Allen Hayashi

Treatment of invasive breast carcinoma with ultrasound-guided radiofrequency ablation

BACKGROUND Radiofrequency ablation (RFA) is a minimally invasive thermal ablation technique. This study reports the safety and efficacy of RFA as a minimally invasive strategy for breast cancers <3 cm diameter in postmenopausal women. METHODS Twenty-two postmenopausal women (aged 60 years or older) with clinical T-1N0 core biopsy proven breast cancers were studied. Thermocoagulation was undertaken using a sonographically guided RF probe under local anesthesia and sedation. The ablated tumor was resected between 1 and 2 weeks later. Endpoints were technical success, completeness of tumor kill, marginal clearance, skin damage, and patient reports of pain and procedural acceptability. RESULTS The procedure was well tolerated and cosmesis was excellent. Pathology revealed a central ablation zone surrounded by hyperemia. Coagulative necrosis was complete in 19 of 22 patients. Disease at the ablation zone margin was found in 3 patients and 5 patients had disease distant to the ablation zone consisting of multifocal tumors (2), in-transit metastasis (1), and extensive ductal carcinoma in situ with microinvasive carcinoma (2). Ninety-five percent of patients would be willing to have RFA again. CONCLUSIONS Radiofrequency ablation can be safely applied in an outpatient setting with acceptable patient tolerance. By itself, RFA cannot be considered effective local therapy. Trials to evaluate RFA complemented with breast irradiation are justified.

Axillary dissection versus no axillary dissection in women with invasive breast cancer and sentinel node metastasis

Question: Does a complete axillary lymph node dissection (ALND) affect the overall survival of patients with sentinel lymph node (SLN) metastasis of breast cancer? Design: Randomized controlled trial. Setting: Multicentre trial that included 115 sites. Patients: There were 856 women with clinical T1–T2 invasive breast cancer, with no palpable adenopathy and 1–2 SLNs containing metastases identified histologically. Intervention: All patients underwent lumpectomy and tangential whole-breast irradiation. Those with SLN metastases indentified by sentinel lymph node dissection (SLND) were randomly assigned to undergo ALND or no further axillary treatment. Those assigned to ALND underwent dissection of at least 10 nodes. Main outcome measures: Overall survival, defined as the time from random assignment until death from any cause. The secondary outcome was disease-free survival. Results: Clinical and tumour characteristics were similar among 420 patients assigned to ALND and 436 assigned to SLND alone. The median number of nodes removed was 17 with ALND and 2 with SLND. At a median follow-up of 6.3 years (last follow-up, Mar. 4, 2010), 5-year overall survival was 91.8% (95% confidence interval [CI] 89.1%–94.5%) with ALND and 92.5% (95% CI 90.0%–95.1%) with SLND alone; 5-year disease-free survival was 82.2% (95% CI 78.3%–86.3%) with ALND and 83.9% (95% CI 80.2%–87.9%) with SLND alone. The hazard ratio for treatment-related overall survival was 0.79 (90% CI 0.56–1.11) without adjustment and 0.87 (90% CI 0.62–1.23) after adjusting for age and adjuvant therapy. Conclusion: Among patients with limited SLN metastatic breast cancer treated with breast conservation and systemic therapy, the use of SLNB alone compared with ALND did not result in inferior survival.

Outcomes of sentinel node biopsy for breast cancer in British Columbia, 1996 to 2001

BACKGROUND This study evaluated the outcomes of the first 5 years of sentinel node biopsy (SNB) in British Columbia (BC), Canada, 1996 to 2001. METHODS There were 547 SNB procedures for breast cancer performed by 29 surgeons at 12 hospitals in BC between October 1996 and July 2001. Identification, accuracy, and false-negative rates were determined and correlated to patient, tumor, and surgical factors with the chi-square test. RESULTS SNB mapping was performed using blue dye alone (15%), radiopharmaceutical alone (6%), or both (79%). A completion axillary dissection was performed in 93%. A median of 2 (range 1 to 16) sentinel nodes was biopsied. The overall identification rate was 88%, accuracy was 92%, and false-negative rate was 22%. All rates were improved in younger (age <50 years) compared with older women. A positive lymphoscintiscan and the mapping agent used were associated with higher identification rates but not accuracy or false negative rates. Increasing surgeon experience was not significantly associated with improvements in identification or false-negative rates. CONCLUSIONS The potential of SNB was not fully translated into surgical practice in BC by 2001.

The Quality of Life of Elderly Women Who Underwent Radiofrequency Ablation to Treat Breast Cancer

The purpose of this article is to explore the effects of radiofrequency ablation (RFA), an investigational treatment for breast cancer, on the quality of life of elderly women. For this descriptive phenomenological study, the authors interviewed 12 White women (aged 60-81 years) 4 months to 1 year after treatment and analyzed these interviews for common themes. They asked questions regarding the lived experience of RFA treatment and its effects on quality of life. Analyses focused on the effects of deciding to have the RFA treatment and the treatment itself. They found quality of life improved because the women felt empowered by (a) their decision to have the procedure, (b) knowing that the procedure might kill the tumor, (c) and feeling that they were contributing to cancer research. The level of support received from the medical team, family and friends, and other cancer survivors also improved participant quality of life.

Current management of appendicitis at a community center—how can we improve?

BACKGROUND Controversies regarding the diagnosis and treatment of appendicitis remain. Practices and outcomes at a community center including imaging, timing of surgery, and surgical technique are reported. METHODS From January to July 2006, 134 patients undergoing appendectomy in Victoria, British Columbia, were reviewed. Accuracy of preoperative imaging, time from the emergency room to the operating room, length of stay, and early complications were analyzed. Patients with and without perforation were compared using sample t tests. RESULTS Preoperative computed tomography was obtained for 101 patients (75%) with a negative appendectomy rate of 3% versus 10% for patients without imaging. Imaging did not prolong the time to surgery (11.8 vs 10.9 h, P = .48). Patients with perforation stayed in the hospital significantly longer and had more complications. CONCLUSIONS The liberal use of computed tomography resulted in fewer negative appendectomies without a significant delay to surgery. Patients with perforation had increased complications and longer hospitalizations. Efforts should be made to identify and treat early appendicitis.

The benefits of computed tomographic colonography in reducing a long colonoscopy waiting list.

Purpose The Radiology Department, Royal Jubilee Hospital, Victoria, BC, with the support of gastroenterologists and surgeons, was awarded a BC Innovation fund to run a pilot project of computed tomographic colonography to reduce an unacceptably long 2-year colonoscopy waiting list. Funds were approved in April 2007 for a 1-year project, which was completed on March 31, 2008. Methods This article describes the challenges of delivering a high-volume computed tomographic colonography program at a busy community hospital, with discussion of the results for the 2,005 patients who were examined. Results Colonoscopy was avoided in 1,462 patients whose computed tomographic studies showed no significant lesions. In the remainder of patients, only lesions larger than 5 mm were reported, with a total of 508 lesions identified in 433 patients. There were 57 cancers of which 52 were reported as either definite or possible cancers, whereas 5 were not seen on initial scans. Some of the patients with cancer had been on the colonoscopy waiting list for 2 years. In addition, there were 461 patients with significant extracolonic findings, including 84 who required urgent or semi-urgent further management for previously unsuspected conditions, such as pneumonia, aneurysms larger than 5 cm, and a range of solid renal, hepatic, and pancreatic masses. There were no procedural complications from the computed tomographic colon studies. Conclusions We have shown that it is feasible to run a high volume CTC service in a general hospital given hospital support and funding. The benefits in this group of over 2000 patients included avoidance of colonoscopy in over 70% of patients, detection of significant polyps or cancer in approximately 20% of patients, and identification of clinically important conditions in 7%–18% depending on the definition used. The estimated costs including capital, operating, and professional fees were in the range of

Quality of life of patients who have undergone the Nuss procedure for pectus excavatum: Preliminary findings ☆ ☆☆ ★

400.