14% of noncarriers. Other primary cancers were also slightly more common in BRCA1/2 mutation carriers (16.5% vs 9.5%). The performed analysis did not show any significant differences between the groups in recurrence-free survival (p=0.312). There was no significant difference between patients with or without BRCA1/2 mutation as regards overall survival (p=0.649) and the risk of TNBC death (p=0.333). The survival from detection of metastases was similar in two groups (p=0.865). Our study demonstrated that the BRCA1 mutation does not affect TNBC patients’ outcomes.

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Prognosis and non-sentinel lymph node status of the breast cancer patients with micrometastatic sentinel lymph nodes.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.27_suppl.140 ◽

2011 ◽

Vol 29 (27_suppl) ◽

pp. 140-140

Author(s):

M. Takahashi ◽

H. Jinno ◽

T. Hayashida ◽

S. Hirose ◽

M. Mukai ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Cancer Patients ◽

Systemic Therapy ◽

Axillary Lymph Node ◽

Lymph Node Status ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Significant Difference

140 Background: Sentinel lymph node biopsy (SLNB) is a more sensitive and accurate nodal staging procedure than axillary lymph node dissection (ALND). Because of detailed pathologic evaluation in SLNs, more nodal micrometastases have been identified. However, it remains controversial whether to perform ALND for patients with micrometastases in SLNs and their prognostic significance is also a matter of debate. The purpose of this study is to determine the non-sentinel lymph node (NSLN) status and prognosis of the patients with micrometastatic SLNs. Methods: A prospective database of 1,012 clinically node-negative, T1-T2 breast cancer patients, who underwent SLNB from January 2002 to Dec 2010 at Keio University Hospital was analyzed. SLNs were detected using a combined method of isosulfun blue dye and small-sized technetium-99m-labeled tin colloid. Intraoperative frozen examination was performed with hematoxylin and eosin (HE) staining. SLNs, fixed and embedded in paraffin, were additionally diagnosed with HE staining and immunohistochemical (IHC) analysis. Results: Micrometastases in SLNs were found in 69 (6.8%) of 1,012 patients. Thirty eight (55.1%) of 69 patients with micrometastatic SLNs underwent immediate or delayed ALND and revealed no NSLN metastasis. Among 31 (44.9%) patients with micrometastatic SLNs who omitted ALND and axillary radiation therapy, no axillary lymph node recurrence has been observed after a median follow-up of 50 months, although 29 patients (93.5%) in these 31 patients received adjuvant systemic therapy. There is no significant difference in recurrence free survival between the patients with micrometastatic and negative SLNs (98.0% vs. 95.7%, respectively). Conclusions: These date suggested that it may not be necessary to perform ALND for the patients with micrometastatic SLNs and the presence of micrometastases in SLNs may not worsen prognosis with proper systemic therapy.

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