This Month in Archives of Surgery FREE

Employing physical examination, mammography, and fine-needle aspiration (FNA) in the evaluation of palpable breast masses, the Oregon Health Sciences Group studied almost 500 women prospectively, assigning a score of 1, 2, or 3 for benign, suspicious, or malignant results. The triple test score (TTS) is the sum of these observations. They noted that all lesions with a TTS of 4 or lower were benign on follow-up (n = 315), and those masses with a TTS of 6 or higher (n = 130) were confirmed malignant on biopsy. Of the 39 lesions (8%) with a score of 5, 19 were malignant and 20 were benign. This was, in their opinion, a clear-cut separation. Simple measures can provide definitive answers for palpable breast masses, with apparent safety and reliability.

In a series in which 37 consecutive patients were cured of their hypoglycemia after surgery, it is obviously worthwhile to note the localization procedures of the authors. All patients underwent portal venous sampling or calcium angiography before their operations, which included palpation and intraoperative ultrasonography. Of all the modalities used, intraoperative ultrasound found all but 2 (35 of 37) of the insulinomas, and those 2 were resected based on regional localization alone (both in the tail of the pancreas). Thus, the combined use of both calcium angiogram and intraoperative ultrasound is recommended.

Following computer-generated models, this study group attempted to determine which currently available biopsy method for evaluating and treating mammographic lesions was most cost-effective. Using 3 different scenarios, a highly suspicious abnormality (Breast Imaging Reporting Data System [BIRADS] 5), a suspicious mammographic abnormality (BIRADS 4), and an abnormality suspicious for ductal carcinoma in situ alone (microcalcification without a mass), it was determined that only for BIRADS 4 lesions did a stereotactic core biopsy prove more cost-effective than needle localization.

In light of a 50% incidence of severe coronary artery disease in patients with abdominal aortic aneurysm, this study was done to determine whether cardiac morbidity and mortality has decreased with increasing experience after endoluminal abdominal aortic aneurysm (EAAA) repair. After reviewing 173 consecutive patients undergoing EAAA repair divided into earlier and later operation groups, it was concluded that adverse cardiac events had not changed in number, and that predictors of these events included the use of multiple graft extensions, female sex, and severity of cardiac disease. Surgeons are using EAAA repair in more high-risk patients. The trend toward EAAA repair has not reduced morbidity and mortality with experience, but it may be employed in sicker patients.

To answer the question, "is it possible to identify a subset of patients with a positive sentinel node (SN) in whom other nodes in the remaining axilla are negative; thus limiting the requirement for complete axillary dissection?" these investigators evaluated 255 consecutive patients who underwent successful SN identification for stage T1 and stage T2 breast cancer. They observed that although the incidence of non-SN metastases seemed to be related to the number of positive SNs and the size of SN metastases, it was not possible to identify a specific group of patients with a positive SN in whom non-SN metastases were absent. Neither the number of positive SNs nor the tumor size (micro or macro) absolutely predicted the involvement of other axillary nodes in breast cancer.