Abstract:
:Today, sentinel lymph node dissection (SLND) has replaced axillary lymph node dissection (ALND) as standard procedure for staging of the axilla in the treatment of breast cancer. SLND can accurately stage the axilla by removing on average only two lymph nodes. Only in case of metastatic spread to sentinel nodes an ALND is offered. Removing fewer nodes has made more extensive histopathological examinations of the lymph nodes possible and as a consequence more metastases are found. This has resulted in stage migration. Based on data from the nationwide Danish Breast Cancer Cooperative Group (DBCG) database we have estimated the magnitude and therapeutic consequences of this stage migration in Denmark by comparing the distribution of lymph node metastases in breast cancer patients operated in 1993-1996 and 2005-2008; before and after introducing SLND. The proportion of patients having macrometastases was not significantly different in the two periods, whereas the proportion of patients with micrometastases increased significantly from 5.1% to 9.0%. However, the proportion of patients offered adjuvant systemic treatment due to positive nodal status as the only high-risk criterion did only increase from 7.8% to 8.8%, when estimated using today´s criteria for risk-allocation, because nodal status is now less important in risk-allocation. In general, only 15-20% of patients with micrometastases and 10-15% of patients with isolated tumor cells (ITC) in sentinel node have further metastatic spread to non-sentinel nodes (NSN). Thus, the majority of these patients does not benefit from additional ALND but still run the risk of arm morbidity. Based on data from the DBCG database, we have developed two models to predict NSN metastases in breast cancer patients with micrometastases or ITC in the sentinel node. A total number of 304 breast cancer patients with ITC and 1577 patients with micrometastases in sentinel node operated in 2001-2008 with SLND and subsequent ALND were identified in the database. In patients with ITC in sentinel node the risk of NSN metastases was significantly associated with younger age at diagnosis, increasing tumor size and increasing proportion of positive sentinel nodes in a multivariate analysis. If patients were ≥ 40 years at diagnosis with tumor size ≤ 2 cm as well as one or more negative sentinel nodes, NSN metastases were found in only 2%. Omission of ALND in this group would spare 1/3 of patients with ITC in sentinel node for an ALND. In patients with micrometastases in sentinel node the risk of NSN metastases was significantly associated with increasing tumor size, lymphovascular invasion, negative hormone receptor status, location of tumor in the upper lateral quadrant of the breast and increasing proportion of positive sentinel nodes in a multivariate analysis. However, a model based on these traditional prognostic markers could not identify a subgroup of patients with a risk of NSN metastases less than 10%. We then investigated whether the biochemical prognostic markers TIMP-1, Ki67 and HER2 could support the model. In a matched case-control study 25 cases with micrometastases in sentinel node and additional metastatic spread to NSN were compared to 50 matched controls with micrometastases in sentinel node but without NSN metastases. Despite being prognostic markers in breast cancer, we found no significant differences in the expression of these three biochemical markers between patients with and without NSN metastases. Not all NSN metastases will become clinically relevant, making ALND redundant in many breast cancer patients. Accordingly, there is a trend towards omission of ALND in breast cancer patients with minimal metastatic disease in sentinel node. As a result, a tool is needed to identify a group of patients with high risk of recurrence, where ALND should still be offered. In our model a small group of patients with micrometastases had a high risk of NSN metastases on nearly 40%, comparable to patients with macrometastases, indicating that ALND may still be recommended in this subgroup in the future.
journal_name
Dan Med Jjournal_title
Danish medical journalauthors
Tvedskov TFsubject
Has Abstractpub_date
2012-07-01 00:00:00pages
B4475issue
7issn
2245-1919pii
B4475journal_volume
59pub_type
杂志文章,评审abstract:INTRODUCTION:Spontaneous reporting of adverse drug reactions (ADRs) is used for continuous risk-benefit evaluation of marketed pharmaceutical products and for signal detection. The Adverse Drug Event Manager (ADEM) is a service offered to clinicians employed at hospitals in the Capital Region of Denmark. The ADEM assis...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2017-01-01 00:00:00
abstract::Strategies to reduce the burden of blood pressure attributable diseases require knowledge of secular trend in PBP and its determinants. The issues were investigated in the Copenhagen City Heart Study. The design of CCHS is a repeated measures study. Such designs are uniquely suited to studying changes of an outcome an...
journal_title:Danish medical journal
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abstract:INTRODUCTION:The treatment strategy for appendiceal mass is controversial, ranging from operation or image-guided drainage to conservative treatment with or without antibiotics. The aim of this study was to assess the various treatment modalities with respect to complications and treatment failure. METHODS:The analysi...
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更新日期:2014-08-01 00:00:00
abstract:INTRODUCTION:Mechanical restraint and other forms of coercion may be used under certain circumstances at psych-iatric wards. The use of coercion receives considerable focus, yet little is known about its diurnal distribution. We examined the initiation of mechanical restraint, sedative drug administration, physical ret...
journal_title:Danish medical journal
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abstract:INTRODUCTION:Clinical practice does not reflect current clinical guidelines recommending an early multimodal non-surgical treatment for knee and hip osteoarthritis (OA). The purpose of this study was to examine the feasibility of such an initiative (Good Life with osteoArthritis in Denmark (GLA:D) in persons with mild ...
journal_title:Danish medical journal
pub_type: 杂志文章
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更新日期:2012-12-01 00:00:00
abstract::Bariatric surgery (e.g. Roux-en-Y gastric bypass (RYGB)) has proven the most effective way of achieving sustainable weight losses and remission of type 2 diabetes (T2D). Studies indicate that the effectiveness of RYGB is mediated by an altered gastrointestinal tract anatomy, which in particular favours release of the ...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2016-11-01 00:00:00
abstract:INTRODUCTION:Severely painful or dysfunctional destroyed wrists can be reconstructed by fusion, interposition of soft-tissue or by arthroplasty using artificial materials. Total and partial wrist arthroplasty (T/PWA) has been used on a regular basis since the 1960's. The objective of this study was to review the litera...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2014-05-01 00:00:00
abstract:INTRODUCTION:Patients with localised and locally advanced renal cancer experience about 20% recurrence during a five-year follow-up period. The aim of the present study was to report recurrence rates and survival in a Danish population with renal cancer. METHODS:Data on patients diagnosed with renal cell carcinoma (RC...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2016-04-01 00:00:00
abstract:INTRODUCTION:Vitamin D plays an important role in a broad range of organ functions, including the cardiovascular system. Only one study has tested the association between vitamin D deficiency and arrhythmia and it found no association. The aim of the present study was to evaluate the association between vitamin D defic...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2012-09-01 00:00:00
abstract:INTRODUCTION:When patients are transferred from intensive care units (ICUs) to general wards with a tracheostomy in situ, there is a risk of suboptimal care and increased morbidity. The aim of this study was to elucidate the management of patients with a tracheostomy in situ at discharge from the ICU to the ward. MATE...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2012-08-01 00:00:00
abstract:INTRODUCTION:This article presents the treatment results of 320 consecutive patients with malignant haematological diagnoses admitted to a tertiary intensive care unit at a Danish University hospital over a six-year period (2005-2010). With reference to international publications, we describe the development in treatme...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2012-03-01 00:00:00
abstract:INTRODUCTION:Difficult airway management is associated with an increased risk of morbidity and mortality. Several preoperative risk factors associated with airway management difficulties have been proposed; however, no clear guideline for airway assessments exists. We therefore hypothesised that Danish airway assessmen...
journal_title:Danish medical journal
pub_type: 杂志文章,多中心研究
doi:
更新日期:2016-10-01 00:00:00
abstract:INTRODUCTION:The objective was to search the literature with a view to providing a general description of critical illness myopathy/polyneuropathy (CIM/CIP), including its genesis and prevention. Furthermore, it was our aim to determine whether new treatments have occurred in the past five years. MATERIAL AND METHODS:...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2012-10-01 00:00:00
abstract:INTRODUCTION:There is no consensus among hip surgeons in Denmark on how to follow up patients after total hip arthroplasty (THA). Agreement on the need for radiographic examinations is also lacking. The purpose of this study was to evaluate if routine outpatient post-operative radiographs, obtained three and 12 months ...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2013-04-01 00:00:00
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journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2014-02-01 00:00:00
abstract:INTRODUCTION:The Danish Adult Diabetes Database (DADD) annually reports a quality indicator for lipid-lowering treatment of type 2 diabetes mellitus (T2DM) patients. This retrospective cohort study aims to A) investigate the reasons for inadequate or lacking lipid-lowering treatment and to B) assess the validity of the...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2018-09-01 00:00:00
abstract:INTRODUCTION:Total mesorectal excision (TME) is the standard surgical treatment for mid and low rectal cancer. The procedure is performed by open, laparoscopic or robotic approaches. Transanal TME (TaTME) is a new procedure that potentially solves some difficulties in the pelvic part of the dissection. We aimed to eval...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2015-07-01 00:00:00
abstract:INTRODUCTION:Hemithyroidectomy for benign thyroid disease has traditionally been considered an inpatient procedure due to concerns about post-operative complications, in particular the risk of post-thyroidectomy bleeding (PTB). Hemithyroidectomy in an outpatient setting has not yet been evaluated in a Danish context. T...
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doi:
更新日期:2020-09-29 00:00:00
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journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2018-05-01 00:00:00
abstract::Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by pain, swelling and progressive destruction of the joints leading to loss of function and invalidity. The bone destruction in RA is characterised by two distinct features: structural joint damage and hand bone loss, and their prevention is an im...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2018-03-01 00:00:00
abstract::Ischemia-reperfusion injuries occur when the blood supply to an organ or tissue is temporarily cut-off and then restored. Even though the restoration of blood flow is absolutely essential in preventing tissue death, the reperfusion of oxygenated blood to the oxygen-deprived areas may in itself augment the tissue damag...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2015-04-01 00:00:00
abstract:INTRODUCTION:Our aim was to study the association between pregnant women's referral status for occupational risk assessment, and their risk of preterm delivery (< 37 weeks), low birth weight (LBW) (< 2,500 g) and small for gestational age (SGA). METHODS:In a cohort study, 1,202 deliveries among pregnant women referred...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2015-08-01 00:00:00
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journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2015-03-01 00:00:00
abstract:INTRODUCTION:Psychiatric disorders are common among patients with irritable bowel syndrome (IBS) which may make a psychiatric evaluation appropriate. The Hospital Anxiety and Depression Scale (HADS) has been recommended internationally for screening. The Common Mental Disorder Questionnaire (CMDQ) is a novel Danish ins...
journal_title:Danish medical journal
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2014-02-01 00:00:00
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journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2017-07-01 00:00:00
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journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2018-02-01 00:00:00
abstract:INTRODUCTION:Since 1992 the Danish Patient Insurance Association (DPIA) has been receiving claims from patients who had suffered an injury during examination or treatment in Danish healthcare. We have presently collected more than 85,000 patient cases in our database, which we make accessible to research that can promo...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2013-08-01 00:00:00
abstract:INTRODUCTION:Despite rehabilitation programmes offered to all patients with newly diagnosed type 2 diabetes in Denmark, a number of patients either never accomplish good diabetes regulation or the regulation deteriorates with time. Therefore, new approaches are needed. The aim of the present study is to examine whether...
journal_title:Danish medical journal
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2013-12-01 00:00:00
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journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2016-10-01 00:00:00
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journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2020-08-07 00:00:00