Abstract:
BACKGROUND:Axillary nodal status is an important prognostic predictor in patients with breast cancer. This study evaluated the sensitivity and specificity of ultrasound-guided core biopsy (Ax US-CB) at detecting axillary nodal metastases in patients with primary breast cancer, thereby determining how often sentinel lymph node biopsy could be avoided in node positive patients. STUDY DESIGN:Records of patients presenting to a breast unit between January 2007 and June 2010 were reviewed retrospectively. Patients who underwent axillary ultrasonography with or without preoperative core biopsy were identified. Sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography and percutaneous biopsy were evaluated. RESULTS:Records of 718 patients were reviewed, with 445 fulfilling inclusion criteria. Forty-seven percent (n = 210/445) had nodal metastases, with 110 detected by Ax US-CB (sensitivity 52.4%, specificity 100%, positive predictive value 100%, negative predictive value 70.1%). Axillary ultrasonography without biopsy had sensitivity and specificity of 54.3% and 97%, respectively. Lymphovascular invasion was an independent predictor of nodal metastases (sensitivity 60.8%, specificity 80%). Ultrasound-guided core biopsy detected more than half of all nodal metastases, sparing more than one-quarter of all breast cancer patients an unnecessary sentinel lymph node biopsy. CONCLUSIONS:Axillary ultrasonography, when combined with core biopsy, is a valuable component of the management of patients with primary breast cancer. Its ability to definitively identify nodal metastases before surgical intervention can greatly facilitate a patient's preoperative integrated treatment plan. In this regard, we believe our study adds considerably to the increasing data, which indicate the benefit of Ax US-CB in the preoperative detection of nodal metastases.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Solon JG,Power C,Al-Azawi D,Duke D,Hill ADdoi
10.1016/j.jamcollsurg.2011.09.024subject
Has Abstractpub_date
2012-01-01 00:00:00pages
12-7issue
1eissn
1072-7515issn
1879-1190pii
S1072-7515(11)01144-6journal_volume
214pub_type
杂志文章abstract:BACKGROUND:Cervical recurrence occurs in up to 30% of patients after surgical treatment for papillary thyroid cancer. This study sought to determine an appropriate algorithm for followup evaluation. STUDY DESIGN:Patients undergoing total thyroidectomy for papillary thyroid cancer were identified. Clinicopathologic dat...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.02.079
更新日期:2007-08-01 00:00:00
abstract:BACKGROUND:Some patients require major leg amputation after lower-extremity prosthetic bypass for graft occlusion or failure of wound healing, despite a patent graft. Amputation above or below the knee was hypothesized to increase susceptibility to prosthetic graft infection in the ipsilateral extremity. STUDY DESIGN:...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2009.01.001
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:In transrectal rigid-hybrid natural orifice translumenal endoscopic sigmoidectomy (trNS), extraction-site laparotomy is avoided, which reduces postoperative pain and improves recovery time. However, current research evaluating anorectal function after trNS is limited. This study aims to evaluate clinical con...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章
doi:10.1016/j.jamcollsurg.2016.04.002
更新日期:2016-08-01 00:00:00
abstract:BACKGROUND:Ovarian hyperstimulation syndrome (OHSS) is one of the most serious complications of ovulation induction by exogenous gonadotropins. The pathophysiologic factors of this syndrome are not well known. Increased capillary permeability causes third space fluid shift, which is responsible for ascites, pleural flu...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-07-01 00:00:00
abstract:BACKGROUND:Recent population-based studies have demonstrated that the use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is associated with a decrease in the rate of common bile duct (CBD) injury. The cost implications of a management strategy involving routine IOC use have not been ad...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(02)01806-9
更新日期:2003-03-01 00:00:00
abstract:BACKGROUND:Although the procedure is generally safe, significant morbidity and even mortality have occurred after laparoscopic donor nephrectomy (LDN). The learning curves for both surgeons and institutions with LDN have not been well delineated, and longterm donor data are not well reported. STUDY DESIGN:A retrospect...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2009.02.060
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:The putative relationship between pancreas divisum and clinical pancreatitis continues to be controversial. Indications for surgical or endoscopic manipulations of the accessory duct ampulla are unclear, and the relative merits of surgical sphincteroplasty, endoscopic sphincterotomy, and accessory duct stent...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1996-07-01 00:00:00
abstract:BACKGROUND:The National Veterans Affairs Surgical Risk Study was designed to collect reliable, valid data on patient risk and outcomes for major surgery in the Veterans Health Administration and to report comparative risk-adjusted postoperative mortality rates for surgical services in Veterans Health Administration. S...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:
更新日期:1997-10-01 00:00:00
abstract:BACKGROUND:The optimal strategy for oncologic sternectomy reconstruction has not been well characterized. We hypothesized that the major factors driving the reconstructive strategy for oncologic sternectomy include the need for skin replacement, extent of the bony sternectomy defect, and status of the internal mammary ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2013.02.014
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND:Immediate reconstruction of perineal defects secondary to abdominoperineal resection (APR) or pelvic exenteration with pedicled flaps decreases postoperative wound complications when compared with direct closure in high-risk patients. Although some authors have been proponents of abdominal-based flaps, here ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2016.06.383
更新日期:2016-10-01 00:00:00
abstract:BACKGROUND:The persistent shortage of transplantable organs remains a critical issue around the world. The purpose of this study was to investigate outcomes, including organ procurement, in trauma patients undergoing resuscitative emergency department thoracotomy (EDT). Our hypothesis was that potential organ donor res...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2010.06.012
更新日期:2010-10-01 00:00:00
abstract:BACKGROUND:The American College of Surgeons maintains that surgical care in the US has not reached optimal safety and quality. This can be driven partially by higher-risk, emergency operations in geriatric patients. We therefore sought to answer 2 questions: First, to what degree does standardized postoperative mortali...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2019.10.018
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:An intraoperative adverse event (iAE) is often directly attributable to the surgeon's technical error and/or suboptimal intraoperative judgment. We aimed to examine the psychological impact of iAEs on surgeons as well as the surgeons' attitude about iAE reporting. STUDY DESIGN:We conducted a web-based cross...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamcollsurg.2016.12.039
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:Protecting future childbearing motivates young women with breast cancer to seek oocyte or embryo cryopreservation. Concerns about delays in cancer treatment may influence patients and practitioners considering these procedures. In this study, we compared timing of chemotherapy in women who underwent ovarian ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2009.08.006
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:Central morbidity and mortality conferences ensure uniform content and more participants but consume work hours in commuting for programs with multiple teaching hospitals. Internet-based televideoconferencing (TVC) technology has the potential to eliminate commuting and expand participation and retain qualit...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamcollsurg.2010.12.002
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:Pancreas transplants are still associated with the highest surgical complication rate of all routinely performed solid organ transplants. To date, the impact of serious surgical complications in the cyclosporine era on perioperative patient morbidity, graft and patient survival, and hospital costs has not be...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(01)00895-x
更新日期:1997-08-01 00:00:00
abstract:BACKGROUND:To evaluate whether abdominal aortic aneurysm (AAA) growth in individual patients can be characterized as continuous or discontinuous (staccato). STUDY DESIGN:From 1996 to 2002, 609 patients presented with unruptured AAAs. Of these, 278 underwent prompt repair and 331 were observed. In this study, we includ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2004.07.031
更新日期:2004-11-01 00:00:00
abstract:BACKGROUND:Emerging literature has supported the safety of nonoperative management of uncomplicated appendicitis. STUDY DESIGN:Patients with emergent, uncomplicated appendicitis were identified by appropriate ICD-9 diagnosis codes in the California Office of Statewide Health Planning and Development database from 1997...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2014.01.003
更新日期:2014-05-01 00:00:00
abstract:BACKGROUND:The aim of this study is to investigate patient-centered quality of life (QOL) outcomes in patients undergoing laparoscopic paraesophageal hernia repair. STUDY DESIGN:We prospectively followed patients who underwent laparoscopic paraesophageal hernia repair between 2009 and 2016. The QOL outcomes were measu...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2017.12.054
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:We recently reported, in a prospective randomized trial, that ultra-staging of patients with colon cancer is associated with significantly improved disease-free survival (DFS) compared with conventional staging. That trial did not control for lymph node (LN) number or adjuvant chemotherapy use. STUDY DESIGN...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章
doi:10.1016/j.jamcollsurg.2015.05.007
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:The prognosis for patients with locally advanced carcinoma of the breast remains poor. This study examines the pathologic evidence of response of the mammary tumor and axillary nodes after preoperative chemotherapy. We sought to determine if there was a relationship between the histologic response and clinic...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1995-03-01 00:00:00
abstract:BACKGROUND:Individuals greater than 60 years old donate an important portion of the organs available for orthotopic liver transplantation (OLT), but use of donors in this age group remains controversial. We hypothesized that proper selection of donors older than age 60 would not disadvantage recipients in terms of pati...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2008.08.009
更新日期:2008-12-01 00:00:00
abstract:BACKGROUND:Dysplastic oral leukoplakia (DOL) has been the index lesion in prevention trials for upper aerodigestive tract squamous cell carcinoma (SCC). Vitamin A derivatives, including 13-cis retinoic acid (13-CRA), have been used to treat DOL and to reduce the risk of subsequent SCC. Results from a trial of 13-CRA in...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s1072-7515(02)01219-x
更新日期:2002-08-01 00:00:00
abstract:BACKGROUND:Direct communication between an aortic prosthesis and the gastrointestinal (GI) tract may present with GI bleeding (aortoenteric fistulas [AEF]) or be incidental to a graft infection (paraprosthetic erosions [PPE]). The purposes of this study were to compare the outcomes of AEF versus PPE and to determine pr...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2008.08.010
更新日期:2008-12-01 00:00:00
abstract:BACKGROUND:The factors important in determining outcome when managing adult blunt splenic injuries continue to be debated. Whether trauma center level designation (Level I versus Level II) affects patient management has not been evaluated. STUDY DESIGN:We conducted a retrospective analysis of prospectively gathered da...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamcollsurg.2003.10.007
更新日期:2004-02-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to determine the overall survival (OS) of patients with resectable gastric cancer treated with preoperative chemoradiation therapy and gastrectomy. STUDY DESIGN:The medical records of patients with gastric adenocarcinoma presenting to our institution (January 1995 to August 201...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.04.004
更新日期:2015-07-01 00:00:00
abstract:BACKGROUND:A low prevalence of high-level clinical studies in the surgical literature has been reported previously. We reviewed a recent sample of surgical publications to assess the current status of clinical research. STUDY DESIGN:A 3-month sample of journal articles in Archives of Surgery, Surgery, and Annals of Su...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.08.013
更新日期:2006-12-01 00:00:00
abstract:BACKGROUND:To gain additional insight into the impact of fatigue on surgery resident proficiency, we set out to quantify its impact on behavioral and neurophysiologic measures. STUDY DESIGN:Simulations were first created using a visio-haptic joystick attached to a surgical instrument (tool) that allows realistic inter...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.03.028
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:Vulvar melanoma is a very rare form of cancer. The purpose of this study was to describe practice patterns for the management of vulvar melanoma. STUDY DESIGN:The National Cancer Data Base was reviewed from 1985 through 1994 for patient reports submitted with a diagnosis of vulvar melanoma. RESULTS:Five hu...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(99)00033-2
更新日期:1999-06-01 00:00:00
abstract:BACKGROUND:We sought to examine our institutional experience (1998 to 2014) with minimally invasive repairs of pectus excavatum (MIRPE). STUDY DESIGN:We conducted a retrospective review and a mailed survey (quality of life assessment). Associations with reoperation due to bar migration and recurrence after bar removal...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.11.020
更新日期:2016-03-01 00:00:00