Eight predictive models assessing the risk of nonsentinel nodes (nonSN) involvement in patients with breast cancer sentinel node (SN) metastasis were tested in a multiinstitutional setting. Data of 200 consecutive patients with metastatic SNs and axillary lymph node dissection from each of the 5 participating centres were entered into the selected nonSN metastasis predictive tools. There were significant differences between centres in the distribution of most parameters used in the predictive models. There were also significant differences in the proportion of cases classified as having low risk of nonSN metastasis. Each predictive tool used in clinical practice for patient and physician decision on further axillary treatment of SN positive patients may require individual institutional validation; such validation may reveal different predictive tools to be the best in different institutions.
COBISS.SI-ID: 1467003
Dr Zwitter analysed the Dutch survey through the perspective of these four elements: biology, verification, stage migration, and treatment. Defining optimal surgery, radiotherapy, and combinedmodality treatment for nonmetastatic disease is of outmost importance for saving as many lives as possible.
COBISS.SI-ID: 1201787
In our review article, we looked for reports of orbital and/or ocular metastases from the thyroid and found 31 reported cases from 1979 to 2012. The orbit and globe are not common sites for metastatic thyroid carcinomas. At the time of onset of ocular symptoms, the vast majority of patients had a long history of thyroid malignancy and evidence of widely disseminated metastatic disease. Patients with choroidal metastases presented with decreased or blurred vision, eye pain, and flashes in 81%, 5%, and 5% of cases, respectively. The diagnosis of a choroidal tumor was usually based on noninvasive diagnostic techniques such as ultrasonography, transillumination, computer tomography (CT), and/or magnetic resonance imaging (MRI) scanning. (131)I scanning revealed uptake in the orbit in 26% of cases with choroidal and/or orbital papillary or follicular carcinoma. For a metastasis that causes a definitive loss of vision and/or persistent pain, the treatment of choice was enucleation. The other treatment options were brachyradiotherapy using (125)I episcleral radioactive plaque insertion, external beam radiation, (131)I therapy, chemotherapy, and/or targeted therapy with small molecules.
COBISS.SI-ID: 1506939
Better knowledge of the frequency of metastases to different sites might help us to perform the appropriate diagnostic tests before treatment and during the course of the disease. The aim of this study was to determine the frequency of metastases from ATC in different sites as found at autopsy. Altogether, 205 patients were treated for ATC at our institute during the years 19722008. Autopsy was performed in 45 cases (30 females, 15 males; median age 66 years). Altogether, 41 cases (91%) had metastases at autopsy. The most common sites of metastases were the lungs (78%), intrathoracic lymph nodes (58%), neck lymph nodes (51%), pleura (29%), adrenal glands (24%), liver (20%), brain (18%), heart (18%), and retroperitoneal lymph nodes (18%). Less common sites of distant metastases were the pericardium, bones, kidneys, mesentery or peritoneum, skin, pancreas, stomach, diaphragm, pituitary gland, ovary, jejunum, axillary lymph nodes, and gingival mucosa. Both distant and regional metastases were present in 23 cases, while only distant metastases were present in 18 cases. An extensive local infiltration of the primary tumor was found in 76% of the cases. The mean number of metastatic sites was 4.02±2.75. Lung metastases were present in 34 of 38 (89%) of our patients who had distant metastases found at autopsy. Two or more metastatic sites were found at autopsy in 84% of cases.
COBISS.SI-ID: 1507195
Recently, many centers have omitted routine axillary lymph node dissection (ALND) after metastatic sentinel node biopsy in breast cancer. In this study, we aim to develop a novel international multicenter predictive tool to estimate a patient-specific risk of having four or more tumor-positive axillary lymph nodes (ALN) in patients with macrometastatic sentinel node(s) (SN). A series of 675 patients with macrometastatic SN and completion ALND from five European centers were analyzed by logistic regression analysis. A multivariate predictive model was created and validated internally by 367 additional patients and then externally by 760 additional patients from eight different centers. Prevalence of four or more tumor-positive ALN in each center's series (P = 0.010), number of metastatic SNs (P ( 0.0001), number of negative SNs (P = 0.003), histological size of the primary tumor (P = 0.020), and extra-capsular extension of SN metastasis (P ( 0.0001) were included in the predictive model. Our novel international multicenter-based predictive tool reliably estimates the risk of four or more axillary metastases after identifying macrometastatic SN(s) in breast cancer.