The described protocol represents an easily reproduced and reliable method for SN detection in breast cancer. Furthermore, the number of visualized axillary nodes reflects the histologic status of the axilla.

BackgroundTreosulfan, an alkylating agent, has demonstrated activity in recurrent ovarian carcinoma. It is equieffective as oral (p.o.) and intravenous (i.v.) formulation. To explore the preference and compliance of elderly patients regarding p.o. or i.v. treosulfan for the treatment of relapsed ovarian carcinoma, women aged 65 years or older were included in this prospective multicenter study. Since elderly patients usually have several concomitant diseases and experience more treatment toxicity, an interim safety analysis was planned and performed after 25 patients finished therapy to assess the tolerability of the treatment regimens.MethodsPatients had a free choice of treosulfan i.v. (7,000 mg/m2 day 1 of a 28-day cycle) or p.o. (600 mg/m2 day 1–28 of a 56-day cycle) for a maximum of 12 cycles (i.v.) or 12 months (p.o.). Indecisive patients were randomized. Toxicity was evaluated according to the NCI-CTC version 2.0.ResultsTwenty-five of 51 recruited patients completed therapy at the time of the planned interim analysis (median age, 75 years; range, 70–82). Median ECOG was 1, and median number of prior chemotherapy regimens was 2. A median number of 4 cycles (range, 1–12) were administered per patient. Anemia was the most common hematological toxicity (88 % of patients). Most frequent non-hematological toxicities were nausea (76 %), constipation (68 %), and fatigue (64 %).ConclusionTreatment was generally well tolerated despite the fact that most patients suffered from multiple comorbidities and were heavily pretreated. There were no unexpected hematological or non-hematological toxicities. Based on this safety analysis, the next step of study recruitment was continued.

Axillary lymph node involvement influences the drainage pattern in breast cancer. Patients with numerous SNs have an increased risk of axillary involvement. A high tracer uptake does not permit the identification of a 'true' SN. A lack of surgical accuracy may lead to pitfalls if the axilla is not screened carefully for all radioactive nodes.

Objective In a prospective study we analysed the frequency of intraoperative capsule rupture among 161 ovarian tumours operated on endoscopically, using total removal of the adnexa with protected retrieval. Subjects and methods Between June 1993 and September 1997 we carried out endoscopic surgery on 161 consecutive patients, presenting with ovarian tumours up to 10 cm in diameter, and assumed to have an increased risk for malignancy on the basis of menopausal status, sonography findings or endoscopic evaluation. The risk of tumour rupture was related to the different phases of the operation (resection and extraction) and to the presence and location of intra‐abdominal adhesions. Results Malignancies were found in 6.83% of the patients. Capsule rupture occurred in 13 cases (8%). There was no instance of malignant cell spillage because of intraoperative capsule rupture. The statistical probability of malignant cell dissemination was 0.55% in our series. During resection, rupture of suspicious but not malignant tumours occurred in six cases (3.7%). The probability of spilling cyst contents was closely associated with the presence and the location of intra‐abdominal adhesions, the highest spillage rate (16.6%) being found in tumours with adhesions to intestine. During extraction, contamination on account of bag rupture occurred in seven cases (4.3%). Conclusion Using adequate endoscopic resection and removal techniques, suspicious ovarian tumours under 10 cm in diameter can be operated on endoscopically with a low risk of tumour rupture.