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A Bembenek

Publications and source records attributed to A Bembenek.

27 records · Page 2Linked to original sources
PubMed2000

Specification of potential indications and contraindications of sentinel lymph node biopsy in breast cancer.

The promising results of various studies applying different methods of SN biopsy in heterogeneous patient subpopulations, show that sentinel lymph node biopsy is a reliable and minimally invasive method for the determination of the nodal status in breast cancer patients. While multicenter studies for the evaluation of the method's accuracy are still ongoing, future indications and contraindications are discussed. Based on our own experience, we try to give an actual overview of the potentials and problems of sentinel node biopsy in breast cancer. Sentinel node detection was performed in 146 patients with breast cancer stages I-III, consisting of 127pT1/2 tumors and 19pT3/4. All of them underwent standard axillary dissection after SN biopsy. Using the radionuclide method including preoperative lymphoscintigraphy and intraoperative gamma. Probe detection, the detection rate varied in relation to the tumor size between 94% for tumors with a diameter < 1 cm, 85% (1-3 cm), 70% (3-5 cm) and 63% (> 5 cm). The accuracy of the SN-biopsy in the prediction of the nodal status varied also with tumor diameter ranging from 100% for very small tumors (< 1 cm), over 97% (1-3 cm) and 88% (3-5 cm), to 67% (> 5 cm). In the subgroup of patients with pT1-2 tumors (n = 106), 57 patients (53%) showed true negative sentinel nodes, 38 (36%) revealed tumor cells in the H&E staining and an additional 7 patients (7%) solely in the immunohistochemical staining. 4 (4%) of these patients, all of them from the first half of the study period, underwent false-negative SN-biopsy, all of them showing lymphangiosis carcinomatosa and/or extensive infiltration of the metastatic lymph node(s). The results presented show, that in about 50% of early breast cancer patients surgical intervention could potentially be avoided after a negative SN-biopsy, and an additional 5-10% of conventionally nodal negative patients can be found by immunohistochemical examination of the sentinel node. The SN concept is not recommended in clinically nodal positive patients or advanced disease. Potential applications include the evaluation of parasternal lymph nodes and patients with recurrent tumor. Before clinical application, quality control of the medical center and the performing surgeon have to be established potentially including the performance of about 20 procedures under supervision for each surgeon, an individual accuracy of at least 93%, and the possibility of immunohistochemical staining as well as a regular follow-up.

Adult↗
PubMed2000

Lymph-node dissection in breast cancer.

BACKGROUND: Along with the ongoing modifications in treatment of primary breast cancer, the purpose and extent of lymph-node dissection has changed. The following is an overview of the current knowledge and practice of lymph-node dissection in breast cancer, with special regard to expected developments in the near future. Axillary dissection is described as a ten-step procedure, including dissection of level-I and -II and Rotter's nodes, without level-III nodes, providing at least ten lymph nodes for accurate staging information. DISCUSSION: Axillary dissection still offers the most efficient local control in node-positive patients, whereas, in primarily node-negative patients, irradiation seems to be equally effective. In general, lymph-node dissection does not alter overall survival but there is no doubt that surgical therapy still contributes to cure in early-breast-cancer patients and seems to be curative for certain patients with stage-I carcinoma. The lymph node status of the axilla is crucial for the indication of adjuvant therapy in early invasive breast cancer, but an increasing number of clinical node-negative patients could be managed with information based on features of the primary tumor, regardless of the nodal status. The most promising new concept for the selection of node-positive patients, while avoiding unnecessary morbidity of axillary dissection in early-breast-cancer patients, is the sentinel-node concept. The principle is based on the identification of the first "sentinel" lymph node reached by lymphatic flow. Thus, only proven node-positive patients undergo axillary dissection. Local failure of internal mammary lymph nodes is rarely recognized; however, internal mammary lymph nodes seem to have an underestimated prognostic significance in about 10-20% of axillary node-negative patients. This may lead to the withholding of systemic therapy for patients with early breast cancer. Nevertheless, there is no indication for a routine parasternal dissection today. The sentinel-node concept may also support the selection of diagnostic internal lymph-node biopsy and subsequent adjuvant therapy in cases with no axillary lymph-node metastases but with internal lymph-node metastases.

Breast Neoplasms↗
PubMed2000

["Sentinel" lymph node biopsy in breast carcinoma. Current experiences].

Recent studies show the sentinel lymph node biopsy (SNB) as a reliable method for the determination of the nodal status in patients with breast cancer. We present our experience with this method during 3 years and discuss its potential and limitations. From 11/95 to 3/99 we performed a sentinel node detection in 146 patients with breast cancer stage I to III. We used the raionuclide method including preoperative lymphscintigraphy and intraoperative gamma.probe detection. The detection rate varied with the tumor size between 94% for tumors with a diameter < 1 cm, 85% (1-3 cm), 70% (3-5 cm) and 63% (> 5 cm). The accuracy of the SNB in the prediction of the nodal status varied also with the tumor diameter between 100% for very small tumors (< 1 cm), 97% (1-3 cm), 88% (3-5 cm) and 67% (> 5 cm). In the subgroup of patients restricted to T1-2-tumors (n = 106), 57 patients (53%) showed true negative, 4 (4%) false negative SNB. 38 (36%) revealed tumor cells in the HE-staining and an additional 7 patients (7%) solely in the immunohistochemical staining. The presented results show, that SNB is a reliable method for the evaluation of the nodal status in early breast cancer patients with a tumor size up to ca. 3 cm. While in about 50% of these patients a surgical intervention could be avoided after a negative SNB, an additional 5-10% of conventionally nodal negative patients can be found by the immunohistochemical examination of the sentinel node. The sn-concept can also identify parasternal metastasis and can be applied in patients after neoadjuvant therapy and patients with recurrent tumor. Indications and contraindications of this method, however, still remain to be determined.

Adult↗
PubMed1999

Sentinel lymph node dissection in breast cancer.

During the last years, the efficacy and reliability of the sentinel lymph node biopsy (snb) as a minimal invasive diagnostic procedure for the nodal status has been intensively evaluated. After the widespread clinical use in the staging of melanoma patients the snb is currently introduced in the clinical management of breast cancer patients. We present our experience with this method during 3, 5 years and discuss its potential and pitfalls. From 11/95 to 3/99 we performed sentinel node detection in 146 patients with breast cancer stage I to III, consisting of 127 patients with pT1/2-tumors and 19 patients with pT3/4-tumors. We used the radionuclid method including preoperative lymphoscintigraphy and intraoperative gamma-probe detection. The detection rate varied with the tumor size between 94% for tumors with a diameter < 1 cm, 85% (1-3 cm), 70% (3-5 cm) and 63% (> 5 cm). The accuracy of the snb in the prediction of the nodal status changed also with the tumor diameter between 100% for very small tumors (< 1 cm), 97% (1-3 cm), 88% (3-5 cm) and 67% (> 5 cm). In the subgroup of patients restricted to T1-2-tumors (n = 106). 57 patients (53%) showed true negative snb. 38 patients (36%) revealed tumor cells in the H&E-staining and an additional 7 patients (7%) solely in the immunohistochemical staining. 4 (4%) of these patients, all of them from the first half of the study period, underwent false-negative snb, 3 of them showing lymphangiosis carcinomatosa. The presented results show, that snb using the radionuclid method is a reliable method for the evaluation of the nodal status in early breast cancer patients with a tumor size up to ca. 3 cm. Therefore the sn procedure should be restricted to small tumors with clinically uninvolved axillary nodes or patients with a ductal carcinoma in situ (DCIS) to rule out invasiveness.

Breast Neoplasms↗
PubMedDate not supplied

[Clinical assessment of schizophrenic syndromes (CASS): rationale, construction, reliability and sensitivity evaluation, and an attempt at normalization of the new diagnostic tool].

UNLABELLED: The CASS (Clinical Assessment of Schizophrenic Syndromes) is a new multi-purpose and multi-level clinical diagnostic instrument consisting of a diagnostic questionnaire (CASS-D) allowing for analysis of a diagnosis of schizophrenia according to DSM-IV and ICD-10 criteria, as well as of three rating scales designed for description and intensity evaluation of schizophrenic syndromes on the global (CASS-G), dimensional (CASS-P, a profile of 13 basic dimensions) or symptomatological (CASS-S, a set of 31 symptoms) level. AIM: The paper presents a rationale and construction principles of the tool followed by a study of its reliability and sensitivity as well as by preliminary attempt to normalize its results. SUBJECTS: Twelve trained diagnosticians assessed twice (at the start and end of their hospitalization) 194 inpatients admitted consecutively, within approximately 6 months, to the Department. METHOD: Results of the CASS were compared with results of the SANS/SAPS, BPRS, and PANSS assessments playing the role of standard, reference instruments. FINDINGS: High agreement coefficients (kappa) were calculated between a diagnosis of schizophrenia based on unoperationalized (clinical) criteria and operationalized diagnoses based on the CASS diagnostic questionnaire including ICD-10 and DSM-IV diagnostic criteria and algorithms. In the case of both complex (many-item) CASS scales (CASS-P, CASS-S) high reliability measures (internal consistency according to Cronbach's alpha) were found. Characteristics of frequency, intensity and dynamics of the CASS individual symptoms, dimensions and of syndrome as a whole were consistent with expectations based on clinical experience. Direct indices of clinical improvement calculated from CASS-G, CASS-P or CASS-S scores obtained at two time-points (admission, discharge) correlated fairly highly with more direct measures based on diagnosticians' clinical global impressions made when summing the results of treatment at discharge from the hospital. This finding suggests that CASS scores may sensitively register changes in patients' mental state during hospital stay and treatment. On the base of empirical distributions of CASS scales, a normalization (sten-scales) was proposed which may be useful for comparison of results obtained in differing groups of patients. Analysis of percentile and sten distributions of the CASS-P and CASS-S pointed out that patients with a diagnosis of schizophrenia had higher mean scores than patients with other diagnoses. This observation as well as above mentioned reasonableness (consistency with clinical experience) of a picture and dynamics of schizophrenic syndromes revealed in CASS assessments may be treated as preliminary assumptions of its content validity. CONCLUSIONS: Results of the study suggest that CASS has satisfactory measures of reliability and sensitiveness. They allow for a preliminary normalization of its scales and prompt to study its validity.

Humans↗
PubMedDate not supplied

[Clinical assessment of schizophrenic syndrome (CASS): validity evaluation of the new diagnostic tool].

AIM: The aim of the study was an evaluation of validity measures of the CASS (Clinical Assessment of Schizophrenic Syndromes)--a new multi-purpose and multi-level clinical diagnostic instrument consisting of a diagnostic questionnaire (CASS-D) allowing to analyze a diagnosis of schizophrenia according to DSM-IV and ICD-10 criteria as well as of three rating scales designed for description and intensity evaluation of schizophrenic syndromes on the global (CASS-G), dimensional (CASS-P, a profile of 13 basic dimensions) or symptomatological (CASS-S, a set of 31 symptoms) level. SUBJECTS: 194 inpatients consecutively admitted to the Department within approximately 6 months were assessed twice (at the start and end of their hospitalization) by 12 trained diagnosticians. METHOD: Several measures of validity were analyzed. Results obtained by means of CASS were compared with results of the SANS/SAPS, BPRS, and PANSS as reference rating scales (diagnostic validity). Characteristics of frequency, intensity, dynamics and specificity of scale items were used to analyze content validity. Factorial structure of CASS scales was applied as a measure of construct validity. FINDINGS: Diagnostic validity of the new instrument seems to be confirmed by its very high correlation coefficients with rating scales recognized as international standards: BPRS, PANSS, and SANS/SAPS. Reasonable characteristics of frequency, intensity, dynamics and specificity of individual items (dimensions, symptoms) and sum scores of CASS scales and relationships between their values strongly suggest their content validity. Both sum (CASS-P, CASS-S) and global (CASS-G) scores of scales under study revealed some specificity--they had significantly higher values in patients with schizophrenia than in patients with other diagnoses. It allows to distinguish in a schizophrenic syndrome described by CASS components which are specific and not specific for this disorder. The latter have been left also in the final version for their practical and clinical importance. Construct validity of the CASS was studied separately for different scales (CASS-P, CASS-S) and different groups (all or only schizophrenic patients) by means of several factor analyses, and performed along identical statistical procedure (principal component method of extraction with criterion eigenvalue > 1, followed by Equamax rotation). Resulting solutions could be interpreted reasonably and consistently with contemporary attempts to find adequate factorial models of intrinsic structure of schizophrenic syndrome. Thus they support confidence for constructive aspect of the CASS validity. CONCLUSIONS: Ultimately, results obtained in the study suggest that the CASS may be considered as an instrument with some promising indices of diagnostic, content and construct validity, which may be potentially useful for clinical and research purposes.

Humans↗
PubMedDate not supplied

[Assessment and self-assessment of patients' attitudes toward their psychotic disorders].

The aim of the study was the evaluation of concordance between rating and self-rating of attitudes toward psychotic disorders in one hundred patients (72 of them with diagnosis of schizophrenia). At discharge from the hospital patients were examined by two scales: Experience of Illness Scale (for rating) and My Experience of Illness Scale (for self-rating). Moderate concordance of results of rating and self-rating of the overall patients' attitude was noted. The higher concordance was found on dimension of evaluation of the illness experience, lower on dimension of reflectiveness to disease experience, and the lowest one on dimension of identification of the disease with self. Two different scales, simultaneously used, seem very beneficial because they reflected attitudes from two different perspectives, creating more complete a picture.

Adolescent↗
PubMedDate not supplied

[Psychopathological profile of acute schizophrenic syndromes diagnosed according to ICD-10 and DSM-IV criteria].

Diagnostic and symptomatological profiles of schizophrenic syndromes diagnosed according to ICD-10 and DSM-IV were compared. For this reason a group of patients fulfilling at least one of these sets of criteria was created and then diagnostic and symptomatological profile was compared between those who fulfilled the ICD-10 and those who fulfilled DSM-IV criteria. 105 inpatients hospitalized in acute phase of their first or one of consecutive episodes were included--102 of them had fulfilled ICD-10, and 90 DSM-IV criteria of schizophrenia. Diagnostic concordance between the two systems of criteria was high (83%). Differentiation of diagnostic profile (i.e. difference between frequency of fulfilling the specific requirements of ICD-10 or DSM-IV criteria) of the symptoms in these two groups was not significant, expert of 6-month criterion of duration of illness, which was significantly less frequently valid in ICD-10 syndromes group. A comparison of symptomatological profiles (i.e. frequency and intensity of symptoms) of schizophrenic syndromes diagnosed by ICD-10 or DSM-IV criteria and described by several rating scales (PANSS, SAPS/SANS, KOSS-S) did not show any significant differences. Results suggested that despite of different ways of defining the schizophrenic syndromes in both diagnostic systems, disorders manifested in the groups of patients created by means of them are very similar in psychopathological picture. This seems to be a significant change in comparison to more prominent differences contrasting the previous versions of the diagnostic systems (i.e. ICD-9 and DSM-III-R).

Acute Disease↗