简介：OBJECTIVE:Tocharacterisedistinctiveclinicalfeaturesofgiantprolactinomasinwomen.DESIGN:Amulticentre,retrospectivecaseseriesandliteraturereview.METHODS:Wecollecteddatafrom15femalepatientswithapituitaryturnoutlargerthan4cmandprolactinlevelsabove1000μg/landidentified19similarcasesfromtheliterature;agender-basedcomparisonofthefrequencyandagedistributionwasobtainedfromaliteraturereview.RESULTS:TheinitialPubMedsearchusingthetermgiantprolactinomas'identified125patients(13women)respondingtotheinclusioncriteria.Thefemale:maleratiowas1:9.Anothersixfemalepatientswerefoundbyextendingtheliteraturesearch,whileourownseriesadded15patients.Themedianageatdiagnosiswas44yearsin

简介：Preoperativestagingoftheaxillainwomenwithinvasivebreastcancerusingultrasound-guidedneedlebiopsy(UNB)identifiesapproximately50%ofpatientswithaxillarynodalmetastasespriortosurgicalintervention.Althoughmoderatelysensitive,itisahighlyspecificstagingstrategythatisrarelyfalsely-positive,henceapositiveUNBallowspatientstobetriagedtoaxillarylymph-nodedissection(ALND)avoidingpotentiallyunnecessarysentinelnodebiopsy(SNB).Inthisreview,weextendourpreviousworkthroughanupdatedliteraturesearch,focusingonstudiesthatreportdataonUNButility.Basedondatafor10,934breastcancerpatients,sourcedfrom35studies,apositiveUNBallowedtriageof1,745cases(simpleproportion16%)toaxillarysurgicaltreatment:theutilityofUNBwasamedian19.8%[interquartilerange(IQR)11.6%-26.7%]acrossthesestudies.Wealsomodelleddatafromasubgroupofstudies,andestimatedthatamongstpatientswithmetastasestoaxillarynodes,theoddsratio(OR)forhighnodaldiseaseburdenforapositiveUNBversusanegativeUNBwas4.38[95%confidenceinterval(95%CI):3.13,6.13],P<0.001.Fromthismodel,theestimatedproportionwithhighnodaldiseaseburdenwas58.9%(95%CI:50.2%,67.0%)forapositiveUNB,whereastheestimatedproportionwithhighnodaldiseaseburdenwas24.6%(95%CI:17.7%,33.2%)ifUNBwasnegative.Overall,axillaryUNBhasgoodclinicalutilityandapositiveUNBcaneffectivelytriagetoALND.However,theevolvinglandscapeofaxillarysurgicaltreatmentmeansthatUNBwillhaverelativelylessutilitywheresurgeonshavemodifiedtheirpracticetoomissionofALNDforminimalnodalmetastaticdisease.

简介：Objective:Upto40%ofwomenover70yearswithprimaryoperablebreastcancerintheUKaretreatedwithprimaryendocrinetherapy(PET)asanalternativetosurgery.Avarietyoffactorsareimportantindeterminingtreatmentforolderbreastcancerpatients.Thisstudyaimedtoidentifythepatientandtumorfactorsassociatedwithtreatmentallocationinthispopulation.Methods:Prospectivelycollecteddataontreatmentreceived(surgeryvs.PET)wereanalysedwithmultivariablelogisticregressionusingthevariablesage,modifiedCharlsonComorbidityIndex(CCI),activitiesofdailyliving(ADL)score,Mini-MentalStateExamination(MMSE)score,HER2status,tumoursize,gradeandnodalstatus.Results:Datawereavailablefor1,122cancersin1,098patientsrecruitedbetweenFebruary2013andJune2015from51UKhospitals.About78%ofthepopulationweretreatedsurgically,withtheremainderbeingtreatedwithPET.Increasingpatientageatdiagnosis,increasingCCIscore,largetumorsize(5cmormore)anddependenceinoneormoreADLcategorieswereallstronglyassociatedwithnon-surgicaltreatment(P<0.05).Conclusion:Increasingcomorbidity,largetumorsizeandreducedfunctionalabilityareassociatedwithreducedlikelihoodofsurgicaltreatmentofbreastcancerinolderpatients.However,ageitselfremainsasignificantfactorfornon-surgicaltreatment;reinforcingtheneedforevidence-basedguidelines.