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Application of the sentinel node concept in breast cancer surgeryHung, Wai-ka., 熊維嘉. January 2011 (has links)
This thesis consisted a series of sentinel node biopsy (SNB) studies in Chinese
patients to evaluate its impact on the management of breast cancer.
Pilot studies
The first SNB pilot study was performed in 30 patients using the blue dye
technique. Accuracy was verified by axillary lymph node dissection (ALND). The
success rate was 83% and the false-negative rate was 25%. The second pilot study
was performed in 50 patients using combined mapping with isotope and dye. The
success rate was 94% with no false-negative. SNB is shown to be feasible and
accurate in Chinese.
The optimal mapping method
Combined mapping was superior to the blue dye technique. This could be due to
the mapping technique or improved experience. One hundred and twenty-three
women were randomly assigned to either the blue dye or combined mapping.
Combined mapping had a higher success rate than the blue dye technique (100%
versus 86%). False-negative rates were similar (0% versus 4.5%). Combined
mapping is the preferred method.
Accuracy of frozen section (FS)
FS was used intra-operatively to guide the need of ALND. In 260 SNB, FS was
compared to serial section and immuno-histochemical staining. FS detected 53 of
86 patients with SN metastases with a false-negative rate of 38.4%. The
false-negative rates for macro-, micro-metastases and isolated tumour cells (ITC)
were 2.4%, 57.7% and 94.4%. FS was accurate to diagnose macro-metastases but
not micro-metastases and ITC.
Can we skip ALND in SN metastases?
139 patients with SNB and ALND were studied to identify predictive factors for
non-SN metastases. 55 had metastatic SN but 38 (69%) had no residual
metastases in non-SN. Tumours <3 cm, a single metastatic SN, micro-metastases
and absence of extra-capsular spread were significant factors to predict no
residual nodal disease. Non-SN metastases were found in 42%, 19% and 0% when
SN contained macro-, micro-metastases and ITC. Based on risk of non-SN
involvement, ALND is indicated for macro- and micro-metastases but not for
ITC.
Extended indication for ductal carcinoma in situ (DCIS)
SNB may be useful for staging of patients with a pre-operative diagnosis of DCIS
because invasive cancer is not infrequently found on pathological examination of
resected specimens after surgical excision. One hundred and seven patients with
DCIS on core biopsy underwent SNB. Thirty-two patients (29.9%) were upstaged
to invasive cancer and 9 (28.1%) had SN metastases. Performing SNB reduced the
re-operation rate from 29.9% to 1.9%. Palpable mass and radiological mass lesion
were associated with upstage.
Extended indication: Sentinel Node Occult Lesion Localisation (SNOLL)
Radioisotope is used to localise non-palpable breast cancer and SN. Seventy-four
patients with non-palpable breast cancers underwent SNOLL. Radioisotope was
injected into cancer and gamma probe guided breast cancer and SN resection.
Primary cancer was removed in 73 patients (99%) after the first-round excision
and 82% had complete excision. Gamma probe identified SN in 82% and
supplementary blue dye increased SN detection to 97%.
SNB modified the practice of breast cancer surgery. It has a major impact on the
diagnosis, staging and treatment of breast cancer. / published_or_final_version / Surgery / Master / Master of Surgery
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Factors associated with the choice of surgery in breast cancer : a systematic reviewTam, Hin-pong, 譚顯邦 January 2013 (has links)
Background: Patients with early stage breast cancer having more aggressive surgery have been reported by several studies. Some studies from US also reported that there is an increasing trend in the use of mastectomy. A study even showed that there is 150% increase in bilateral mastectomy rate using data from Surveillance, Epidemiology, and End Results registries (SEER). The increasing use of mastectomy leads to the concerns about reasons behind the decision of surgery type. The objective of this literature review is to identify the factors which would affect the choice of surgery. We will make recommendations on guideline, implementation and the use of appropriate surgery, to prevent the unnecessary mastectomy.
Methods: Literature search of articles was conducted using several database including PubMed, MEDLINE and Google Scholar. The keywords used were
“Mastectomy rate” AND “breast cancer”, “Breast surgery choice” AND "factor", “Breast conserving surgery” AND “choice”. The periods were limited to 1990-2013.
Results: Of 4335 articles identified, 11 studies were found to be relevant to the review. These studies were from different countries with different sample sizes, analysis method and study designs. The rate of mastectomy was widely varied across countries. The rate was clearly lower in western countries, such as Canada, UK and US, while in Asia like Hong Kong and Turkey, the rate is much higher. All of the reviewed studies evaluated different factors, which can influence the choice of treatment. These factors can be broadly categorized as demographics, clinical data, body image and sexuality, surgeon and psychological effects. Factors about age, marital status, family history, tumor size, histological type, nodal status, body image, fears of recurrence, further treatment and dying from cancer and surgeons were included in different studies found to have significant effect on individual in decision of surgery type.
Conclusion: Both patient and surgeon play an important role in the selection of surgery. The evidence suggests that reducing unknown bias of surgeons and concerns from patients can help choosing the optimal surgery type. Adequate communication and information are necessary for patient in making the decision on treatment. / published_or_final_version / Public Health / Master / Master of Public Health
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Segurança oncológica no uso de células tronco de origem adiposa e lipofilling na reconstrução mamária após câncer /Rietjens, Mario. January 2012 (has links)
Orientador: Marilza Vieira Cunha Rudge / Coorientador: Jose Ricardo Paciência Rodrigues / Coorientador: Jean Yves Petit / Banca: Gilberto Uemura / Banca: Luiz Henrique Gebrim / Banca: Angelo Gustavo Zucca Mathes / Banca: Luiz Antônio Guimarães Brondi / Resumo: Lipofilling ou enxerto de gordura é uma técnica muito utilizada para corrigir defeitos em qualquer região do corpo humano. O objetivo deste estudo foi analisar a segurança desta técnica para corrigir defeitos de reconstruções mamárias após câncer de mama. Foram analisados 158 pacientes que receberam 194 procedimentos de enxerto de gordura, segundo a técnica de Coleman e realizados por um único cirurgião (MR). 98% das pacientes desta série tinham cirurgia oncológica mamária precedente: conservadora ou mastectomia com reconstrução. A única complicação pós-operatória encontrada nesta série foi a liponecrose associada à mastite em sete casos (3.6%), todos tratados com terapia antibiótica e curativos diários. Nos pacientes com precedente de cirurgia conservadora e tratados com enxerto de gordura, somente quatro (5.9%) apresentaram pequenas alterações na mamografia, simulando alterações benignas. Conclusão: O enxerto gorduroso pode ser uma boa solução para reparar defeitos após reconstrução em pacientes tratados de câncer de mama e pode reduzir indicações de cirurgias maiores, como reconstruções com retalhos miocutâneos. A incidência de complicações pósoperatórias é muito baixa e não ocorrem alterações significativas nas mamografias de seguimento oncológico. Dois pontos ainda não estão elucidados: qual o percentual de gordura que é reabsorvida após o lipofilling e se existe a possibilidade das células-tronco de origem adiposa estimular células neoplásicas a induzirem recidiva local / Abstract: Fat grafting is largely used to correct soft-tissue defects in any region of the human body. This study analysed its safety when the technique is used to correct defects after breast cancer reconstruction. A total of 158 patients who underwent 194 breast fat grafting procedures were analysed. Almost all patients (98%) had a personal history of breast cancer treated with conservative surgery or mastectomy followed by breast reconstruction. In all cases, fat grafting was performed according to the Coleman's technique by a single surgeon. Immediate complications included liponecrosis and infection in seven cases (3.6%) that required only daily dressings and oral antibiotics administration. In cases of fat grafting after conservative surgery, only four patients (5,9%) showed minor alterations in the postoperative mammograms, consisting of the appearance of benign images. Breast fat grafting can be a good solution to repair defects after breast-cancer treatment and reconstruction, and can reduce the indication for more extensive surgeries such as myocutaneous flaps. Postoperative complication rates are very low and there is little alteration in the follow-up mammograms. Two points remain unclear - What is the percentual of the fat is absorbed after grafting and the potential risk of local "domant" tumour cells being stimulated to induce a local recurrence / Doutor
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Biopsychosocial factors in breast cancerDonaghy, Kathleen B. January 1997 (has links)
In the treatment of early stage breast cancer, both mastectomy and lumpectomy followed by radiation therapy have been recognized as having similar survival rates. Increasingly, women are being given the opportunity to choose which of these surgical treatment options they wish to pursue. Decisions tend to be made rather quickly, and some women may later regret their treatment choice. In this study, an instrument (Breast Cancer Treatment Inventory (BCTI)) was developed that identified five primary sources of influence that affect women's breast cancer treatment decisions: cosmetic outcome, preparedness, physician's choice, short-term effects, and long-term effects. Items were generated and refined by oncology professionals and breast cancer survivors, followed by a pilot study conducted with members of a breast cancer support group. The resulting 28-item scale was completed by 139 early stage breast cancer patients. A series of oblique factor analyses yielded a five-factor solution with reliabilities ranging from .66 - .87. Content validity was enhanced by involving oncology experts and women with breast cancer in the item generation procedures. Use of the BCTI may assist women through a methodical and effective decision-making process. The BCTI may also be appropriate for research studiesinvolving the process and prediction of treatment selection since it meets requirements for ease of administration, brevity, reliability, and validity. / Department of Counseling Psychology and Guidance Services
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Segurança oncológica no uso de células tronco de origem adiposa e lipofilling na reconstrução mamária após câncerRietjens, Mario [UNESP] 12 November 2012 (has links) (PDF)
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rietjens_m_dr_botfm.pdf: 3697637 bytes, checksum: f5c127c5ef85b386268af90c2b45484c (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Lipofilling ou enxerto de gordura é uma técnica muito utilizada para corrigir defeitos em qualquer região do corpo humano. O objetivo deste estudo foi analisar a segurança desta técnica para corrigir defeitos de reconstruções mamárias após câncer de mama. Foram analisados 158 pacientes que receberam 194 procedimentos de enxerto de gordura, segundo a técnica de Coleman e realizados por um único cirurgião (MR). 98% das pacientes desta série tinham cirurgia oncológica mamária precedente: conservadora ou mastectomia com reconstrução. A única complicação pós-operatória encontrada nesta série foi a liponecrose associada à mastite em sete casos (3.6%), todos tratados com terapia antibiótica e curativos diários. Nos pacientes com precedente de cirurgia conservadora e tratados com enxerto de gordura, somente quatro (5.9%) apresentaram pequenas alterações na mamografia, simulando alterações benignas. Conclusão: O enxerto gorduroso pode ser uma boa solução para reparar defeitos após reconstrução em pacientes tratados de câncer de mama e pode reduzir indicações de cirurgias maiores, como reconstruções com retalhos miocutâneos. A incidência de complicações pósoperatórias é muito baixa e não ocorrem alterações significativas nas mamografias de seguimento oncológico. Dois pontos ainda não estão elucidados: qual o percentual de gordura que é reabsorvida após o lipofilling e se existe a possibilidade das células-tronco de origem adiposa estimular células neoplásicas a induzirem recidiva local / Fat grafting is largely used to correct soft-tissue defects in any region of the human body. This study analysed its safety when the technique is used to correct defects after breast cancer reconstruction. A total of 158 patients who underwent 194 breast fat grafting procedures were analysed. Almost all patients (98%) had a personal history of breast cancer treated with conservative surgery or mastectomy followed by breast reconstruction. In all cases, fat grafting was performed according to the Coleman’s technique by a single surgeon. Immediate complications included liponecrosis and infection in seven cases (3.6%) that required only daily dressings and oral antibiotics administration. In cases of fat grafting after conservative surgery, only four patients (5,9%) showed minor alterations in the postoperative mammograms, consisting of the appearance of benign images. Breast fat grafting can be a good solution to repair defects after breast-cancer treatment and reconstruction, and can reduce the indication for more extensive surgeries such as myocutaneous flaps. Postoperative complication rates are very low and there is little alteration in the follow-up mammograms. Two points remain unclear – What is the percentual of the fat is absorbed after grafting and the potential risk of local “domant” tumour cells being stimulated to induce a local recurrence
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Reconstrução de mama com TRAM turbinado na perfurante contralateral / Bresat reconstruction with perforator turbocharged TRAMSbalchiero, Juliano Carlos 26 August 2008 (has links)
Orientador: Cesar Cabello dos Santos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T14:18:12Z (GMT). No. of bitstreams: 1
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Previous issue date: 2008 / Resumo: Introdução: O Retalho Miocutâneo Transverso do Músculo Reto Abdominal (TRAM) Pediculado é uma técnica muito utilizada em reconstrução de mama, entretanto em situações em que é necessária a utilização das áreas II e IV do retalho as alternativas são os retalhos bipediculados de maior morbidade ou livres de maior complexidade. O TRAM turbinado com anastomose dos vasos epigástricos inferiores profundos na perfurante contralateral pode ser uma alternativa nestes casos. Objetivos: Apresentamos uma série de pacientes submetidas à reconstrução mamária tardia unilateral, com TRAM pediculado
preservando a musculatura turbinada na perfurante contralateral e avaliado quanto aos resultados, tempo cirúrgico e complicações relacionadas à mama reconstruída e à área doadora.abdominal. Sujeitos e métodos: Durante o período de março de 2005 a abril de 2006, 22 pacientes foram selecionadas para reconstrução mamária tardia unilateral no Serviço de Cirurgia Plástica e Microcirurgia do Instituto Nacional de Câncer no Rio de Janeiro, Hospital do Câncer Unidade I, por apresentarem os seguintes critérios: 1. Grave seqüela produzida pela mastectomia com extensiva perda cutânea associada a alterações tróficas produzidas pela radioterapia 2. Necessidade de utilização das áreas II e IV do retalho abdominal para obtenção de simetria com a mama contralateral. Resultados: A técnica proposta foi realizada em 17 pacientes. A média de tempo de seguimento foi de 11 meses (9 a 18 meses). A média da idade foi de 47,7 (35 a 68 anos) anos e a média do Índice de Massa Corporal foi de 27,31% (18,75% a 31,7%). A porção lateral do músculo reto abdominal do lado pediculado foi preservada em 12 pacientes. Em todos os casos foram incluídas no retalho as áreas II e IV. A média do tempo cirúrgico foi de 7 horas e 15 minutos (de 5 horas e 20 minutos a 9 horas). A média do tempo de hospitalização foi de 8 dias (6 a 10dias). Foram observadas 4 complicações na área doadora abdominal em 3 pacientes, sendo um abaulamento contralateral; duas deiscências de sutura e uma epidermólise das bordas do retalho abdominal e da cicatriz umbilical. Na mama reconstruída foram observadas 3 perdas parciais de 10% em 2 casos e 30% em um caso; e duas liponecroses associadas a perdas parciais. Ocorreu um caso de TVP com embolia pulmonar de evolução favorável. Conclusões: O TRAM turbinado com anastomose microcirúrgica na perfurante contralateral demonstrou ser uma alternativa viável para reconstrução mamária, atingindo resultados satisfatórios na maioria das pacientes e com uma morbidade e tempo cirúrgico aceitáveis / Abstract: Background: The Transverse Rectus Abdominis Miocutaneous (TRAM) Flap is a technique widely used in breast reconstruction, however in situations where it required the use of flap areas II and IV the alternatives are bipedicle flaps or free
flaps of greater morbidity and complexity. The turbocharged TRAM anastomosing the deep inferior epigastric artery and vein with contralateral perforators can be an alternative in these cases. Objective: We present a series of patients undergoing unilateral delayed breast reconstruction with TRAM preserving the muscle turbocharged on contralateral perforator vessels and evaluated on the results, operative time and surgical complications related to the reconstructed breast and abdominal donor site. Patients and methods: During the period March 2005 to April 2006, 22 patients were selected for unilateral delayed breast reconstruction at the Plastic Surgery and Microsurgery Department of the Instituto Nacional de Câncer in Rio de Janeiro, Brazil, Hospital de Câncer I, for present the following criteria: 1. Severe sequelae produced by mastectomy with extensive skin loss associated with trophic skin changes produced by radiotherapy. 2. Need to use the areas II and IV of the abdominal flap for obtaining symmetry with the contralateral breast. Results: The proposed technique was performed on 17 patients. Follow-up ranged from 9 to 18 months (average 11 months). The average patients age was 47.7 years (35 to 68 years) and the average Body Mass Index (BMI) was 27.31% (18.75% to 31.7%). The lateral portion of the rectus muscle was preserved in 12 patients. In all cases were included in the
flap areas II and IV. The average surgical time was 7 hs and 15 min (5hs and 20 minutes to 9 hs). The average period of hospitalization was 8 days (6 to 10 days). There were 4 abdominal donor site complications in 3 patients: One abdominal bulging; two minor suture deiscences and a epidermolysis on the flap edge and umbilical scar. In the reconstructed breast were 3 partial loss of 10% in 2 cases and 30% in one case, and two minor fat necrosis associated with partial losses. There was a case of DVT with pulmonary embolism, with good outcome. Conclusions: The turbocharged TRAM with microsurgical anastomosis in contralateral perforators proved to be an effective alternative to breast reconstruction achieving satisfactory results in the majority of patients and with an acceptable morbidity and surgical time / Mestrado / Ciencias Biomedicas / Mestre em Tocoginecologia
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Pilot study of a survey to identify the prevalence and risk factors for chronic neuropathic pain in women following breast cancer surgeryBokhari, Fozia 08 April 2010 (has links)
Breast cancer is the most common cancer among Canadian women. Chronic neuropathic pain post breast surgery (PPBS), also known as chronic post mastectomy/lumpectomy pain syndrome, is a poorly understood complication posing a significant clinical challenge with major negative impact on patients' quality of life. This study aims to: 1) provide a preliminary determination of the prevalence rate of women who suffer from PPBS; and 2) explore potential risk factors associated with women developing PPBS. This pilot study used a prospective, longitudinal, quantitative survey design, with a demographic questionnaire and the Brief Pain Inventory. Seventeen women were recruited at a breast health clinic in Western Canada; 23.5% developed PPBS. Younger age (≤50 years), more invasive surgery, acute post-operative pain, and less analgesic use at the acute post-operative period, were more commonly found in the women who developed PPBS. Future research is required to confirm the significance of these potential risk factors.
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Pilot study of a survey to identify the prevalence and risk factors for chronic neuropathic pain in women following breast cancer surgeryBokhari, Fozia 08 April 2010 (has links)
Breast cancer is the most common cancer among Canadian women. Chronic neuropathic pain post breast surgery (PPBS), also known as chronic post mastectomy/lumpectomy pain syndrome, is a poorly understood complication posing a significant clinical challenge with major negative impact on patients' quality of life. This study aims to: 1) provide a preliminary determination of the prevalence rate of women who suffer from PPBS; and 2) explore potential risk factors associated with women developing PPBS. This pilot study used a prospective, longitudinal, quantitative survey design, with a demographic questionnaire and the Brief Pain Inventory. Seventeen women were recruited at a breast health clinic in Western Canada; 23.5% developed PPBS. Younger age (≤50 years), more invasive surgery, acute post-operative pain, and less analgesic use at the acute post-operative period, were more commonly found in the women who developed PPBS. Future research is required to confirm the significance of these potential risk factors.
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Die invloed van 'n mastektomie op die man-vrou verhouding : 'n pastorale ondersoekGrobbelaar, Frederik Russouw 09 1900 (has links)
Thesis (MTh)--Stellenbosch University, 1993 / ENGLISH ABSTRACT: Seeing that breast cancer is the most common cancer in women and that it has such a high
incidence that every woman should be aware of it, time has come for the theology, and
especially for pastoral care, to provide some answers on the possible problems that
accompany the illness. Treatment of breast cancer almost always include a degree of
surgical intervention through which part of or a whole breast, and in extreme cases even
the underlying tissue, is being removed. This procedure, to some extent, influences a
woman's experience of her physique which in turn has an effect on the intimate space of
her marriage.
The mastectomy patient may experience that the operation, with all the psychological
affects it has, disturbs her inner life rythm and that results in her relationships also being
pressurised. The crisis of a mastectomy should be handled as a relationship crisis within a
marriage, in which the husband can play an important therapeutic role. The husbands
contribution will be greatly effected by: a) His commitment to the relationship and b)
The correlation between his male identity, his sexuality and his perceptions of the female
physique.
Within the crisis of mastectomy, the woman's body-image should not be separated from
her faith identity and the quality of her marriage - there exists a dynamic interaction
between these three, which means that the handling of the crisis of a mastectomy is
directly dependent on the quality if her loving relationship and on the way in which she
experiences her faith. The faith factor plays an important role in the handling of the
crisis, by creating a distance between the trauma of the loss and the way in which she
experiences her identity.
Pastoral care can play a vital role in the handling of the crisis of a mastectomy by means
of guidance and support, as it proclaims the active presence of God through the marrid
body of Jesus Christ. The husband of the mastectomy patient can, in his therapeutic role,
be guided to be much more sensitive for the emotional needs of his wife, in regard to
aspect of sexuality. This would give her the support she needs and work constructively
towards the goal of healing. / AFRIKAANSE OPSOMMING: Aangesien borskanker die algemeenste kanker onder vroue is en dit sulke geweldige
afmetings aangeneem het dat elke vrou daarmee moet rekening hou, het dit tyd geword dat
die teologie, en met name die pastoraat, ditself ook ten opsigte van die moontlike
problematiek wat daarmee saamgaan, moet verantwoord. Die behandeling van borskanker
behels in die meerderheid van gevalle 'n mate van chirurgiese ingrepe waardeur 'n deel
van of die hele bors, en in ekstreme gevalle ook die onderliggende weefsel, verwyder
word. Hierdie prosedure oefen, in 'n mindere of meerdere mate, 'n invloed op die vrou
se belewing van haar liggaamlikheid uit wat weer na die intieme band van die huwelik kan
deurwerk.
Die mastektomiepasiënt kan ervaar dat die operasie, met al die sielkundige effekte wat dit
inhou, haar innerlike lewensritme versteur sodat die verhoudinge waarin sy leef ook onder
druk geplaas word. Binne die huwelik sou 'n mens dan die krisis van 'n mastektomie as
'n verhoudingskrisis moet hanteer, waarin die eggenoot 'n belangrike terapeutiese funksie
kan vervul. Die man se bydrae word egter deurslaggewend bepaal deur: a) Sy
verbintenis aan die verhouding en b) Die korrelasie tussen sy manlike identiteit,
seksualiteit en die persepsies met betrekking tot die liggaamlikheid van die vrou.
Binne die krisis van 'n mastektomie kan die vrou se liggaamsbeeld nie van haar
geloofsidentiteit en die kwaliteit van haar huwelik losgemaak word nie - hierdie drie staan
in 'n interdinamiese verband en beteken dat die verwerking van die krisis van 'n
mastektomie direk van die kwaliteit van die liefdesverhouding en die ervaring van geloof,
afhang. In die verwerking van die krisis vervul die geloofsfaktor 'n deurslaggewende rol
om afstand tussen die emosionele trauma van die verlies en die ervaring van identiteit te
skep.
Die pastoraat kan 'n belangrike funksie vervul ten opsigte van begeleiding en
ondersteuning in die verwerking van die krisis van 'n mastektomie deurdat dit God se
aktiewe betrokkenheid by die situasie, aan die hand van die liggaamlikheid van Jesus
Christus, verkondig. As terapeut kan die eggenoot begelei word om, op die gebied van
die seksuele, baie sterker op die emosionele behoeftes van die mastektomiepasiënt ingestel te wees, om haar sodoende te ondersteun en in die proses van heling mee te werk.
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