Publications by authors named "Tomasz Jastrzebski"

15 Publications

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Guidelines of the Association of Polish Surgeons and the Polish Society of Surgical Oncology on the accreditation of healthcare centers providing cytoreductive surgery and HIPEC for primary and secondary peritoneal cancers.

Pol Przegl Chir 2020 May;92(4):47-53

Department of Surgical Oncology, Medical University of Lublin.

Surgical interventions in patients with peritoneal metastases combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and systemic treatment are becoming more common and, when applied to selected patient groups, they reach 5-year survival rates of 32-52%. Good clinical outcomes require experienced and well-equipped healthcare centers, experienced surgical team and adequate patient qualification process. As a result of the discussion on the need for evaluation of quality of care and treatment outcomes and at the request of the Peritoneal Cancer Section of the Polish Society of Surgical Oncology, accreditation standards have been developed and the Accreditation Committee has been established for healthcare centers providing cytoreductive surgery and HIPEC for the management of primary and secondary peritoneal cancers.
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May 2020

Hyperthermic intraperitoneal chemotherapy (HIPEC) in combined treatment of locally advanced and intraperitonealy disseminated gastric cancer: A retrospective cooperative Central-Eastern European study.

Cancer Med 2019 06 29;8(6):2877-2885. Epub 2019 Apr 29.

Vilnius universtiy hospital Santaros klinikos, Vilnius, Lithuania.

Background And Objectives: Clinical experience in Western Europe suggests that cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are promising methods in the management of gastric cancer (GC) with peritoneal metastases. However, there are almost no data on such treatment results in patient from Central-Eastern European population.

Methods: A retrospective cooperative study was performed at 6 Central-Eastern European HIPEC centers. HIPEC was used in 117 patients for the following indications: treatment of GC with limited overt peritoneal metastases (n = 70), adjuvant setting after radical gastrectomy (n = 37) and palliative approach for elimination of severe ascites without gastrectomy (n = 10).

Results: Postoperative morbidity and mortality rates were 29.1% and 5.1%, respectively. Median overall survival in the groups with therapeutic, adjuvant, and palliative indications was 12.6, 34, and 3.5 months. The only long-term survivors occurred in the group with peritoneal cancer index (PCI) of 0-6 points without survival difference in groups with PCI 7-12 vs PCI 13 or more points.

Conclusions: GC patients with limited peritoneal metastases can benefit from CRS + HIPEC. Hyperthermic intraperitoneal chemotherapy could be an effective method of adjuvant treatment of GC with a high risk of intraperitoneal progression. No long-term survival may be expected after palliative approach to HIPEC.
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http://dx.doi.org/10.1002/cam4.2204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558472PMC
June 2019

Peritoneal metastases of colorectal origin - cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). The financial aspect.

Pol Przegl Chir 2017 Dec;89(6):1-6

Department of Surgical Oncology, Lower Silesian Oncology Center, Wrocław.

The incidence of peritoneal carcinomatosis of colorectal cancer amounts to 5%-15% for synchronous metastases and as much as 40% in cases of local recurrence. Best results are obtained for cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC). This treatment offers much better outcomes, leading to 5-year survival rates of as much as 30%-50%. The procedures require significant experience in abdominal surgery, are time-consuming (mean duration of the procedure ranging from 6 to 8 hours) and are burdened by complications that are due not only to the procedure itself but also to the intraperitoneal administration of the cytostatic drug at elevated temperature (41.5 °C). After the procedure, patients are required to be admitted to intensive care units due to potential complications associated with the extent and duration of the procedure as well as chemotherapy administered in hyperthermia. Postoperative management of these patients requires appropriate experience of the entire medical and nursing team. Cytoreductive surgeries combined with HIPEC as highly specialized medical procedures should be assessed for their potential long-term benefits and their costs should be appropriately calculated with consideration to realistic reimbursement rates. Realistic valuation and reimbursement covering the overall average cost of the procedure is recommended by the National Consultant in Surgical Oncology as well as the ESMO consensus guidelines.
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http://dx.doi.org/10.5604/01.3001.0010.6733DOI Listing
December 2017

Przerzuty do otrzewnej raka jelita grubego.

Pol Przegl Chir 2017 Oct;89(5):34-42

Clinic of Oncological Surgery, Ludwik Rydygier Collegium Medicum UMK in Toruń, Center of Oncology in Bydgoszcz.

Częstość przerzutów do otrzewnej w raku jelita grubego wynosi 5%-15% w przypadku przerzutów synchronicznych i aż 40% w przypadku wystąpienia wznowy miejscowej. Najlepsze wyniki leczenia uzyskuje się poprzez skojarzone wykonanie zabiegu cytoredukcyjnego w połączeniu z dootrzewnową chemioterapią perfuzyjną w hipertermii (HIPEC). Wyniki takiego leczenia są zdecydowanie lepsze i pozwalają na osiągnięcie przeżyć 5-letnich na poziomie 30%-50%. Zabiegi te wymagają dużego doświadczenia w chirurgii jamy brzusznej, są czasochłonne (średni czas procedury chirurgicznej wynosi 6-8 godzin) i obarczone powikłaniami związanymi nie tylko z zabiegiem operacyjnym, ale także podaniem cytostatyku do jamy otrzewnej w podwyższonej temperaturze (41,5 st. C). Chorzy po zabiegu wymagają pobytu na oddziale intensywnej terapii, co jest związane z wystąpieniem potencjalnych powikłań spowodowanych rozległością zabiegu, długością procedury chirurgicznej, zastosowaniu chemioterapii w połączeniu z hipertermią. Prowadzenie pooperacyjne tych chorych wymaga doświadczenia całego zespołu lekarskiego i pielęgniarskiego. Zabiegi cytoredukcyjne w połączeniu z HIPEC jako wysoce specjalistyczne procedury medyczne powinny być merytorycznie ocenione pod kątem korzyści długoterminowych dla chorych i odpowiednio skalkulowane pod względem realnej wysokości refundacji. Jako procedura zalecana w wytycznych Kionsultanta Krajowego d.s. Chirurgii Onkologicznej oraz wytycznych ESMO, niezbędna jest jej realna wycena i refundacja pokrywająca jej całkowite średnie koszty.
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http://dx.doi.org/10.5604/01.3001.0010.5605DOI Listing
October 2017

Preoperative nutritional support in cancer patients with no clinical signs of malnutrition--prospective randomized controlled trial.

Support Care Cancer 2015 Feb 6;23(2):365-70. Epub 2014 Aug 6.

Department of Surgical Oncology, Medical University of Gdańsk, Smoluchowskiego 17, 80-952, Gdańsk, Poland,

Purpose: Preoperative nutrition is beneficial for malnourished cancer patients. Yet, there is little evidence whether or not it should be given to nonmalnourished patients. The aim of this study was to assess the need to introduce preoperative nutritional support in patients without malnutrition at qualification for surgery.

Methods: This was a prospective, two-arm, randomized, controlled, open-label study. Patients in interventional group received nutritional supplementation for 14 days before surgery, while control group kept on to their everyday diet. Each patient's nutritional status was assessed twice--at qualification (weight loss in 6 months, laboratory parameters: albumin, total protein, transferrin, and total lymphocyte count) and 1 day before surgery (change in body weight and laboratory parameters). After surgery, all patients were followed up for 30 days for postoperative complications.

Results: Fifty-four patients in interventional and 48 in control group were analyzed. In postoperative period, patients in control group suffered from significantly higher (p < 0.001) number of serious complications compared with patients receiving nutritional supplementation. Moreover, levels of all laboratory parameters declined significantly (p < 0.001) in these patients, while in interventional arm were stable (albumin and total protein) or raised (transferrin and total lymphocyte count).

Conclusions: Preoperative nutritional support should be introduced for nonmalnourished patients as it helps to maintain proper nutritional status and reduce number and severity of postoperative complications compared with patients without such support.
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http://dx.doi.org/10.1007/s00520-014-2363-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289010PMC
February 2015

[Pseudomyxoma peritonei spread into the right inguinal hernia sac--a case report].

Pol Merkur Lekarski 2013 Oct;35(208):217-20

Department of Surgical Oncology, Academic Clinical Centre, Medical University of Gdansk.

Pseudomyxoma peritonei (PMP) is a rare, progressive disease of unknown origin. The incidence is estimated at about 1-2/100,000,000 per year. The primary tumor site is usually discovered in the appendix or- in case of women--in ovaries, appearing as tumors of low malignancy. Making an accurate diagnosis causes difficulties--symptoms tend to be misleading, suggesting more frequent pathologies of the abdominal cavity. It is also not rare that the patient is for a long time asymptomatic. We present a case of a 68-year-old patient of the Surgical Oncology Department treated for pseudomyxoma peritonei, diagnosed incidentally at the time of clinical examination for the reasons of chronic hypertension. The symptoms reported by the patient did not suggest any neoplastic process of the peritoneal cavity. Systemic chemotherapy of two paths (a total number of 10 cycles) did not result and at the time of post-treatment control, due to no response to standard chemotherapy, it was decided to administer chemotherapy intraperitoneally in hyperthermia (HIPEC). During the operation, peritoneal cytoreduction prior to the scheduled HIPEC was performed; the right-sided inguinal hernia was repaired. Within the hernia sac the implanted myxoid cells were found, their presence inside was probably the main reason of clinical manifestation of the disease.
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October 2013

Endoscopic submucosal dissection of gastric ectopic pancreas.

Wideochir Inne Tech Maloinwazyjne 2013 Sep 5;8(3):249-52. Epub 2013 Mar 5.

Department of Oncological Surgery, University Clinical Center, Medical University of Gdansk, Poland.

Patients with gastric tumors usually present with symptoms of discomfort or pain in the epigastrium, regurgitations, nausea, vomiting or melena. Treatment options include open and laparoscopic total or partial gastrectomy and recently endoscopic mucosal resection. A case of successful endoscopic submucosal dissection is described with the unusual pathological finding of heterotopic pancreatic tissue forming a gastric tumor. The 67-year-old male patient was operated on due to the initial diagnosis of gastro-intestinal stromal tumor of the gastric trunk. Two intra-operative biopsies were negative for cancer cells. Submucosal endoscopic dissection was performed with IT and Hook knives (Olympus). A literature review was performed. The operative time was 180 min with hospital stay of 6 days. During the injection of the carmine dye and the air insufflation pneumoperitoneum occurred and remained clinically silent during the observation period. The pathology result showed a heterotopic pancreatic tissue type 2 according to Heinrich's classification with microfoci of intestinal metaplasia. Preoperative diagnostics of gastric masses might be misleading and such tumors not necessarily should be excised. There are several surgical options with endoscopic submucosal dissection being probably the safest one and a non-disabling approach. Patients tolerate that kind of surgery well with good postoperative functional outcomes.
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http://dx.doi.org/10.5114/wiitm.2011.33709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796718PMC
September 2013

Totally laparoscopic feeding jejunostomy - a technique modification.

Wideochir Inne Tech Maloinwazyjne 2011 Dec 20;6(4):256-60. Epub 2011 Dec 20.

Department of Oncological Surgery, Hospital of Medical University of Gdansk, Poland.

In oncological patients with upper gastrointestinal tract tumours, dysphagia and cachexy necessitate gastrostomy or jejunostomy as the only options of enteral access for long-term feeding. In this article the authors describe a modified technique of laparoscopic feeding jejunostomy applied during the staging laparoscopy. A 48-year-old male patient with gastroesophageal junction tumour and a 68-year-old male patient with oesophageal tumour were operated on using the described technique. Exploratory laparoscopy was performed. Then the feeding jejunostomy was made using a Cystofix(®) TUR catheter. The jejunum was fixed to the abdominal wall with four 2.0 Novafil™ transabdominal stitches. Two additional sutures were placed caudally about 4 cm and 8 cm from the jejunostomy, aiming at prevention of jejunal torsion. Total operating time was 45 min. There was no blood loss. There were no intraoperative complications. The only adverse event was one jejunostomy wound infection that responded well to oral antibiotics. There were no mortalities. The described technique has most of the benefits of laparoscopic feeding jejunostomy with some steps added from the open operation making the procedure easier to perform as part of a staging operation with a relatively short additional operating time. The proposed transabdominal stitches make the technique easier to apply. Two additional 'anti-torsion sutures' prevent postoperative volvulus. Use of the Cystofix catheter allows easy introduction of the catheter into the peritoneal cavity and the jejunal lumen, providing a good seal at the same time. Further studies on larger groups of patients are required to assess long-term outcomes of the proposed modified technique.
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http://dx.doi.org/10.5114/wiitm.2011.26262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516942PMC
December 2011

Paraesophageal hernia repair followed by cardiac tamponade caused by ProTacks.

Ann Thorac Surg 2012 Oct;94(4):e87-9

Department of Oncological Surgery, Academic Clinical Center, Medical University of Gdansk, Gdansk, Poland.

We describe a case of cardiac tamponade caused by ProTacks Autosuture used for mesh fixation during a laparoscopic Nissen operation with giant paraesophageal hernia repair. Perforations of the posterior descendent artery and epicardial vein of the right ventricle were caused by ProTacks used for Parietex Composite Mesh fixation. Protruding ProTacks were secured from inside the pericardiac sac with a synthetic vascular patch during emergency sternotomy. Quick and multidisciplinary cooperation ended with emergency cardiothoracic procedure saving the patient's life and preventing further damage to the heart muscle and its vessels.
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http://dx.doi.org/10.1016/j.athoracsur.2012.03.107DOI Listing
October 2012

94% accuracy of intraoperative imprint touch cytology of sentinel nodes in skin melanoma patients.

Anticancer Res 2008 Jan-Feb;28(1B):465-9

Department of Surgical Oncology, Medical University of Lodz, Poland.

Unlabelled: The aim of the present study was to assess whether the reliability of imprint touch cytology (ITC) of sentinel nodes in skin melanoma patients allows intraoperative decisions regarding simultaneous radical lymphadenectomy to be made.

Patients And Methods: The results of ITC of sentinel nodes were compared with the results of standard histopathological and immunohistochemical examinations.

Results: A total of 148 sentinel nodes were identified in 98 lymph node groups in 85 skin melanoma patients. ITC revealed the presence of metastases in 7 out of 16 melanoma-positive sentinel nodes (sensitivity, 43.7%). There were no false-positive results of ITC of sentinel nodes (specificity, 100%). The negative predictive value of ITC was 93.6%, the positive predictive value was 100%, and the accuracy of the method was 93.9%.

Conclusion: ITC of sentinel nodes is a reliable method. There was no risk of overtreatment due to false-positive results of sentinel node ITC in our study. High accuracy of the method warrants its clinical use.
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April 2008

Intraoperative, radio-guided sentinel lymph node mapping in 110 nonsmall cell lung cancer patients.

Ann Thorac Surg 2006 Jul;82(1):237-42

Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland.

Background: Sentinel lymph node identification has been tested in lung cancer patients with conflicting results. The present study was designed to assess the sensitivity, negative predictive value, and accuracy of intraoperative sentinel lymph node mapping by means of a radio-guided method in patients with nonsmall cell lung cancer to find the most appropriate definition of sentinel lymph node and to evaluate the usefulness of different particle sizes of radiocolloid.

Methods: One hundred ten patients with clinically N0 nonsmall cell lung cancer were enrolled in the pilot study of intraoperative sentinel node identification. Four quadrants of the peritumoral tissue were injected with 2 mL of 0.5 mCi technetium-99m suspension. Four radiocolloids of different particle size were used. After complete lymphadenectomy, all resected lymph nodes were examined with hematoxylin-eosin staining. All sentinel nodes negative for metastases by routine staining were searched further for metastatic deposits with both serial sections and immunohistochemistry for cytokeratins.

Results: The radio-guided method had a high identification rate, a high sensitivity, and a high negative predictive value (100%, 87%, and 93%, respectively) when immunohistochemistry was considered. When standard hematoxylin and eosin staining was applied, sensitivity and negative predictive value of sentinel lymph node labeling was lower (74% and 89%, respectively). No significant differences were found in either the sensitivity or negative predictive value among the colloid solutions of different particle size used in radio labeling, although smaller particles have shown a tendency to produce better results.

Conclusions: The radio-guided technique provides efficient sentinel lymph node identification in lung cancer. Further studies are warranted to confirm the clinical utility of this strategy.
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http://dx.doi.org/10.1016/j.athoracsur.2006.01.094DOI Listing
July 2006

Possibilities of improving the parameters of hyperthermia in regional isolated limb perfusion using epidural bupivacaine and accurate temperature measurement of the three layers of limb tissue.

Melanoma Res 2006 Jun;16(3):249-57

Department of Oncological Surgery, Medical University of Gdańsk, Gdańsk, Poland.

The present study presents the author's modification of the method, which aims to create proper parameters of the treatment. The selected group consisted of 15 women and eight men, with a mean age of 57.2 years (range from 26 to 72 years). The patients were divided into two groups, depending on whether they were given epidural bupivacaine (group I - 13 patients treated between the years 2001 and 2004) or not [group II (control) - 10 patients treated earlier, between the years 1997 and 2000]. We observed a significant change in the temperature of thigh muscles (P=0.009) and shank muscles (P=0.006). In the control group II, there was a statistically significant difference (P=0.048) in the temperatures between the muscles and subcutaneous tissue on the one hand and the shank skin on the other. That difference was mean 0.67 degrees Celsius (from 0.4 to 0.9) during the perfusion after applying the cytostatic. The temperature of the skin was lower than the temperature of the deeper tissues of the shank and did not exceed 39.9 degrees Celsius. Such a difference in the temperatures was not observed in case of the group I patients who were given bupivacaine into the extrameningeal space before applying the cytostatic. The difference in the temperatures was on average 0.26 degrees Celsius and was not statistically significant (P=0.99), whereas the shank skin temperature was 40.0-40.6 degrees Celsius. The attained results imply that despite the noticeable improvement in the heating of the limb muscles after application of bupivacaine, the improvement in the heating of the skin and subcutaneous tissue is still not satisfactory, although the growing tendency implies such a possibility.
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http://dx.doi.org/10.1097/01.cmr.0000205018.15988.edDOI Listing
June 2006

Coexistence of hepatocellular carcinoma and gastrointestinal stromal tumor: a case report.

World J Gastroenterol 2006 Jan;12(4):665-7

Klinika Chirurgii Onkologicznej Akademii Medycznej w Gdansku, Debinki 7, 80-211 Gdansk, Poland.

Malignant gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors originating from the wall of the gastrointestinal tract. Their coexistence with other tumors originating from other germ layers is unique. We have reported a case of a 63-year-old GIST patient presenting as an epigastric mass associated with hepatic tumor. Histologically, the mesenteric tumor was composed of spindle cells showing both neural and smooth muscle differentiation. Immunohistochemical examination showed positive staining for CD117, vimentin, S-100, and SMA, while CD34 antigen was negative. The hepatic tumor was diagnosed as hepatocellular carcinoma (HCC). To the best of our knowledge, this is the first case of GIST and HCC coexistence. The rarity of the case, however, should not lead to ignoring such a possibility in differential diagnosis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4066109PMC
http://dx.doi.org/10.3748/wjg.v12.i4.665DOI Listing
January 2006

K-RAS point mutation, and amplification of C-MYC and C-ERBB2 in colon adenocarcinoma.

Folia Histochem Cytobiol 2004 ;42(3):173-9

Department of Surgical Oncology, Medical University, Gdańsk, Poland.

The routine multidisciplinary management of colon cancer is based mainly on tumor staging, histology, grading and vascular invasion. In this approach, important individual information derived from molecular characteristics of the tumor may be missed, especially since significant heterogeneity of molecular aberrations in cancer cells has been observed, and recognition of every of relationships between them may be of value. K-RAS, C-MYC and C-ERBB2 are protooncogenes taking part in carcinogenesis and tumor progression in the colon. They influence cell proliferation, differentiation and survival. K-RAS point mutation, as well as amplification of C-MYC and C-ERBB2 were searched in 84 primary colon adenocarcinomas resected with curative intent. Multiplex polymerase-chain reaction and restriction fragment length polymorphism were performed to assess codon 12 K-RAS point mutation. Amplification of C-MYC and C-ERBB2 genes was evaluated by densitometry after agarose gel separation of the respective multiplex PCR products. No relation was found among mutated and/or amplified genes, and between searched molecular aberrations and pathoclinical features. In multivariate analysis, nodal status appeared to be the only independent prognostic indicator. In colon adenocarcinoma, codon 12 K-RAS point mutation and amplification of C-MYC and C-ERBB2 seem to occur independently in the process of tumor progression. Amplification of C-ERBB2 tends to associate with more advanced stage of disease. Concomitant occurrence of codon 12 K-RAS mutation, C-MYC and C-ERBB2 amplification was of no prognostic value in respect to survival.
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February 2005

Comparison of peritumoral and subareolar injection of Tc99m sulphur colloid and blue-dye for detection of the sentinel lymph node in breast cancer.

Nucl Med Rev Cent East Eur 2002 ;5(2):159-61

Department of Surgical Oncology, Medical University of Gdańsk, Poland.

Background: The new trend in diagnosis of the lymph node is sentinel node biopsy. This method has become increasingly accepted as a minimally invasive alternative to routine axillary dissection. Although the results of numerous studies have shown that sentinel node biopsy can accurately determine the axillary nodal status, the identification rates and false-negative rates have been variable. The sentinel lymph node is defined as the first node in the lymphatic basin that receives the primary lymphatic flow.

Material And Methods: Between September 1998 and August 2002 123 patients with primary operative breast cancer without clinical palpable axillary lymph nodes were enrolled in the study. There were two groups of patients according to sentinel node identification technique: 51 patients (Group I) received parenchymal, peritumoral injection of 1.0 ml of 16 MBq Tc(99m)-radiolabelled sulphur colloid and single intradermal injection of blue-dye over the tumour. The next 72 patients (Group II) received intradermal, periareolar one-site injection of 0.5 ml of 16 MBq Tc(99m)-radiolabelled sulphur colloid and blue-dye.

Results: Sentinel lymph node was found in 41 (80.4%) cases in Group I and in 67 (93.0%) cases in Group II (p = 0.028). The localisation of the axillary lymph node as a "hot spot" visualised by lymphoscintigraphy was successful in 39/51 (76.5%) cases in Group I and 67/72 (93.0%) in Group II, p = 0.004). In both groups the success of sentinel node identification in the axillary region by lymphoscintigraphy was connected with sentinel lymph node finding during surgery (Group I: p < 0.001, Group II: p < 0.001).

Conclusions: This study shows that intradermal, periareolar one-site injection of Tc(99m)-radiolabelled sulphur colloid and blue-dye is superior to peritumoral 4-sites injections Tc(99m)-radiolabelled sulphur colloid and single intradermal injection of blue-dye over the tumour in sentinel lymph node identification.
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January 2004