30 research outputs found
Evaluation of implementation of sentinel node biopsy in Australia
No full textBACKGROUND: Sentinel node biopsy (SNB) has been a major change in surgical technique for the management of early breast cancer. In June 2008, the National Breast and Ovarian Cancer Centre (NBOCC) released evidence-based guidelines for the use of SNB in Australia. During 2010, NBOCC undertook a cohort study to identify the extent to which clinical practice in Australia reflected the recommendations for use of SNB in the 6 months after release of the guidelines. METHODS: Records obtained from four datasets, Royal Australasian College of Surgeons National Breast Cancer Audit, New South Wales Central Cancer Registry, Victorian Cancer Registry and Medicare Benefits Schedule records, were analysed to determine the extent to which the four key guideline recommendations had been implemented. This was supplemented by an audit of written SNB protocols of a sample of pathology laboratories in Australia. RESULTS: Across all cohorts, between 78 and 83% of women in Australia with tumours < 3 cm had an SNB. Data were not available to indicate whether nodes were clinically negative. The likelihood of women having an SNB decreased outside the metropolitan regions, for women treated as public patients compared with private patients and as the size of the tumour increased. In 90% of procedures both preoperative lymphoscintigraphy with isotope and blue dye were used. CONCLUSION: The findings from the study confirm that best practice recommendations from the NBOCC guidelines for SNB were largely being implemented for women with early breast cancer in Australia within 6 months of their release.Trenna Morris, Neil Wetzig, Sue Sinclair, James Kollias and Helen Zorba
Sentinal node biopsy and large (>3cm) breast cancer
No full textBACKGROUND Sentinel node biopsy is an accurate method for staging the axilla in early (small) breast cancers. However, data for the role of this technique for large breast cancers remain limited. METHOD From the Royal Adelaide Hospital Sentinel Node database and the SNAC trial database, 100 subjects were identified with clinically node negative, large (≥3 cm) primary breast cancer who had undergone sentinel node biopsy and immediate axillary clearance. The pathology results from the sentinel node and axillary specimens were analysed. RESULTS Average tumour size was 3.91 cm (range 3–10 cm) and 65 of 100 cases had metastatic disease in the axillary nodes. A sentinel node was successfully identified in 93 out of 100 cases with an average of 1.75 sentinel nodes sampled. Sixty-two per cent (58 out of 93) were sentinel node positive and 43% (43 out of 100) had a positive non-sentinel node. The false negative rate following successful sentinel node identification was 4.9% (3 out of 61). CONCLUSION Sentinel node biopsy was an accurate tool for staging the axilla with a false negative rate comparable to that seen in small tumours. However, given the increased incidence of metastases with larger cancers, further prospective investigation is warranted.Jesse D. Beumer, Grantley Gill, Ian Campbell, Neil Wetzig, Owen Ung, Gelareh Farshid, Roger Uren, Martin Stockler and Val Gebsk
Identification of the sentinel lymph node in the SNAC-1 trial
No full textBACKGROUND: A combination of scintigraphy and a lymphotropic dye (patent blue dye (BD)) is the recommended technique to detect the sentinel lymph node (SLN) in early breast cancer. This study determined the effect of clinical factors on SLN identification in the sentinel node biopsy versus axillary clearance (SNAC) trial. METHODS: A total of 1088 women were registered. Lymphatic mapping was performed using preoperative lymphoscintigraphy (LSG) and gamma probe (GP) combined with peritumoural injection of patent BD (971 patients) or BD alone (106 patients). RESULTS: SLNs were identified in 1024 women (94%), localized with LSG in 779 (81.4%), and were identified by GP in 879 (91.8%). The BD identified SLNs in 890 of 1073 (82%) women. Three patients had allergic reactions. BD detected the SLNs in 141 of 178 women with negative LSG mapping and in 44 of 79 women with no hot SLNs detected intraoperatively. Age, body mass index (BMI) and tumour presentation (screen detected versus symptomatic) were significantly related to the identification of the SLN. For BD, the primary tumour location was significantly related to identification rate. The detection of blue SLN was significantly lower in women with inner quadrant tumours. CONCLUSION: The combined technique resulted in a high identification rate. BD contributed to the identification of the SLNs in patients where LSG and GP failed to identify the sentinel node. Special attention to these techniques is needed in particular groups of patients such as those with high BMI, screen-detected primary tumours and tumour located in the inner quadrants.Amira A. Elmadahm, Peter G. Gill, Melissa Bochner, Val J. Gebski, Diana Zannino, Neil Wetzig, Ian Campbell, Martin Stockler, Owen Ung, John Simes and Roger Ure
Comparing patients' and clinicians' assessment of outcomes in a randomised trial of sentinel node biopsy for breast cancer (the RACS SNAC trial)
No full textThe original publication can be found at www.springerlink.comThe RACS sentinel node biopsy versus axillary clearance (SNAC) trial compared sentinel-node-based management (SNBM) and axillary lymph-node dissection (ALND) for breast cancer. In this sub study, we sought to determine whether patient ratings of arm swelling, symptoms, function and disability or clinicians’ measurements were most efficient at detecting differences between randomized groups, and therefore, which of these outcome measures would minimise the required sample sizes in future clinical trials. 324 women randomised to SNBM and 319 randomised to ALND were included. The primary endpoint of the trial was percentage increase in arm volume calculated from clinicians’ measurements of arm circumference at 10 cm intervals. Secondary endpoints included reductions in range of motion and sensation (both measured by clinicians); and, patients’ ratings of arm swelling, symptoms and quality of life, using the European Organisation for Research and Treatment of Cancer Breast Cancer Module (EORTC QLM-BR23), the body image after breast cancer questionnaire (BIBC) and the SNAC study specific scales (SSSS). The relative efficiency (RE, the squared ratio of the test statistics, with 95% confidence intervals calculated by bootstrapping) was used to compare these measures in detecting differences between the treatment groups. Patients’ self-ratings of arm swelling were generally more efficient than clinicians’ measurements of arm volume in detecting differences between treatment groups. The SSSS arm symptoms scale was the most efficient (RE = 7.1) The entire SSSS was slightly less so (RE = 4.6). Patients’ ratings on single items were 3–5 times more efficient than clinicians’ measurements. Primary endpoints based on patient-rated outcome measures could reduce the required sample size in future surgical trials.Michaella J. Smith, P. Grantley Gill, Neil Wetzig, Tatiana Sourjina, Val Gebski, Owen Ung, Ian Campbell, James Kollias, Xanthi Coskinas, Avis Macphee, Leonie Young, R. John Simes, Martin R. Stockler and The Royal Australasian College of Surgeons SNAC Trial Grou
Participation in the RACS sentinel node biopsy versus axillary clearance trial
No full textBackground: The Royal Australasian College of Surgeons (RACS) SNAC trial is a randomized controlled trial of sentinel node biopsy (SNB) versus axillary clearance (AC). It opened in May 2001 and is recruiting rapidly with good acceptance by consumers. Methods: A study of eligibility and treatment choices was conducted between November 2001 and September 2002 for women presenting with early breast cancer to 10 centres participating in the trial. Results: More than half of the 622 women (54%) were ineligible for trial entry because they had large (> 3 cm) or multicentric cancers. Participation was offered to 92% of eligible women and was taken up by 63%. The commonest reason for not participating was the desire to choose treatment rather than have it randomly allocated. Despite this there is a great acceptance of clinical trials because very few women (4% of those eligible) gave ‘lack of interest in clinical trials’ as the reason for non-participation. Few women who declined trial participation chose to have SNB alone (4.5% of those eligible). Conclusion: Sentinel node biopsy may become the standard of care for managing small breast cancers, but a significant number of patients will still require or choose axillary dissection. Results from large randomized trials are needed to determine the relative benefits and harms of SNB compared with AC. Surgeons must carefully discuss options for management with their patients.Neil R Wetzig, P. Grantley Gill, Owen Ung, John Collins, James Kollias, David Gillett, Val Gebski, Caroline Greig, Adam Ray and Martin Stockler for the RACS SNAC Group (2005) Participation in the RACS Sentinel Node Biopsy Versus Axillary Clearance Tria
Sentinel node biopsy for breast cancer: Using local results for estimation of risk to the patient
No full textBackground: Sentinel node biopsy (SNB) is being increasingly used but its place outside randomized trials has not yet been established. Methods: The first 114 sentinel node (SN) biopsies performed for breast cancer at the Princess Alexandra Hospital from March 1999 to June 2001 are presented. In 111 cases axillary dissection was also performed, allowing the accuracy of the technique to be assessed. A standard combination of preoperative lymphoscintigraphy, intraoperative gamma probe and injection of blue dye was used in most cases. Results are discussed in relation to the risk and potential consequences of understaging. Results: Where both probe and dye were used, the SN was identified in 90% of patients. A significant number of patients were treated in two stages and the technique was no less effective in patients who had SNB performed at a second operation after the primary tumour had already been removed. The interval from radioisotope injection to operation was very wide (between 2 and 22 h) and did not affect the outcome. Nodal metastases were present in 42 patients in whom an SN was found, and in 40 of these the SN was positive, giving a false negative rate of 4.8% (2/42), with the overall percentage of patients understaged being 2%. For this particular group as a whole, the increased risk of death due to systemic therapy being withheld as a consequence of understaging (if SNB alone had been employed) is estimated at less than 1/500. The risk for individuals will vary depending on other features of the particular primary tumour. Conclusion: For patients who elect to have the axilla staged using SNB alone, the risk and consequences of understaging need to be discussed. These risks can be estimated by allowing for the specific surgeon's false negative rate for the technique, and considering the likelihood of nodal metastases for a given tumour. There appears to be no disadvantage with performing SNB at a second operation after the primary tumour has already been removed. Clearly, for a large number of patients, SNB alone will be safe, but ideally participation in randomized trials should continue to be encouraged
Psychosocial impact of newly diagnosed advanced breast cancer
No full textThe purpose of this study was to delineate the key emotional concerns of women newly diagnosed with recurrent or metastatic breast cancer. Sixty-six women diagnosed with metastatic breast cancer within the previous 6 months, receiving treatment at the Medical Oncology Departments of two metropolitan teaching hospitals, completed measures of HADS, IES, CARES-SF and Memorial Symptom Assessment Scale, and participated in a semistructured interview. There were high levels of psychological morbidity, 56.7% of women younger than 55 years qualifying as 'cases' on the HADS, compared with 34.5% of women aged over 55 years. The total HADS score was significantly correlated with the Global and Physical Subscales of the MSAS and CARES. Women younger than 55 years had significantly higher levels of intrusive and avoidant symptoms than women over 55 years. Women also reported high numbers of physical symptoms. Key themes which emerged during the interviews were: difficulties in communicating with doctors, perceived delay in diagnosis, the emotional impact, concerns about the family, feelings about why the cancer developed, other life stress and trauma, and use of non-prescribed treatments. Copyright (c) 2004 John Wiley & Sons, Ltd
Influence of Notch Effects Created by Laser Cutting Process on Fatigue Behavior of Metastable Austenitic Stainless Steel
No full textAbstractLaser cutting is an attractive and innovative manufacturing process which has many advantages compared to conventional cutting methods. However, with increasing workpiece thickness an increase of the roughness along the kerf surface can be observed, which, in turn, can negatively affect the mechanical properties, in particular the fatigue strength. In this context, the purpose of the present study is to investigate the impact of the geometrical surface characteristics and microstructural changes after laser cutting in order to support the cutting process optimization concerning cyclic durability. Fatigue strength evaluation is performed with specimens cut out by high-power solid-state disk laser from sheets with thickness of 2, 4 and 6mm made of metastable austenitic stainless steel type 304. Cyclic tests are carried out using a resonant pulsation testing system at test frequencies around 100Hz at two different load modes, purely reversal load condition (R = -1) and tensile-tensile load condition (R = 0.1). In order to evaluate separately the effect of surface relief over the cutting kerf and burr in form of re-solidified drops, the fatigue specimens are tested at different surface conditions. The investigation comprises fractographic analyses in order to evaluate the influence of the surface roughness and surface-related macro defects on crack initiation. Additionally, phase analyses are performed to assess the deformation-induced phase transformation during cyclic testing and its influence on fatigue behavior, as well as microstructural investigation to analyze the material microstructural changes during the cutting process and its impact on material mechanical properties. The influence on fatigue strength of parts cut by laser is quantified and the characteristic dominating the fatigue life is identified
SNAC1: A randomised trial of sentinel node based management versus axillary clearance for women with small breast cancers
No full textSNAC1 will determine if sentinel node based management (a smaller operation removing a few lymph nodes) results in better quality of life and equivalent cure rates after 10 years follow-up compared with routine axillary clearance (a larger operation removing many lymph nodes) in over 1000 women with early breast cancer recruited to this large scale randomized trial from 2001 to 2005$AUD 379,379.41Project GrantsStandard Project Gran
SNAC1: A randomised trial of sentinel node based management versus axillary clearance for women with small breast cancers
No full textSNAC1 will determine if sentinel node based management (a smaller operation removing a few lymph nodes) results in better quality of life and equivalent cure rates after 10 years follow-up compared with routine axillary clearance (a larger operation removing many lymph nodes) in over 1000 women with early breast cancer recruited to this large scale randomized trial from 2001 to 2005$366,663.00Project GrantsStandard Project Gran
