| 1. |
- Bergkvist, Leif, et al.
(author)
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Axillary recurrence rate after negative sentinel node biopsy in breast cancer : three-year follow-up of the Swedish Multicenter Cohort Study
- 2008
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In: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 247:1, s. 150-156
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Journal article (peer-reviewed)abstract
- Background: Sentinel lymph node biopsy is an established staging method in early breast cancer. After a negative biopsy, most institutions will not perform a completion axillary dissection. The present study reports the current axillary recurrence (AR) rate, overall and disease-free survival in the Swedish Multicenter Cohort Study.Methods: From 3534 patients with primary breast cancer ≤3 cm prospectively enrolled in the Swedish multicenter cohort study, 2246 with a negative sentinel node biopsy and no further axillary surgery were selected. Follow-up consisted of annual clinical examination and mammography. Twenty-six hospitals and 131 surgeons contributed to patient accrual.Results: After a median follow-up time of 37 months (0-75), the axilla was the sole initial site of recurrence in 13 patients (13 of 2246, 0.6%). In another 7 patients, axillary relapse occurred after or concurrently with a local recurrence in the breast, and in a further 7 cases, it coincided with distant or extra-axillary lymphatic metastases. Thus, a total of 27 ARs were identified (27 of 2246, 1.2%). The overall 5-year survival was 91.6% and disease-free survival 92.1%.Conclusions: This is the first report from a national multicenter study that covers, not only highly specialized institutions but also small community hospitals with just a few procedures per year. Despite this heterogeneous background, the results lie well within the range of AR rates published internationally (0%-3.6%). The sentinel node biopsy procedure seems to be safe in a multicenter setting. Nevertheless, long-term follow-up data should be awaited before firm conclusions are drawn.
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| 2. |
- Bergkvist, Leif
(author)
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Resolving the controversies surrounding lymphatic mapping in breast cancer
- 2008
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In: Future Oncology. - : Future Medicine Ltd. - 1479-6694 .- 1744-8301. ; 4:5, s. 681-688
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Research review (peer-reviewed)abstract
- Sentinel lymph node biopsy has rapidly become the standard of care in the primary treatment of breast cancer. Most of the initially identified potential contra indications towards the procedure, such as nonpalpability, large tumor size, pregnancy and being previously operated in the breast or axilla, have been ruled out, whereas multifocality represents an unsolved problem. There is no consensus about the best use of the technique in patients receiving neoadjuvant treatment. There is no place for sentinel lymph node biopsy in pure ductal carcinoma in situ, but it can be used for large high-grade in situ cancer diagnosed through core biopsy, especially if a mastectomy is planned. Morbidity is low, and the recurrence rates reported so far are reassuring. However, long-term results are lacking, and results from ongoing randomized trials are awaited.
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| 3. |
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| 4. |
- Celebioglu, F., et al.
(author)
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Sentinel node biopsy in non-palpable breast cancer and in patients with a previous diagnostic excision
- 2007
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In: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 33:3, s. 276-280
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Journal article (peer-reviewed)abstract
- Aim: As a means of staging the axilla with minimal surgical trauma, sentinel lymph node biopsy (SNB) has dramatically altered the management of early-stage breast cancer. The aim of this prospective multicentre study was to assess the safety of the method in cases of non-palpable tumours and in cases with an open biopsy prior to SNB. Method: In the period 1999-2001, 57 non-palpable breast cancers and 75 patients with diagnostic biopsy were collected prospectively to the first part of the study. In the second part, 745 patients with non-palpable breast cancers and 86 cases with prior open surgery diagnosed between 2000 and 2005 were followed up till the end of 2005. All patients in the first part of the study had an axillary clearance irrespective of sentinel node status, whereas in the second part axillary clearance was done only if the sentinel node was metastatic. Results: The detection rate was 95% in the group of non-palpable breast cancers, with a false negative rate of 5.6% (1/18), and the corresponding figures for the group with prior intervention were 96% and 10% (2/20). Two axillary recurrences, after a negative SNB at primary surgery, were found in the non-palpable group after 16 and 17 months, respectively. No axillary recurrence has been observed in the group of cancers with a prior open biopsy. Four women in the non-palpable group and two women with a diagnostic operation experienced distant metastases. Conclusion: We conclude that SNB is a safe procedure for women with non-palpable breast cancer, as well as after previous open diagnostic excision.
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| 5. |
- Dahlberg, Leif, et al.
(author)
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Starkt samband övervikt/obesitas och ortopediska åkommor. Fetmaepidemins konsekvenser vidgas.
- 2008
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In: Läkartidningen. - 0023-7205. ; 105:34, s. 2246-2248
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Journal article (peer-reviewed)abstract
- t is well known that overweight/obesity are risk factors for several important conditions of internal medicine. The positive correlation between gonarthrosis and a high BMI is also well investigated. However, the possible correlation between owerweight/obesitas and other orthopaedic conditions are less well studied and are therefore rarely discussed in either medical terms or economical considerations. Objective: To examine the relationship between owerweight/obesity and orthopaedic conditions. Patient BMI was compared with a reference population BMI in two assessments. In one we investigated patients who were diagnosed with ankle fracture in the emergency room (n=79). In the other we investigated outpatients with various orthopaedic conditions (n=647). In both assessments patients were recruited in a consecutive mode. The BMI of the patients with ankle fracture was self reported as were the BMI of the normal population. The outpatients were weighted and measured. Patients with ankle fractures differed significantly from the reference population, (1.92 units (p<0.001). The fracture odds ratio of BMI>30 was 3.46 (p<0.001). Similarly, the outpatients had 1.44 higher BMI units than the references (p<0,001). Odds ratio to become an orthopaedic outpatient if BMI>30 was 2.3 (p<0.001). In both investigations results were age and gender standardised. Both studies indicate that there is a positive correlation between BMI and the risk of sustaining orthopaedic conditions. Although there may be reporting-bias, results seem prominent enough to conclude that orthopaedic conditions may be added to other medical disciplines regarding negative consequences of overweight/obesity and strengthens the need for preventive measures aimed at the epidemic progress of overweight/obesity.
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| 6. |
- de Boniface, Jana, 1971-
(author)
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Sentinel Node Biopsy in Breast Cancer : Clinical and Immunological Aspects
- 2007
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Doctoral thesis (other academic/artistic)abstract
- The most important prognostic factor in breast cancer is the axillary lymph node status. The sentinel node biopsy (SNB) is reported to stage the axilla with an accuracy > 95 % in early breast cancer. Tumour-related perturbation of T-cell function has been observed in patients with malignancies, including breast cancer. The down-regulation of the important T-cell activation molecules CD3-ζ and CD28 may cause T-cell dysfunction, anergy, tolerance and deletion.The expression of CD3-ζ and CD28 was evaluated in 25 sentinel node biopsies. The most pronounced down-regulation was seen in the paracortical area, where the best agreement between both parameters was observed. CD28 expression was significantly more suppressed in CD4+ than in CD8+ T-cells.From the Swedish sentinel node database, 109 patients with breast cancer > 3 cm planned for both SNB and a subsequent axillary dissection were identified. The false negative rate (FNR) was 12.5%. Thirteen cases of tumour multifocality were detected on postoperative pathology. The FNR in this subgroup was higher (30.8%) than in patients with unifocal disease (7.8%; P = 0.012).From the Swedish SNB multicentre cohort trial, 2246 sentinel node-negative patients who had not undergone further axillary surgery were selected for analysis. After a median follow-up time of 37 months (range 0-75), 13 isolated axillary recurrences (13/2246; 0.6%) were found. In another 14 cases, local or distant failure preceded or coincided with axillary relapse (27/2246; 1.2%). In conclusion, the immunological analysis of the sentinel node might provide valuable prognostic information and aid selection of patients for immunotherapy. SNB is encouraged in breast cancer larger than 3 cm, if no multifocal growth pattern is present. The axillary recurrence rate after a negative SNB in Sweden is in accordance with international figures. However, a longer follow-up is mandatory before the true failure rate of the SNB can be determined.
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| 7. |
- Eaker, Sonja, et al.
(author)
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Differences in management of older women influence breast cancer survival : results from a population-based database in Sweden
- 2006
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In: PLoS Medicine. - : Public Library of Science (PLoS). - 1549-1676. ; 3:3, s. e25-
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Journal article (peer-reviewed)abstract
- BACKGROUND: Several reports have shown that less aggressive patterns of diagnostic activity and care are provided to elderly breast carcinoma patients. We sought to investigate whether differences in the management of older women with breast cancer are associated with survival. METHODS AND FINDINGS: In an observational study using a population-based clinical breast cancer register of one health-care region in Sweden, we identified 9,059 women aged 50-84 y diagnosed with primary breast cancer between 1992 and 2002. The 5-y relative survival ratio was estimated for patients classified by age group, diagnostic activity, tumor characteristics, and treatment. The 5-y relative survival for breast cancer patients was lower (up to 13%) in women 70-84 y of age compared to women aged 50-69 y, and the difference was most pronounced in stage IIB-III and in the unstaged. Significant differences in disease management were found, as older women had larger tumors, had fewer nodes examined, and did not receive treatment by radiotherapy or by chemotherapy as often as the younger women. Adjustment for diagnostic activity, tumor characteristics, and treatment diminished the relative excess mortality in stages III and in the unstaged, whereas the excess mortality was only marginally affected in stage IIB. CONCLUSIONS: Less diagnostic activity, less aggressive treatment, and later diagnosis in older women are associated with poorer survival. The large differences in treatment of older women are difficult to explain by co-morbidity alone.
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| 8. |
- Eaker, Sonja, et al.
(author)
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Social differences in breast cancer survival in relation to patient management within a National Health Care System (Sweden)
- 2009
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In: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 124:1, s. 180-187
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Journal article (peer-reviewed)abstract
- Epidemiologic studies have shown that cancer survival is poorer in low compared with high socioeconomic groups. We investigated whether these differences were associated with disparities in tumour characteristics and management. This cohort study was based on 9,908 women aged 20-79 years at diagnosis with primary breast cancer identified in a Swedish population-based clinical register. Information on socioeconomic standing was obtained from a social database. The 5-year cause-specific survival (CSS) and mortality hazard ratios (HR) were estimated by Cox proportional hazard models to assess differences in survival between socioeconomic groups while adjusting for diagnostic intensity, tumour characteristics and treatment. Following adjustment for age, year and stage at diagnosis, the risk of dying of breast cancer was 35% lower among women with high education compared with that of low education (HR = 0.65, 95% CI 0.53-0.80). When compared with women with high education, a lower percentage of women with low education had been investigated for proliferation (84 vs. 76%) or hormone receptor status (89 vs. 81%), had tumours
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| 9. |
- Eklund, Arne, 1957-
(author)
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Laparoscopic or Open Inguinal Hernia Repair - Which is Best for the Patient?
- 2009
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Doctoral thesis (other academic/artistic)abstract
- Inguinal hernia repair is the most common operation in general surgery. Its main challenge is to achieve low recurrence rates. With the introduction of mesh implants, first in open and later in laparoscopic repair, recurrence rates have decreased substantially. Therefore, the focus has been shifted from clinical outcome, such as recurrence, towards patient-experienced endpoints, such as chronic pain. In order to compare the results of open and laparoscopic hernia repair, a randomised multicentre trial - the Swedish Multicentre trial of Inguinal hernia repair by Laparoscopy (SMIL) - was designed by a study group from 11 hospitals. Between November 1996 and August 2000, 1512 men aged 30-70 years with a primary inguinal hernia were randomised to either laparoscopic (TEP, Totally ExtraPeritoneal) or open (Lichtenstein) repair. The primary endpoint was recurrence at five years. Secondary endpoints were short-term results, frequency of chronic pain and a cost analysis including complications and recurrences up to five years after surgery. In total, 1370 patients, 665 in the TEP and 705 in the Lichtenstein group, underwent operation. With 94% of operated patients available for follow-up after 5.1 years, the recurrence rate was 3.5% in the TEP and 1.2% in the Lichtenstein group. Postoperative pain was lower in the TEP group up to 12 weeks after operation, resulting in five days less sick leave and 11 days shorter time to full recovery. Patients in the TEP group had a slightly increased risk of major complications. Chronic pain was reported by 9-11% of patients in the TEP and 19-25% in the Lichtenstein group at the different follow-up points. Hospital costs for TEP were higher than for Lichtenstein, while community costs were lower due to shorter sick leave. By avoiding disposable laparoscopic equipment, the cost for TEP would be almost equal compared with Lichtenstein. In conclusion, both TEP and Lichtenstein repair have advantages and disadvantages for the patient. Depending on local resources and expertise both methods can be used and recommended for primary inguinal hernia repair.
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| 10. |
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