bluuebunny/crossref_metadata_2025_split huggingface dataset:
469 Novel Applications of Cross-Sectional Imaging in Oncoplastic Surgical Planning for Breast Cancer Following Neoadjuvant Chemotherapy
Authors: Begaj A , McLean R , Bhaskar P 
Published: October 2021

Abstract

Background
Cross-sectional imaging using MRI is most commonly used to evaluate the response to neoadjuvant chemotherapy. Furthermore, CT scan of chest, abdomen, and pelvis (CAP) is used in staging the breast cancer. This study seeks to evaluate the feasibility of using preoperative cross-sectional imaging in oncoplastic surgical planning for patients undergoing neoadjuvant chemotherapy for breast cancer.

Method
All female patients who underwent neoadjuvant chemotherapy for breast cancer between January 2019 and January 2020 and underwent breast MRI pre- and post-neoadjuvant chemotherapy and staging CTCAP were included. All images were independently reviewed and analysed by two consultant breast radiologists. Chest wall symmetry, breast volume differences, skin flap thickness, arterial supply to nipple, intercostal perforators and LD pedicle were assessed on both CT and MRI.

Results
Nineteen women were included in this study. Breast measurements were best made by MRI due to difficulty interpreting the CT images when supine. The majority of the patients had a dual arterial supply. There was substantial inter–observer agreement in visualisation of MICAP and AICAP. The inter–observer reliability reduced when the radiologists were asked to visualize the LICAP and the thoracodorsal artery with moderate inter–observer agreement, as the MRI images were difficult to interpret laterally.

Conclusions
This study shows that MRI is suitable to detect most intercostal perforators and is the first study to highlight cross-sectional modalities for assessment of intercostal perforators and may aid preoperative surgical planning and choice of perforator. We have suggested potential addition of CT angiography in cases where the surgeon plans oncoplastic surgery.
496 Perioperative Utility of Tranexamic Acid in Oncological Breast Surgery: A Systematic Review and Meta-Analysis
Authors: Chan K Y , Keogh S , Grealish A , Merrigan A , Tormey S 
Published: October 2021

Abstract

Background
Tranexamic acid (TXA) is a synthetic anti-fibrinolytic agent used in various surgical procedures to achieve haemostasis and reduce blood loss. Recently TXA has seen an increase in perioperative utility as a result of its ease of administration, high therapeutic index and low cost. Its safety and effectiveness in oncological breast surgery (OBS) remain understudied.

Method
PubMed, EMBASE, SCOPUS and other relevant sources were searched for studies investigating the effect of TXA in OBS, published up to October 2020. Primary outcomes of interest were local wound effects. Estimates of effect, when quantitative data was available, were pooled with a random effects model to estimate summary hazard ratios and 95% confidence intervals. Qualitative data was reported using descriptive statistics. Evidence quality was assessed using the Cochrane Collaboration tool.

Results
7 studies involving 1844 patients were included. Quantitative data was available for: mean total drainage volume, duration of drain in-situ and rates of seroma and haematoma formation. A significant reduction in rate of haematoma formation (OR 0.40, 95% CI 0.18-0.89, P = 0.02, I2=28%) was observed in the TXA group. There were no significant differences in the other outcomes. There was no significant increase in rates of adverse events.

Conclusions
Trends were observed in the present meta-analysis, although TXA did not appear to significantly alter the OBS outcomes. Current studies are insufficiently powered to isolate the effects of TXA on surgical morbidity. Further large prospective studies are needed to assess complications and determine the ideal dosage regime. At this juncture, prophylactic TXA in OBS cannot be recommended.
510 Transitioning to an In-House In-Situ Hybridisation Assay Accelerates Indeterminate HER-2 Lesion Results
Authors: Patel B , Schrire T , Potter S 
Published: October 2021

Abstract

Introduction
NICE guidelines 1.6.5 recommend that: ‘HER2 status [should be] available and recorded at the pre-operative multidisciplinary team (MDT) meeting when systemic treatment is discussed,’ to aid decision-making regarding neoadjuvant therapy. However, indeterminate HER2 lesions require additional testing by in-situ hybridisation (ISH). This may lead to delays in treatment decision-making, particularly if the testing is outsourced. Our institution has recently switched to using an in-house ISH assay. We compared time between biopsy and ISH results over two periods before and after the introduction of in-house testing, to assess if this improved the availability of HER-2 results, in line with NICE guidelines.

Method
This audit gained local approval. All breast cancer patients discussed at MDT over a two-month time period before (1/11/18-31/12/18) and after (1/9/20-30/10/20) the introduction of in-house ISH testing were identified retrospectively. The numbers of patients requiring ISH and the median time from biopsy to ISH report were compared in the two groups using the Mann-Whitney U test.

Results
106 cases were analysed before the intervention, 39 (37%) of which required ISH with a median wait time of 30 days (13-87). 90 cases were analysed after the intervention, 13 (14%) of which required ISH with a median wait time of 7 days (5-16) (p &lt; 0.01).

Conclusions
By setting up an in-house ISH assay, we significantly reduced the delay between biopsy and HER2 status result for patients with borderline HER2 results. HER2 status is now available at the pre-operative MDT meeting to optimise treatment decision making, as recommended by NICE.
551 Patient Satisfaction with Telephone Consultations in A One-Stop Breast Clinic During COVID-19 Pandemic
Authors: Phyu S , Bunza R , Vashisht R , Barkeji M , Elfadl D 
Published: October 2021

Abstract

Aim
Telemedicine has gained an important role in medical practice lately, particularly in the outpatient setting. In our unit, virtual consultations were previously used for results clinics only. However, the first wave of COVID-19 pandemic necessitated change of practice to address issues of triage, infection control, cancer target times, and decreased capacity in the face of maintained demand. New patients underwent a telephone consultation followed by a clinic visit one week afterwards to complete triple assessment. We aimed to assess patient satisfaction with the phone consultation and subsequent care.

Method
Patients referred from general practice to the Breast Unit at West Middlesex University Hospital, who had a telephone appointment in the period 15/04/2020 to 15/07/2020, were included. The study was registered with the Clinical governance department. Patients received text messages with anonymised links to an online survey and were contacted over the telephone to explain the survey.

Results
219 successful phone calls were made to eligible patients, and 126 patients responded to the survey (57.5%). 78% felt that they were able to express all or most of their concerns over the phone. 86% spent less than 2 hours in clinic. 87% felt social distancing and safety measures were adequate. More than 75% were overall satisfied with their care.

Conclusions
We further discuss responses to this survey. Patients were largely satisfied; however, areas of improvement were identified, and changes need to be made to ensure telemedicine is used to its full potential and is appropriately incorporated in the post COVID-19 practice.
1093 Pyoderma Gangrenosum Complicating Surgery for Breast Cancer in A Patient with Insulin Treated Diabetes. A Case Report
Authors: Croitoru C , McGoldrick C , Irwin G 
Published: October 2021

Abstract

Aim
Although rare, Pyoderma Gangrenosum (PG) occurs as a significant complication of breast surgery. The early manifestations are similar to necrotising wound infection, so diagnosis and correct management are often delayed.

Method
We present the case of a 51-year-old female, diagnosed with multifocal right breast cancer, who underwent right sentinel lymph node biopsy and bilateral skin-spearing, nipple-sacrificing mastectomies with immediate implant reconstruction (patient’s choice). Her medical history included type 2 diabetes on insulin, hypertension, and obesity. One week postoperatively the right breast wound showed signs of not healing. After 5 weeks of conservative management including input from tissue viability, wound debridement and negative pressure wound therapy (NPWT), the phenomenon of pathergy raised the clinical suspicion of PG which was confirmed histologically.

Results
A multidisciplinary approach was instituted. The patient was started on steroid and non-steroid immune modulation therapy. She underwent further wound debridement, implant removal with NPWT and she received Tamoxifen as adjuvant chemotherapy had to be delayed. The wound healed 27 weeks after initial surgery.

Conclusions
Pyoderma Gangrenosum is an ulcerative skin disorder of unknown aetiology which is associated with systemic illnesses. It needs to be recognised and requires aggressive systemic therapy. There is little information about its long-term evolution.
1290 A Move to Magseed For Breast Conserving Surgery
Authors: Chandrasekar B , Seward J , Ooi J 
Published: October 2021

Abstract

Aim
Wire guided localisation(WGL) to localise non-palpable breast tumours has been the standard for years. WGL has limitations; patient discomfort, fixed scheduling to facilitate insertion on the day of surgery and wire migration. A 2015 audit in our department found that 51% of patients undergoing wide local excision (WLE) used preoperative localisation techniques; of which 84% was WGL. The overall re-excision rate for WLE was 27%. We altered our practice to Magseed localisation from July 2019 to improve patient experience, and surgical efficiency, as there are similar outcomes between WGL and Magseed in the literature. This audit aims to examine if there are improvements in our re-excision rate. We aim to evaluate which is the best method for localisation in our department.

Method
A retrospective audit was conducted following registration with the local audit office. Patients who underwent breast conserving surgery between September 2019 and September 2020 were identified. The surgical approach, re-excision and complications were recorded and compared to the 2015 results.

Results
100 patients underwent WLE in the study period. The percentage of patients undergoing therapeutic mammaplasty was 26% (14% in 2015). 63% underwent preoperative localisation; of which 71% used Magseed and 5% used wire. The overall re-excision rate was 20%.

Conclusions
Our re-audit has demonstrated an increase in patients requiring pre-operative localisation, probably due to the use of primary endocrine treatment during COVID-19. We gladly observed 26% improvement in re-excision rates suggesting success with Magseed.
1330 How Does the Tumour-Free Margin Width After Breast-Conserving Surgery in Patients with Ductal Carcinoma in Situ (DCIS) Impact Local Recurrence Rates?
Authors: Doski S 
Published: October 2021

Abstract

Introduction
In the UK, breast conserving surgery (BCS) has been indicated to completely excise ductal carcinoma in situ(DCIS) to negative margins for around 70% of diagnosed women. The tumour-free radial surgical margin width is an important marker for determining the local recurrence (LR). Setting the margin too wide will result in additional re-excision and too low may result in increased LR rates. This review investigates the different tumour-free margins and its effect on LR.

Method
A literature review was conducted using the Cochrane library and Pubmed database with key terms. Cohort studies of more than 100 participants with a five-year follow up in women over 18 were included.

Results
&gt;2mm versus 0mm: LR was significantly reduced in DCIS from one very-low evidence retrospective cohort studies (N = 1,503). &gt;2mm versus 1-2mm: Meaningful reduction in LR with DCIS was found in one very low-quality retrospective cohort study(N = 433). &gt;2mm versus &lt;1mm: Clinically meaningful reduction in LR for DCIS was found in very low-quality retrospective study (N = 466). &gt;2mm versus 1-2mm: Meaningful reduction in LR with DCIS was found in one very low-quality retrospective cohort study(N = 433).

Conclusions
LR rates were reduced by further increasing the negative margin width in DCIS but only low-quality evidence was available to define these margins. This is an area for further research to enhance patient care and prevent increased LR.
1331 An Observational Study Investigating the Role of Therapeutic Mammoplasty in Breast Tumours Greater Than 40mm
Authors: Marchitelli G , Fung D , Kalra L 
Published: October 2021

Abstract

Aim
For large breast tumours, therapeutic mammoplasty (TM) provides a breast-conserving approach to the conventional mastectomy. The prevalence and outcomes following TM in larger breast tumours is relatively unknown. This study aims to analyse the short-term outcomes and local recurrence rate following TM for breast tumours of varying sizes.

Method
Single-centre retrospective analysis of data from all patients undergoing a TM between June 2016-October 2019. Variables reviewed included age, imaging, tumour size, pre-operative histology, adjuvant chemotherapy and radiotherapy, post-operative pathology, post-operative complications, and recurrence rates.

Results
192 patients undergoing a TM procedure were included, 126 (66%) patients had tumours &lt;40mm and 66 (34%) patients had tumours &gt;40mm. The average age of participants was 61 years with a mean follow-up of 31 months. The mean size of tumours &gt;40mm was 56.8mm, of these patients 15% had positive margins, 2 (3%) patients required a further mastectomy and 8 (12%) underwent margin re-excisions. In lesions &gt;40mm there were six episodes (9%) of T-junction delayed wound healing with two requiring surgical management, two episodes (3%) of wound infections requiring antibiotics and four episodes (6%) of seroma with one requiring surgery for an infected seroma. Two patients were found to have metastatic disease and no patients were found to have local recurrence at the most recent follow-up.

Conclusions
Our study demonstrated TM offers a surgical option with suitable cosmetic and oncological outcomes for women with early breast tumours above 40mm. These results warrant further study into the long-term outcomes for patients undergoing TM with tumours &gt;40mm.
1389 Axillary Staging in Ductal Carcinoma in Situ with Microinvasion: A Systematic Review
Authors: Choi B , Jegatheeswaran L , Patel V , Lupi M , Babu E , Nakhoul M , Haria P l 
Published: October 2021

Abstract

Introduction
Ductal carcinoma in situ with microinvasion (DCISM) is a rare subtype of DCIS, with a foci of tumour cells penetrating through the basement membrane. A conundrum for surgeons is that definitive diagnosis is made upon histological examination of the final specimen. In the UK, there are no specific guidelines on the role of axillary staging in the management of DCISM cases.

Method
A systematic review was conducted on the databases MEDLINE and Embase using the keywords: breast, DCISM, microinvasion, “ductal carcinoma in situ with microinvasion”, sentinel lymph node biopsy, SLNB, axillary staging was performed. 23 studies were selected for analysis. Primary outcome was the positivity of lymph node metastases; secondary outcome looked at characteristics of DCISM that may affect node positivity.

Results
2959 patients were included. Significant heterogeneity was observed amongst the studies with regards to metastases (I2=61%; P &lt; 0.01). Lymph node macrometastases was estimated to be 2%. Significant subgroup difference was not observed between SLNB technique and lymph node macrometastases (Q = 0.74; p = 0.69). Statistical significance was observed between the focality of the DCISM and lymph node macrometastases (Q = 8.71; p = 0.033).

Conclusions
DCISM is not linked with higher rates of clinically significant metastasis to axillary lymph nodes. Survival rates are very similar to those seen in cases of DCIS. Current evidence suggests that axillary staging in cases of DCISM will not change their overall management. A conscientious multidisciplinary team approach evaluating pre-operative clinical and histological information to tailor the management specific to individual cases of DCISM would be a preferred approach than routine axillary staging.
1443 Comparison of Outcomes Between Immediate Direct-to-Implant Breast Reconstruction versus Two-Stage Implant Breast Reconstruction; a Systematic Review and Meta-analysis
Authors: Kelly O , Balasubramanian I , Cullinane C , Prichard R 
Published: October 2021

Abstract

Background
Direct-to-implant (DTI) breast reconstruction is increasingly performed as the preferred method of immediate breast reconstruction following mastectomy. The proposed advantages of DTI over two-stage tissue expander (TE)/implant reconstruction relate to fewer surgical procedures. This systematic review and meta-analysis aims to evaluate the safety and efficacy of DTI versus conventional TE/implant breast reconstruction.

Method
A systematic review was performed (PubMed, Embase, Scopus) to identify relevant studies that compared outcomes between DTI and TE/Implant reconstructions. Publications up to October 2020 were included. The primary outcome was overall complication rate. Secondary outcomes included infection rate and implant loss.

Results
Nineteen studies, including 32,971 implant-based breast reconstructions, were analysed. Median age was 48 years. Mean BMI was 25.9. There was no statistically significant difference between the two groups. Duration of follow up ranged from 1-60 months. Overall complications were significantly more likely to occur in the DTI group (OR 1.81 [1.17-2.79]). Overall complications refers to all reported complications including seroma, haematoma, would dehiscence, infection, skin necrosis and capsular contracture. Implant loss was also significantly higher in the DTI cohort (OR 1.31 [1.12-1.78]). There was no significant difference in infection rates between the two groups. Subgroup analyses, focusing on high-powered multicentre studies showed that the risks of overall complications were significantly higher in the DTI group (OR 1.51 [1.06-2.14]).

Conclusions
This meta-analysis demonstrates significantly greater risk of complications and implant loss in the DTI breast reconstruction group. These findings serve to aid both patients and clinicians in the decision-making process regarding implant reconstruction following mastectomy
1594 Invasive Ductal Carcinoma with Osteoclast Giant Cells During Pregnancy: A Case Report and A Review of Literature
Authors: Abdulrahman H , Johnston D , Diab S , Skelly B 
Published: October 2021

Abstract
Mammary carcinoma with Osteoclast Giant Cells (OGCs) is a rare tumour. Although several cases were reported, the significance of this histological finding remains incompletely understood. OGCs may occur in several types of breast carcinoma with different epidemiological characteristics but, in association with pregnancy, OGCs has not been reported to date. Here we report a case 37-year-old presenting with a symptomatic breast lump in pregnancy that has been confirmed clinically and radiologically. Microscopic examination of biopsies and surgical specimens showed OGCs accompanying invasive ductal carcinoma with no evidence of axillary metastasis. Immunohistochemical analysis revealed tumour cells to be positive for oestrogen, and progesterone receptors, with human epidermal growth factor negative status (ER6, PR8, HER2 negative).
This is the first case of OGCs during pregnancy to be reported, to our best of knowledge, following a search of the literature published in English language.
63 The “Brighton Connector”: A Simple, Reproducible and Cost-Effective Technique for Bilateral Antegrade Cerebral Perfusion During Aortic Arch Surgery
Authors: Holland L , Singh S , Vieira M , Narayana A , Lewis M , Hyde J , Modi A 
Published: October 2021

Abstract

Aim
Surgery of the aortic arch presents significant technical and physiological challenges. Selective antegrade cerebral perfusion (SACP) during arch surgery has been shown to improve mortality and neurological outcomes in these patients. At our centre, we aimed to develop a safe, reliable, and cost-effective technique to provide bilateral antegrade cerebral perfusion without the need of another pump head.

Method
We developed our system using equipment that is included in the accessory packaging for the Sorin Xtra cell saver system, which is readily available in cardiac surgical units nationwide, but often discarded as it is not required. An EOPA arterial return cannula and the TRUE FLOW RDB SACP cannula were joined using our novel connection.

Results
A single surgeon has used the “Brighton Connector” for 6 patients in the last two years. All patients made a satisfactory recovery with a 0% rate of mortality or permanent neurological deficit.

Conclusions
All components in our circuit are already approved for use in cardiac theatres, and the connection tubing would normally be discarded, making our method cost neutral. We demonstrate through a case series that mortality and neurological outcomes are good and comparable with other techniques.
178 Outcomes After Paediatric Extracorporeal Cardiopulmonary Resuscitation (ECPR) In A Tertiary Centre
Authors: Ashry A , Harky A , Abousteit A , Smith T , Brady A , Horan M , Nolan S , Lotto A , Guerrero R , Dhannapuneni R 
Published: October 2021

Abstract

Objective
To report our outcomes in utilizing extracorporeal membrane oxygenation (ECMO) institution for cardiac arrest.

Method
Retrospective records of all patients that needed ECPR between January 2015 and July 2020 have been reviewed. Primary outcomes were survival to ECMO decannulation, hospital discharge and one year survival. Secondary outcomes were the need for ECMO re-cannulation and neurology outcome using Paediatric Cerebral Performance Category (PCPC).

Results
A total of 44 consecutive patients were identified. 75 % were post cardiac surgery (n = 33), mean time from arrest to initiation of ECMO was 39.5 mins +/- 17.7 mins. Mean highest lactate prior to ECMO was 12.9 +/- 4.4. 79.6 % of patients received central cannulation. 11.4 % of patients (n = 5) needed more than one run of ECMO. Mean hours on ECMO were 175.4 +/- 212.5 hours and mean PCPC score was 2.14 +/- 1.68. Mean ICU stay was 16.2 +/- 16.9 days and total hospital stay was 47 +/- 68.5 days. Overall Survival to ECMO weaning was 68.4 % (n = 13) vs 92 % (n = 23) in neonates and paediatric patients, respectively. Survival to hospital discharge was 47.4 % (n = 9) vs 72 % (n = 18) and one year survival was 42.1 % (n = 8) vs 72 % (n = 18) in the neonatal and paediatric cohort, respectively.

Conclusions
Our survival rates are encouraging and in line with current published literature and comparable favourably to International ELSO (Extracorporeal life support organisation) registry for neonates and paediatric patients of all cause ECPR. Paediatric patients showed a survival advantage over neonates after ECPR.