Detection of Cervical Lymph Nodes in Head and Neck Cancer: A Study of the Correlation Between Ultrasonic and Histological Findings in Wales
Authors: R. Khosla, D. Owens, J. Rees, A. Tomkinson
Journal: International Journal of Surgery (2010)

s / International Journal of Surgery 8 (2010) 501–578 559 Results: 85 patients (88 lesions) underwent laparoscopic resection during this period. 84 lesions were visualised endoscopically. Of these, 52 (61.9%) were tattooed. 36 (69%) were tattooed at first endoscopy, 15 (28.8%) at a further procedure, and one unknown. The tattoo was adjudged as visible and accurate in 74%, visible but inaccurate in 9% and not visible in 17%. There was no relationship between tattoo visibility and BMI (p 1⁄4 0.35) or male sex (p 1⁄4 0.54). Of the 32 lesions visualised but not tattooed, 14 were in the right colon and 6 in the rectum below the peritoneal reflection. No tattoo-related complications were encountered. Conclusion: The practice of tattooing colorectal lesions varies in frequency and accuracy. We advocate that all suspicious lesions, except perhaps mid-low rectal lesions, are tattooed at a defined distance below the tumour in case surgery is required. DETECTION OF CERVICAL LYMPH NODES IN HEAD AND NECK CANCER: A STUDY OF THE CORRELATION BETWEEN ULTRASONIC AND HISTOLOGICAL FINDINGS IN WALES R. Khosla, D. Owens, J. Rees, A. Tomkinson. University Hospital Wales Cardiff The prognosis of patients with Head and Neck cancer relates to a degree on the presence and region of local metastatic disease to the neck. Preoperatively it is essential that an accurate evaluation is undertaken so effective treatment can be undertaken. Ultrasonography has been shown to be effective in examining the cervical nodes and had become an investigation of choice in Head and Neck surgery. A retrospective study of 50 patients with Head and Neck carcinoma was undertaken examining each region of the neck for evidence of local metastatic disease. All patients had undergone elective neck dissection which followed pre-operative assessment with ultrasound. 29 (58% CI 48.21 and 67.2) were found to have malignant lymphadenopathy on ultrasound examination compared with 27 (54% CI 44.26 and 63.44) on histological assessment. Correlation using Kappa statistics for categorical data shows correlation at 0.96 or very good agreement. Overall ultrasonography had high sensitivity and specificity 85% and 79% respectively. Positive and negative predictive values were strong at 82% each although false positive and false negative rates of detection were 21% and 15% respectively. ConclusionUltrasound remains an effective pre-operative investigation in the assessment of Head and Neck cancer with high correlation of results. BREAST CANCER SCREENING: WORTH THE PAIN? P. Ravindra , D. Myers . 1 Royal Derby Hospital; 2 University of Nottingham Medical School Aims: In recent years, some parties have suggested that it is not worth attending national breast cancer screening as it causes more harm than benefit. A recent study by Gotzsche et al (2009) concluded that the UK national patient information leaflet should be revised to reflect this. Methods: This study attempted to reproduce these results by retrospective analysis of all patients registered at one UK general practice invited to be screened for breast cancer over a period of 21 years. Results: A total of 1128 patients were invited to be screened over a 21year period. 97% had normal results. Out of 24 recalled, 6 resulted in invasive investigations. It was extrapolated that for every 2000 women screened for 10 years, two experienced false alarms and less than 1 (0.5) underwent additional procedures. Patients were 100 times less likely to experience a false alarm and 20 times less likely to undergo an invasive procedure than suggested by Gotzsche et al. Conclusions: This audit demonstrated that the data presented by detractors of the breast screening programme could not be reproduced in a primary care population, thus presenting a strong argument as to why it would be misleading to revise patient information leaflets. BLOOD TRANSFUSION IN GENERAL SURGERY; MSBOS GUIDELINES ARE ACCURATE AND CAN DECREASE BLOOD WASTAGE R.A.B. Thomas , H. Daniels , J. Duncan . Monklands Hospital, Lanarkshire; Hairmyres Hospital, Lanarkshire Background: Blood products are important for safe surgical practice but limited. The local Maximum Surgical Blood Ordering Schedule (MSBOS) simplifies blood transfusion requests but is outdated. SIGN guidelines recommend a cross-match:transfusion(CT) ratio of (1.5-2):1 ensuring that over 50% of cross-matched units are transfused. In 2005, only 40% were transfused. The remainder were potentially wasted. Aims To characterise General Surgical blood use and assess MSBOS compliance over eight weeks. To determine the CT ratio for elective General Surgical patients. Methods: All elective general surgical patients were included for eight weeks. An individual patient proforma was completed with operative and transfusion details. Cross-match requests and transfusions were confirmed by Blood Bank. Results: In 104 elective admissions, there were 45 cross-match requests with 126 units of blood cross-matched. 36 units were transfused and 90 units were returned. CT ratio was 3.5:1 (29%). 64% of operations followed MSBOS. The remainder exceeded MSBOS. Conclusion: Blood transfusion guidelines were not met. There was no evidence that patient safety was compromised. If MSBOS had been followed, the CT ratio would have been 2.2:1 (45%), closer to current guidelines.When blood requests exceededMSBOS recommendations, the excess blood was never given.We have now simplified the schedule and educated staff. Repeat audit is underway. HER2 POSITIVE BREAST CANCER AUDIT: IDENTIFICATION AND AVAILABILITY OF RECEPTOR STATUS AND DECISION TO TREAT WITH HERCEPTIN J. Pottle, C. Bradshaw, N. Rudarakanchana, K. Hogben. Department of Breast Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust Introduction: HER2 receptor overexpression occurs in approximately 20% of invasive breast cancers. These cancers tend to be more aggressive, with a higher risk of recurrence. Although immunohistochemistry (IHC) can determine HER2 status, results can be equivocal. Alternatively, the more involved and expensive fluorescent in situ hybridisation (FISH) can be used. Using Herceptin, a monoclonal antibody against HER2 receptors, in combination with chemotherapy can improve survival in late stage HER2 positive breast cancer. Methods: Single unit retrospective study of 265 patients with invasive breast cancer between 1st August 2008 and 31st July 2009. Results: 15.5% of cancers were HER2 positive. Initially 15 patients had equivocal results on IHC; 10 required FISH and 3 were subsequently found to be HER2 positive. In 4%, HER2 status was not available at the multidisciplinary meeting. 27.5% of HER2 positive cancers did not receive treatment with Herceptin, commonly because of co-morbidities or no indication for chemotherapy.