Background:Negative pressure wound therapy was developed for treating wounds associated with unfavorable healing factors. The principles of the negative pressure wound therapy applied on clean and closed surgical incision originate the closed incision negative pressure therapy (ciNPT). We evaluated the use of ciNPT in the setting of oncological breast surgery.Methods:From January 1, 2015, to June 31, 2015, we prospectively selected 37 patients undergoing oncological breast surgery with a minimum of 4 risk factors. Seventeen patients (25 surgeries) voluntary tested ciNPT (ciNPT sample), whereas the remaining 20 (22 surgeries) chose conventional postsurgery dressing (Standard Care sample). Follow-up controls to evaluate postsurgical complications were performed on days 7, 14, 30, and 90. At 12 months, the quality of life, scar, and overall aesthetic outcomes were evaluated with specific questionnaires filled in by surgeon and patient. The Standard Care sample was investigated on risk factors associated with poor healing.Results:The ciNPT sample showed a significant prevalence of high risk factors, especially extensive undermining and bilateral surgeries, and a predominance of women under 65 years; only 1/25 (4%) surgical procedures was followed by complications. In the Standard Care sample, 10 of 22 surgeries (45%) were followed by complications. The difference in complication rate between the 2 samples was significant. The BIS (Body Image Scale) scores suggested that most patients were satisfied with their body image regardless of the type of dressing. All other questionnaire scores clearly vouched for a significant superiority of the ciNPT. Previous surgery ≤ 30 days emerged as the surgery-related high risk factor most frequently associated with postsurgery complications.Conclusion:The results of our study support the use of ciNPT in oncological breast surgery: it showed to be a well-tolerated, adaptable, and reliable dressing capable of reducing postsurgical complications and improving scar outcomes in patients presenting with high risk factors.

Objective: To assess the reliability of using the One-Step Nucleic Acid Amplification (OSNA) assay as a single test on whole sentinel lymph nodes (SLN) as a method of intraoperative diagnosis and staging of SLNs in breast cancer.Background: Combining histological and molecular assessment of metastasis on the same SLN may not fully reproduce the actual load of cancer cells present in the SLN and create problems in decisions regarding axillary dissection.

The combination of preoperative lymphatic mapping with intra-operative probe detection is becoming the standard procedure for identifying tumour lymphatic spread at the time of initial treatment in breast cancer. There are a number of identification techniques for sentinel lymph nodes, but the concordance of the results of a sentinel lymph node biopsy with axillary lymph node dissection did not vary significantly among them. Periareolar (p.a.) injection of tracer is a new procedure specifically studied to overcome some limitations of other techniques; in two groups of patients with early breast cancer we compared the periareolar with the subdermal technique. One hundred and fifty biopsy proven breast cancer patients were consecutively enrolled in this study. This population was divided into two groups: (1) group A, including 100 cancers; lymphatic mapping was performed by s.d. injection of both blue dye and radiotracer; and (2) group B, including 50 cancers; lymphatic mapping was performed with a combination of blue dye injected p.a. and radiotracer injected s.d. For group A, with both techniques we identified one or more SLNs in 100/100 tumours; blue dye detected the SLNs in 99/100 cancers (99%), lymphoscintigraphy in 93/100 cancers (93%). The concordance rate was 92%. For group B, with both techniques we identified one or more SLNs in 49/50 cancers (98%); blue dye detected the SLNs in 48/50, lymphoscintigraphy in 46/50 cancers (92%). The concordance rate was 92%. In the present study p.a. and s.d. injection of blue dye give similar and comparable results. The periareolar technique is simpler and has several advantages over the subdermal technique.

Specimen radiography was reliable in identifying clear margins (74% positive predictive value) and reduced the rate of reintervention from 31% to 20%. Better results will be provided by digital mammographic equipment.

The accuracy of lymphatic mapping with labelled nanocolloid is limited by the presence of axillary nodal metastases, and particularly by the degree of SLN tumoural invasion and the presence and number of other axillary nodal metastases. Neither of these elements seems to interfere with the blue dye identification rate. The combination of the two tracers maximises the SLN identification rate.