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1.  Regression of Fibroadenomas with Centchroman: a Randomized Controlled Trial 
The Indian Journal of Surgery  2013;77(Suppl 2):484-489.
Fibroadenoma is a common cause of breast lump in young girls. Nearly 10–15 % of lesions regress spontaneously over the period of 6 to 60 months. The aim of study was to investigate the role of Centchroman in regression of fibroadenoma in comparison to natural observation and to study the association of hormonal receptors with degree of regression. The study was carried out at the outpatient clinic of Department of Surgery, All India Institute of Medical Sciences, New Delhi, from November 2004 to November 2007. Patients aged ≤30 years with fibroadenoma were included. Patients with fibroadenoma equal to or larger than 5 cm and with polycystic ovarian disease were excluded. Patients were randomized in two groups. Patients in active therapy arm were prescribed Centchroman 30 mg daily for 12 weeks, and another group was observed without any intervention (control group). Patients were followed at weeks 4, 8, 12, and 24 to assess response to therapy. Twenty-two (31.88 %) fibroadenomas in Centchroman arm disappeared completely as compared to four (7.69 %) in control arm over a period of 6 months. There was a decrease in the volume of fibroadenoma in ten (19.23 %) patients in control arm and 36 (52.17 %) patients in Centchroman arm. Centchroman therapy allowed 31 % fibroadenoma to regress completely with scanty menses or amenorrhea as the only side effect.
doi:10.1007/s12262-013-0886-4
PMCID: PMC4692841  PMID: 26730050
Fibroadenoma; Centchroman; Polycystic ovarian disease; Saheli; Hormone receptor; Antiestrogen
2.  Duct Ectasia and Periductal Mastitis in Indian Women 
The Indian Journal of Surgery  2014;77(Suppl 3):957-962.
There is very little awareness of the general physicians and surgeons about the benign breast conditions such as duct ectasia (DE) and periductal mastitis (PDM) causing nipple discharge. Not only that these benign breast diseases ring a false alarm of cancer, they are also the second most common cause of benign breast diseases. The objective was to study the clinical and microbiological profiles of duct ectasia and periductal mastitis in Indian women for better understanding of the disease process, in order to be able to treat them well. Forty-one consecutive patients presenting to the Surgical Out-Patient Department with non-bloody nipple discharge with clinical and radiological features suggestive of DE or PDM were included. Microbial culture and cytopathological study of the nipple discharge were done. Histopathological studies and culture of the ductal tissue taken intraoperatively were carried out. There is no significant difference in the age distribution among women with DE and PDM. Smoking is not associated with DE and PDM of Indian patients in contrast to the Western literature evidence. Infective etiology was present in nearly 46 % of the patients in the study population more so in the periductal mastitis cases. The most common isolated pathogens were Staphylococcus aureus and Staphylococcus epidermidis, unlike in Western population where nearly 50 % were anaerobes. Since the isolated organisms were resistant to the routinely used antibiotics in high proportion of cases, culture and sensitivity should be done in all possible cases for appropriately treating the subareolar sepsis before proceeding with the definitive treatment in the form of duct excision.
doi:10.1007/s12262-014-1079-5
PMCID: PMC4775567  PMID: 27011490
Duct ectasia; Periductal mastitis; Nipple discharge; Culture of nipple discharge; Duct ectasia in Indian women; Mastitis in Indian women; Mammary duct excision; Benign breast disease; Management of periductal mastitis/duct ectasia
3.  Are Breast Surgical Operations Clean or Clean Contaminated? 
The Indian Journal of Surgery  2015;77(Suppl 3):1360-1362.
The breast surgeries are classically taught as clean surgical procedures. The infection rates following breast surgery ranges from 3 to 15 %, which is much higher than infection rates after clean surgery (ranging from 1.5 to 3 %). This high infection rate following breast surgery can be explained by opening of the ductal system to outside world through nipple similar to the gastrointestinal and genitourinary system. We conducted a systematic review of infection following breast surgeries. We searched various randomized controlled trials, meta-analysis, and Cochrane Reviews over PubMed and Medline via the Internet. These evidences were found to support the thesis, “Breast surgeries need to be reclassified as clean-contaminated”. We recommend the use of prophylactic antibiotics in breast surgery.
doi:10.1007/s12262-015-1252-5
PMCID: PMC4775677  PMID: 27011565
Breast surgery; Clean contaminated; Wound infection; Surgical site infection; Milk ducts; Bacteria
4.  Identification of Amino Acids at the Catalytic Site of a Ferredoxin-Dependent Cyanobacterial Nitrate Reductase 
Biochemistry  2015;54(36):5557-5568.
An in silico model of the ferredoxin-dependent nitrate reductase from the cyanobacterium Synechococcus sp. PCC 7942, and information about active sites in related enzymes, had identified Cys148, Met149, Met306, Asp163, and Arg351 as amino acids likely to be involved in either nitrate binding, prosthetic group binding, or catalysis. Site-directed mutagenesis was used to alter each of these residues, and differences in enzyme activity and substrate binding of the purified variants were analyzed. In addition, the effects of these replacements on the assembly and properties of the Mo cofactor and [4Fe-4S] centers were investigated using Mo and Fe determinations, coupled with electron paramagnetic resonance spectroscopy. The C148A, M149A, M306A, D163N, and R351Q variants were all inactive with either the physiological electron donor, reduced ferredoxin, or the nonphysiological electron donor, reduced methyl viologen, as the source of electrons, and all exhibited changes in the properties of the Mo cofactor. Charge-conserving D163E and R351K variants were also inactive, suggesting that specific amino acids are required at these two positions. The implications for the role of these five conserved active-site residues in light of these new results and previous structural, spectroscopic, and mutagenesis studies for related periplasmic nitrate reductases are discussed.
doi:10.1021/acs.biochem.5b00511
PMCID: PMC4638386  PMID: 26305228
5.  Image guided versus palpation guided core needle biopsy of palpable breast masses: a prospective study 
Background & objectives:
Biopsy of palpable breast masses can be performed manually by palpation guidance or under imaging guidance. Based on retrospective studies, image guided biopsy is considered more accurate than palpation guided breast biopsy; however, these techniques have not been compared prospectively. We conducted this prospective study to verify the superiority and determine the size of beneficial effect of image guided biopsy over palpation guided biopsy.
Methods:
Over a period of 18 months, 36 patients each with palpable breast masses were randomized into palpation guided and image guided breast biopsy arms. Ultrasound was used for image guidance in 33 patients and mammographic (stereotactic) guidance in three patients. All biopsies were performed using 14 gauge automated core biopsy needles. Inconclusive, suspicious or imaging-histologic discordant biopsies were repeated.
Results:
Malignancy was found in 30 of 36 women in palpation guided biopsy arm and 27 of 36 women in image guided biopsy arm. Palpation guided biopsy had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 46.7, 100, 100, 27.3 per cent, respectively, for diagnosing breast cancer. Nineteen of 36 women (52.8%) required repeat biopsy because of inadequate samples (7 of 19), suspicious findings (2 of 19) or imaging-histologic discordance (10 of 19). On repeat biopsy, malignancy was found in all cases of imaging-histologic discordance. Image guided biopsy had 96.3 per cent sensitivity and 100 per cent specificity. There was no case of inadequate sample or imaging-histologic discordance with image guided biopsy.
Interpretation & conclusions:
Our results showed that in palpable breast masses, image guided biopsy was superior to palpation guided biopsy in terms of sensitivity, false negative rate and repeat biopsy rates.
doi:10.4103/0971-5916.187108
PMCID: PMC4989833  PMID: 27488003
Breast biopsy; breast cancer; image guided; palpation guided
6.  Surgical Resection of Phyllodes Tumour: a Radical Approach as a Safeguard Against Local Recurrence 
The Indian Journal of Surgery  2013;77(2):161-163.
Phyllodes tumour is a rare benign neoplasm of the breast. It is a mixed tumour of epithelial and mesenchymal origin. The epithelial element is characterized by proliferation of ductolobular units. The fibrous tissue and collagen bundles represent the mesenchymal element. It is also known as “cystosarcoma” phyllodes to characterize some important features, viz. cyst-like or cleft-like spaces within the mass along with a leaf- or frond-like pattern of the stromal element. The tumour is well known for its high potential for local recurrence. Most patients in developing countries present with very large breast tumours with close proximity to the skin and pectoralis major. In these cases, there is a need to perform a three-dimensional en bloc removal of the mass with overlying skin and underlying muscle(s). If a skin flap is raised in the vicinity of the tumour, there is a risk of cutting close to the tumour, increasing risk of local recurrence. Here, we describe a surgical technique that permits a three-dimensional en bloc removal of phyllodes tumour.
doi:10.1007/s12262-013-0935-z
PMCID: PMC4484526  PMID: 26139976
Phyllodes tumour; Radical surgery; Wide local excision; Cystosarcoma
7.  Characterization of lesions in dense breasts: Does tomosynthesis help? 
Context:
Mammography in dense breasts is challenging due to lesion obscuration by tissue overlap. Does tomosynthesis offers a solution?
Aims:
To study the impact of digital breast tomosynthesis (DBT) in characterizing lesions in breasts of different mammographic densities.
Settings and Design:
Prospective blinded study comparing mammography in two views with Mammography + Tomosynthesis.
Methods and Material:
Tomosynthesis was performed in 199 patients who were assigned Breast imaging reporting and data system (BIRADS) categories 0, 3, 4, or 5 on two-dimensional (2D) mammogram. Mammograms were first categorized into one of 4 mammographic breast densities in accordance with the American College of Radiology (ACR). Three radiologists independently analyzed these images and assigned a BIRADS category first based on 2D mammogram alone, and then assigned a fresh BIRADS category after taking mammography and tomosynthesis into consideration. A composite gold-standard was used in the study (histopathology, ultrasound, follow-up mammogram, magnetic resonance imaging). Each lesion was categorized into 3 groups—superior categorization with DBT, no change in BIRADS, or inferior BIRADS category based on comparison with the gold-standard. The percentage of lesions in each group was calculated for different breast densities.
Results:
There were 260 lesions (ages 28–85). Overall, superior categorization was seen in 21.2% of our readings on addition of DBT to mammography. DBT was most useful in ACR Densities 3 and 4 breasts where it led to more appropriate categorization in 27 and 42% of lesions, respectively. DBT also increased diagnostic confidence in 54.5 and 63.6% of lesions in ACR Densities 3 and 4, respectively.
Conclusions:
In a diagnostic setting, the utility of tomosynthesis increases with increasing breast density. This helps in identifying the sub category of patients where DBT can actually change management.
doi:10.4103/0971-3026.184416
PMCID: PMC4931780  PMID: 27413268
Breast cancer; dense breasts; digital breast tomosynthesis
8.  Cucumis melo ssp. Agrestis var. Agrestis Ameliorates High Fat Diet Induced Dyslipidemia in Syrian Golden Hamsters and Inhibits Adipogenesis in 3T3-L1 Adipocytes 
Pharmacognosy Magazine  2015;11(Suppl 4):S501-S510.
Background:
Cucumis melo ssp. agrestis var. agrestis (CMA) is a wild variety of C. melo. This study aimed to explore anti-dyslipidemic and anti-adipogenic potential of CMA.
Materials and Methods:
For initial anti-dyslipidemic and antihyperglycemic potential of CMA fruit extract (CMFE), male Syrian golden hamsters were fed a chow or high-fat diet with or without CMFE (100 mg/kg). Further, we did fractionation of this CMFE into two fractions namely; CMA water fraction (CMWF) and CMA hexane fraction (CMHF). Phytochemical screening was done with liquid chromatography-mass spectrometry LC- (MS)/MS and direct analysis in real time-MS to detect active compounds in the fractions. Further, high-fat diet fed dyslipidemic hamsters were treated with CMWF and CMHF at 50 mg/kg for 7 days.
Results:
Oral administration of CMFE and both fractions (CMWF and CMHF) reduced the total cholesterol, triglycerides, low‐density lipoprotein cholesterol, and very low‐density lipoprotein-cholesterol levels in high fat diet-fed dyslipidemic hamsters. CMHF also modulated expression of genes involved in lipogenesis, lipid metabolism, and reverse cholesterol transport. Standard biochemical diagnostic tests suggested that neither of fractions causes any toxicity to hamster liver or kidneys. CMFE and CMHF also decreased oil-red-O accumulation in 3T3-L1 adipocytes.
Conclusion:
Based on these results, it is concluded that CMA possesses anti-dyslipidemic and anti-hyperglycemic activity along with the anti-adipogenic activity.
SUMMARY
The oral administration of Cucumis melo agrestis fruit extract (CMFE) and its fractions (CMWF and CMHF) improved serum lipid profile in HFD fed dyslipidemic hamsters.CMFE, CMWF and CMHF significantly attenuated body weight gain and eWAT hypertrophy.The CMHF decreased lipogenesis in both liver and adipose tissue.CMFE and CMHF also inhibited adipogenesis in 3T3-L1 adipocytes.
Abbreviation used: CMA: Cucumis melo ssp. agrestis var. agrestis, CMFE: CMA fruit extract, CMWF: CMA water fraction, CMHF: CMA hexane fraction, FAS: Fatty acid synthase, SREBP1c: Sterol regulatory element binding protein 1c, ACC: Acetyl CoA carboxylase, LXR α: Liver X receptor α.
doi:10.4103/0973-1296.172945
PMCID: PMC4787080  PMID: 27013786
3T3-L1 adipocytes; Cucumis melo ssp. agrestis var. agrestis; direct analysis in real time-mass spectrometry analysis; dyslipidemia; high-fat diet; Syrian golden hamster
9.  Interrupted Abdominal Closure Prevents Burst: Randomized Controlled Trial Comparing Interrupted-X and Conventional Continuous Closures in Surgical and Gynecological Patients 
The Indian Journal of Surgery  2012;76(4):270-276.
Reduction in the risk of abdominal dehiscence with application of interrupted method of laparotomy closure and comparison with risk of burst with continuous method of closure. Three hundred forty eight patients undergoing laparotomy (114–elective gynecology, 114–emergency gynecology, 120–emergency surgery) were randomized into three arms to undergo closure with continuous, interrupted-X, and Modified Smead-Jones suturing techniques. Burst abdomen occurring up to 4 weeks of operation. Twenty-nine (8.33 %) of 348 patients developed burst in the post-operative period. 19 (15.70 %) of 121 patients in continuous arm developed burst. Five of 110 (4.55 %) patients in Interrupted-X arm and 5 of 117 (4.27 %) patients in Modified Smead-Jones arm developed burst. Interrupted suturing was associated with significant reduction in risk of burst when compared with continuous closure. Important predictors of burst were Intraperitoneal sepsis, cough, uremia, and surgical site infection.
doi:10.1007/s12262-012-0611-8
PMCID: PMC4175669  PMID: 25278649
Abdominal wound dehiscence; Burst abdomen; Interrupted X suture; Randomized trial; Emergency laparatomy; Gynecological surgery; Prof Hughes’ far & near suture
10.  A Systematic Review of Current Understanding and Management of Mastalgia 
The Indian Journal of Surgery  2013;76(3):217-222.
Breast pain or mastalgia is the common symptom in the breast. The two most common concerns of patients presenting with mastalgia are: the fear that breast pain is a symptom of breast cancer and the presence of severe pain that affects a woman’s quality of life. Breast pain requires thorough assessment and should be investigated in the same manner as any other breast symptom. We conducted a systematic review of treatment for breast pain. We searched various reviews, randomized controlled trial, and observational studies over Pubmed and Medline via internet. Searches were carried out on MEDLINE (1950–present), EMBASE (1980–present), and CINAHL (1981–present) using the NHS Evidence Healthcare Databases Advanced Search interface. A further search was also carried out on Cochrane Database of Systematic Reviews (issue 12 of 12, Dec 2011) and Central Register of Controlled Trials (issue 4 of 4, Oct 2011). If no abnormality is found in the breast on assessment, then a combination of reassurance, breast support brassiere, and topical NSAID gel massage are usually effective. Antiestrogen (centchroman/tamoxifen) therapy for 3 to 6 months is the second-line treatment of choice. Danazol may be used in resistant cases. Gamma-linolenic acid or evening primrose oil though commonly prescribed is not effective.
doi:10.1007/s12262-013-0813-8
PMCID: PMC4141056  PMID: 25177120
Mastalgia; Cyclical mastalgia; Noncyclical mastalgia; Centchroman; Danazol; Diclofenac gel
11.  A Prospective Randomized Study to Compare the Effectiveness of Honey Dressing vs. Povidone Iodine Dressing in Chronic Wound Healing 
The Indian Journal of Surgery  2012;76(3):193-198.
To compare the healing of chronic wounds with honey dressing vs. Povidone iodine dressing in adult subjects with chronic wounds of ≥6 weeks of duration, attending wound care clinic in Surgical Out Patient Department of All India Institute of Medical Sciences, Surgical Out Patient Department of Jai Prakash Narayan Apex Trauma center, New Delhi. Forty five subjects were randomized into two groups i.e., Honey & Povidone iodine dressing group. Dressing was done on alternate day basis for 6 weeks of followup period. Main outcome measure was complete healing at 6 weeks. Wound healing status was assessed at 2 weekly intervals till 6 weeks. Seven out of 22 subjects in honey treated group achieved complete healing as compared to none out of 20 subjects in Povidone iodine treated group. There was a significant decrease in the wound surface area, pain score & increase in comfort score in Honey dressing group in comparison to the Povidone Iodine group at 0.05 level of significance. Honey dressing is highly effective in achieving healing in chronic wounds as compared to Povidone iodine dressing.
doi:10.1007/s12262-012-0682-6
PMCID: PMC4141059  PMID: 25177115
Honey dressing; Povidone iodine dressing; Chronic wound healing; Occlusive dressing; Randomized trial
13.  Prevention of Gossypiboma 
doi:10.1007/s12262-013-0910-8
PMCID: PMC4039676  PMID: 24891790
15.  Management of Lactational Mastitis and Breast Abscesses: Review of Current Knowledge and Practice 
The Indian Journal of Surgery  2012;75(6):430-435.
Most breast abscesses develops as a complication of lactational mastitis. The incidence of breast abscess ranges from 0.4 to 11 % of all lactating mothers. The traditional management of breast abscesses involves incision and drainage of pus along with antistaphylococcal antibiotics, but this is associated with prolonged healing time, regular dressings, difficulty in breast feeding, and the possibility of milk fistula with unsatisfactory cosmetic outcome. It has recently been reported that breast abscesses can be treated by repeated needle aspirations and suction drainage. The predominance of Staphylococcus aureus allows a rational choice of antibiotic without having to wait for the results of bacteriological culture. Many antibiotics are secreted in milk, but penicillin, cephalosporins, and erythromycin, however, are considered safe. Where an abscess has formed, aspiration of the pus, preferably under ultrasound control, has now supplanted open surgery as the first line of treatment.
doi:10.1007/s12262-012-0776-1
PMCID: PMC3900741  PMID: 24465097
Breast abscess; Mastitis; Breast feeding
16.  The First and Second Echelon Sentinel Lymph Node Evaluation in Oral Cancer 
The Indian Journal of Surgery  2012;75(5):377-382.
Sentinel lymph node biopsy shows promise as a minimally invasive technique that samples the first echelon (station) of nodes to predict the need for more extensive neck dissection. This paper discusses the accuracy and feasibility of sentinel node and “station II node” biopsy for predicting the status of neck in 20 patients of oral cancer. We identified sentinel node in these patients. The next higher-order nodes, that is, second echelon of nodes known as “station II nodes” were delineated by further injecting 0.1 ml of isosulfan blue dye in sentinel lymph node. Identification rate for station I nodes was 95 %. Station II nodes were identified in 84 % of patients. One patient had false negative station I node. Station II node status was false negative in two patients. “Station I and station II concept” is feasible in early-stage tumors of oral cavity.
doi:10.1007/s12262-012-0497-5
PMCID: PMC3824774  PMID: 24426480
Sentinel node (station I node); Oral cancer; Second echelon (station) node; Neck dissection
17.  How do I do it? Passing a Pedicled Flap Through a Subcutaneous Tunnel 
The Indian Journal of Surgery  2013;75(4):317-318.
Latissimus dorsi myocutaneous flaps are used to cover body structures or replace tissue that has been lost due to trauma, infection, or surgical excision for tumor. Transfer of these flaps from donor to recipient site is a vital step of surgery as forceful passage of flap may cause damage to blood supply of flap or devitalize the tissue by excessive shearing force. Use of polyvinyl chloride bag for transfer of latissimus dorsi flap through subcutaneous tunnel has been found to be very effective in dealing with this problem.
doi:10.1007/s12262-013-0814-7
PMCID: PMC3726818  PMID: 24426461
Latissimus dorsi; Myocutaneous flap; Subcutaneous tunnel
18.  The Roles of Four Conserved Basic Amino Acids in a Ferredoxin-Dependent Cyanobacterial Nitrate Reductase 
Biochemistry  2013;52(25):4343-4353.
The roles of four conserved basic amino acids in the reaction catalyzed by the ferredoxin-dependent nitrate reductase from the cyanobacterium Synechococcus sp. PCC 7942 have been investigated using site-directed mutagenesis in combination with measurements of steady-state kinetics, substrate-binding affinities and spectroscopic properties of the enzyme’s two prosthetic groups. Replacement of either Lys58 or Arg70 by glutamine leads to a complete loss of activity, with both the physiological electron donor, reduced ferredoxin and with a non-physiological electron donor, reduced methyl viologen. More conservative, charge-maintaining K58R and R70K variants were also completely inactive. Replacement of Lys130 by glutamine produced a variant that retained 26% of the wild-type activity with methyl viologen as the electron donor and 22% of the wild-type activity with ferredoxin as the electron donor, while replacement by arginine produces a variant that retains a significantly higher percentage of the wild-type activity with both electron donors. In contrast, replacement of Arg146 by glutamine had minimal effect on the activity of the enzyme. These results, along with substrate-binding and spectroscopic measurements, are discussed in terms of an in silico structural model for the enzyme.
doi:10.1021/bi400354n
PMCID: PMC3741069  PMID: 23692082
19.  Doping Induced Structural Stability and Electronic Properties of GaN Nanotubes 
The Scientific World Journal  2014;2014:984591.
The present paper discusses the effect of manganese doping on the structural stability and electronic band gap of chiral (2, 1), armchair (3, 3), and zigzag ((6, 0) and (10, 0)) single walled GaN nanotube by using density functional theory based Atomistix Toolkit (ATK) Virtual NanoLab (VNL). The structural stability has been analyzed in terms of minimum ground state total energy, binding, and formation energy. As an effect of Mn doping (1–4 atoms), all the GaN nanotubes taken into consideration show semiconducting to metallic transition first and after certain level of Mn doping changes its trend.
doi:10.1155/2014/984591
PMCID: PMC3953657  PMID: 24707225
20.  Doppler Ultrasound Flowmetry Predicts 15 Year Outcome in Patients with Skin Melanoma 
The Indian Journal of Surgery  2012;74(4):278-283.
This prospective cohort study was conducted to find the role of tumor neovascularization in skin melanoma measured by preoperative Doppler ultrasound flowmetry in determining the 15-year outcome. Setting: Department of Surgery, University of Wales College of Medicine, Cardiff, UK. Seventy-one primary melanomas in 67 patients were studied with a 10 MHz Doppler ultrasound flowmeter. The flow signals were recorded on an audiotape. The peak systolic frequency, mean systolic frequency, and minimum diastolic frequency were measured on a spectrum analyzer. The follow-up (median 144 months) information is complete till December 2005 on 63 patients. Blood flow signals were detected in 41 lesions; these were labeled Doppler flow positive. No flow was detected in 22 lesions, labeled Doppler flow negative. Among the Doppler flow positive group, 39% patients have died with metastatic melanoma, whereas none of the patients with a Doppler-negative lesion have died or developed any recurrence. Higher peak systolic frequency (above 2,500 MHz.) was associated with a hazard ratio for death due to melanoma of (HAZARD RATE = 5.99). Higher risk of death, locoregional, and systemic recurrences were associated with higher peak systolic frequency. Doppler flowmetry performed preoperatively is a noninvasive, quick, and simple method to assess tumor blood flow which may help in predicting long-term survival and planning neoadjuvant therapies aimed at inhibiting angiogenesis or targeting tumor vasculature.
doi:10.1007/s12262-011-0398-z
PMCID: PMC3444611  PMID: 23904713
Tumor blood flow; Neovascularization; Malignant melanoma; Recurrence; Doppler ultrasound flowmetry; Cohort study; Survival
21.  Role of fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography in the evaluation of axillary lymph node involvement in operable breast cancer in comparison with sentinel lymph node biopsy 
Purpose:
Role of (18 [F] fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose [FDG] positron emission tomography-computed tomography [PET-CT]) in the evaluation of axillary lymph node involvement in T1T2N0 breast cancer and compare results with sentinel lymph node biopsy (SLNB).
Methods:
A total of 37 patients of proven T1T2N0 breast cancer were included in the study. Patients with past history of breast surgery, T3T4 disease, uncontrolled diabetes mellitus and pregnant patients were excluded from the study. Pre-operative FDG PET-CT was performed followed by sentinel lymph node (SLN) biopsy with blue dye or combined technique.
Results:
SLN was identified in 32 of 37 patients with an identification rate of 86.48% (32/37). With combined technique SLN identification rate was 100% (6/6) while with blue dye alone; it was 83.8% (26/31). Among 37 patients, 16 had axillary metastases of which 12 had macrometastases and four had micrometastases detected by immunohistochemistry (IHC). Of 12 patients with axillary macrometastases, skip metastases were present in two patients in whom SLN was negative and in two patients SLN was not identified, but axillary dissection showed metastases. PET-CT had shown sensitivity, specificity, negative predictive value and positive predictive value of 56%, 90%, 73%, and 81.8%, respectively. IHC of SLN detected four patients with micrometastases upstaging the disease by 11% (4/37).
Conclusion:
Because FDG PET-CT has a high specificity in the evaluation of axillary lymph node involvement in T1T2N0 breast cancer patients according to the results of this study if FDG PET-CT is positive in axillary lymph nodes, axillary lymph node dissection may be considered instead of SLNB.
doi:10.4103/0972-3919.119542
PMCID: PMC3822412  PMID: 24250021
Breast cancer; fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography; immunohistochemistry; sentinel lymph node biopsy
22.  Clinical Significance of Altered Expression of β-Catenin and E-Cadherin in Oral Dysplasia and Cancer: Potential Link with ALCAM Expression 
PLoS ONE  2013;8(6):e67361.
Background
Perturbations in cell adhesion molecules are linked to alterations in cadherin-catenin complexes and likely play major roles in invasion and metastasis; their impact on early precancerous stages remains yet unknown. We showed ALCAM overexpression in early oral lesions and its cytoplasmic accumulation in oral squamous cell carcinoma (OSCC) to be a predictor of disease progression and poor prognosis. This study tested the hypothesis that alterations in E-cadherin and β -catenin expressions are early events in oral tumorigenesis, associated with disease prognosis, and correlate with perturbations in ALCAM expression.
Methods
Expressions of E-cadherin and β-catenin were analyzed in the same cohort of 105 OSCCs, 76 oral lesions and 30 normal oral tissues by immunohistochemistry and correlated with clinicopathological parameters and prognosis. The effect of siRNA mediated ALCAM knockdown on E-cadherin and β -catenin was determined using western blot, confocal microscopy and RT-PCR analysis in oral cancer cells.
Results
Significant loss of membranous E-cadherin and β-catenin expression was observed from normal, hyperplasia, dysplasia to OSCCs (ptrend <0.001); and correlated with cytoplasmic ALCAM accumulation in OSCCs (p  = 0.006). Multivariate analysis revealed β-catenin membrane loss and ALCAM/β-cateninnuclear/cytoplasmic accumulation to be significant predictors for late clinical stage (p<0.001, OR = 8.7; p = 0.006, OR = 9.9, respectively) and nodal metastasis (p = 0.003, OR = 3.8; p = 0.025, OR = 3.4 respectively). Cox’s regression showed E-cadherin membrane loss/ALCAM cytoplasmic expression [p<0.001; HR = 4.8] to be independent adverse prognosticators in OSCCs. siRNA mediated silencing of ALCAM resulted in concurrent increase in E-cadherin and β-catenin both at the transcript and protein levels.
Conclusions
Losses of E-cadherin and β-catenin expressions are early events in oral tumorigenesis; their associations with aggressive tumor behavior and disease recurrence underscore their potential as prognostic markers. Correlation of loss of E-cadherin and β-catenin with cytoplasmic ALCAM accumulation both in vitro and in in vivo suggests that these dynamic changes in cell adhesion system may play pivotal role in oral cancer.
doi:10.1371/journal.pone.0067361
PMCID: PMC3696121  PMID: 23840677
23.  Most Breast Cancer Screening Trials Have a Flawed Design 
The Indian Journal of Surgery  2011;73(6):419-422.
In the present article, we discuss that why most breast cancer screening trials have a flawed origin. We suggest some solutions to correct these flaws so that more valid and reliable screening trials can be conducted in the future.
doi:10.1007/s12262-011-0342-2
PMCID: PMC3236276  PMID: 23204698
Breast cancer; Screening trials; Bias; Quality of life; Mammography
24.  Re-Evaluate the Effect of Hyperbaric Oxygen Therapy in Cancer - A Preclinical Therapeutic Small Animal Model Study 
PLoS ONE  2012;7(11):e48432.
Tumor hypoxia is a known driver of angiogenesis that also facilitates tumor growth. Moreover, poorly oxygenated central tumor area remains relatively radio or chemo resistant. HBO therapy is known to elevate the levels of dissolved oxygen and eliminates tumor hypoxia. It has been one of the modalities in cancer treatment; therefore its optimization is important. In this experimental study, no cancer enhancing effect was seen during the course of HBO therapy; however, post therapy there was an accelerated growth and progression of tumor. HBO treated mice lived shorter and the response to therapy was dose & tumor volume dependent. HBO therapy probably exert its effect on the cancer proliferating cells through multiple pathways such as increased DNA damage, apoptosis & geno-toxicity leading to slow cancer progression while post therapy tumorigenic effect could be due to impaired DNA repair mechanism, mutagenic effect & aneuploidy as well as altered blood supply & nutrients. Tumor growth reached plateau with time and this finding validated theoretical model predicting tumor reaching an asymptotic limit. While, marked asymmetry observed in tumor volume progression or cancer cell proliferation rate in each of the experimental C3H mouse suggested a need for an alternate small animal pre-clinical cancer therapeutic model.
doi:10.1371/journal.pone.0048432
PMCID: PMC3492351  PMID: 23144880
25.  Giant Myofibroblastoma of the Male Breast: A Case Report and Literature Review 
Myofibroblastomas are soft-tissue neoplasms that are thought to arise from myofibroblasts. They are mostly observed in males 41–85 years of age; however, this lesion also occurs in women. The usual clinical presentation is a unilateral painless lump that is not adherent to overlying or underlying structures. Microscopically, myofibroblastomas can be divided into 5 subtypes: classical, epithelioid, collagenised, cellular, and infiltrative. Mammary ducts and lobules are absent in the typical histological subtypes and the adjacent breast parenchyma may form a pseudocapsule. The majority of myofibroblastomas are immunoreactive for CD34, desmin, smooth muscle actin, and vimentin and are negative for cytokeratin and S-100 protein. We present a case of a giant myofibroblastoma arising in the background of gynecomastia in an adult male.
PMCID: PMC3629667  PMID: 23610552
breast; gynecomastia; mesenchymal; myofibroblastoma; spindle cell

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