ABSTRACT: The aim of this study was to prospectively assess a previously described and independently validated clinicopathological score for counselling and selecting patients for sentinel node biopsy or axillary clearance. The clinicopathological score is based on the size of primary tumour, grade of primary tumour, age of the patient, quadrant of the breast and lymphovascular invasion, which are all independent predictors of lymph node involvement. The clinicopathological score may assist patients to decide if they would benefit from sentinel node biopsy or axillary clearance as a primary procedure.
All patients with invasive breast cancer were counselled for the possible rate of lymph node positivity, need for a second operation and false negative rate for sentinel node biopsy. Based on a previously validated clinicopathological score (Table 1), patients with a score of 10 or below were classed as less likely to have positive lymph nodes and hence were offered for minimally invasive axillary surgery and patients with a score of 11 or above were regarded to have high risk of nodal involvement and were counselled for axillary clearance.
Only 3 of 31 patients in the low score group had axillary metastasis and needed further axillary treatment. The node positivity rate in the low score group was 10% compared to 63% for the high score group.
It is concluded that until pre-operative axillary staging becomes widely available, by using the clinicopathological score for patient's selection for minimally invasive axillary surgery, it may be possible to avoid a second axillary procedure in a large majority of patients.
European Journal of Surgical Oncology 04/2007; 33(2):153-6. · 2.50 Impact Factor
ABSTRACT: Selecting patients for sentinel node biopsy, based on grade and size of the primary tumour, often results in the need for a second operation of axillary clearance since intra-operative pathological assessment of sentinel node is in its evolution at present. It may be possible to refine the clinical criteria to select patients for the type of axillary surgery.
By using a score based on clinicopathological predictors of axillary lymph node involvement, we hypothesise that it may be possible to identify patients at high or low risk of nodal involvement. This information can be used to assist patients to make informed decision regarding risks and benefits of sentinel node biopsy or axillary clearance.
A score was devised based on the clinicopathological variables of 113 patients to assess the likelihood of lymph node positivity. This score was validated on an independent data set of 89 patients who underwent sentinel node biopsy and axillary surgery. Based on the score, patients were divided into two groups, high score and low score groups. For the low score group, lymph node positivity was 18% for the original score and 24% for the validation score. Lymph node positivity rate was 67% for the high score group for the original series and 65% for the validation series of patients.
A clinicopathological scoring system can assist in selecting patients with breast cancer for sentinel node biopsy.
European Journal of Surgical Oncology 01/2007; 32(10):1170-4. · 2.50 Impact Factor
ABSTRACT: The aim of this study was to investigate the feasibility of use of breast pain questionnaire (BPQ), a short, focussed and robustly designed tool to assess severity of mastalgia and its impact on quality of life, in a busy breast clinic. Seventy-four consecutive women completed BPQ prior to their consultation with a Breast Surgeon. Based on the BPQ score, mastalgia was graded as mild (score 0-100) in 26%, moderate (score 101-200) in 59% and severe (score >200) in 15% of patients. In 93% of patients breast pain lasted for more than 5 days and visual analogue score (VAS) was more than 3.5 in 82% of patients. The breast pain was described as mild (12%) discomforting (55%), distressing (22%) excruciating (3%) or horrible (8%). All results are presented as median (interquartile ranges). Out of maximum possible 100, overall pain rating was 17(9-31), percent sensory component was 21(12-33) and percent affective component was 0(0-17). The percent VAS was 60(40-80), percent pain index was 40(40-60) and quality of life score (maximum possible 60) was 20(0-40). Of maximum possible score of 360, total breast pain was 137(99-180). In conclusion BPQ can be used routinely in a busy breast clinic as a quick, user-friendly and reliable tool to assess the degree and severity of breast pain in order to provide an organised approach to the management of mastalgia.
The Breast 09/2006; 15(4):498-502. · 2.49 Impact Factor