Imaging: Recent submissions
Now showing items 1-20 of 40
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A 10-month impact evaluation of a journal club among diagnostic radiographers in a single NHS Trust: A service evaluation studyIntroduction: Journal clubs (JC) have emerged as a popular tool within medical and health professions to deliver outcomes such as promotion of evidence-based practice (EBP), improvement of critical appraisal skills, as well as stimulation of research interest among participating professionals. However, the delivery of these outcomes within the diagnostic radiography profession has not been evidenced and this is the aim of this service evaluation. Methods: This evaluation adopted a pre- and post-evaluation survey design to explore the impact of a novel JC introduced among diagnostic radiographers in a UK NHS Trust. Impact was assessed based on four pre-determined outcomes such as Knowledge of EBP, Attitude to EBP, Critical Appraisal Skill and Research interest. Open ended questions in the post evaluation survey were also used to obtain participants feedback on JC activities attended. Results: Evaluation of the four pre-determined outcomes indicated that JC activities participated by diagnostic radiographers resulted in positive changes across all evaluated categories. Attitude to EBP was the only outcome to show a statistically significant positive change across all participants, highlighting that the JC affected EBP attitudes positively for those that attended. Furthermore, thematic analysis of open-ended questions indicated that the collaboration experienced among JC members during critical appraisal of articles was a motivation for continued participation while factors such as high clinical workload and absence of management in meetings were identified as mitigating barriers. Conclusion: Participation in the JC showed positive improvements in all pre-determined categories. The collaborative nature of JC was motivating for staff, however barriers such as management absence in meetings, and high clinical workload did cause some challenges. Research is recommended to look at the longer-term impact of JC activities amongst diagnostic radiographers.
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A dedicated structured data set for reporting of invasive carcinoma of the breast in the setting of neoadjuvant therapy: recommendations from the International Collaboration on Cancer Reporting (ICCR).AIMS: The International Collaboration on Cancer Reporting (ICCR), a global alliance of major (inter-)national pathology and cancer organisations, is an initiative aimed at providing a unified international approach to reporting cancer. ICCR recently published new data sets for the reporting of invasive breast carcinoma, surgically removed lymph nodes for breast tumours and ductal carcinoma in situ, variants of lobular carcinoma in situ and low-grade lesions. The data set in this paper addresses the neoadjuvant setting. The aim is to promote high-quality, standardised reporting of tumour response and residual disease after neoadjuvant treatment that can be used for subsequent management decisions for each patient. METHODS: The ICCR convened expert panels of breast pathologists with a representative surgeon and oncologist to critically review and discuss current evidence. Feedback from the international public consultation was critical in the development of this data set. RESULTS: The expert panel concluded that a dedicated data set was required for reporting of breast specimens post-neoadjuvant therapy with inclusion of data elements specific to the neoadjuvant setting as core or non-core elements. This data set proposes a practical approach for handling and reporting breast resection specimens following neoadjuvant therapy. The comments for each data element clarify terminology, discuss available evidence and highlight areas with limited evidence that need further study. This data set overlaps with, and should be used in conjunction with, the data sets for the reporting of invasive breast carcinoma and surgically removed lymph nodes from patients with breast tumours, as appropriate. Key issues specific to the neoadjuvant setting are included in this paper. The entire data set is freely available on the ICCR website. CONCLUSIONS: High-quality, standardised reporting of tumour response and residual disease after neoadjuvant treatment are critical for subsequent management decisions for each patient.
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'PartBreCon' study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps.BACKGROUND: Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes. METHODS: STROBE-compliant protocol ascertained CWPF outcomes between March 2011-March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis. RESULTS: Across 15 centres, 507 patients with median age (54 years, IQR; 48-62), body mass index (25.4 kg/m2, IQR; 22.5-29), tumour size (26 mm, IQR; 18-35), and specimen weight (62 g, IQR; 40-92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11-39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%). CONCLUSIONS: This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.
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Primary Hyperparathyroidism: Outcomes of Repeated Imaging After Initial Negative Radiological Localization.BACKGROUND: Radiological localization imaging aids in the identification of abnormal parathyroid glands resulting in primary hyperparathyroidism (PHPT), thereby facilitating minimally invasive parathyroid surgery. Sometimes initial imaging may fail to identify the abnormal gland and imaging may therefore be repeated. This study explored patient outcomes of repeated parathyroid localization imaging, after initial negative gland localization, at a United Kingdom institution. METHODOLOGY: Data was retrospectively collected and analyzed for patients with PHPT undergoing repeated imaging during a five-year period (2015-2020). The total number of episodes of scanning, types of scans performed, the time interval between scans and the imaging success of gland localization were recorded. We explored the reasons for repeated imaging and attempted to identify any factors that might predict subsequent positive radiological localization. RESULTS: A total of 45 patients were identified who underwent repeated localizing imaging after first localizing imaging was negative. Of these, 39 did not undergo surgery despite repeat imaging being undertaken; 11 out of these 39 patients (28%) had subsequent positive localization scans. Again, a large proportion of patients were managed conservatively, despite the repeated sets of imaging being done. Patients undergoing three or four sets of repetitive imaging did not have imaging or surgical success. CONCLUSION: A streamlined parathyroid pathway should be followed whereby patients should be triaged for suitability for surgery prior to repeated imaging. A second set of scans should be offered when patients are unsuitable for conservative management and are willing and fit to undergo surgery. There is no merit to repeating imaging more than twice.
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Development and evaluation of a brief educational cartoon on trainee clinicians' awareness of risks of ionising-radiation exposure: a feasibility pre-post intervention study of a novel educational tool to promote patient safetyBackground: Over recent decades, CT scans have become routinely available and are used in both acute medical and outpatient environments. However, there is a small increase in the risk of adverse consequences, including an increase in the risk of both malignancy and cataracts. Clinicians are often unaware of these facts, and this represents a challenge for medical educators in England, where almost 5 million CT scans are done annually. New whiteboard methodologies permit development of innovative educational tools that are efficient and scalable in communicating simple educational messages that promote patient safety. Methods: A short educational whiteboard cartoon was developed to explore the prior observation that adolescents under the care of paediatricians had a much lower risk of receiving a CT scan than those under the care of clinicians who care for adults. This explored the risks after receiving a CT scan and strategies that can be used to avoid them. The educational cartoon was piloted on new doctors who were attending induction training at a busy teaching hospital. Results: The main output was the educational whiteboard cartoon itself. Before the new medical trainees' induction, 56% (25/45) had received no formal training in radiation awareness, and this decreased to 26% (6/23) after the exposure to the educational cartoon (p=0.02). At baseline, 60% (27/45) of respondents considered that young females were at highest risk from exposure to ionising radiation, and this increased to 87% (20/23) after exposure to the educational cartoon (p=0.06). Conclusions: This proof-of-concept feasibility study demonstrates that whiteboard cartoons provide a novel and feasible approach to efficiently promote patient safety issues, where a short succinct message is often appropriate.
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Patient and public beliefs about the role of imaging in the management of non-specific low back pain: a scoping review.BACKGROUND OR CONTEXT: Routine imaging for non-specific low back pain is advised against in guidelines yet imaging continues to occur. Patient and public beliefs regarding imaging may be a driving factor contributing to this. OBJECTIVES: To review the current evidence in relation to patient and public beliefs regarding imaging for low back pain. DATA SOURCES: A systematic scoping review was conducted in databases Medline, Embase, Cinahl, Psyc info (inception - Jan 2018). STUDY SELECTION: Any method of study including beliefs of adults about imaging for non-specific low back pain. DATA EXTRACTION AND DATA SYNTHESIS: Descriptive data was extracted and patient and public beliefs about imaging for low back pain was analysed using conventional qualitative content analysis. RESULTS: 12 studies from an initial search finding of 1135 were analysed. 3 main themes emerged; (1) The Desire for imaging; (2) Influences on patient desire for imaging including (a) clinical presentation, (b) past experience and (c)relationships with care professionals and (3) Negative consequences of imaging. LIMITATIONS: Few qualitative studies were found, all studies were in English language, the majority of studies were older than 2003. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS: There is little available evidence on patient and public beliefs about imaging but what evidence there is suggests that imaging is seen as positive in the management of low back pain and patient desire for a diagnosis is a big driver of this. There is also a suggestion that these beliefs may still be being influenced by health care professionals.
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Evaluation of the impact of a brief educational message on clinicians' awareness of risks of ionising-radiation exposure in imaging investigations: a pilot pre-post intervention study.BACKGROUND: In the context of increasing availability of computed tomography (CT) scans, judicious use of ionising radiation is a priority to minimise the risk of future health problems. Hence, education of clinicians on the risks and benefits of CT scans in the management of patients is important. METHODS: An educational message about the associated lifetime cancer risk of a CT scan was added to all CT scan reports at a busy acute teaching hospital in the UK. An online multiple choice survey was completed by doctors before and after the intervention, assessing education and knowledge of the risks involved with exposure to ionising radiation. RESULTS: Of 546 doctors contacted at baseline, 170 (31%) responded. Over a third (35%) of respondents had received no formal education on the risks of exposure to ionising radiation. Over a quarter (27%) underestimated (selected 1 in 30,000 or negligible lifetime cancer risk) the risk associated with a chest, abdomen and pelvis CT scan for a 20 year old female. Following exposure to the intervention for 1 year there was a statistically significant improvement in plausible estimates of risk from 68.3 to 82.2% of respondents (p < 0.001). There was no change in the proportion of doctors correctly identifying imaging modalities that do or do not involve ionising radiation. CONCLUSIONS: Training on the longterm risks associated with diagnostic radiation exposure is inadequate among hospital doctors. Exposure to a simple non-directional educational message for 1 year improved doctors' awareness of risks associated with CT scans. This demonstrates the potential of the approach to improve knowledge that could improve clinical practice. This approach is easily deliverable and may have applications in other areas of clinical medicine. The wider and longer term impact on radiation awareness is unknown, however, and there may be a need for regular mandatory training in the risks of radiation exposure.
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Safety and feasibility of breast lesion localization using magnetic seeds (Magseed): a multi-centre, open-label cohort study.PURPOSE: Wire localization has several disadvantages, notably wire migration and difficulty scheduling the procedure close to surgery. Radioactive seed localization overcomes these disadvantages, but implementation is limited due to radiation safety requirements. Magnetic seeds potentially offer the logistical benefits and transcutaneous detection equivalence of a radioactive seed, with easier implementation. This study was designed to evaluate the feasibility and safety of using magnetic seeds for breast lesion localization. METHODS: A two-centre open-label cohort study to assess the feasibility and safety of magnetic seed (Magseed) localization of breast lesions. Magseeds were placed under radiological guidance into women having total mastectomy surgery. The primary outcome measure was seed migration distance. Secondary outcome measures included accuracy of placement, ease of transcutaneous detection, seed integrity and safety. RESULTS: Twenty-nine Magseeds were placed into the breasts of 28 patients under ultrasound guidance. There was no migration of the seeds between placement and surgery. Twenty-seven seeds were placed directly in the target lesion with the other seeds being 2 and 3 mm away. All seeds were detectable transcutaneously in all breast sizes and at all depths. There were no complications or safety issues. CONCLUSIONS: Magnetic seeds are a feasible and safe method of breast lesion localization. They can be accurately placed, demonstrate no migration in this feasibility study and are detectable in all sizes and depths of breast tissue. Now that safety and feasibility have been demonstrated, further clinical studies are required to evaluate the seed's effectiveness in wide local excision surgery.
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Axillary tumour burden in women with one abnormal node on ultrasound compared to women with multiple abnormal nodes.AIM: To determine if the number of abnormal nodes seen on preoperative axillaryultrasound (AUS) is a predictor of the number of positive nodes at histology for women with needle-biopsy-proven positive nodes. MATERIALS AND METHODS: This prospective multicentre cohort study included consecutive patients with early breast cancer who had needle-biopsy-proven positive nodes on AUS and underwent axillary lymph node dissection (ALND) between October 2015 and July 2016. The number of abnormal nodes at preoperative AUS was recorded by breast radiologists or radiographers. RESULTS: One hundred and twenty-three patients were included in the study. The median age of the women was 62 (range 30-93) years. Fifty-four of the 123 (44%) women had one abnormal node, whereas 69 (56%) had multiple abnormal nodes on AUS. Forty of the 123 (33%) women had two or fewer nodes with metastases at histology after ALND. Tumours ≤20 mm (p<0.001) and one abnormal node on AUS (p<0.001) were associated with two or fewer nodes with metastases at ALND. Both remained significant in logistic regression analysis. The likelihood of at least three metastases based on the combination of these two factors had 95% sensitivity (79 of 83), 35% specificity (14 of 40), a negative predictive value of 78% (14 of 18), and a positive predictive value of 75% (79 of 105). CONCLUSION: Among women with needle-biopsy-proven positive nodes, around three in four women (78%) with an invasive tumour ≤2 cm and one abnormal node on AUS have two or fewer positive nodes at ALND. These women are overtreated by upfront ALND and can be offered sentinel node biopsy (SNB).
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CT imaging doses in radiotherapy-a single centre audit: Purpose or Objective: There is a growing awareness of dose delivered to parts the body outside the target volume during external beam radiotherapy. This concomitant dose could arise from external linac head leakage and scatter, scattered therapy dose outside the target volume, as well as nontherapeutic doses from imaging for planning and delivery, such as CT planning scans. Total concomitant dose has increased steadily with the introduction of more imaging procedures to the treatment process and the drive for better images quality. Much of this exposure is only loosely monitored and it could be the case that the cumulative concomitant dose has a negative biological effect even within the context of radiotherapy [1]. To quantify the dose contributed by CT planning scans, a retrospective dose audit was carried out on a TOSHIBA AQUILION LB multislice CT scanner at Derby Teaching Hospitals in July 2015. Material and Methods: A cohort of 200 patients were identified, twenty each from ten of the most frequently used CT scanning protocols who were scanned in the 12 months immediately prior to the dose audit. Patients undergoing CT planning scans were initially identified in the Mosaiq Oncology Information System (Elekta, Crawley, UK) and subsequently interrogated via the PACSWeb system, (Centricity Enterprise Web V3.0, GE Healthcare, Barrington, IL). Data harvested from PACSWeb included: Number of slices, slice thickness, CTDIVOL, DLP, Patient sex, Patient Age, total scan time, transverse width and AP width. Mean Effective Dose (E) was derived from values of DLP for each examination using appropriately normalised coefficients. As yet, there are no published UK national guidelines for planning CT scans. However, to put the results of this audit into context we have compared local DLP and CTDIvol to similar values published for a previous UK national (diagnostic CT) dose audit [2]. The following relationships were reported: CSA vs Age, CTDIvol vs CSA, DLP vs CSA, CTDIvol by Patient, DLP by Patient. Results: The mean scan length, DLP, CTDIvol and Effective Dose by Protocol were found for each protocol. The most significant result was that the DLP values from the Head & Neck protocol were tightly clustered but higher than one would normally expect. The mean DLP was a factor of 4 greater than the head and neck reference level reported in the previous UK national (diagnostic CT) dose audit. Conclusion: The results from this CT dose audit can be used as local Radiotherapy Imaging Reference Levels (RIRL). They will be able to guide protocol optimisation, allow comparison with other similarly equipped radiotherapy departments and participation in regional and national audits. The higher than expected DLP values for the Head & Neck protocol highlighted here has prompted a reassessment of the scanning parameters and may lead to protocol optimisation. (Figure Presented).
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Audit of Pectoralis (PECS) and Serratus Anterior Plane (SAP) blocks for breast surgeryIntroduction The principal objective of the audit is to -"Improve the quality of care delivered to the patient by minimising the opioid consumption intra and postop and to reduce the complication from opioids." Materials and methods (NA for case report) Formal approval of Derby Hopitals NHS Trust Clinical Governance Team ( equivalent to IRB ) acquired and medical records depatment were contacted for data collection. Retrospective data collection of patients undergoing "minor" breast surgery, between April 2015 - January 2016, in Derby Teaching Hospitals NHS Trust. Procedures excluded: - Reconstruction - Bilateral surgery - Free Flaps Data collected: - Procedure type - PECS block (Y/N) - SAP block (Y/N) - Intraoperative analgesia - Recovery pain score - Recovery opioid consumption - Recovery Nausea and vomiting Results/Case report Conclusions:- Out of 67 patients, 16 had blocks 49 of those with no block, received intra-op opiods +/- adjuvant IV analgesics In recovery, 1 in 16 with PECs required rescue analgesia (6.25%); opposed to 6 in 51 without PECs (11.76%). PONV rates were higher in patients without PECs. Surgery associated with stress response, which has metabolic neuroendocrine haematological and inflammatory /immunological response (cytokine stress responses, suppressed cell-mediated immunity) These are the major factors for peri-op immune suppression and provide a milieu for possible tumor cell proliferation leading to metastases. PECS and SAP Blocks are - Depositing Local Anaesthetic between Thoracic muscles "Myofascial block", similar to Transversus Abdominal Plane (TAP) block easy to do with the advent of USG, increasing accuracy Ability of RA to improve long term outcome after cancer surgery can be attributed to at least 3 different mechanismsattenuates the immunosuppressive effect of surgery decreases the opioid requirement RA + GA more balanced anaesthesia.
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Forensic radiology: The role of cross-sectional imaging in virtual post-mortem examinationsThe aim of this review is to assess the benefits and limitations of using Multi Slice Computed Tomography and Magnetic Resonance as non-invasive post-mortem imaging methods. Method: The author utilised SciVerse (Science Direct), Scopus, PubMed and Discover to search for relevant articles. The following search terms were used: virtopsy, minimally invasive post-mortem imaging, autopsy, Multi Slice Computed Tomography, Magnetic Resonance. Articles which discussed the use of non-invasive imaging techniques for post-mortem examinations were included in the review. Any articles published before 2003 were excluded with a few exceptions. Findings: The decline in use of the conventional post-mortem method has led to the need for an alternative method of investigation which increases both sensitivity and specificity, and also is more acceptable to the family of the deceased. Discussion/conclusion: There are numerous factors affecting the usability of these non-invasive post-mortem options including cost and availability. With the price of non-invasive post-mortem examinations often rising above 1000, it is considered to be less economically viable than the conventional method. Therefore, further research into this method and its implementation in hospitals has been delayed.
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Demand for CT scans increases during transition from paediatric to adult care: An observational study from 2009 to 2015.OBJECTIVE: Avoiding unnecessary radiation exposure is a clinical priority in children and young adults. We aimed to explore demand for CT scans in a busy general hospital with particular interest in the period of transition from paediatric to adult medical care. METHODS: We used an observational epidemiological study based in a teaching hospital. Data were obtained on numbers and rates of CT scans from 2009 to 2015. The main outcome was age-stratified rates of receiving a CT scan. RESULTS: There were a total of 262,221 CT scans. There was a large step change in the rate of CT scans over the period of transition from paediatric to adult medical care. Individuals aged 10-15 years experienced 6.7 CT scans per 1000 clinical episodes, while those aged 19-24 years experienced 19.8 CT scans per 1000 clinical episodes (p<0.001). This difference remained significant for all sensitivity analyses. CONCLUSION: There is almost a threefold increase in rates of CT scans in the two populations before and after the period of transition from paediatric to adult medical care. While we were unable to adjust for case mix or quantify radiation exposure, paediatricians' diagnostic strategies to minimize radiation exposure may have clinical relevance for adult physicians, and hence enable reductions in ionizing radiation to patients. Advances in knowledge: A large increase in rates of CT scans occurs during adolescence and paediatricians' strategies to minimize radiation exposure may enable reductions to all patients.
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Adequacy of percutaneous non-targeted liver biopsy under real-time ultrasound guidance when comparing the Biopince™ and Achieve™ biopsy needle.AIM: The purpose of this study was to compare the adequacy rates of percutaneous liver biopsies, in parenchymal liver disease, using the Biopince™ 16G and Achieve™ 18G biopsy needles in relation to the Royal College of Pathologists guidelines and to assess risk of complications. METHOD: Data for all percutaneous non-targeted 'medical' liver biopsies using the Biopince™ 16G and Achieve™ 18G biopsy needles were collected retrospectively over a 2-year period. Total biopsy core length and number of portal tracts was recorded along with adequacy of biopsy as assessed according to RCPath criteria. RESULTS: In total 194 percutaneous liver biopsies met the inclusion criteria; 53 using the Biopince™ needle and 141 using the Achieve™ needle.The mean total core length was 23mm (SD 4.1) and 20mm (SD 6.8) for the Biopince™ and Achieve™ needles respectively (p=0.0005). The mean number of portal tracts was 11 (SD 4.2) and 7 (SD 3.4) for the Biopince™ and Achieve™ needles respectively (p<0.0001). An adequate biopsy was obtained in 15 (31.3%) and 1 (1.3%) case using the Biopince™ and Achieve™ needles respectively (p<0.001). Compromised biopsies were obtained in 32 (66.7%) and 39 (50.6%) cases using the Biopince™ and Achieve™ needles respectively. Inadequate biopsies were obtained in 1 (2%) and 37 (48.1%) cases using the Biopince™ and Achieve™ needles respectively. CONCLUSION: The Biopince™ 16G needle, when compared with the Achieve™ 18G needle, acquires a significantly greater total core length and number of portal tracts with significantly improved adequacy rates. There were no major complications associated with its use. Advances in knowledge: The Biopince™ 16G needle achieves significantly better specimen adequacy, when compared with the Achieve™ 18G needle and with no added major complications associated with its use.
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Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial.BACKGROUND: In England, participation in breast cancer screening has been decreasing in the past 10 years, approaching the national minimum standard of 70%. Interventions aimed at improving participation need to be investigated and put into practice to stop this downward trend. We assessed the effect on participation of sending invitations for breast screening with a timed appointment to women who did not attend their first offered appointment within the NHS Breast Screening Programme (NHSBSP). METHODS: In this open, randomised controlled trial, women in six centres in the NHSBSP in England who were invited for routine breast cancer screening were randomly assigned (1:1) to receive an invitation to a second appointment with fixed date and time (intervention) or an invitation letter with a telephone number to call to book their new screening appointment (control) in the event of non-attendance at the first offered appointment. Randomisation was by SX number, a sequential unique identifier of each woman within the NHSBSP, and at the beginning of the study a coin toss decided whether women with odd or even SX numbers would be allocated to the intervention group. Women aged 50-70 years who did not attend their first offered appointment were eligible for the analysis. The primary endpoint was participation (ie, attendance at breast cancer screening) within 90 days of the date of the first offered appointment; we used Poisson regression to compare the proportion of women who participated in screening in the study groups. All analyses were by intention to treat. This trial is registered with Barts Health, number 009304QM. FINDINGS: We obtained 33 146 records of women invited for breast cancer screening at the six centres between June 2, 2014, and Sept 30, 2015, who did not attend their first offered appointment. 26 054 women were eligible for this analysis (12 807 in the intervention group and 13 247 in the control group). Participation within 90 days of the first offered appointment was significantly higher in the intervention group (2861 [22%] of 12 807) than in the control group (1632 [12%] of 13 247); relative risk of participation 1·81 (95% CI 1·70-1·93; p<0·0001). INTERPRETATION: These findings show that a policy of second appointments with fixed date and time for non-attenders of breast screening is effective in improving participation. This strategy can be easily implemented by the screening sites and, if combined with simple interventions, could further increase participation and ensure an upward shift in the participation trend nationally. Whether the policy should vary by time since last attended screen will have to be considered. FUNDING: National Health Service Cancer Screening Programmes and Department of Health Policy Research Programme.
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Factors influencing local control in patients undergoing breast conservation surgery for ductal carcinoma in situ.BACKGROUND: The aim of our study was to assess various predictors for local recurrence (LR) in patients undergoing breast conservation surgery (BCS) for ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: An audit was performed of 582 consecutive patients with DCIS between Jan 1975 to June 2008. In patients undergoing BCS, local guidelines reported a margin of ≥10 mm during the above period. Guideline with regard to margin of excision changes soon after this period. We retrospectively analysed clinical and pathological risk factors for local recurrence in patients undergoing BCS. Statistical analysis was carried out using SPSS version 19, and a cox regression model for multivariate analysis of local recurrence was used. RESULTS: Overall 239 women had BCS for DCIS during the above period. The actuarial 5-year recurrence rate was 9.6%. The overall LR rate was 17% (40/239. LR was more common in patients ≤50 years: (10/31 patients, 32%) compared to patients > 50 years (30/208, 14%, P = 0.02). Forty three per cent of patients (6/14) with <5 mm margin developed LR which was significantly higher compared to patients with 5-9 mm margin (12%, 3/25) and with ≥10 mm margin (14%, 27/188, P = 0.01). On multivariate analysis age ≤50 years, <5 mm pathological margin were independent prognostic factors for local recurrence. CONCLUSION: Our study shows that younger age (≤50 years) and a margin < 5 mm are poor prognostic factors for LR in patients undergoing breast conservation surgery for DCIS.
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Symmetrisation procedures in breast reconstruction patients constitute a rising workload in our DGH.INTRODUCTION: In breast cancer patients undergoing reconstructive surgery, achieving symmetry is of considerable importance. The aim of our study was to identify the proportion of breast cancer patients undergoing reconstructive surgery requiring contralateral symmetrisation procedures. PATIENTS AND METHODS: This is a retrospective review of consecutive patients undergoing reconstructive procedures following cancer surgery from April 2005 to April 2012. RESULTS: One hundred and fifty three patients had symmetrisation procedure of the opposite side during this period. The median age was 53 years (22-79). Reduction mammoplasty was the commonest procedure (94 patients), followed by mastopexy (34 patients) and augmentation mammoplasty (25 patients). Overall, it represent approximately one third of (153/489; 31.2%) of all the major reconstruction procedures in this unit. CONCLUSION: Almost half the number of patients (153/336) undergoing breast reconstruction as a part of breast cancer surgery had a symmetrisation procedure performed on the opposite side which constitutes a significant reconstructive workload in our unit. Consideration should be given to the above when planning departmental work force and training.
