Question

ing 4. Why is the arm of the affected side draped free during many breast procedures? 5. Describe how you would handle and maintain a breast biopsy sample for frozen section. 6. What is the principle of sentinel node biopsy? 17. What retractors should be available for tissue-sparing mastectomy? hat 8. Why is the ESU not used for dissection of a breast tumor:

Answer 1

ANS.

4. Beast surgery is performed with the patient in the supine position. a pad May b place under the affected side at the level of back to elevate affected area. The affected area is prepared and draped free in most case. Except of simple lumpectomy without axillary node dissection.

If the arm draped free, an arm board is used, as in lymph surgery. The allow the surgeon to elevate the arm for exposure to the axilla at various angle. Care must be taken not to allow the arm to drop off arm board during surgery.

5.

the clinical diagnosis is cancer, fresh breast tissue is submitted for frozen section examination before immediate mastectomy. Although this is still true, many breast biopsies are currently performed as outpatient procedures in the setting of an abnormal mammogram or a vaguely palpable abnormality. Frequently the lesion is small (less than 1.0 cm.) or is not grossly visible. The appropriate pathologic examination of breast biopsy material is determined by whether it is a mass or only a cluster of calcifications seen on a mammogram. Each breast biopsy specimen must be handled in a manner that will maximize the opportunity to arrive at the correct histologic diagnosis. In many instances, this means that a frozen section examination is contraindicated.

The frozen section procedure is a pathological laboratory procedure to perform rapid microscopic analysis of a specimen. It is used most often in oncological surgery. ... The report given by the pathologist is usually limited to a "benign" or "malignant" diagnosis, and communicated to the surgeon operating via intercom.

During an operation, tissue is transferred to the frozen tissue lab directly from the operating room. There, it is placed on a freezing microtome machine where the bottom of the sample is frozen within seconds.

6.

The principle of sentinel node biopsy--

Therefore, the principle of sentinel lymph node biopsy is that if there is no cancer in the sentinel lymph node(s), then there should be no cancer in other lymph nodes “downstream” from the sentinel lymph node. ... Use both a radioactive dye and a blue dye to find the sentinel lymph nodes.

Sentinel node biopsy is a surgical procedure used to determine whether cancer has spread beyond a primary tumor into your lymphatic system. It's used most commonly in evaluating breast cancer and melanoma.

The sentinel nodes are the first few lymph nodes into which a tumor drains. Sentinel node biopsy involves injecting a tracer material that helps the surgeon locate the sentinel nodes during surgery. The sentinel nodes are removed and analyzed in a laboratory.

If the sentinel nodes are free of cancer, then cancer is unlikely to have spread, and removing additional lymph nodes is unnecessary.

If a sentinel lymph node biopsy reveals cancer, your doctor might recommend removing more lymph nodes.

7.

The term skin sparing mastectomy (SSM) was first used by Toth and Lappert in 1991 .

They described preoperative planning of mastectomy incisions in an attempt to maximize skin preservation and facilitate immediate breast reconstruction (IBR). The procedure removes the breast, nipple-areola complex, previous biopsy incisions, and skin overlying superficial tumors

Preservation of the inframammary fold (IMF) and native skin greatly enhances the aesthetic result of breast reconstruction. The operation has been adopted for patients with early breast cancer treated by total mastectomy and immediate reconstruction but has not gained universal acceptance. Most surgeons surveyed agree that the procedure improves the cosmetic results of immediate breast reconstruction .

8.

the purpose and extent of lymph-node dissection has changed. The following is an overview of the current knowledge and practice of lymph-node dissection in breast cancer, with special regard to expected developments in the near future. Axillary dissection is described as a ten-step procedure, including dissection of level-I and -II and Rotter's nodes, without level-III nodes, providing at least ten lymph nodes for accurate staging information.