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Marking of axillary lymphatic nodes in breast cancer patients.
Dostálek, Lukáš ; Pavlišta, David (advisor) ; Daneš, Jan (referee) ; Zikán, Michal (referee)
Introduction Axillary dissection has little diagnostic and therapeutic benefit in the node-positive breast cancer patients in whom axillary disease has been completely eradicated after neoadjuvant chemotherapy (ypN0). We sought to assess the efficacy of an algorithm used for the identification of the ypN0 patients consisting of intraoperative evaluation of sentinel and tattooed (initially positive) lymph nodes. Methods Included were T1 and T2 breast cancer patients with one to three positive axillary lymph nodes marked with carbon who were referred for neoadjuvant chemotherapy followed by a surgery. Axillary dissection was performed only in the patients with residual axillary disease after neoadjuvant chemotherapy on ultrasound or with metastases described in the sentinel or tattooed lymph nodes either intraoperatively or in the final histology. Results Out of 62 included initially node-positive patients, 15 (24%) were spared axillary dissection. The detection rate of tattooed lymph node after neoadjuvant chemotherapy was 81%. The ypN0 patients were identified with 91% sensitivity and 38% specificity using ultrasound and intraoperative assessment of both sentinel and tattooed lymph node according to the final histology. Discussion/Conclusion Lymph node marking with carbon dye is a useful and...
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Lymphedema of the upper extremity as a complication after breast tumour curative radiotherapy.
LOUDA, Marek
Lymphedema of the upper extremity is a serious complication after breast cancer treatment. This thesis concerns lymphedema of the upper extremity after a curative treatment for breast cancer. Describes breast cancer therapy, its methods and curative purposes. Explain what sentinel node disection is and what compliactins expect after its removal. Becouse essential part in breast cancer treatment také radiotherapy, thesis intoduces radiation dozes, radiation volums and radiation therapy technique. The goal of this thesis was to evaluate number of lymphedema of the upper extremity at patients after axilary node disection and at patients after sentinel node disection and adjuvant radiation therapy treatment. The explorative question was whether a sentinel node disection reduces origin of lymphedema upper extremity independently on radiation therapy extent and iradiation volum. The metholodgy was based on collecting data of patients with breast cancer tumour from register of oncological patients in Hospital České Budějovice joint stock company. Data were subsequently processed and compared to data obtained from vocational literature.
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Comparing of three histology methods leading to the diagnosis.
DOLEJŠÍ, Lenka
The main aim of this thesis was to compare three methods of histology from both the theoretical analysis to determine the final diagnosis and resulting the level of surgical procedures. I compared the rapid intraoperative biopsy (RPB), dyeing of hematoxylineosin (HE) and immunostaining method (IHC) especailly monoclonal antibody Cytokeratin 7 (CK 7). All of the three methods of histology are being used to examine the sentinel lymph node (SN). The SN is removed to the patients with diagnosed breast cancer. I paid attention to describe individual procedures of the selected methods of histology in the first part of this thesis. I also pointed out the complications during detecting the nodes of the carcinom of breast. And I underlined the advantages of detecting SN, which is nowadays widely supplied to all patients compare to the method of axillary nodes dissection used before. Before the SN detecting method was implemented, there used to be an old method which primarily removed the axillary nodes from each patient after the carcinom of breast had been detected. This quite extensive action caused further complications regarding the deconditioning of the limbs dynamics and swelling. With this respect the patient´s following treatment and recovery went worse. Currently the axillary nodes are being removed only if metastasis in sentinel lymph node was detected. My thesis shows that there were found many more sentinel nodes without metastasis and therefore, these days, there are many patients saved from the dissection of axillary nodes. This is mainly assured by an early detection of carcinoma. The methodical part of my thesis was carried out in the hospital of České Budějovice in the pathological lab (PAO NCB), where I have been employed. This part is divided into pre-analytic, analytic and post-analytic phases. The pre-analytical phase emphasizes the importance of correct biopsy and trasport of its sample to the lab. The analytical phase pays attention to each method individually. I describe all the procedures which each sample must go through before a diagnosis can be done. The post analytical phase summarizes the diagnose itself. In the part of the thesis which is aimed at results, I show statistical evaluations of the whole amount of examined paraffine embedded tissues and sample forms within the period of 2003 2013. There is also intercepted annual grow of IHC since its implementation in 1998 until 2013. I analysed a continual change of primary antibodies used at PAO NCB. I also evaluated my own measured results. In the term from March 2013 to March 2014 I processed altogehter 142 SN, which were removed from proved breast cancer. Each SN was processed through RPB, followed by dyeing through HE and examined with IHC antibody CK 7. There were found 22 metastasis of breast cancer in SN through the rapid intraoperative biopsy, other 16 metastasis were detected through HE staining and another 7 positive results in SN were detected through IHC antibody CK 7. We found altogether 45 positive metastasis in SN. 97 sentinel lymph nodes were negative. According to the processed results we proved that the biggest detection of metastasis in SN was through the method of IHC antibody CK 7. I also analysed the impact of patients´ age regarding the metastasis in SN. I divided the patients into 5 categories according to the age (see graph 5, 6). The largest number of SN positive was in the category 61-70 years of age. In the discussion part I described the evaluation of measured results and pointed out strong changes of RPB, HE and IHC methods which have been processed in the PAO NCB department within the past few years.
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Lymphoscintigraphy {--} the posibility of detection of sentinel lymph node
SVOBODOVÁ, Petra
At present, sentinel node identification through the use of lymphoscintigraphy is one of the standard methods of tumor diagnosis and treatment. The most frequent indications for the sentinel node are breast cancer and malignant melanoma. Lymphoscintigraphy is a noninvasive method enabling imaging lymph flow from the injection site through lymphatic vessels via catchment nodes onwards. In fact, the sentinel node detection method is just a specialized part of the general lymphoscintigraphy. The objective of this thesis was to assess sentinel lymph nodes imaging using lymphoscintigraphy and using agamasonde. I made up a group of 77 patients from the Regional Hospital Kolín as a research sample that underwent the sentinel lymph node detection in the nuclear medicine department. In the cases of breast cancer, the sentinel lymph node was imaged in 95% by using lymphoscintigraphy. Without the possibility of using the gamasonde measurement that figure would be 91%. By combining the both methods the reliability of detection is increased.
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