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Heaney RM, Sweeney L, Flanagan F, O'Brien A, Smith C. Ipsilateral microcalcifications after breast-conserving surgery: is it possible to differentiate benign from malignant calcifications? Clin Radiol 2021; 77:216-223. [PMID: 34973807 DOI: 10.1016/j.crad.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
Abstract
AIM To analyse stereotactic biopsies of microcalcifications in patients with previous ipsilateral breast-conserving surgery (BCS) to identify the positivity rate, assess for an association between the patient's primary cancer or mammographic appearances of the microcalcifications, and the risk of recurrence. MATERIALS AND METHODS Relevant patients from 2018-2020 were identified via a retrospective review of the prospectively maintained radiological procedure database. Clinicopathological features of the patients' primary tumour and new calcifications were obtained from the hospital electronic patient record system and the national integrated medical imaging system. RESULTS Thirty-one percent of recurrences post-ipsilateral BCS presented as isolated microcalcifications on mammography. Fifty-three percent of patients undergoing stereotactic biopsy of ipsilateral calcifications had recurrence. A positive margin status was associated with new or recurrent malignancy. There was no significant correlation between oestrogen-receptor status, sentinel lymph node status, adjuvant radiotherapy or chemotherapy and the risk of recurrence. Calcifications within the tumour bed were more likely to be benign while calcifications within the same quadrant but remote from the tumour bed were more likely malignant. All coarse calcifications were benign while 67% of fine linear/fine linear branching and 89% of fine pleomorphic calcifications were malignant. CONCLUSION Increased time since diagnosis, positive margin status, fine pleomorphic and fine linear calcifications in the same quadrant as the tumour bed were associated with malignancy. Patients with coarse calcifications and calcifications within the tumour bed may avoid stereotactic biopsy and undergo short-interval surveillance.
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Affiliation(s)
- R M Heaney
- Mater Misericordiae University Hospital, Dublin, D07 Y7C6, Ireland.
| | - L Sweeney
- Mater Misericordiae University Hospital, Dublin, D07 Y7C6, Ireland
| | - F Flanagan
- Mater Misericordiae University Hospital, Dublin, D07 Y7C6, Ireland
| | - A O'Brien
- Mater Misericordiae University Hospital, Dublin, D07 Y7C6, Ireland
| | - C Smith
- Mater Misericordiae University Hospital, Dublin, D07 Y7C6, Ireland
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2
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Kelly C, Fitzpatrick P, Quinn C, Flanagan F, Connors A, Larke A, Mooney T, O'Doherty A. Ductal Carcinoma in Situ in Ireland, 2008-2020: Screening Data related to Low-Risk Management Trials. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Four clinical trials are on-going to determine if active surveillance is a feasible management option for patients with low-risk ductal carcinoma in situ (DCIS), in response to concerns that breast cancer screening programmes have increased the incidence of DCIS, some of which may never progress to invasive cancer. This study aimed to describe the epidemiology of screen-detected DCIS in Ireland through the BreastCheck, the national breast screening programme in Ireland (commenced 2000 but fully national since 2008).
Methods
This was a cross-sectional analysis of anonymised BreastCheck data provided by the National Screening Service, including all cases of screen-detected DCIS between 2008 and 2020. Statistical tests included Mann-Whitney U, Chi square, and multivariable logistic regression.
Results
2,240 women were diagnosed with DCIS through BreastCheck between 2008 and 2020 (1353 (60.4%) high-grade and 876 (39.1%) low/intermediate grade). The overall rate of screen-detected DCIS incidence has remained relatively stable during this time. Women with high- grade DCIS were older than women with low/intermediate DCIS (57 (IQR 53-61) years v 56 (IQR 56-61) years; p < 0.001). They were also more likely to have been diagnosed at a subsequent screening episode than at an initial episode (71.0% v 57.5%; p < 0.001). After adjustment (deprivation score, screening unit and year) the odds ratio for high-grade was 1.62 (95% CI 1.30-2.03; p < 0.001) for subsequent compared with initial screening episode.
Conclusions
When trial results are available, these data will assist with service planning should active surveillance be approved as a management option. Based on trial inclusion criteria, up to 40% of women diagnosed with DCIS through BreastCheck may be eligible for consideration for active surveillance. These women are younger and often diagnosed on initial screening episode, so may require longer active follow-up.
Key messages
Majority of DCIS in national screening programme is high grade. Randomised controlled trial evidence will provide guidance on management of low-risk DCIS.
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Affiliation(s)
- C Kelly
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Department of Public Health North East, Health Service Executive, Navan, Ireland
| | - P Fitzpatrick
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- National Screening Service, Dublin, Ireland
| | - C Quinn
- BreastCheck, National Screening Service, Dublin, Ireland
| | - F Flanagan
- BreastCheck, National Screening Service, Dublin, Ireland
| | - A Connors
- BreastCheck, National Screening Service, Dublin, Ireland
| | - A Larke
- BreastCheck, National Screening Service, Dublin, Ireland
| | - T Mooney
- National Screening Service, Dublin, Ireland
| | - A O'Doherty
- BreastCheck, National Screening Service, Dublin, Ireland
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3
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Baldelli P, Cardarelli P, Flanagan F, Maguire S, Phelan N, Tomasi S, Taibi A. Evaluation of microcalcification contrast in clinical images for digital mammography and synthetic mammography. Eur J Radiol 2021; 140:109751. [PMID: 34000600 DOI: 10.1016/j.ejrad.2021.109751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/17/2021] [Accepted: 04/30/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this work was to compare, in a clinical study, digital mammography and synthetic mammography imaging by evaluating the contrast in microcalcifications of different sizes. METHODS A retrospective review of microcalcifications from 46 patients was undertaken. A Hologic 3-Dimensions mammography system and a HD Combo protocol was used for simultaneous acquisition of the digital and synthetic images. Microcalcifications were classified in accordance with their size, and patient breast images were classified in accordance with their density as adipose, moderately dense and dense. The contrast of the microcalcifications was measured and the contrast ratio between synthetic and digital images was compared. An additional qualitative assessment of the images was presented to correlate the conspicuity of the microcalcifications with the suppression of the structure noise. RESULTS Microcalcifications in adipose background always exhibit a comparable or better contrast on synthetic images, regardless their size. For moderately dense background, synthetic images show a better contrast in 91.2 % of cases for small microcalcifications and in 90.9 % of cases for large microcalcifications. For a dense background, better contrast is seen in 89.5 % of cases for small microcalcifications, and in 85.7 % of cases for large microcalcifications. The contrast ratio increases with increasing breast glandularity. The suppression of structure noise also contributes to the enhancement of microcalcifications in the synthetic images. CONCLUSIONS Synthetic mammography imaging is superior to digital mammography imaging in terms of microcalcification contrast, regardless their size and breast density.
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Affiliation(s)
- P Baldelli
- Breastcheck, National Breast Screening Program, 36 Eccles Street, Dublin 7, Ireland
| | - P Cardarelli
- National Institute for Nuclear Physics - Ferrara Division, via Saragat 1, 44122 Ferrara, Italy.
| | - F Flanagan
- Breastcheck, National Breast Screening Program, 36 Eccles Street, Dublin 7, Ireland; Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - S Maguire
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - N Phelan
- Breastcheck, National Breast Screening Program, 36 Eccles Street, Dublin 7, Ireland
| | - S Tomasi
- Dept of Physics and Earth Sciences, University of Ferrara, via Saragat 1, 44122 Ferrara, Italy
| | - A Taibi
- Dept of Physics and Earth Sciences, University of Ferrara, via Saragat 1, 44122 Ferrara, Italy
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4
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Quinn EM, Dunne E, Flanagan F, Mahon S, Stokes M, Barry MJ, Kell M, Walsh SM. Radial scars and complex sclerosing lesions on core needle biopsy of the breast: upgrade rates and long-term outcomes. Breast Cancer Res Treat 2020; 183:677-682. [PMID: 32696314 DOI: 10.1007/s10549-020-05806-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 07/11/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Radial scars and complex sclerosing lesions of the breast are part of a group of "indeterminate" breast lesions, which are excised due to risk of coexistent carcinoma. The aim of this study was to assess rate of upgrade of these lesions to invasive and in situ carcinoma and to quantify the risk of development of subsequent cancer in women diagnosed with these lesions. METHODS A retrospective review of a prospectively maintained breast screening database was performed. All patients with radial scar identified at either core biopsy or final excision biopsy between January 2006 and July 2012 were identified. Full pathological reports for both core biopsy and final excision biopsy were reviewed. Patient outcomes were followed for a mean of 117.1 months. RESULTS Of 451 B3 biopsies performed at our screening unit, 95 (22%) were found to have a radial scar or complex sclerosing lesion (CSL) on core needle biopsy. Within this group, 77 had no atypia on CNB, with 7 (9%) upgraded to invasive/in situ carcinoma on final excision. Of nine with definite atypia on CNB, 3 (33%) were upgraded. In those patients without atypia or malignancy on final excision, 7.5% developed cancer during 10-year follow-up. CONCLUSION Patients with radial scar with atypia have a higher risk of upgrade to malignancy. Further research is needed to identify which patients may safely avoid excision of radial scar. Patients with a diagnosis of radial scar on CNB are at increased subsequent risk of breast cancer and may benefit from additional screening.
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Affiliation(s)
- E M Quinn
- Department of Surgery, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland.
| | - E Dunne
- Department of Surgery, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland
| | - F Flanagan
- Department of Radiology, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland
| | - S Mahon
- Department of Histopathology, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland
| | - M Stokes
- Department of Surgery, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland
| | - M J Barry
- Department of Surgery, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland
| | - M Kell
- Department of Surgery, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland
| | - S M Walsh
- Department of Surgery, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland
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5
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Mooney T, Fitzpatrick P, Greehy G, Flanagan F, Larke A, Connors A, O’Doherty A. A decade of screening: development of BreastCheck, the National Breast Screening Programme in Ireland prior to EUREF accreditation in 2015. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30107-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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6
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Breatnach CR, Flanagan F, James A, Corcoran JD, Franklin O, El-Khuffash A. The Use of Inhaled Nitric Oxide in a Tertiary Neonatal Intensive Care Unit. Ir Med J 2015; 108:275-278. [PMID: 26625652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
There is currently insufficient evidence to create a standardised protocol for the use and weaning of inhaled nitric oxide (iNO). We aimed to determine our application of iNO in this patient cohort. We performed a retrospective chart review on patients receiving iNO therapy for persistent pulmonary hypertension of the newborn (PPHN) from a single tertiary neonatal centre in 2014. The data was entered into the European Inhaled Nitric Oxide Registry. Thirty two babies were treated with iNO during this period, 9 of which were less than 32 weeks gestation. The median time to initiation of iNO treatment was 4-5 hours and the median duration of treatment was 74 hours for term and 66 hours for preterm infants. We recommend that further use of the European Inhaled Nitric Oxide Registry across more neonatal units in the Republic of Ireland could lead to the development of national guidelines on iNO use and weaning in this cohort.
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7
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Glackin L, Flanagan F, Healy F, Slattery DM. Outpatient parenteral antimicrobial therapy: a report of three years experience. Ir Med J 2014; 107:110-112. [PMID: 24834583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although outpatient parenteral antimicrobial therapy (OPAT) is practiced internationally, there is a paucity of data regarding outcomes of paediatric OPAT. A retrospective analysis, of 3 years experience (January 2010 to 2013) was performed at a tertiary paediatric Respiratory unit. There were 362 OPAT courses administered to 32 children, of which 30 had cystic fibrosis and the remaining two had recurrent pneumonia. A total of 3,688 days of antibiotics were administered. The median age was 8.8 years (range 2.75 - 17.8 years). Sixteen (50%) were male. Each child received an average of 11 courses and median duration of OPAT was 10 days (range 2-21 days). Tobramycin was the commonest antimicrobial prescribed, with ceftazidime second. During this period, there was one readmission (0.3%) post discharge and 3 (2%) portocath infections. All patients attended for weekly review and laboratory monitoring. OPAT appears safe, effective and reduces the need for inpatient beds.
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8
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Keavey E, Phelan N, O'Connell AM, Flanagan F, O'Doherty A, Larke A, Connors AM. Comparison of the clinical performance of three digital mammography systems in a breast cancer screening programme. Br J Radiol 2012; 85:1123-7. [PMID: 22096222 PMCID: PMC3587096 DOI: 10.1259/bjr/29747759] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 09/14/2011] [Accepted: 09/19/2011] [Indexed: 11/05/2022] Open
Abstract
This study compares the clinical performance of three digital mammography system types in a breast cancer screening programme. 28 digital mammography systems from three different vendors were included in the study. The retrospective analysis included 238 182 screening examinations of females aged between 50 and 64 years over a 3-year period. All images were double read and assigned a result according to a 5-point rating scale to indicate the probability of cancer. Females with a positive result were recalled for further assessment imaging and biopsy if necessary. Clinical performance in terms of cancer detection rate was analysed and the results presented. No statistically significant difference was found between the three different mammography systems in a population-based screening programme, in terms of the overall cancer detection rate or in the detection of invasive cancer and ductal carcinoma in situ. This was shown in both prevalent and subsequent screening examination categories. The results demonstrate comparable cancer detection performance for the three imaging system types operational in the screening programme.
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Affiliation(s)
- E Keavey
- BreastCheck, National Cancer Screening Service, Western Unit, Galway, Ireland.
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9
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Abstract
The primary purpose of this study was to evaluate the impact of digital mammography screening on breast dose by analysing the results of a patient dose survey of the Irish breast screening programme. Results from the survey were used to determine a dose reference level for the screening programme. Approximately, 100 examinations were acquired for each of the digital mammography systems operational in the screening programme. Each examination consisted of two standard views of each breast. The mean glandular dose for each acquired image was calculated. The dose reference level was established by calculating the 95th percentile of the average mean glandular dose for the average compressed breast thickness of the mediolateral oblique views. The overall average mean glandular dose per examination was 2.72 ± 0.04 mGy. The average compressed breast thickness was 61.4 ± 0.03 mm. The average compression force was 109 ± 7 N. A dose reference level value of 1.75 mGy was established for the screening programme. The results of this clinical dose survey provide a valuable indication of the dose performance of modern full field digital mammographic imaging systems. The results demonstrate clearly the dose benefits of digital mammography. The dose benefit of digital screening was further demonstrated by the establishment of a comparatively lower diagnostic reference level for the screening programme. The comparison of the dose performance of individual X-ray systems with the diagnostic reference level highlights the need for more optimisation within the service.
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Affiliation(s)
- P Baldelli
- BreastCheck, The National Cancer Screening Service, 36 Eccles Street, Dublin 7, Ireland.
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10
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Doyle B, Al-Mudhaffer M, Kennedy MM, O'Doherty A, Flanagan F, McDermott EW, Kerin MJ, Hill AD, Quinn CM. Sentinel lymph node biopsy in patients with a needle core biopsy diagnosis of ductal carcinoma in situ: is it justified? J Clin Pathol 2009; 62:534-8. [PMID: 19190009 DOI: 10.1136/jcp.2008.061457] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The incidence of ductal carcinoma in situ (DCIS) has increased markedly with the introduction of population-based mammographic screening. DCIS is usually diagnosed non-operatively. Although sentinel lymph node biopsy (SNB) has become the standard of care for patients with invasive breast carcinoma, its use in patients with DCIS is controversial. AIM To examine the justification for offering SNB at the time of primary surgery to patients with a needle core biopsy (NCB) diagnosis of DCIS. METHODS A retrospective analysis was performed of 145 patients with an NCB diagnosis of DCIS who had SNB performed at the time of primary surgery. The study focused on rates of SNB positivity and underestimation of invasive carcinoma by NCB, and sought to identify factors that might predict the presence of invasive carcinoma in the excision specimen. RESULTS 7/145 patients (4.8%) had a positive sentinel lymph node, four macrometastases and three micrometastases. 6/7 patients had invasive carcinoma in the final excision specimen. 55/145 patients (37.9%) with an NCB diagnosis of DCIS had invasive carcinoma in the excision specimen. The median invasive tumour size was 6 mm. A radiological mass and areas of invasion <1 mm, amounting to "at least microinvasion" on NCB were predictive of invasive carcinoma in the excision specimen. CONCLUSIONS SNB positivity in pure DCIS is rare. In view of the high rate of underestimation of invasive carcinoma in patients with an NCB diagnosis of DCIS in this study, SNB appears justified in this group of patients.
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Affiliation(s)
- B Doyle
- Irish National Breast Screening Programme and Department of Histopathology, St Vincent's University Hospital, Dublin, Ireland.
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11
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Sweeney KJ, Kell MR, Aziz NA, Prunty N, Holloway P, Kennedy M, Flanagan F, Kerin MJ. The clinical and pathological differences in prevalent round screen-detected and symptomatic invasive breast cancer. Ir Med J 2007; 100:550-552. [PMID: 17955686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The potential benefits of breast cancer screening include the detection of cancers at a more favourable stage, however, cancers detected during the prevalent round of screening may differ from true screen-detected cancers. These differences are poorly defined. This study prospectively assessed all women between 50 and 64 years of age undergoing curative surgery for breast cancer, both screen-detected and symptomatic, in one screening centre during the prevalent round of the national breast cancer-screening programme. Four hundred and thirty seven patients (364 screen-detected and 73 symptomatic patients) underwent surgery for breast cancer. Symptomatic breast cancers were of a higher grade (p < 0.0001; Chi2) and less likely to be oestrogen receptor positive (49% versus 88%; p < 0.0001; Fisher's exact test); however there was no difference in size of tumour or axillary nodal positivity. This study suggests that tumours detected by screening during the prevalent round of a screening programme are of a more prognostically favourable type than symptomatic breast cancers in the same age group.
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Affiliation(s)
- K J Sweeney
- Department of Surgery, Mater Misericordiae Hospital, Eccles Street, Dublin 7.
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12
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Burke JP, Power C, Gorey TF, Flanagan F, Kerin MJ, Kell MR. A comparative study of risk factors and prognostic features between symptomatic and screen detected breast cancer. Eur J Surg Oncol 2007; 34:149-53. [PMID: 17498912 DOI: 10.1016/j.ejso.2007.03.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 03/27/2007] [Indexed: 10/23/2022] Open
Abstract
AIMS To compare prognostic factors in screen detected breast cancer (SDBC) and symptomatically presenting breast cancer (SBC). METHODS Data were examined on 100 SDBC and 100 SBC. Multiple clinical patient factors were assessed including histopathological features. Using the Gail model each patient's risk of developing breast cancer was calculated and these data were examined for differences between groups. RESULTS There was no difference in the mean age of patient presentation or in the risk of breast cancer development between groups (2.2% vs. 2.2%, SDBC vs. SBC, actuarial risk of cancer at 5 years). SDBC patients had a significantly lower grade (1.95 vs. 2.44, SDBC vs. SBC, P<0.05), a smaller size of tumour (15.4mm vs. 29.3mm, SDBC vs. SBC, P<0.05) and a higher rate of oestrogen (94% vs. 81%, P<0.05) and progesterone (75% vs. 52%, P<0.05) receptor positivity. When compared using the Nottingham Prognostic Index, SDBC was associated with a better prognosis (r=-0.444, P<0.001). CONCLUSIONS Though both groups have similar demographics and risk, SDBC patients appear to have more favourable prognostic features. This has implications for the application of systemic therapy in breast cancer and supports the observation that SDBC is a more indolent form of disease.
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Affiliation(s)
- J P Burke
- Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
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13
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Doyle EM, Banville N, Quinn CM, Flanagan F, O'Doherty A, Hill ADK, Kerin MJ, Fitzpatrick P, Kennedy M. Radial scars/complex sclerosing lesions and malignancy in a screening programme: incidence and histological features revisited. Histopathology 2007; 50:607-14. [PMID: 17394497 DOI: 10.1111/j.1365-2559.2007.02660.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Radial scars (RS) are benign entities, frequently identified on screening mammography, which may be associated with malignancy. Much debate has been generated with regard to the optimum management of RS. We present our experience of RS in the first 5 years of a screening programme. The aim was to evaluate (i) the incidence of atypia and malignancy and (ii) the value of the preoperative core biopsy. We also further characterize the histological features. METHODS AND RESULTS One hundred and twenty-five histologically confirmed cases of RS were reviewed (111 had preoperative biopsies). Thirty-one (24.8%) patients had a final malignant diagnosis (11 with invasive malignancy) and 28 (22.4%) showed atypia (including lobular carcinoma in situ). In those with core biopsies and a final malignant diagnosis, 12 cases were categorized as B5 (41.3%), three as B4 (10.3%), 12 as B3 (41.3%) and two as B2 (7%). Common histological features included obliterated ducts and chronic inflammation with, less frequently, neural hyperplasia (16.8%) and perineural invasion (3.2%). CONCLUSIONS The high incidence of atypia and malignancy identified in our study justifies our policy of removing all mammographically detected RS. We emphasize the utility of preoperative core biopsy evaluation in permitting one-stage surgical therapy in those with B5 diagnoses.
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Affiliation(s)
- E M Doyle
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
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14
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Ni Bhrian P, Martin Z, Canning C, Kell M, Gorey T, Flanagan F, Stokes M, O'Connor B. P35 Analyses of serum samples from breast cancer patients using a novel biomarker assay. Breast 2007. [DOI: 10.1016/s0960-9776(07)70100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Conneely JB, Kell MR, Boran S, Flanagan F, Kerin MJ. A case of bilateral breast cancer with Peutz-Jeghers syndrome. Eur J Surg Oncol 2005; 32:121-2. [PMID: 16246518 DOI: 10.1016/j.ejso.2005.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Accepted: 08/18/2005] [Indexed: 11/30/2022]
Affiliation(s)
- J B Conneely
- Breast Check Eccles Unit, Department of Surgery, Mater Misericordiae Hospital, University College Dublin, Dublin, Ireland.
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16
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Burke JP, Kell MR, Flanagan F, Kerin MJ. Screen detected breast cancer: a different disease? Ir J Med Sci 2005. [DOI: 10.1007/bf03170147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Kell MR, Sweeney KJ, Moran CJ, Flanagan F, Kerin MJ, Gorey TF. Minimally invasive parathyroidectomy with operative ultrasound localization of the adenoma. Surg Endosc 2004; 18:1097-8. [PMID: 15136931 DOI: 10.1007/s00464-003-9228-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2003] [Accepted: 12/21/2003] [Indexed: 11/24/2022]
Abstract
BACKGROUND Minimally invasive parathyroidectomy is the procedure of choice for primary hyperparathyroidism due to parathyroid adenoma. Adequate perioperative adenoma localization is essential for this operation. We describe a technique using ultrasound to perform minimally invasive parathyroidectomy. METHODS 99mTc sestamibi scanning was performed on patients with primary hyperparathyroidism to localize parathyroid adenomas; no intraoperative gamma probe was used. We also performed pre- and intraoperative ultrasound scanning to localize these adenomas. RESULTS All patients underwent successful localization and removal of their parathyroid adenomas. At follow-up, all patients were well, with calcium within normal limits. CONCLUSION The use of intraoperative ultrasound facilitates minimally invasive parathyroidectomy and may obviate the need for intraoperative 99mTc sestamibi scanning.
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Affiliation(s)
- M R Kell
- Department of Surgery, Mater Misericordiae Hospital, University College Dublin, Dublin 7, Ireland.
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18
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Mckena S, Fenlon H, McNicholas M, Flanagan F. Breast carcinoma presenting as a benign appearing mass: a radiological—pathological pictorial review. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)90721-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
Radial scar (RS) is a benign, well recognised, radiological and pathological entity. Histologically, it is characterised by a fibroelastotic core with entrapped ducts and surrounding radiating ducts and lobules. Postmortem studies indicate that these lesions are present commonly in the population, especially in association with benign breast disease. In recent years, their clinical relevance has assumed more importance with the introduction of population based screening programmes. The exact pathogenesis of RS is unknown. Accumulating evidence indicates that they are associated with atypia and/or malignancy and, in addition, may be an independent risk factor for the development of carcinoma in either breast. In view of the association with atypia and malignancy, excision biopsy is justified in RS, although it has been argued that core biopsy evaluation and surveillance may be appropriate in selected patients.
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Affiliation(s)
- M Kennedy
- Department of Pathology, The National Breast Screening Programme Eccles Unit and Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
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Canning C, O’Hanlon DM, McDowell D, Flanagan F, Gorey TF, Kerin MJ. Metastatic screening in early breast cancer: can we be selective? Ir J Med Sci 2002. [DOI: 10.1007/bf03170027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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McDowell DT, Canning C, Cooke FJ, Conneely J, O’Hanlon D, Flanagan F, Kennedy M, Kerln MJ. Sentinel lymph node biopsy and impalpable breast cancer. A two-year Mater Hospital retrospective. Ir J Med Sci 2002. [DOI: 10.1007/bf03170025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Flanagan F, Barton P, Ennis J. The axilla — What can mammography offer? Eur J Cancer 1998. [DOI: 10.1016/s0959-8049(98)80334-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Colbert SA, O'Hanlon DM, Flanagan F, Page R, Moriarty DC. The laryngeal mask airway reduces blood flow in the common carotid artery bulb. Can J Anaesth 1998; 45:23-7. [PMID: 9466022 DOI: 10.1007/bf03011987] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The introduction of the laryngeal mask airway (LMA) has had a major impact on anaesthetic practice in the last ten years. Previous authors have demonstrated pressures equivalent to mean arterial blood pressure within the cuff of the LMA. This study examined the effects of cuff inflation on the cross sectional area, flow and velocity of blood flow at the level of the carotid sinus. METHODS Seventeen patients scheduled to have LMAs inserted as part of routine anaesthetic management were recruited into the study. Measurements of the common carotid artery bulb area, peak velocity and blood flow were performed upon LMA cuff inflation and deflation using a 5 MHz pulse wave Doppler probe. RESULTS Deflation of the cuff resulted in an increase in the cross sectional area (from 0.58 +/- 0.05 to 0.64 +/- 0.04 cm2; P < 0.005), an increase in blood flow (from 65.6 +/- 5.6 to 73.9 +/- 5.6 cm3.sec-1; P < 0.05) and a slight but non significant increase in velocity of blood flow. CONCLUSION This study demonstrates that inflation of the cuff on the LMA results in a decrease in carotid bulb cross sectional area which results in a decrease in blood flow.
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Affiliation(s)
- S A Colbert
- Department of Anaesthesia, Mater Misericordiae Hospital, Dublin, Ireland
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Abstract
The cross-sectional area of the common carotid artery bulb was measured using a 5 MHz pulse wave Doppler probe in a patient undergoing general anaesthesia using a laryngeal mask airway (LMA). A simultaneous measurement of blood velocity was performed to allow determination of the blood flow. Following inflation of the cuff on the LMA, the cross-sectional area of the right carotid artery bulb decreased from 1.09 to 0.89 cm2, flow velocity increased 120 to 176 cm s-1 and the blood flow increased from 130.8 to 156.6 cm3 s-1. On the left the cross-sectional area decreased from 1.16 to 1.13 cm2, the velocity increased 136 to 151 cm s-1 and the blood flow increased from 157.8 to 170.6 cm3 s-1. While a reduction in cross-sectional area was observed in the carotid bulb in this patient, this was accompanied by an increase in the velocity and a consequent increase in blood flow. In patients with atheromatous disease involving the carotid arteries this decrease in cross-sectional area may prove clinically significant. The use of the LMA may not be suitable for this population.
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Affiliation(s)
- S Colbert
- Department of Anaesthesia, Mater Misericordiae Hospital, Dublin, Ireland
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Yim JH, Barton P, Weber B, Radford D, Levy J, Monsees B, Flanagan F, Norton JA, Doherty GM. Mammographically detected breast cancer. Benefits of stereotactic core versus wire localization biopsy. Ann Surg 1996; 223:688-97; discussion 697-700. [PMID: 8645042 PMCID: PMC1235213 DOI: 10.1097/00000658-199606000-00007] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The authors evaluated the differences between stereotactic core needle biopsy (SCNBx) and needle localization surgical biopsy (NLBx) in cost and treatment course for patients with mammographically detected breast cancer. SUMMARY BACKGROUND DATA Stereotactic core needle breast biopsy is a reproducible and reliable alternative to surgical biopsy for histologic diagnosis of mammographic lesions. METHODS Records from 52 consecutive patients with invasive breast cancer diagnosed by SCNBx (n = 21) or NLBx (n = 31) over 2 years were reviewed. Episode-of-care costs were extracted from the Barnes Hospital billing system database. RESULTS At the time of excision, surgical margins were statistically more frequently positive in patients treated with NLBx (55%) than patients treated with SCNBx (0%, p < 0.0001). Furthermore, patients in the NLBx group undergoing breast conservation surgery required re-excision more frequently (74%) than those in the SCNBx group (0%, p = 0.001). There were no complications in either group after the diagnostic procedure. All SCNBx results were correct in the diagnosis of invasive breast cancer. The median cost of SCNBx was approximately $1000 less than the median cost of NLBx. This cost difference was carried through the definitive procedure, whether it was breast conservation or mastectomy. CONCLUSIONS This study shows the advantage of SCNBx to diagnose breast cancer and definitive operative care at a single procedure. The preoperative diagnosis of breast cancer eliminated positive operative margins and procedures to re-excise breast tissue. The use of SCNBx also saved approximately $1000 per patient compared with the use of NLBx. Our data suggest that SCNBx is the diagnostic procedure of choice for mammographically detected cancers.
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Affiliation(s)
- J H Yim
- Department of Surgery, Washington University School of Medicine, and General Surgery Administration, Barnes Hospital, St. Louis, Missouri, USA
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Lawler M, Locasciulli A, Bacigalupo A, Humphries P, Ljungman P, McCann SR, Nolan N, McDermott EW, Reynolds JR, McCann A, Rafferty R, Sweeney P, Carney D, O’Higgins NJ, Duffy MJ, Gardiner C, Reen DJ, O’Connell MA, Kelleher D, Hall N, O’Neill LAJ, Long A, McCarthy JV, Fernandes RS, Cotter TG, Ryan E, Kitching A, MacMathuna P, Mulligan E, Merriman R, Dervan P, Kelly P, Gorey TF, Lennon JR, Crowe J, Bennett MA, Kay EW, Curran B, O’Donoghue DP, Leader M, Croke DT, O’Connor JM, McKelvey-Martin VJ, McKenna PG, O’Riordan JM, Tobin A, O’Mahoney M, Keogh FM, O’Riordan J, McNamara C, McEneaney P, Daly PA, Farrell M, Young S, Gibbons D, McCarthy P, Mulcahy H, Parfrey NA, Sheahan K, Lambkin H, Mothersill C, Chin D, Sheehan K, Kelehan P, Parfrey N, Morrin M, Khan F, Delaney P, Rowan DM, Orminston WJ, Donnellan PP, Khalid A, Kerin M, O’Hanlon DM, Kent P, Given HF, Kennedy SM, McGeoch G, Spurr NK, Barrett J, O’Sullivan G, Collins JK, Willcocks T, Kennedy S, Dolan J, Gallagher W, McDermott E, O’Higgins N, Hagan R, McManus R, Ormiston W, Daly P, Sheils O, McDermott M, O’Briain DS, Maher D, Costello P, Flanagan F, Stack J, Ennis J, Grimes H, Yanni A, Harrison M, Lowry WS, Russell SEH, Atkinson RJ, White P, Hickey I, Bell DW, Biggart D, Doyle J, Staunton MJ, Gaffney EF, Dervan PA, McCabe MM, Fennelly JJ, Carney DN, O’Reilly M, McMahon JN, Moriarty M, Hurson B, O’Neill AJ, Magee H, O’Loughlin J, Dervan PA, Cremin P, Orminston W, McCarthy J, Redmond P, Duggan S, Rea S, Bouchier-Hayes D, O’Donnell J, Duggan C, Crown J, Bermingham D, Nugent A, Fleming C, Crosby P, Wolff S, McCarthy D, Walsh CB, Cassidy M, Husain S, Kay E, Thornhilll M, Whelan D, Barry D, Turner M, Prenderville W, Murphy F, Prendiville W, Gibson G, O’Grady T, Carmody M, Donohoe J, Walshe J, Murphy GM, O’Donoghue J, Kerin K, Ahern S, Molloy K, Goulden N, Pamphilon DH, O’Connell M, Power C, Leroux A, Perricaudet M, Walls D, Britton F, Brennan L, Barnett YA, Madden B, Wakelin LPG, Loughrey HC, Corley P, Redmond HP, Watson RWG, Keogh I, O’Hanlon D, Walsh S, Callaghan J, McNamara M, Benedict-Smith A, Barnes C, Neylon D, Fenton M, Searcey M, Topham CM, Wakelin LG, Howarth NM, Purohit A, Reed MJ, Potter BVL, Hatton WJ, McKerr G, Harvey D, Carson J, Hannigan BM, McCarthy PJ, McClean S, Hill BT, Costelloe C, Denny WA, Fingleton B, McDonnell S, Butler M, Corbally N, Dervan PA, Stephens JF, Martin G, McGirl A, Lawlor E, Gardiner N, Lynch S, Arce MD, O’Brien F, Duggan A, O’Herlihy S, Shanahan F, O’Keeffe G, McCann S, Sweeney K, Neill AO, Pamphilon D, Sheridan M, Reid I, Seymour CB, Walshe T, Hennessy TP, O’Mahony A, O’Connell’ J, Lawlor C, Nolan S, Morrisey D, Pedlow PJ, Walsh M, Lowry SW, McAleer JJA, McKeown SR, Afrasiabi M, Lappin TRJ, Joiner B, Hirst KV, Hirst DG, Sweeney E, VanderSpek J, Murphy J, Foss F. Irish Association for Cancer Research. Ir J Med Sci 1995. [DOI: 10.1007/bf02967834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kennedy M, Grace A, Sweeney EC, Mooney EE, Walker J, Hourihane DO, Walsh S, Lynch M, Sheehan C, Boissel L, Cryan B, Fanning S, Staunton MJ, Gaffney EF, Costello P, McCann A, Flanagan F, Stack J, Dervan P. Royal academy of medicine in Ireland section of pathology Proceedings of Registrar’s Prize Meeting held Wednesday 26th January, 1994. Ir J Med Sci 1995. [DOI: 10.1007/bf02968125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Barry MC, Burke P, Joyce WP, Sheehan S, Broe P, Bouchier-Hayes D, Mccollum PT, Holdsworth RI, Stonebridge PA, Belch JJ, O≿suilleabhain C, Waldron D, Hehir D, O≿donnell JA, Brady MP, Kelly J, O≿donnell J, Morasch MD, Couse NF, Colgan MP, Moore DJ, Shanik GD, Russell JD, O≿dwyer TP, Russell J, Walsh M, Lennon GM, Sweeney P, Grainger R, Mcdermott TED, Thornhill JA, Butler MR, Vashisht R, Koppikar M, Rogers HS, Stokes MA, Carroll T, Regan MC, Fitzpatrick JM, Gorey TF, Mccarthy J, Redmond HP, Duggan S, Watson RWG, O≿donnel R, Clements WDB, Mccaigue MD, Halliday IM, Rowlands BJ, O≿hanlon D, Kerin M, Kent P, Grimes H, Maher D, Given HF, Keogh I, Given HF, McAnena O, O≿hanlon DM, Chin D, Mccarthy P, Kennedy S, Dolan J, Mercer P, Mcdermott EW, Duffy MJ, O≿higgins NJ, Delaney CP, Mcgeeney KF, Dolan S, Campbell C, Mccluggage G, Halliday MI, Khan F, Delaney P, Barrett N, Morrin M, Ma QY, Anderson NH, Magee GD, Norwood W, Meagher PJ, Kelly CJ, Deasy JM, Baldota S, Jakoubek F, Mcloughlin H, Eustace PW, Waldron R, Johnston JG, Shuaib I, Strunz B, Hall T, Williams N, Delaney PV, Donnelly VS, O≿herlihy C, O≿connell PR, Walsh M, Attwood SEA, Evoy DA, Boyle B, Brown S, Stephens RB, Gillen P, Attwood S, Tanner WA, Keane FBV, Morris S, Reid S, Neary P, Horgan P, Traynor O, Hyland J, Barrett J, Collins JK, O≿sullivan G, Boyle TJ, Lyerly JK, Gallagher HJ, Naama H, Shou J, Daly JM, Wang JH, Barclay RG, Creagh T, Smalley T, Waters C, Mundy AR, Campbell GR, Stokes K, Kelly C, Abdih H, Bouchier Hayes D, Loughnane F, Ahearne M, Akram M, Drumm J, Collins GN, Mulvin D, Malone F, Kelly D, Delaney C, Mckeever J, Mehigan D, Keaveny TV, Hennessy A, Grace P, Mcgee H, Boyle CAO, Mohan P, Cross KS, Feeley TM, O≿donoghue JM, Al-Ghazal SK, Mccann J, Regan M, Stokes M, Graham F, Young L, Flanagan F, Ennis J, Fitzpatrick J, Gorey T, Walsh S, Callahan J, Macgowan SW, Malone C, Young LS, Wood AE, Madhavan P, O≿sullivan R, Durkan M, Nyhan T, Lynch G, Egan J, Mcavinchey D, Bulle B. Sylvester O’halloran surgical scientific meeting. Ir J Med Sci 1994. [DOI: 10.1007/bf02967098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Between 1979 and 1985, 10 patients were treated for renal carcinoma with extension into the inferior vena cava but without evidence of disseminated disease. Two of these had tumour thrombus extension up to the level of the hepatic veins and in four the extension was above the level of the diaphragm, two of which entered the atrium. Thrombus was removed en bloc at radical nephrectomy. Six patients are still alive, with a mean survival of 22 months. There was no correlation between the level of tumour thrombus and perinephric extension or indeed any correlation between tumour thrombus level and overall survival. It is suggested that tumour thrombus in the inferior vena cava, in the absence of metastatic disease, should be managed by radical surgery.
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Affiliation(s)
- M K O'Donohoe
- Department of Urology, Mater Misericordiae Hospital, Dublin, Irish Republic
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Flanagan F. Consider a career in quality assurance. Tex Hosp 1986; 42:32-3. [PMID: 10289729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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