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    <recommendedItem id="20100101_19_451"
                     title="Sentinel Nodes Predict Spread in Oral Cancer (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb/18367?impressionId=1265815774882"
                     
      &lt;p&gt;In early oral squamous cell carcinoma, a sentinel node biopsy correctly predicted an absence of lymphatic metastasis in all but 4% of patients, researchers said.&lt;/p&gt;
&lt;p&gt;For T1 and T2 lesions that were clinically node-negative, the procedure  --  combined with additional sectioning and immunohistochemistry  --  yielded a negative predictive value of 96%, according to Francisco Civantos Jr., MD, of the University of Miami, and colleagues.&lt;/p&gt;
&lt;p&gt;For T1 lesions, the value was 100%, while for T2 cancers it was 94%, the researchers reported online in the &lt;em&gt;Journal of Clinical Oncology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The finding may position the procedure as an intermediate option between watchful waiting and selective neck dissection, the researchers said, asserting that it&apos;s now &quot;reasonable&quot; to conduct a head-to-head trial of sentinel node biopsy and neck dissection.&lt;/p&gt;
&lt;p&gt;The procedure has significantly increased the sensitivity for detecting lymphatic metastasis in melanoma and breast cancer patients, Civantos and colleagues noted.&lt;/p&gt;
&lt;p&gt;But in oral cancer, many surgeons prefer a completion neck dissection, they added, despite the &quot;measurable morbidity&quot; that&apos;s associated with the procedure. On the other hand, because of that morbidity, other specialists prefer watchful waiting and elective neck irradiation.&lt;/p&gt;
&lt;p&gt;To investigate the issue, Civantos and colleagues conducted a multicenter trial in which patients with early invasive oral cancers were treated with both procedures  --  a sentinel node biopsy, followed by completion selective neck dissection.&lt;/p&gt;
&lt;p&gt;The primary goal was to see if a negative hematoxylin and eosin finding on the sentinel node biopsy accurately predicted the negativity of the other cervical lymph nodes removed in the neck dissection.&lt;/p&gt;
&lt;p&gt;All told, 140 patients qualified and had the dual procedures, the researchers reported.&lt;/p&gt;
&lt;p&gt;The sentinel nodes were identified using a radioactive gamma probe. The primary tumor was removed transorally, followed by the sentinel node biopsy through a small incision within the area of the planned incision for the neck dissection.&lt;/p&gt;
&lt;p&gt;Staining of the sentinel nodes at the various trial sites resulted in 106 that were negative. Of those, 100 were also negative by hematoxylin and eosin staining of the neck dissection specimens.&lt;/p&gt;
&lt;p&gt;That yielded a negative predictive value of 94%, the researchers said.&lt;/p&gt;
&lt;p&gt;Additional step sectioning and immunohistochemistry at a central pathology lab increased the negative predictive value to 96%, they said.&lt;/p&gt;
&lt;p&gt;Both findings were significant, they reported, with a one-sided &lt;em&gt;P&lt;/em&gt;-value of &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001.&lt;/p&gt;
&lt;p&gt;One limitation of the study, the researchers noted, is that the dual procedures may have interfered with each other, in that sentinel lymph biopsy might have changed the way the neck dissection was performed or the other way around.&lt;/p&gt;
&lt;p&gt;But that &quot;may actually lead to underestimation of the accuracy of this technique,&quot; they said, since the neck dissections were guided by information gleaned from nuclear imaging and the gamma probe used in the sentinel node procedure.&lt;/p&gt;
&lt;p&gt;The study was also limited, the researchers said, because many surgeons involved were only moderately experienced and none was experienced &quot;at levels currently considered appropriate for surgeons caring for breast cancer or melanoma.&quot;&lt;/p&gt;
&lt;p&gt;Nonetheless, they said, the negative predictive value found in the study was &quot;higher than anticipated for a multi-institutional setting with relatively inexperienced surgeons.&quot;&lt;/p&gt;
&lt;p&gt;They added that only a clinical trial in which outcomes after a negative sentinel node biopsy are simply observed for several years would yield a true negative predictive value for the procedure.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the National Cancer Institute.&lt;/p&gt;&lt;p&gt;Civantos reported no conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_896"
                     title="AAPS: Surgery Effectively Reduces Lymphedema"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Surgery/PlasticSurgery/tb/13404?impressionId=1265815774882"
                     
      RANCHO MIRAGE, Calif., March 24 -- For breast cancer patients with lymphedema, surgery can improve lymphatic drainage, researchers said, but whether the benefits last long term remains to be seen. 
              &lt;p&gt; 
              &lt;p&gt;Lymphaticovenular bypass &quot;microsurgery&quot; on the upper arm reduced arm volume by up to 39% in these patients, David W. Chang, M.D., of the University of Texas M.D. Anderson Cancer Center in Houston, and colleagues found.
              &lt;p&gt; 
              &lt;p&gt;The effects in a prospective, single center study appeared durable through one year, although longer-term follow-up is needed, Dr. Chang reported here at the American Association of Plastic Surgeons meeting.
              &lt;p&gt; 
              &lt;p&gt;Compression garments, massage, and other conservative medical treatment remain the first line of defense for the 25% to 40% of breast cancer patients who develop lymphedema after chemotherapy or radiation therapy.
              &lt;p&gt; 
              &lt;p&gt;Although a wide variety of palliative surgical techniques have been pioneered in Europe and Asia, these options have been controversial and limited, Dr. Chang said.
              &lt;p&gt; 
              &lt;p&gt;At M.D. Anderson, he said, surgeons use lymphaticovenular bypass. This minimally-invasive technique involves two or three 1-inch or smaller incisions in the arm to insert microsurgical tools used to redirect lymphatic fluid to veins 0.3 to 0.8 mm in diameter.
              &lt;p&gt; 
              &lt;p&gt;&quot;For the most part, lymphedema in the U.S. has not been treated surgically,&quot; Dr. Chang said. &quot;The reason it hasn&apos;t gained popularity is that it&apos;s technically challenging and doesn&apos;t cure the lymphedema.&quot;
              &lt;p&gt; 
              &lt;p&gt;Given this skepticism, his group monitored outcomes of 20 consecutive patients who had lymphaticovenular bypass at their institution from December 2005 through September 2008. 
              &lt;p&gt; 
              &lt;p&gt;All of the women had stage 2 or 3 lymphedema for a mean duration of 4.8 years before the surgery. Their breast cancer therapy had included axillary lymph node dissection in all cases, with preoperative radiation therapy as well in 16 cases.
              &lt;p&gt; 
              &lt;p&gt;Surgery lasted an average of 3.3 hours and patients were discharged within 24 hours afterward. The procedure included a mean of 3.5 lymphaticovenular bypasses per patient. 
              &lt;p&gt; 
              &lt;p&gt;After surgery, patients resumed nonsurgical strategies, including compression garments.
              &lt;p&gt; 
              &lt;p&gt;Prospective follow-up over the next 18 months revealed significant postoperative clinical improvement in 19 of the 20 women. 
              &lt;p&gt; 
              &lt;p&gt;Three patients reported clinical lymphedema reduction without a corresponding significant quantitative volume reduction. 
              &lt;p&gt; 
              &lt;p&gt;The researchers found that, whereas before surgery, the affected arm was an average of 34% larger than the unaffected arm on quantitative volumetric analysis, the mean volume reduction afterward was:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;29% at one month
                &lt;li&gt;33% at three months
                &lt;li&gt;39% at six months 
                &lt;li&gt;25% at 12 months 
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;Dr. Chang cautioned against over-interpreting the dip in the results at one year. Based on a series from researchers in Asia and Europe, limb volume plateaus at some point after surgery but yields durable results.
              &lt;p&gt; 
              &lt;p&gt;He also noted that arm volume didn&apos;t capture other qualitative benefits that may be more important for patient quality of life. &quot;Patients feel the arm is softer and lighter than before.&quot;
              &lt;p&gt; 
              &lt;p&gt;The researchers reported no postoperative complications or lymphedema exacerbations.
              &lt;p&gt; 
              &lt;p&gt;&quot;Lymphaticovenular bypass using a &apos;super-microsurgical&apos; approach appears to be effective in improving the severity of lymphedema in patients with breast cancer,&quot; they concluded.
              &lt;p&gt; 
              &lt;p&gt;Dr. Chang said his team believes that these results will improve over time with continued fluid volume reductions. However, he acknowledged the small sample size and the need for long-term follow up.
              &lt;p&gt; 
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The researchers reported no conflicts of interest.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
             
    </recommendedItem>
    <recommendedItem id="20090101_3_351"
                     title="APHA: Premenopausal Invasive Breast Cancer Rates Found Rising"
                     score="-0.005"
                     href="