Biomedical subjects

Sheldon Feldman

Publications and source records attributed to Sheldon Feldman.

4 recordsLinked to original sources

PubMed2006

Less is more: transmammary axillary lymph node evaluation: an initial clinical experience.

BACKGROUND: Standard axillary node dissection has the potential to cause a significant amount of morbidity. Sentinel lymph node biopsy has considerably decreased this rate of morbidity; however, data recently presented, based on ACOSOG Z-10, suggest that even this less invasive technique can have a lymphedema rate as high as 7%. The transmammary axillary lymph node evaluation procedure (TANE) removes the sentinel node via the breast incision, thus eliminating the axillary incision. This may decrease morbidity, including lymphedema, dyesthesias, pain, and loss of range of motion, and it will also improve cosmetic outcome. METHODS: This is a prospective observational study to determine if it is feasible to perform both the partial mastectomy and sentinel lymph node biopsy via a single incision. All patients were consented for a partial mastectomy and sentinel lymph node biopsy. The partial mastectomy was performed in the standard fashion. The sentinel lymph node biopsy was performed via the same incision either before or after the breast specimen was removed. The sentinel lymph node biopsy was then performed in the standard fashion. RESULTS: The TANE method was attempted in 44 patients from June 2005 to March 2006 and was successful in 43, for a rate of 97.73%. The mean age of the patients was 57.6 years, with a range of 34 to 82 years. The average tumor size was 1.57 cm, with a range of 0.4 cm to 4.5 cm. The TANE procedure was performed most often in patients with tumors located in the upper outer quadrant (79.54%). There were no perioperative complications. CONCLUSION: Our prospective study showed that this is a feasible procedure for sentinel lymph node biopsy and axillary lymph node dissection. The number of sentinel and axillary nodes obtained was within the standard published norms. Our technical success rate was 97.33%, and we did not have any perioperative complications. In this pilot study, there was the cosmetic benefit of only 1 incision. Future studies will examine if the TANE procedure can objectively decrease morbidity compared to a separate axillary incision.

Adult↗

PubMed2006

Primary systemic therapy of breast cancer.

Primary systemic therapy (PST) or neoadjuvant therapy is used in nonmetastatic breast cancer to treat systemic disease earlier, decrease tumor bulk ideally to a complete pathological response (pCR), and reduce the extent of surgery. The multitude of clinical trials using PST in breast cancer patients has not proven the fundamental hypotheses of improved overall survival and disease-free survival that drove the investigation of PST. The other potential advantages of PST, which include increasing the rate of breast-conserving surgery and predicting outcome to a particular chemotherapy regimen, are also not conclusively established. We examined the published literature on PST for breast cancer and predominantly focused our review on data from large, randomized clinical trials comparing primary systemic chemotherapy with adjuvant chemotherapy, different primary systemic chemotherapy regimens, primary systemic chemotherapy with hormonal therapy, and different preoperative hormonal therapies. Although the optimal neoadjuvant chemotherapy regimen has not been established, a combination of four cycles of an anthracycline followed by four cycles of a taxane appears to produce the highest pCR rate (22%-31%). In patients with HER-2-positive breast cancer, concurrent use of neoadjuvant trastuzumab with an anthracycline-taxane combination has produced provocative results that require further confirmatory studies. Preoperative hormonal therapy is associated with low pCR rates and should be reserved for patients who are poor candidates for systemic chemotherapy. The optimal management of patients with residual disease after the administration of maximum neoadjuvant therapy remains to be defined. The surgical approach, including the role of sentinel node biopsy and delivery of radiation therapy after PST in breast cancer patients, is evolving. Ongoing clinical trials will help identify the subset of patients who would most benefit from the use of PST, establish the most effective PST regimen, and determine the optimal multidisciplinary approach in the management of breast cancer.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2004

Lobular carcinoma in ectopic axillary breast tissue.

Accessory mammary tissue is reported to occur in 2 per cent to 6 per cent of women and results from failure of regression of a portion of the galactic band, which runs from the axilla to the groin during embryogenesis. The differential diagnosis of a mass located along the course of the primitive milk line must include accessory breast tissue. This tissue is subject to the same physiologic and pathologic changes as in the breast proper. There are numerous case reports of masses arising in accessory breast tissue ranging from fibroadenomas and phyllodes tumors to invasive mucinous adenocarcinoma. The predominant pathology, as with the pectoral breast, is that of invasive ductal carcinoma. We present the case of a lobular carcinoma arising in axillary ectopic breast tissue. Although this has previously been reported, it is a rare entity.

Aged↗

PubMedDate not supplied

Postlactational microcalcifications.

A case of postlactational microcalcifications is reported. A 42-year-old woman presented for screening mammography 2 months after completion of breast-feeding. Comparison to her pregravid screening mammogram revealed the appearance of multiple groups of indeterminate microcalcifications bilaterally (BIRADS IV). She underwent bilateral stereotactic core biopsies of representative areas, yielding benign pathology. There have been anecdotal accounts and five reported cases of lactational microcalcifications in the radiology literature. We discuss the possible etiologies as well as implications of this mammographic finding.

Adult↗