OBJECTIVES: 1) To determine the accuracy rate of sentinel lymph node  biopsy  (SLNB)  by  comparing  frozen  section  (FS)  with permanent formalin processed specimen by hematoxylin and eosin (H&E) staining; 2) To correlate with axillary lymph node dissection (ALND) histopathology results for those with positive SLNB.
METHODS: This  was  a  retrospective  study  on  all  breast  cancer patients  who  underwent  SLNB  using  methylene  blue  dye.  The number of SLN harvested, number of lymph nodes confirmed on frozen section, frozen section result, number of SLN confirmed on paraffin block H&E, result of H&E. If frozen section of SLN was positive for metastasis, further data on the axillary lymph nodes harvested and its final H&E result were noted. The accuracy rate was determined.  Whenever a discordance of FS and H&E findings occurred, the interpreting pathologists were interviewed for the cause.
RESULTS: A total of 34 SLNB procedures were performed. There were 24 SLNBs that turned out negative on frozen section while 10 were positive for metastasis and underwent further ALND. Three of the 24 negative SLNBs turned out to be positive (false negative rate of 12.5%). Out of the 10 positive SLNBs, 1 turned out to be negative (false positive rate of 10%). Only 6 of the 10 patients with (+) SLNB had  more  positive  nodes  harvested  upon  further  ALND.The accuracy rate of SLNB on frozen section was 88%, with sensitivity and  specificity  of  90%  and  87.5%  respectively.  There  were  5 pathologists involved in the interpretations of the SLNB, and in 76% the  pathologist  interpreting  the  FS  was  different  from  the  one interpreting  the  permanent  specimen  H&E.  The  reasons  for discordance between frozen section and final H&E reading were inter-reader variability and tissue sampling limitation during frozen section.
CONCLUSION: The accuracy of frozen section in SLNB procedure is 88%.

Human ; Sentinel Lymph Node Biopsy ; Hematoxylin ; Methylene Blue ; Formaldehyde ; Lymph Nodes ; Axilla ; Lymph Node Excision ; Breast Neoplasms

The objective of the study was to describe the incorporation of breast cancer screening program in the medical curriculum of a medical school and determine its feasibility in finding breast cancer.

METHODS: From school year 2011 - 2012, a 3-hour module that assesses third year medical students' proficiency in clinical breast examination (CBE) was incorporated into the pre-clinical clerkship program at the Cebu Institute of Medicine. The students who have satisfactorily completed the module were invited to participate in the Breast Cancer Control Outreach Program (BCAcop). Pertinent data included: number of participating consultants and students,number of patients seen as well as their demographic and clinical profile, breast cancer cases found.

RESULTS: Four BCAcop were conducted and 6 consultants supervised the medical students in the CBE modules and BCAcop. Seventy seven medical students passed the CBE module and participated in BCAcop. A total of 254 patients with age range of 8 to 80 (mean32 years) attended the lay forum while 246 patients (96.9%) consulted at the on-site breast clinic. Among those examined, 146 patients (59.3%) had essentially normal breasts. Fibrocystic change was the most frequent diagnosis with 49 patients (19.9%), followed by fibroadenoma with 34 patients (13.8%). Six patients (2.4%) were suspected to have breast cancer. Four patients (66.7%) proceeded to have a biopsy and were confirmed. Two patients availed of treatment.

CONCLUSION: Incorporating breast cancer screening program in the medical school curriculum encourages medical students to participate in breast cancer control outreaches where their basic knowledge and skills on clinical breast exam are reinforced with actual patient contact. Furthermore, women with breast cancer are found and offered treatment through this program.

Human ; Fibroadenoma ; Clinical Clerkship ; Early Detection Of Cancer ; Fibrocystic Breast Disease ; Breast ; Breast Neoplasms

OBJECTIVE: To evaluate the quality of life (QoL) after palliative surgery of patients with advanced breast or gastrointestinal malignancies

METHODS: Quality of Life (QoL) of 32 patients with advanced breast or gastrointestinal cancer (Stage IIIB up to Stage IV) was evaluated before surgery (baseline), then 7 and 30 days after surgery using the Medical Outcomes Study Short form (SF-36v2? Questionnaire).Statistical significance of the difference in outcomes was tested using the two-tailed T-test at 95% CI.

RESULTS: Preoperatively, the patients scored poorly (scores below the average mean of 50) in all 8 subscales of the SF-36v2?. Seven days after a palliative surgery, patients showed significant improvement in all subscales except Vitality and Social Functioning.The patients experienced statistically significant changes in quality of life subscale scores on Physical Functioning, Role-Physical, Bodily Pain, General Health, Role Emotional, and Mental Health after surgery. A significant change in all subscales occurred 30 days after surgery compared to the baseline and 7 days post-op.

CONCLUSIONS: While patients with advanced malignancy experienced problems with quality of life preoperatively, they improved postoperatively but not to the level of a normal person.

Human ; Mental Health ; Palliative Care ; Quality Of Life ; Postoperative Period ; Outcome Assessment (health Care) ; Pain ; Gastrointestinal Neoplasms

Objectives: To determine if ultrasound can increase the accuracy of fine needle aspiration biopsy in confirming malignancy in clinically malignant breast masses. Methods: Clinically malignant breast masses underwent ultrasound, fine needle aspiration biopsy/cytology, and tissue biopsy. Accuracy of each test and in combination were calculated using histopathology as gold standard. Results: The accuracy of ultrasound alone was only 67.5% sensitivity of 90.0%, specificity of 33.3%, positive predictive value of 67.2% and negative predictive value of 68.8%, while FNAB alone has an accuracy of 89.2%, sensitivity of 90.0%, specificity of 87.9%, postive predictive value of 91.8%, and negative predictive value of 85.3%. With concordant findings in ultrasound and FNAB, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value are 94.3%, 97.6%, 81.8%, 95.3%, and 90%, respectively. Conclusion: With concordant findings in ultrasound and FNAB, accuracy in confirming malignancy is 94.3%. Key words: breast cancer, breast ultrasonography, fine needle aspiration biopsy/cytology
NOT IDENTIFIED

Objectives: To determine the accuracy of SLNB using methylene blue dye. Methods: Breast cancer patients consulting at the VSMMC Breast Center with biopsy proven adenocarcinoma of the breast, a Tis, T1, T2 or T3 primary breast tumor and clinically negative ipsilateral axilla by palpation and ultrasound, were included in the study. The subjects underwent either modified radical mastectomy or breast conservation theraphy. Subareolar injection of 5 ml 1% methylene blue dye 5 minutes prior to sentinel lymph node biopsy. Three blue staining axillary lymph nodes were taken and sent to pathology for frozen section evaluation and after surgery, H & E staining. A completion axillary lymph node dissection was done in all patients. Accuracy of SLNB using methylene blue was calculated using final histopathology results as gold standard. Results: Twent patients were included in this study. SLNB in this group had an accuracy, sensitivity, specificity, PPV, and NPV of 95.0% 83.3%, 100%, 100%, and 93.3%, respectively. The false negative rate is 6.7%. On the average, the SLN's were identified in 14 minutes. Conclusion: Sentinel lymph node dissection with methylene blue has an accuracy of 95% in the VSMMC Breast Center. Key words: sentinel lymph node biopsy, methylene blue dye, breast cancer
Human ; Female ; SENTINEL LYMPH NODE BIOPSY

Objective: To determine if early discharge after mastectomy is a safe alternative to the standard duration of postoperative hospital confinement. Methods: This is a review of breast cancer patients who were discharged early after mastectomy consulting at the breast center at the Vicente Sotto Memorial Medical Center from May 2007-May 2010. The following variables were recorded: date of surgery, date of discharge, presence of surgical site morbidities such as infection, dehiscence, necrosis and significant pain, date of 1st drain removal, date of 2nd drain removal, presence of seroma, application of elastic bandage. Results: Of the 60 patients: 43 (71.7%) were from CVGH Breast Specialty Clinic and 17 (28.3%) from VSMMC Breast Clinic. There were 9 patients (15%) who developed surgical site morbidities, namely: infection -3 (5.0%), minimal partial wound dehiscence -4 (6.7%), superficial skin necrosis -2 (3.3%). No patient complained of significant pain on follow-up. The first drain was removed within a mean of 6 days. The second drain was removed a mean of 7 days. Fifteen patients (25%) developed seroma. There was no readmission due to morbidities. Conclusion: Early discharge after mastectomy is a safe alternative to the standard duration of postoperative hospital confinement. Key words: mastectomy, postoperative pain
Human ; MASTECTOMY ; PAIN, POSTOPERATIVE

INTRODUCTION: The VSMMC Breast Center actively promotes the practice of monthly breast self-examination and annual clinical breast examination to aid in the early detection of breast cancer. The object of this study was to determine the performance outcome (proportion of participants who passed) on the technical aspect of the proficiency in clinical breast examination (ProCBE) module at the Vicente Sotto Memorial Medical Center.

METHODS: The study is a retrospective analytical review designed to evaluate the proficiency in clinical breast examination program (ProCBE) done at VSMMC Breast Center. The participants' skills on the technical aspect (Position, perimeter/pattern and palpation/ pressure) were evaluated through a return demonstration. Testing the difference between proportion using z-test was used for statistical analysis.

RESULTS: One hundred fifty-two participants were included in the ProCBE class which included medical doctors, medical interns, and registered nurses. In the positioning station, 87.3%, 86.4%, and 80.4% of doctors, interns, and nurses passed. In the primeter/ pattern station, 97.5%, 90.9% and 66.7% of doctors, interns and nurses passed. In the palpation/pressure station, 54.4%, 50.0% and 66.7% of doctors, interns, and nurses passed the module.

CONCLUSION: Overall, 43.0%, 27.3% and 29.4% of doctors, interns, and nurses passed the technical aspect of the proficiency in clinical breast examination module, respectively.

Human ; Breast Neoplasms

OBJECTIVE: To determine the accuracy of core needle biopsy (CNB) in the diagnosis of breast cancer at Vicente Sotto Memorial Medical Center (VSMMC).

METHODS: Records of all patients who underwent both CNB and were retrieved. A 2x2 table, using final histopathological reports as gold standard was constructed to calculate the sensitivity, specificity, predictive values and accuracy of CNB.

RESULTS: Of the 84 patients who were included in the study, 71 were positive result. Sensitivity of CNB in this institution was 94.6% specificity was 90%, while positive and negative values were 98.6% and 69.2% respectively. Overall accuracy was 94%.

CONCLUSION: The accuracy rate of core needle biopsy at VSMMC is 94% comparable to reports from other centers abroad.

Human ; Biopsy, Large-core Needle ; Sensitivity And Specificity ; Breast Neoplasms