[Axillary lymph node dissection after breast reconstruction by pedicled Latissimus dorsi: Operative steps and outcomes]

OBJECTIVES

We retrospectively reviewed all the cases of axillary lymph node dissection (ALND) performed within a year after an immediate breast reconstruction procedure by a pedicled Latissimus dorsi, which is transferred to the anterior thoracic wall through an axillary funnel. Operative technical steps are described taking account of the new anatomical relationship of the axilla.

METHODS

We assessed postoperative immediate complications and late sequelaes.

RESULTS

From 1999 to 2013, 21 ALND were performed. Immediate postoperative period was free of complication in 85% of cases when following the operative steps described in this work. Partial or total necrosis of the reconstructed breast did not occur. With a median follow-up of 64 months, 6 patients (28% of the whole population) presented at least one sequelae like a feeling of heavy arm (n=2, 9%) or a lymphedema (n=3, 14%), a chronic neuropathic pain (n=4, 19%) or a limitation in the arm range of motion (n=2, 9%).

CONCLUSION

ALND after immediate breast reconstruction by a pedicled Latissimus dorsi is feasible and safe, without any additional postoperative complication in comparison with a classic ALND.

Using one-step nucleic acid amplification (OSNA) for intraoperative detection of lymph node metastasis in breast cancer patients avoids second surgery and accelerates initiation of adjuvant therapy

BACKGROUND

Sentinel lymph node (SLN) analysis is conventionally analyzed using immunohistochemistry and in the case of SLN involvement, justifies a second surgery for axillary lymph node (ALN) resection, thus delaying the initiation of adjuvant therapies.

PATIENTS AND METHODS

Three hundred and eighty-one patients with early stage breast cancer (BC) were considered in this retrospective study. SLNs were detected using combined radioisotope and dye detection. SLN involvement was analyzed using routine intraoperative One-Step Nucleic Acid Amplification (OSNA) assay, in 100 patients and compared with the conventional histopathology carried out previously in 281 patients.

RESULTS

Considering positive SLNs as '++' (CK19 mRNA copy number>5000), '+' (250 < CK19 mRNA copy number <5000) and positive by inhibition in the OSNA group and macro-, micrometastases and isolated tumor cells in the histopathology group, no difference in SLN involvement rate was found between the two groups with 29.0% and 29.9% of positive SLNs, respectively. Using OSNA intraoperatively, the mean time to process the SLN was 42 min allowing immediate ALN resection, reduced significantly (P < 0.01) the re-intervention rate (9% versus 39%) and significantly (P < 0.01) accelerated the initiation of adjuvant therapy (6.2 versus 8.4 weeks).

CONCLUSIONS

Using OSNA for intraoperative SLN analysis avoids second surgery for ALN resection in most patients and accelerates initiation of adjuvant therapy.

Development of scanning X-ray microscopes for materials science spectromicroscopy at the Advanced Light Source

The development of two zone-plate microscopes for X-ray spectroscopic analysis of materials is described. This pair of instruments will provide imaging NEXAFS analysis of samples in transmission at atmospheric pressure and imaging XPS and NEXAFS analysis of sample surfaces in a UHV environment.