42 research outputs found
One-step nucleic acid amplification: the possible value in assessing sentinel lymph node metastasis during mastectomy
No full textAlison E Hunter-Smith, Zenon Rayter Breast Surgery Unit, Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, UK Abstract: Breast cancer is the most common cancer in women, worldwide, and 1,400 deaths per day are attributed to it. The success of national screening programs has seen breast cancers being diagnosed at an earlier stage. With conservative surgery to the breast demonstrating equivalent long-term outcomes, the last 10 years have seen a growing interest in the safety of less invasive management for the axilla in breast cancer patients. One-step nucleic acid amplification (OSNA) is a validated, reliable, and efficient tool in identifying micro- and macro-metastases intraoperatively. It is the most widely used intraoperative analysis tool within the United Kingdom, and is employed by over 320 units across Europe and Asia. Recent evidence from the AMAROS, IBCSG 23-01, and ACOSOG Z0011 trials has changed surgical practice in managing the axilla of patients with breast cancer. We propose a clinical algorithm demonstrating the role of OSNA as an intraoperative analysis tool in today’s management of breast cancer as well as prospects for the future use of OSNA. Keywords: breast cancer, sentinel lymph node, intraoperative assessment, one-stop nucleic acid amplification, mastectom
A multicentre prospective longitudinal study establishing level II evidence of health related quality of life after types of immediate latissimus dorsi (LD) breast reconstruction
No full textA multi centre prospective longitudinal study evaluating health related quality of life after immediate Latissimus dorsi (LD) breast reconstruction
No full textIntroduction: NICE recommends that the majority of women should be offered immediate breast reconstruction with its potential to improve health related quality of life (HRQL). There is conflicting evidence with a lack of ‘hard’data to best inform clinicians and their patients. Our aim was to evaluate the effects of implant-assisted LD (LDI) versus autologous LD (ALD) breast reconstruction on HRQL over 12 months. Methods: A prospective longitudinal multicentre study commenced in early 2007. Patient reported outcome measures using the EORTC C30 (general HRQL), BR-23 (breast + arm symptoms), Body Image Scale (BIS) and HADS, were completed pre-operatively and at 3, and 12 months after surgery. Longitudinal analyses tested the effects of treatment variables, baseline HRQL, age and time on QL domains (3–12 months). Significance was set at p = 0.01. Results: One hundred and seventy one patients (93 ALD, 78 LDI) were recruited. There were no significant differences in HRQL domains between LDI and ALD (±RT). Chemotherapy patients reported poorer overall HRQL (p < 0.001), poorer role (p = 0.003) and social (p = 0.01) functioning, and greater fatigue (p = 0.002) and depression (p = 0.01). Older patients had fewer HRQL issues (p = 0.01). Significant improvements over time were seen for overall HRQL and other domains (p < 0.001). There were no significant differences between LDI and ALD for patient satisfaction with surgical outcome. Good satisfaction with overall breast appearance and surgical outcome was significantly associated with fewer body image concerns. Conclusion: There is an important need for cumulative clinical evidence in this field on which to base patient informed consent and clinical recommendations
