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Vacuum-assisted breast biopsy(VABB) for the diagnosis of nonpalpable breast lesions: results of 600 procedures
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ABSTRACTS
and reduced sensibility to adjuvant therapies, as confirmed by the worse outcome of node-positive patients overexpressing TIMP-1. Vacuum-assisted breast biopsy(VABB) for the diagnosis of nonpalpable breast lesions: results of 600 procedures R. Amadori b , A. Fontana a , A. Sartani a , A. Norsa a , D. Bossi a , A. Gambaroc, R. Biancob, D. Foschia, F. Corsia a Department of Surgery, Luigi Sacco Hospital, University of Milan, Milan b Department of Radiology, Luigi Sacco Hospital, University of Milan, Milan c Department of Oncology Luigi Sacco Hospital, University of Milan, Milan Background: This paper reports the results obtained by the Senology Unit of the Surgery Department of Luigi Sacco Hospital in Milan from November 2005 to October 2009 in order to evaluate VABB efficacy for the diagnosis of non-palpable breast lesions. Materials and Methods: During a period of 48 months, 616 VAAB were performed (563 under stereotactic guidance and 53 under US guidance). 502 patients underwent a VABB after the detection of suspect mammary micro-calcifications, while in 61 patients a parenchymal distortions or mammary nodules were detected. The radiological classification of the lesions was: 4 BIRADS 2 (0.6%), 191 BIRADS 3 (31%), 353 BIRADS 4 (57.3%) and 33 BIRADS 5 (5.4%). The extension of the lesions varies from 0.3 to 9 cm (average 1.42 cm). We used an 11 G needle in 606 procedures (98.4%) and an 8 G needle in 10 patients (1.6%). At the end of the VABB, we placed a radiopaque marker in 384 patients. From October 2007 a cylindrical capsule made of anallergic and hyperechogenic collagen was
associated with the placement of the marker. This clip, linked with a collagen capsule, allowed precise pre-operative localisation of the lesion with an ultrasound scan. Moreover, after performing resection, the removed breast tissue underwent radiography to verify the inclusion of the clip inside the glandular parenchyma. Results: Breast tissue removed with VABB allowed an histological diagnosis in 606 cases (98.4%). The detail was: 273 (44.3%) malignant lesions (B5), 7 (1.1%) lesions suspected of being malignant (B4), 65 (10.6%) lesions of uncertain behaviour (B3), and 261 (42.4%) benign lesions (B2). Only 10 VABB (1.6%) removed an inadequate quantity of breast tissue (B1). A precocious complication, consisting of a post-bioptic haematoma developed in 15 patients (2.4%). 124 patients with a VABB positive for neoplasia or highly suspect underwent a surgical breast resection in our Hospital. We then compared the match between the histological examination (obtained with VABB) and the result of the histological examination of the surgical resection. In 119 cases (96%) the two data matched. Conclusions: Our results confirm how VAAB is an easily reproducible, non-invasive, comfortable and cheap technique for the diagnosis of nonpalpable breast lesions. It allows surgical procedures for the diagnosis of lesions that are often benign (42.4% in our case study) to be avoided. Moreover, if the lesion is a cancer this procedure allows a precise localisation of the original lesion. This is the most important factor for successful excision of a non-palpable malignant mammary lesion: it allows the goal of oncologically correct surgical radicality to be reached, obtaining at the same time a fulfilling aesthetic result, thanks to the noninvasive character of the operation and the conservation of mammary parenchyma.
Esophageal and Gastric Cancer Surgical outcome of gastric cancer: 508 cases experience Ljevin Boglione, Luca Pomba, Mauro Garino, Gian Ruggero Fronda Azienda Ospedaliero-Universitaria San Giovanni Battista di Torino SC Chirurgia Generale, Dir. Prof Gian Ruggero, C.so A.M.Dogliotti 14, 10126 Torino, Fronda Background: Gastric cancer is one of the most common cancers in Europe, ranking fifth, and is the fourth most common cause of death. Management still remains controversial. We report our experience. Material and Methods: Patients suffering from gastric cancer were treated according to the Japanese Gastric Cancer Treatment Guidelines (2002) and staged with the 6th edition of the TNM staging system and the 2nd English edition of the Japanese Classification of Gastric Carcinoma. Kaplan-Meier analysis was used to estimate survival. Results: 508 patients were treated from November 1993 to December 2009: 111 early gastric cancers and 393 advanced were found. We performed 273 subtotal gastrectomy, 194 total gastrectomy (204 D1, 248 D2, 13 D3), 31 surgical palliations. Splenectomy was performed in 120 cases, splenopancreasectomy in 18 and pancreasectomy in 18. Resection of other organs was performed in 20 cases. Gallbladder was always removed. According to the TNM classification we found: 12 stage 0 (2.4%), 75 stage IA (14.9%), 77 stage IB (15.3%), 90 stage II (17.9%), 62 stage IIIA (12.3%), 19 stage IIIB (3.8 %) and 169 stage IV (33.5%). According to Japanese classification: 9 stage 0 (1.8%), 78 stage IA (15.5%), 75 stage IB (14.9%), 91 stage II (18.1%), 65 stage IIIA (12.9%), 26 stage IIIB (5.2%), 160 stage IV (31.7%). Morbidity was 11.0 % with no statistical difference between D1 (10.8%) and D2 (11.7%). Mortality was 4.1% (D1: 5.9%, D2: 2.5%, D3: 7.7%). For 370 patients we reported a five-year follow-up. The global five-year survival rate was 41.5%: 91.0% for ECG and 26.6% for AGC. According to JGCA, survival in 2 resections: 100% for stage IA, 91.3% for stage IB; 72.2% for stage II; 33.3% for stage IIIA; 0% for IIIB and 7.1% IV. Conclusions: In our series morbidity, mortality and five-year survival rate are similar to those reported in the literature. In stages IA, IB, II with D2 lymphadenectomy we have reached even better results.
Timing of surgery after neoadjuvant chemo-radiotherapy for oesophageal cancer of the thoracic oesophagus M. Cagol a , A. Ruol b , C. Castoro a , R. Alfieri a , G. Zanchettin b , S. Mantoanb, L. Facciob, E. Anconab a Surgical Oncology, Istituto Oncologico Veneto, IOV-IRCCS, Padova, Italy b Clinica Chirurgica I, Department of Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy Background: Neoadjuvant chemoradiotherapy followed by surgery is the standard treatment for locally advanced cancer of the thoracic oesophagus. Oesophagectomy is usually performed within 30e60 days of completion of neoadjuvant treatment. Moreover, the optimal timing of surgery is still unknown. Aim of the present study is to evaluate if the timing of surgery after completion of neoadjuvant chemoradiation affects postoperative outcome and prognosis in patients with squamous cell carcinoma (SCC) of the thoracic oesophagus. Materials and Methods: 129 consecutive patients with SCC of the thoracic oesophagus, treated with neoadjuvant chemoradiotherapy and surgery between 1998 and 2007, were examined. The relationships between the timing of surgery after completion of chemoradiotherapy and outcomes were evaluated. Patients were divided into three groups: Group 1, timing to surgery < 30 days (n¼17); Group 2, 31e60 days (n¼83); Group 3, 61e90 days (n¼29). Another analysis was done dividing patients in two groups using the median value of timing intervals (46 days) as a cut-off level: Group A, < 46 days (n¼66); Group B, > 46 days (n¼63). Results: There were no significant differences in terms of type of neoadjuvant regimen among groups. Postoperative morbidity rates, tumour downstaging and pathological complete responses were comparable. The analysis of the three groups of patients showed that the overall four-year survival was 15.6% in Group 1, 46.9% in Group 2, and 35.9% in Group 3 (p¼0.13). As for patients who underwent complete R0 resection (n¼106), the four-year survival was 19.9% in Group 1, 55.5% in Group 2, and 47.3% in Group 3 (p¼0.18). The rate of tumour recurrence after R0 resection was inversely related to the time interval between completion
ABSTRACTS
and reduced sensibility to adjuvant therapies, as confirmed by the worse outcome of node-positive patients overexpressing TIMP-1. Vacuum-assisted breast biopsy(VABB) for the diagnosis of nonpalpable breast lesions: results of 600 procedures R. Amadori b , A. Fontana a , A. Sartani a , A. Norsa a , D. Bossi a , A. Gambaroc, R. Biancob, D. Foschia, F. Corsia a Department of Surgery, Luigi Sacco Hospital, University of Milan, Milan b Department of Radiology, Luigi Sacco Hospital, University of Milan, Milan c Department of Oncology Luigi Sacco Hospital, University of Milan, Milan Background: This paper reports the results obtained by the Senology Unit of the Surgery Department of Luigi Sacco Hospital in Milan from November 2005 to October 2009 in order to evaluate VABB efficacy for the diagnosis of non-palpable breast lesions. Materials and Methods: During a period of 48 months, 616 VAAB were performed (563 under stereotactic guidance and 53 under US guidance). 502 patients underwent a VABB after the detection of suspect mammary micro-calcifications, while in 61 patients a parenchymal distortions or mammary nodules were detected. The radiological classification of the lesions was: 4 BIRADS 2 (0.6%), 191 BIRADS 3 (31%), 353 BIRADS 4 (57.3%) and 33 BIRADS 5 (5.4%). The extension of the lesions varies from 0.3 to 9 cm (average 1.42 cm). We used an 11 G needle in 606 procedures (98.4%) and an 8 G needle in 10 patients (1.6%). At the end of the VABB, we placed a radiopaque marker in 384 patients. From October 2007 a cylindrical capsule made of anallergic and hyperechogenic collagen was
associated with the placement of the marker. This clip, linked with a collagen capsule, allowed precise pre-operative localisation of the lesion with an ultrasound scan. Moreover, after performing resection, the removed breast tissue underwent radiography to verify the inclusion of the clip inside the glandular parenchyma. Results: Breast tissue removed with VABB allowed an histological diagnosis in 606 cases (98.4%). The detail was: 273 (44.3%) malignant lesions (B5), 7 (1.1%) lesions suspected of being malignant (B4), 65 (10.6%) lesions of uncertain behaviour (B3), and 261 (42.4%) benign lesions (B2). Only 10 VABB (1.6%) removed an inadequate quantity of breast tissue (B1). A precocious complication, consisting of a post-bioptic haematoma developed in 15 patients (2.4%). 124 patients with a VABB positive for neoplasia or highly suspect underwent a surgical breast resection in our Hospital. We then compared the match between the histological examination (obtained with VABB) and the result of the histological examination of the surgical resection. In 119 cases (96%) the two data matched. Conclusions: Our results confirm how VAAB is an easily reproducible, non-invasive, comfortable and cheap technique for the diagnosis of nonpalpable breast lesions. It allows surgical procedures for the diagnosis of lesions that are often benign (42.4% in our case study) to be avoided. Moreover, if the lesion is a cancer this procedure allows a precise localisation of the original lesion. This is the most important factor for successful excision of a non-palpable malignant mammary lesion: it allows the goal of oncologically correct surgical radicality to be reached, obtaining at the same time a fulfilling aesthetic result, thanks to the noninvasive character of the operation and the conservation of mammary parenchyma.
Esophageal and Gastric Cancer Surgical outcome of gastric cancer: 508 cases experience Ljevin Boglione, Luca Pomba, Mauro Garino, Gian Ruggero Fronda Azienda Ospedaliero-Universitaria San Giovanni Battista di Torino SC Chirurgia Generale, Dir. Prof Gian Ruggero, C.so A.M.Dogliotti 14, 10126 Torino, Fronda Background: Gastric cancer is one of the most common cancers in Europe, ranking fifth, and is the fourth most common cause of death. Management still remains controversial. We report our experience. Material and Methods: Patients suffering from gastric cancer were treated according to the Japanese Gastric Cancer Treatment Guidelines (2002) and staged with the 6th edition of the TNM staging system and the 2nd English edition of the Japanese Classification of Gastric Carcinoma. Kaplan-Meier analysis was used to estimate survival. Results: 508 patients were treated from November 1993 to December 2009: 111 early gastric cancers and 393 advanced were found. We performed 273 subtotal gastrectomy, 194 total gastrectomy (204 D1, 248 D2, 13 D3), 31 surgical palliations. Splenectomy was performed in 120 cases, splenopancreasectomy in 18 and pancreasectomy in 18. Resection of other organs was performed in 20 cases. Gallbladder was always removed. According to the TNM classification we found: 12 stage 0 (2.4%), 75 stage IA (14.9%), 77 stage IB (15.3%), 90 stage II (17.9%), 62 stage IIIA (12.3%), 19 stage IIIB (3.8 %) and 169 stage IV (33.5%). According to Japanese classification: 9 stage 0 (1.8%), 78 stage IA (15.5%), 75 stage IB (14.9%), 91 stage II (18.1%), 65 stage IIIA (12.9%), 26 stage IIIB (5.2%), 160 stage IV (31.7%). Morbidity was 11.0 % with no statistical difference between D1 (10.8%) and D2 (11.7%). Mortality was 4.1% (D1: 5.9%, D2: 2.5%, D3: 7.7%). For 370 patients we reported a five-year follow-up. The global five-year survival rate was 41.5%: 91.0% for ECG and 26.6% for AGC. According to JGCA, survival in 2 resections: 100% for stage IA, 91.3% for stage IB; 72.2% for stage II; 33.3% for stage IIIA; 0% for IIIB and 7.1% IV. Conclusions: In our series morbidity, mortality and five-year survival rate are similar to those reported in the literature. In stages IA, IB, II with D2 lymphadenectomy we have reached even better results.
Timing of surgery after neoadjuvant chemo-radiotherapy for oesophageal cancer of the thoracic oesophagus M. Cagol a , A. Ruol b , C. Castoro a , R. Alfieri a , G. Zanchettin b , S. Mantoanb, L. Facciob, E. Anconab a Surgical Oncology, Istituto Oncologico Veneto, IOV-IRCCS, Padova, Italy b Clinica Chirurgica I, Department of Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy Background: Neoadjuvant chemoradiotherapy followed by surgery is the standard treatment for locally advanced cancer of the thoracic oesophagus. Oesophagectomy is usually performed within 30e60 days of completion of neoadjuvant treatment. Moreover, the optimal timing of surgery is still unknown. Aim of the present study is to evaluate if the timing of surgery after completion of neoadjuvant chemoradiation affects postoperative outcome and prognosis in patients with squamous cell carcinoma (SCC) of the thoracic oesophagus. Materials and Methods: 129 consecutive patients with SCC of the thoracic oesophagus, treated with neoadjuvant chemoradiotherapy and surgery between 1998 and 2007, were examined. The relationships between the timing of surgery after completion of chemoradiotherapy and outcomes were evaluated. Patients were divided into three groups: Group 1, timing to surgery < 30 days (n¼17); Group 2, 31e60 days (n¼83); Group 3, 61e90 days (n¼29). Another analysis was done dividing patients in two groups using the median value of timing intervals (46 days) as a cut-off level: Group A, < 46 days (n¼66); Group B, > 46 days (n¼63). Results: There were no significant differences in terms of type of neoadjuvant regimen among groups. Postoperative morbidity rates, tumour downstaging and pathological complete responses were comparable. The analysis of the three groups of patients showed that the overall four-year survival was 15.6% in Group 1, 46.9% in Group 2, and 35.9% in Group 3 (p¼0.13). As for patients who underwent complete R0 resection (n¼106), the four-year survival was 19.9% in Group 1, 55.5% in Group 2, and 47.3% in Group 3 (p¼0.18). The rate of tumour recurrence after R0 resection was inversely related to the time interval between completion