bluuebunny/crossref_metadata_2025_split huggingface dataset:
390 Characterisation of a Platelet Rich Fibrin Membrane and Formation of an Autologous Fibrin Mesh
Authors: Burke Joshua , Helliwell Jack , Kowal Mikolaj , Jayne David 
Published: October 2021

Abstract

Aim
Platelet-rich fibrin (PRF) is a three-dimensional fibrin scaffold with associated platelets and leukocytes which releases high quantities of growth factors over a sustained period of time. PRF has shown promising clinical results in promoting wound healing and tissue regeneration. The aims of this feasibility study were to establish optimal spinning methods for production of PRF, to quantify the production of vascular endothelial growth factor (VEGF) by PRF and to explore new vehicles of clinical PRF delivery.

Method
Assessment of optimal production involved comparisons between Protocol 1 (EDTA bottle) and Protocol 2 (no additive) at three different centrifugation forces: 400g, 1000g and 1700g. VEGF production was analysed using ELISA with varied incubation periods and PRF plug segments. Novel methods for PRF delivery were explored using surgical sutures and a Zimmer® Skin Graft Mesher.

Results
Protocol 2 demonstrated shorter average time to blood draw (9.8s compared to 13.6s) and to centrifuge (25.5s compared to 33.1s) with a decreased range of values. All PRF segments exhibited a positive correlation between incubation time and amount of VEGF produced with the bottom segments producing on average more VEGF. A segment of the fibrin plug was successfully secured on a suture and meshed in a 1:1.5 ratio.

Conclusions
PRF production can be optimised using blood bottles with no additive and high centrifugation forces. VEGF production by PRF peaks at 120 hours with the bottom PRF segment exhibiting the highest rate of production. The first description of a PRF mesh enables new clinical applications.
166 An audit of Patient Satisfaction after Breast Reconstruction and Presentation of a Novel Decision-Making Aid for Oncological Breast Surgery Patients
Authors: Badhams E 
Published: October 2021

Abstract

Background
Breast reconstruction presents women with life-changing decisions at a time of immense pressure due to a concurrent cancer diagnosis.

Objectives
To assess whether patient satisfaction with breast care teams, patient autonomy in pre-operative consultation and information provision at Ysbyty Glan Clwyd (YGC) met the standards published in the National Mastectomy and Breast Reconstruction Audit (NMBRA), 2011. To use data collected to generate a novel decision-making aid.

Method
A patient satisfaction questionnaire, ‘Betsi-Q’, was created and sent to 100 mastectomy patients from YGC. Statistical significance was tested using Chi-squared test, T-test (Yates correction) and Z- score.

Results
Completed questionnaires were returned by 44 respondents (44%). Although shy of the 90% NMBRA recommendation, patient satisfaction with the team was reported high in 35/41 respondents (85%). The audit identified 36 respondents (86%) felt they made an informed decision regarding breast reconstruction, exceeding the 80% NMBRA recommendation. Information regarding the emotional and sexual benefits of breast reconstruction over mastectomy alone, were discussed with 10 respondents (26%), despite recommendations to discuss with all patients. Exploration of more than one option for breast reconstruction was only reported in 29/42 respondents (70%), below the 90% NMBRA recommendation.

Conclusions
Patient satisfaction with the team at YGC is high but efforts to ensure all patients are making an informed decision should be made. The decision-making tool designed alongside this audit aims to address these recommendations. Early identification and correction of misinformation, along increasing the variety of resources for patient education will be beneficial to manage expectations and enhance patient experience.
362 Comparison of PREDICT Score to Oncotype Dx Score in Early Invasive Breast Cancer
Authors: Frixou M , Makaranka S , Urquhart G , Elsberger B 
Published: October 2021

Abstract

Aim
The PREDICT score is used to help define decisions about benefits of chemotherapy in early invasive breast cancer. With a PREDICT score of 5% or more chemotherapy should be considered, 3% to 4% is a borderline decision and less than 3% chemotherapy is not pursued. We set out to compare the PREDICT score to Oncotype Dx recurrence score (RS), which predicts chemotherapy benefit based on 21-gene breast cancer assay.

Method
Data for patient and tumour characteristics, and treatment choice was collected from electronic patient records of 98 patients who had an RS score done between February 2017-September 2020. This data was then compared to the patients’ PREDICT scores.

Results
98 patients were analysed with 2 excluded due to having nodal macro-metastases. Mean patient age was 53 years with an average tumour size of 27mm. 31/96 (32%) patients had a PREDICT score ≥5%, with 21/31 (68%) having a low RS score (&lt;26). 57/96 (59%) patients had a PREDICT score of 3-4%, with 40/57 (70%) having a low RS score. 8/96 (8%) patients had a PREDICT score of &lt; 3%, with 7/8 (88%) having a low RS score. Additionally, 7/8 (88%) patients in this group were pre-menopausal.

Conclusions
68% of patients in the ≥5% PREDICT group had a low RS score and so have avoided chemotherapy. In the 3-4% group, approximately 1 in 3 tested were shown to have a chemotherapy benefit. In the &lt;3% group most patients were pre-menopausal, and chemotherapy was safely avoided. A bigger dataset and comparison to other health boards is required.
392 Magseed-Guided Wide Local Excision During the COVID-19 Pandemic: A Tenable Solution to Barriers in Accessing Elective Breast Cancer Surgery
Authors: Teh J J , Cai W , Kedrzycki M , Thiruchelvam P T R , Elson D S , Leff D R 
Published: October 2021

Abstract

Introduction
Magseed-guided localisation has emerged as a suitable alternative to wire-guided localisation (WGL) for impalpable breast cancers, with advantages including advanced insertion and simpler logistical planning. Given the severe disruption to elective surgeries during the Covid-19 pandemic, a local Magseed pathway was developed enabling safe patient flow. Magseed was inserted well in advance of the operation, enabling time to self-isolate and obtain a negative COVID swab prior to admission to a dedicated COVID -free suite. We present the patient-reported outcomes of the new pathway.

Method
A prospective service evaluation was conducted in a University hospital. Patients undergoing Magseed-guided wide local excision (WLE) from 01/07/2020 to present were surveyed to detail their experiences on the Magseed pathway. Qualitative data investigating anxiety and comfort post-insertion were reported using 10-fold Likert scales. Quantitative data was collected on patient demographics and tumour specification.

Results
41/46 women who underwent Magseed localisation WLE completed the survey, with median age 65 years (IQR 53-72) and median BMI 26.5 kg/m2 (IQR 22.4-30.8). 71% had invasive ductal carcinoma with or without ductal carcinoma in-situ. 10% women found the procedure uncomfortable (&lt;5) and 98% women reported low anxiety (&lt;5) over seed displacement. If given the choice, 98% patients would prefer Magseed over WGL.

Conclusions
The new Magseed pathway is regarded positively among patients, despite ongoing disruption in elective breast cancer services. Given the progression of the second wave and likelihood of future outbreaks, Magseed localisation could be adopted widely to ensure continuous provision of safe elective surgeries.
407 Requesting, Treatment and Outcomes Following Oncotype DX Testing in Breast Cancer
Authors: Issa H , Seward J , Meara N 
Published: October 2021

Abstract

Aim
Oncotype DX (ODX) is a 21-gene assay for invasive breast cancer that yields a recurrence score (RS) value which indicates the risk of distant recurrence and the benefit from chemotherapy. NICE has laid down guidance regarding the criteria for test requesting which include having early breast cancer at an intermediate risk of distant recurrence that is ER-positive, HER2-negative and LN-negative. The aim of this study was to determine whether ODX was appropriately requested and followed. Treatment and outcomes were also observed.

Method
The study included all patients from The Countess of Chester Hospital who had undertaken ODX testing in the years 2015-2017. Patients were identified and clinicopathological data was obtained from clinic notes and pathology reports. NPI and PREDICT scores were calculated. The ODX original cut-off values were used.

Results
All 65 patients included in the study were ER-positive, 1 was HER2-positive and 1 was LN-positive. 9 patients had ODX requested inappropriately, all of which were low risk on both NPI and PREDICT. Chemotherapy was received by 1/32 low risk patients (RS 0-17), 6/24 intermediate risk patients (RS 18-30) and 5/5 high risk patients (RS 31-100). 57 patients had no recurrence, 2 patients had local recurrence (intermediate RS), 1 patient had distant recurrence (low RS) and 1 patient had metastasis (low RS). Chemotherapy was not received by any of the patients who experienced recurrence.

Conclusions
Adherence to NICE guidance regarding ODX requesting needs further emphasising. This would help reduce unnecessary patient investigation, costs, and pathology-lab workload.
653 Adverse Effects of Isosulfan Blue Dye in Sentinel Lymph Node Mapping in Breast Cancer: A meta-analysis
Authors: Yoong A , Fanelli D , Pratheepan P , Das A , Agilinko J 
Published: October 2021

Abstract

Aim
The aim of the study is to investigate the available evidence on the adverse effects of the use of isosulfan blue dye in sentinel lymph node mapping in breast cancer patients and to determine the treatment modalities for such complications.

Method
We carried out a thorough search of relevant articles in PubMed, Medline and Embase databases using the PRISMA guideline. Studies reporting on the adverse effects of isosulfan blue dye were included. Adverse effects were subdivided into 3 groups: Grade I, Grade II and Grade III. Weighted means were extracted and evaluated for procedure adverse reactions. A meta-analysis of proportion was conducted using random-effect models to analyse adverse effects rates.

Results
Grade I reactions were seen in 184 patients, Grade II in 4 patients and 50 patients developed Grade III reactions. The total rate of adverse reactions was 1.10% [CI: 0.96 to 1.26]; Grade I reaction rate was 0.82% [CI: 0.70 to 0.96], Grade II reaction rate was 0.02% [CI: 0.006 to 0.054] and Grade III reaction rate was 0.24% [CI = 0.18 to 0.32].

Conclusions
Currently, there is no level 1 evidence (meta-analysis) in the literature on the use of isosulfan blue dye in sentinel lymph node mapping in breast cancer patients. In our study, despite the low adverse reaction rate of isosulfan use, clinicians should still be aware of such complications following administration to ensure prompt treatment.
900 Effects Of COVID-19 Pandemic Restrictions on the 2ww Breast Referrals in A UK Specialist Breast Service
Authors: Tokode O , Rastall S 
Published: October 2021

Abstract

Aim
Recommendations were issued to the hospital Trusts to configure service delivery to balance cancer care with patient and hospital staff safety during the COVID-19 pandemic. It was felt the service restrictions might lead to delays in diagnosis and treatment of cancer patients. We conducted an audit to compare 2ww breast referrals in our center between May to July of 2019 and 2020.

Method
We triaged all referrals to face-face consultation or telephone consultation in our center during the pandemic. Patients with suspicious symptoms were offered face-face consultation after the telephone triage.

Results
Data analysis showed that the referrals fell by 28.3% (N 1569 versus N 1125). The largest reduction was noted in May (34.4% versus 24.2%). Mean waiting time in 2019 was 19.86 (± 7.14) and 11.43 (± 3.48) in 2020. The proportion of patients referred for suspected breast cancers increased across all age groups in 2020 (range +10.4% to 16.2%). Significantly more breast cancers were diagnosed in 2020 (7.1% versus 5.1%). No breast cancer was diagnosed in under 25 patients. 29.1% of the 522 patients telephoned were discharged, and others were seen in the clinic.

Conclusions
The COVID-19 infection’s management caused a fall in 2ww referrals and shortened waiting times but increased breast cancer diagnosis. Many 2ww referrals during the COVID-19 infection were unnecessary. The telephone consultation reduced waiting times but may have deferred clinic visitation for most patients.
912 Unusual Presentation Of JAK-2; A Degenerating Breast Neurofibroma
Authors: Crompton R , Salman R 
Published: October 2021

Abstract

Introduction
29-year-old lady presented to ED with acutely enlarging painless right breast swelling. No history of trauma; diagnosis likely breast abscess. Significant growth during short inpatient admission with incidental clinical finding of multiple cutaneous skin nodules from childhood, mother had similar lesions. CT chest performed illustrating large anterior chest wall mass 15.2x15.7x24.7cm. Transferred to regional plastic surgery unit for resection. Haematological abnormality identified on routine bloods which was life changing.

Description
Attended ED following a three-day history of a rapidly progressive right breast mass causing necrosis and blistering of overlying skin with drop in haemoglobin from 138 to 94 overnight. Transferred to regional plastic surgery unit where she underwent an evacuation of breast haematoma and excision of neurofibroma and was transfused 2 units of blood. Pathology revealed a degenerating neurofibroma. Abnormal coagulation and blood film during inpatient stay prompted subsequent bone marrow biopsy which revealed diagnosis of myeloproliferative neoplasm later found to be JAK-2 V617F mutation positive.

Discussion
Patient moved to UK 6 years ago from Lithuania, previously lived within area affected by Chernobyl nuclear disaster. JAK-2 myeloproliferative disease typically presents in middle aged but also reported as radiation acquired. Risk benefit of anti-platelet therapy for myeloproliferative malignancy evaluated due to high probability of re-bleeding. Complex case of Neurofibromatosis-1 and Myeloproliferative disease; diagnosis presented as a breast lump. Multidisciplinary input from surgery, haematology, genetics and neurology for best outcome.
1017 Sentinel Node Biopsy Vs Axillary Node Clearance in Early Breast Cancer
Authors: Karki S , Hassen Y , Babu E , Chakravorty A 
Published: October 2021

Abstract

Aim
The introduction of sentinel node biopsy (SLNB) in the late 1990s negated the need for axillary node clearance (ANC) in patients demonstrated to have early invasive breast cancer and histologically node-negative disease. However, the latest evidence from large multi-centre randomised trials suggests that patients could be spared this potentially debilitating procedure077. However, these following criteria must be met:

Method
A retrospective study of the database of breast cancer patients who had ANC between January 2018 to December 2019 in a single institution was undertaken. The histological results of patients who fulfilled the above criteria were analysed.

Results
Out of 75 patients who had ANC, 2 were excluded due to inadequate data.The average age was 59 (range 34-83).Of the remaining 73 patients, 57 patients (78%) had early breast cancer (T1/2), 11 (19%) of which fulfilled the criteria for sparing of ANC. Of those 11 patients, 8 (73%) had 0 LNs and 3 (27%) had 1 involved lymph node on histological assessment.

Conclusions
It has been observed that significant morbidity is associated with ANC. A greater subset of patients can benefit from a more sophisticated and evidence-based approach to the management of the axilla in early breast cancer, safely avoiding ANC without compromising survival.
1417 Post-Operative Breast Cancer Surveillance: The Crucial Role of Timing in Effective ‘Track and Trace’
Authors: Rees N , Okocha M 
Published: October 2021

Abstract

Aim
The aim of this quality improvement project is to assess our centre’s compliance to current NICE guidelines regarding annual mammogram follow-up for every breast cancer patient for 5 years and to elucidate any mechanisms that may optimise the efficiency of this surveillance process.

Method
We prospectively reviewed individual radiology requests following all wire-guided wide local excisions (WG-WLE), wide local excisions (WLE) and mastectomies undertaken at Bristol Breast Centre, a large tertiary referral centre, from January 2017-August 2020.

Results
Over the almost 4-year audit period, 1,885 operations were carried out. Specifically, 401 operations were performed from January 2017-June 2017, 677 from July 2017-January 2019 and 807 from February 2019-August 2020. Compliance to NICE guidelines was 95%, 100% and 95% from January 2017-June 2017, July 2017-January 2019 and February 2019-August 2020, respectively. Interestingly, compliance rates from February 2019-August 2020 varied according to the type of operation carried out; compliance was 97%, 94% and 91% for WG-WLE, WLE and mastectomy, respectively. This appears to result from the corresponding number of tardy radiological requests that were made following each of the three procedures. Specifically, the proportion of database requests filed in excess of one month post-operatively for each procedure type were 8%, 10% and 21% for WG-WLE, WLE and mastectomy, respectively.

Conclusions
Efficient annual mammographic surveillance depends on prompt post-operative radiological requests. Such database requests should ideally be enacted less than one month post-operatively. We suggest the adoption of an automatic electronic prompt could facilitate more effective post-operative mammogram surveillance.
1488 Cosmetic Tourism in Aesthetic Breast Surgery
Authors: McCrossan S , Martin S , Hill C 
Published: October 2021

Abstract

Introduction
Medical tourism is expanding on a global basis, with patients seeking cosmetic surgery in countries abroad. Little information is known regarding the risks and outcomes of cosmetic tourism, in particular, for aesthetic breast surgery.

Method
A systematic-review was conducted using the PRISMA (Preferred Reporting Items for Systematic-reviews and Meta-analyses) guidelines. Fifty-seven titles were screened, 42 abstracts were reviewed leaving 30 full texts. Twenty-one of these met the inclusion criteria.

Results
One-hundred and fifty patients partook in cosmetic tourism for aesthetic breast surgery. Forty-two percent of patients had an implant-based procedure. Other procedures included mastopexy (n = 4), bilateral breast reduction (n = 10) and silicone injections (n = 2). One-hundred and sixty complications were recorded, common complications included wound infection 31% (n = 46), breast abscess/ collection 14% (n = 21), wound dehiscence 12% (n = 18) and ruptured implant 9% (n = 13). Clavien-Dindo classification of complications includes 67 (45%) IIIb-complications with 78 returns-to-theatre, 2 class-IV complications (ICU stay) and one class-V-death of a patient. Explanation occurred in 38% (n = 24) of implant-based augmentation patients.

Conclusions
Aesthetic breast surgery tourism is popular within the cosmetic tourism industry. However, with infective complications (31%) and return-to-theatre rates (45%) significantly higher than expected, it is clear that having these procedures abroad significantly increases the risks involved. Professional bodies for cosmetic surgery in each country must highlight and educate patients how to lower this risk if they do choose to have cosmetic surgery abroad. In this current era of an intra-pandemic world where healthcare is already stretched, the burden from cosmetic tourism complications must be minimised.
1543 Response to Neoadjuvant Chemotherapy as An Indication for Breast-Conserving Surgery
Authors: Wilkinson A , Lee L , Alford N , Okocha M , Gill J 
Published: October 2021

Abstract

Aim
Pathological response to neoadjuvant chemotherapy (NAC) seeks to induce tumour regression pre-operatively. The present study aimed to assess tumour response to NAC and to evaluate the appropriateness of subsequent breast-conserving surgery (BCS) to avoid disfiguration of healthy breast tissue.

Method
Analysis of all patients undergoing NAC and wide local excision (WLE) surgery for primary breast cancer between April 2012 and December 2020 at a tertiary breast unit was conducted. Statistical analysis was performed using IBM® SPSS Statistics Software v27.0.

Results
A database of 1490 female patients undergoing WLE was retrieved, of whom 88 received NAC. Average patient age was 56 (SD = 11). Tumours were either invasive ductal (n = 86, 97.7%) or lobular (n = 2, 2.27%) carcinomas and grade 2 (n = 31, 35.2%) or grade 3 (n = 57, 64.8%). Chemotherapy regimens included: 30 FEC-T (34.1%), 22 FEC (25%), 19 TC (21.6%) and 17 other (19.3%). On average, tumour diameter (mm) decreased by 45.9%(34.5) with NAC and a further 2.29%(57.7) from NAC cessation to excision. Tumour diameter varied significantly across time points χ2 (3) = 29.057, p &lt; 0.001. Post-hoc tests revealed a significant reduction in tumour diameter from pre- to post-NAC [Mean(SD):

29.6(10.9) vs 16.1(11.3), p &lt; 0.001] and from pre-NAC to excision [14.1(12.0), p &lt; 0.001] but not from post-NAC to excision (p = 1.000).

Conclusions
Tumour diameter significantly reduced with the addition of NAC. There was no statistical difference between post-NAC and post-operative diameter, suggesting no growth between NAC cessation and surgery. Our findings support the use of NAC, where possible, to avoid the need for large resection margins.
1573 Can the Technique of Local Perforator Flaps Reduce the Volume of Mastectomies?
Authors: Karagiannidis G , Mallidis E 
Published: October 2021

Abstract

Aim
National reported mastectomy rate varies from 25% - 45%. Also, when a reduction therapeutic mammoplasty is needed, symmetrisation of the contralateral side will follow. Can the “relative new” technique of local perforator flaps, reduce the volume of mastectomies and contralateral surgery in a District General Hospital?

Method
Retrospective review of yearly breast cancer treatment operations in Ipswich Hospital.

Results
332 surgical operations performed for breast cancer. 79/332 (23,7%) had mastectomy, 54/332 (16,26%) had therapeutic mammoplasty with symmetrisation contralateral surgery, 32/332 (9,63%) had local perforator Flap Surgery. From the perforator flap operations, 23/32 (23/332: 6,92%) would have mastectomy (+/- reconstruction) and 9/32 (11/332: 2,71%) would have therapeutic reduction mammoplasty with contralateral symmetrisation surgery if this surgical option was not available. 0/32 (0,00%) of the local perforator flaps failed.

Conclusions
Local perforator flaps have resulted in 6,92% reduction in mastectomy rate (also eliminating the possible need for reconstructions). This was in small volume breasts and lower pole carcinomas and 2,71% reduction in symmetrisation surgery. This reduction also reduces the cost of cancer treatment without compromising oncological outcome or patient satisfaction.