Leaders of the past.
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Biographies as Topic↗
Biomedical subjects
C Berman
Publications and source records attributed to C Berman.
Selective lymphadenectomy in patients with Merkel cell (cutaneous neuroendocrine) carcinoma.
BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive cutaneous tumor with a propensity for local recurrence, regional and distant metastases. There are no well-defined prognostic factors that predict behavior of this tumor, nor are treatment guidelines well established. METHODS: Staging of patients with a new diagnosis of MCC was attempted using selective lymphadenectomy concurrent with primary excision. Preoperative and intraoperative mapping, excision, and thorough histologic evaluation of the first lymph node draining the tumor primary site [sentinel node] was performed. Patients with tumor metastasis in the sentinel node underwent complete resection of the remainder of the lymph node basin. RESULTS: Twelve patients underwent removal of 22 sentinel nodes. Two patients demonstrated metastatic disease in their sentinel lymph nodes, and complete dissection of the involved nodal basin revealed additional positive nodes. The node-negative patients received no further surgical therapy, with no evidence of recurrent local or regional disease at a maximum of 26 months follow-up (median 10.5 months). CONCLUSIONS: While the data are preliminary and initial follow-up is limited, early results suggest that sentinel lymph node mapping and excision may be a useful adjunct in the treatment of MCC. This technique may identify a population of patients who would benefit from further surgical lymph node excision.
Biopsy↗
Microstaging of breast cancer patients using cytokeratin staining of the sentinel lymph node.
BACKGROUND: Sentinel lymph node (SLN) mapping is an effective and accurate method of axillary nodal evaluation for metastatic disease. Cytokeratin (CK) immunohistochemical (IHC) staining of the SLN has found micrometastatic disease previously undetected by routine hematoxylin and eosin (H&E) stains. The purpose of this study is to determine the number of patients who were upstaged or microstaged, i.e., detected to have micrometastatic disease only by combined lymphatic mapping with CK IHC. METHODS: Two hundred and ten patients with newly diagnosed breast cancer underwent intraoperative lymphatic mapping using a combination of vital blue dye and technetium-labeled sulfur colloid. The excised sentinel lymph nodes were examined grossly, by imprint cytology, by standard H&E histology, and by IHC stains for CK. SLNs that were only CK positive were confirmed to be malignant by histologic examination. RESULTS: CK IHC staining was performed on 381 SLNs in 210 breast cancer patients. Forty-seven of 210 patients (22.4%) had positive nodes. Thirty of these 47 patients (63.8%) had both H&E- and CK-positive SLNs, and an additional 17 of the 47 positive patients (36.2%) had only CK-positive SLNs. Seventeen of the 180 patients (9.4%) who were negative on H&E staining were upstaged by CK IHC staining of malignant cells in the SLN. Comparison of tumor size with the total number of node-positive patients demonstrated that 16 of 30 node-positive T0 and T1 patients (53.5%) and 22 of 39 nodes (56.4%) were upstaged by CK IHC staining. T2 and T3 patients were less frequently upstaged by cytokeratin analysis of lymph nodes. Only one of 17 node-positive patients (5.9%) and seven of 34 nodes (20.6%) in patients with T2 and T3 tumors were upstaged. CONCLUSION: CK IHC staining of SLNs shifted 9.4% of patients from stage I to stage II. There was a significant upstaging influence noted in patients with tumor sizes under 2 cm. This microstaging shift or upstaging may account for the significant proportion of stage I breast cancer treatment failures. Microstaging of the SLNs using more sensitive assays may help identify a subgroup of patients with invasive breast cancer who would benefit from systemic adjuvant treatment, while sparing a disease-free subset of patients the additional risks of toxic adjuvant chemotherapy.
Biopsy, Needle↗
Computer database for melanoma: a clinical management and research tool to ensure continuous quality assessment.
The need for an efficient method to handle data and for chart documentation is more apparent today than at any time in the past. High volume clinics for screening, diagnosis, and treatment are the rule rather than the exception in modern practice. A papermill medical record department or tumor registry fails on a day-to-day basis because of inefficiency of data collection, filing, storage, and abstraction. Requirements of the Joint Commission for the Accreditation of Health Care Organizations (JCAHO) include the setting of standards and the ability to query data to ensure the standards are met. A PC-based software program has been developed with the following features: (1) ongoing timed queries of the data are possible on any variable collected in the database to monitor trends in the standards established for care in the clinic; (2) a daily update of the database is performed so that it may be used as a clinical management tool, acting as an electronic medical record or as a clinical research tool; (3) the software will summarize the chart by abstracting a predetermined list of key data elements to improve clinical efficiency; (4) chart documentation is improved for Medicare coding requirements to maximize physician reimbursement; and (5) clinic notes and referral letters are generated the same day as the clinic visit to allow patients to have a copy of their clinic notes or for same day FAXing to the referring doctors. To date, > 1,200 patients with melanoma have been registered and entered into the system.(ABSTRACT TRUNCATED AT 250 WORDS)
Databases, Factual↗
Identification of lymphatic drainage basins in patients with cutaneous melanoma.
Lymphoscintigraphy has been shown to be of assistance in predicting lymphatic basins at risk for the development of metastatic disease in patients with cutaneous malignant melanoma. To further establish the efficacy of this method, 212 patients presenting to the H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida with primary melanoma of the head, neck, and trunk have been studied. All patients had clinical stage 1 or 2 melanoma and were candidates for elective lymph node dissection. Drainage patterns identified by lymphoscintigraphy were compared to those predicted by historical anatomical guidelines and were found to be discordant in 63% of patients with tumors of the head and neck, and in 32% of those with primary lesions located on the trunk. Operative intervention was changed because of these findings in 47% of all patients, with 19% undergoing dissection of nonclassical lymph node basins. An additional 28% did not have a node dissection because of failure of the scintigram to demonstrate a predominant drainage basin or the demonstration of multiple drainage sites. After a mean follow-up of 2.8 years, there have been no recurrences in basins not positive by lymphoscintigraphy. The lymphatic drainage from cutaneous melanoma of the head, neck, and trunk cannot be reliably predicted by clinical judgment or classic anatomic guidelines, and lymphoscintigraphy is indicated in these patients prior to elective lymph node dissection.
Antimony↗
Radiologic imaging in malignant melanoma: a review.
The role of imaging in the staging of malignant melanoma is reviewed. Computed tomography (CT) and magnetic resonance (MR) are useful for detecting liver, lung, and central nervous system (CNS) metastases in asymptomatic patients at high risk and in symptomatic patients. Plain films, bone scan, and gastrointestinal (GI) studies are useful in patients with skeletal or GI complaints. Additionally, imaging studies have a primary role for ascertaining the response, if any, to treatment.
Humans↗
Radioguided surgery for the ultrastaging of the patient with melanoma.
PURPOSE: Lymphatic mapping techniques have changed the standard of surgical care for the malignant melanoma population and are being investigated to improve the staging and decrease the morbidity of patients with all types of cancer. This study aimed to describe a combination of techniques and the use of multiple disciplines for accurately staging and treating patients with melanoma. MATERIALS AND METHODS: Over a 4-year period, 595 patients were studied using a protocol consisting of preoperative lymphoscintigraphy using filtered technetium sulfur colloid to define all regional basins at risk for metastatic disease, and intraoperative lymphatic mapping with a vital blue dye and radiocolloid to identify the node in the basin most at risk for metastases (the sentinel lymph node). Detailed pathological exam (serial sectioning, immunohistochemical staining, reverse transcriptase polymerase chain reaction [RT-PCR] analysis) of the sentinel lymph node was used to stage the melanoma patient. RESULTS: A combination of blue dye and radiocolloid intraoperative mapping resulted in a 98% success rate for the identification of the sentinel lymph node. Routine pathological examination identified 73.8% of the metastases. The remainder were detected with serial sectioning (7.8%) and immunohistochemical staining (18.4%). RT-PCR analysis based on a tyrosinase probe has upstaged 47% of the histologic sentinel lymph node-negative population. CONCLUSION: Lymphatic mapping technology provides accurate staging of the melanoma patient, at lower costs for the health care system and a lower morbidity for the patient.
Adolescent↗