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Medical Meeting Reports

American College of Surgery Clinical Congress

October 10-15, 1999


NEW CONCEPTS MAY HELP IN THE MANAGEMENT OF BREAST CANCER
font=>by Paul Recchia, Ph.D.

D. Krag, MD, University of Vermont College of Medicine, Burlington, VA, reviewed new breast cancer data in axillary node dissection and post-surgical management of metastasis.

Radioactive Seeds as a Tool in Axillary Management

Dr. Krag discussed the results of an investigation on women biopsied with low-dose radioactive seeds inserted in mamographic lesions with suspicious nodes. The seeds were located using a gamma detector, the lesions removed surgically, and removal was verified with the detector. Implanting seeds to better identify the lesion allowed far less tissue to be removed than standard operative procedures. In standard procedures, much normal tissue is removed as a precaution and from lack of ability to differentiate lesion from normal tissue. In the axillary node dissection, the mass of the excised node was about 80% smaller than the typical specimen from standard techniques. According to Dr. Krag, this new technique of combining seed insertion with detection for lesion removal is precise, fast, spares normal breast tissue, is well tolerated, and is cost effective. A clinical trial, the NASBP-32 study, is currently underway to compare sentinel node dissection to axillary node dissection.

Halting Metastasis Important to Breast Cancer Management

Earlier work on magnetized antibodies to cancer cells showed that 90% of breast cancer patients had cancer cells circulating in the blood prior to surgery. However, only a small percentage of patients develop post-surgical metastases. Dr. Krag performed a small pilot study to monitor circulating cancer cells post surgery. The investigators drew blood at the time of surgery and then once a week for several weeks. At the time of surgery, 95% of patients had circulating cancer cells in the blood. Removing the lesion eliminates the "production system" for circulating cancer cells. In addition, the body is able to clear many of the circulating cells through immunological processes. As a result, the number of circulating cells drops rapidly after surgery. At 48 hours post surgery, most circulating cancer cells are cleared from the body, but about 30% persist in blood. This reduction in circulating cancer cells seems to minimize the cell's chances of attaining a critical density for metastasis.

Ortho Biotech

Funded through an unrestricted educational grant by Ortho Biotech.



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