The British journal of surgery
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To assess the safety of a conservative approach to fibro-adenoma of the breast we prospectively studied 321 women with this clinical diagnosis, and performed aspiration cytology and excision biopsy. There was histological confirmation of fibro-adenoma in 217 (68 per cent), the remainder having various benign conditions and 4 (1.3 per cent) had carcinoma. Aspiration cytology had a sensitivity of 87 per cent and a specificity of 76 per cent for fibro-adenoma. ⋯ To estimate the risk of missing carcinoma we compared the annual frequency of carcinoma with fibro-adenoma in young women and found a ratio of 1:470 between 15 and 19 years, 1:133 between 20 and 24 years and 1:9 in the 25-29 age group. To assess patients' views on non-operative treatment of benign breast masses we asked 124 women, 10 days postoperatively, whether they preferred a conservative approach for a cytologically benign lump: 26 (21 per cent) opted for conservative management in the future and 8 (7 per cent) would have preferred conservatism rather than their recent excision. A conservative approach is safe for clinically and cytologically benign breast lumps in women under 25 years, but very few will accept it.
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During the 31 year period 1954 to 1985, 225 major hepatic resections have been performed for symptomatic primary carcinoma of the liver, of which right hepatic lobectomy was performed in 115, extended right hepatic lobectomy in 11, trisegmentectomy in 2, left hepatic lobectomy in 94, and middle hepatectomy in 3. In addition there were 107 partial hepatic resections for 89 asymptomatic small hepatocellular carcinomas. In the 225 patients undergoing major hepatic resection, the operative mortality was 8.0 per cent. ⋯ Of 207 cases who survived major hepatic resection, 119 cases died within one year after the operation, mainly due to recurrence of cancer in the remaining residual lobe, lung metastasis or late hepatic failure. The 5 year survival rate is 18.0 per cent, 12 patients are still alive and well after more than 5 years and the longest survival is 23 years. Of the 89 patients with small asymptomatic hepatocellular carcinomas, 28 died within one to four years of surgery because of a second new growth.