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Zaborowski AM, Doogan K, Clifford S, Dowling G, Kazi F, Delaney K, Yadav H, Brady A, Geraghty J, Evoy D, Rothwell J, McCartan D, Heeney A, Barry M, Walsh SM, Stokes M, Kell MR, Allen M, Power C, Hill ADK, Connolly E, Alazawi D, Boyle T, Corrigan M, O’Leary P, Prichard RS. Nodal positivity in patients with clinically and radiologically node-negative breast cancer treated with neoadjuvant chemotherapy: multicentre collaborative study. Br J Surg 2024; 111:znad401. [PMID: 38055888 PMCID: PMC10763529 DOI: 10.1093/bjs/znad401] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/06/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The necessity of performing a sentinel lymph node biopsy in patients with clinically and radiologically node-negative breast cancer after neoadjuvant chemotherapy has been questioned. The aim of this study was to determine the rate of nodal positivity in these patients and to identify clinicopathological features associated with lymph node metastasis after neoadjuvant chemotherapy (ypN+). METHODS A retrospective multicentre study was performed. Patients with cT1-3 cN0 breast cancer who underwent sentinel lymph node biopsy after neoadjuvant chemotherapy between 2016 and 2021 were included. Negative nodal status was defined as the absence of palpable lymph nodes, and the absence of suspicious nodes on axillary ultrasonography, or the absence of tumour cells on axillary nodal fine needle aspiration or core biopsy. RESULTS A total of 371 patients were analysed. Overall, 47 patients (12.7%) had a positive sentinel lymph node biopsy. Nodal positivity was identified in 22 patients (29.0%) with hormone receptor+/human epidermal growth factor receptor 2- tumours, 12 patients (13.8%) with hormone receptor+/human epidermal growth factor receptor 2+ tumours, 3 patients (5.6%) with hormone receptor-/human epidermal growth factor receptor 2+ tumours, and 10 patients (6.5%) with triple-negative breast cancer. Multivariable logistic regression analysis showed that multicentric disease was associated with a higher likelihood of ypN+ (OR 2.66, 95% c.i. 1.18 to 6.01; P = 0.018), whilst a radiological complete response in the breast was associated with a reduced likelihood of ypN+ (OR 0.10, 95% c.i. 0.02 to 0.42; P = 0.002), regardless of molecular subtype. Only 3% of patients who had a radiological complete response in the breast were ypN+. The majority of patients (85%) with a positive sentinel node proceeded to axillary lymph node dissection and 93% had N1 disease. CONCLUSION The rate of sentinel lymph node positivity in patients who achieve a radiological complete response in the breast is exceptionally low for all molecular subtypes.
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Affiliation(s)
| | - Katie Doogan
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Siobhan Clifford
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gavin Dowling
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
| | - Farah Kazi
- Department of Breast Surgery, St James’s Hospital, Dublin, Ireland
| | - Karina Delaney
- Department of Breast Surgery, St James’s Hospital, Dublin, Ireland
| | - Himanshu Yadav
- Cork Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - Aaron Brady
- Department of Breast Surgery, Bon Secours Hospital Cork, Cork, Ireland
| | - James Geraghty
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Denis Evoy
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Jane Rothwell
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Damian McCartan
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Anna Heeney
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mitchel Barry
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Siun M Walsh
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Maurice Stokes
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Malcolm R Kell
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Allen
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
| | - Colm Power
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
| | - Arnold D K Hill
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
| | | | - Dhafir Alazawi
- Department of Breast Surgery, St James’s Hospital, Dublin, Ireland
| | - Terence Boyle
- Department of Breast Surgery, St James’s Hospital, Dublin, Ireland
| | - Mark Corrigan
- Cork Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - Peter O’Leary
- Department of Breast Surgery, Bon Secours Hospital Cork, Cork, Ireland
| | - Ruth S Prichard
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
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Kuzmova M, Cullinane C, Rutherford C, McCartan D, Rothwell J, Evoy D, Geraghty J, Prichard RS. The accuracy of MRI in detecting pathological complete response following neoadjuvant chemotherapy in different breast cancer subtypes. Surg Oncol 2023; 51:102011. [PMID: 37931546 DOI: 10.1016/j.suronc.2023.102011] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/04/2023] [Revised: 08/03/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Pathological complete response (pCR) following neo-adjuvant chemotherapy (NACT) for breast cancer is associated with improved disease-free and overall survival in certain breast cancer subtypes. Magnetic Resonance Imaging (MRI) is increasingly used as standard to assess treatment response in patients receiving NACT. The aim of this study was to determine the clinical utility of MRI in accurately predicting pCR post-NACT. METHODS A single-centre, retrospective study was conducted in breast cancer patients, who received NACT between 2013 and 2020. Patients who had an MRI before and after NACT were included. Pathological and MRI radiological response rates to NACT were analyzed and MRI accuracy assessed in detecting pCR according to breast cancer subtype. RESULTS One hundred and sixty-seven patients were included in the study. Forty-one of the 167 patients achieved pCR (24.6 %), with the highest proportion in HR- HER2+ subgroup (58.3 %), followed by triple negative breast cancer (TNBC) (35 %). Only 22.2 % and 10.5 % of patients with HR + HER2+ and HR + HER2-respectively achieved pCR. The overall accuracy of MRI in predicting pCR after NACT was 77.3 %. The greatest accuracy was in TNBC (87.5 %) with a specificity and positive predictive value (PPV) of 100 % and the highest number of correctly diagnosed complete responses (14 of 40). MRI was less accurate in predicting response rates in HR + HER2- (PPV 91.2 %) and HR + HER2+ groups (PPV 90.5 %). MRI performed significantly better in predicting complete response in TNBC compared to HR + HER2-subtype (p = 0.0057). CONCLUSION MRI is a clinically useful adjunct in assessing pCR following NACT and appears to predict pathological response more accurately in TNBC compared to HR + HER2-breast cancer subtypes. This has significant clinical implications in terms of surgical planning, adjuvant treatment options and prognosis.
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Affiliation(s)
- Miroslava Kuzmova
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland.
| | - Carolyn Cullinane
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Claire Rutherford
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Damian McCartan
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Jane Rothwell
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Denis Evoy
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - James Geraghty
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Ruth S Prichard
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
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Zaborowski AM, Roe S, Rothwell J, Evoy D, Geraghty J, McCartan D, Prichard RS. A systematic review of oncological outcomes after nipple-sparing mastectomy for breast cancer. J Surg Oncol 2023; 127:361-368. [PMID: 36208279 DOI: 10.1002/jso.27115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/05/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 02/01/2023]
Abstract
Nipple-sparing mastectomy is an alternative to skin-sparing mastectomy in select patients. Increasing evidence supports its use in the setting of breast cancer, however concerns still exist regarding oncological safety. The aim of this systematic review was to evaluate long-term oncological outcomes of patients who underwent nipple-sparing mastectomy for breast cancer. A systematic review of the literature was performed to evaluate oncological outcomes in patients with breast cancer who underwent nipple-sparing mastectomy. Five major databases (PubMed, Embase, Scopus, Web of Science and Cochrane) were searched. The review included all original articles published in English reporting long-term oncological outcomes. 2334 studies were identified. After applying inclusion and exclusion criteria, 17 retrospective studies involving 7107 patients were included. The indication for nipple-sparing mastectomy was invasive carcinoma in 6069 patients (85.4%) and in situ disease in 1038 (14.6%). Median follow up was 48 months (range 25-94). The weighted mean rates of local recurrence and recurrence involving the nipple-areola complex were 5.4% (0.9-11.9) and 1.3% (0-4.9), respectively. The weighted mean distant failure rate was 4.8% (1.5-23.0). Therapeutic nipple-sparing mastectomy is oncologically safe in select patients with breast cancer.
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Affiliation(s)
- Alexandra M Zaborowski
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Simon Roe
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Jane Rothwell
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Denis Evoy
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - James Geraghty
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Damian McCartan
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Ruth S Prichard
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
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Zaborowski A, Kaur I, O'Connell L, McNally S, Quinn C, Walshe J, Rothwell J, Evoy D, Geraghty J, McCartan D, Prichard R. Predictors of axillary pathologic complete response following neoadjuvant chemotherapy for node positive breast cancer. European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2022.03.047] [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: 10/18/2022]
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O'Connell L, Zaborowski A, Walsh J, Prichard R, McCartan D, Evoy D, Geraghty J, Kaur I, Quinn C. De-escalation of axillary surgery post neoadjuvant therapy in hormone-positive breast cancer: Feasible or futile. European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2022.03.055] [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: 10/18/2022]
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Lloyd A, O'Connell L, Zaborowski A, Kearns C, Boland M, Evoy D, Geraghty J, Rothwell J, McCartan D, Prichard R. The role of routine sentinel lymph node biopsy in elderly patients with breast cancer. European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2022.03.094] [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: 11/16/2022]
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Zaborowski A, Doogan K, O'Connell L, McNally S, Quinn C, Walshe J, Rothwell J, Evoy D, Geraghty J, McCartan D, Prichard R. Predictors of ypN0 status in patients with clinically node negative breast cancer treated with neoadjuvant chemotherapy. Eur J Surg Oncol 2022. [DOI: 10.1016/j.ejso.2022.03.064] [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: 10/18/2022] Open
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Cullinane C, Gillan H, Geraghty J, Evoy D, Rothwell J, McCartan D, McDermott EW, Prichard RS. OUP accepted manuscript. BJS Open 2022; 6:6526446. [PMID: 35143625 PMCID: PMC8830753 DOI: 10.1093/bjsopen/zrab149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/22/2021] [Indexed: 11/15/2022] Open
Abstract
Background The significance of exogenous hormone manipulation as part of fertility treatment and its relationship to the development of breast cancer remains uncertain. Several historical reviews have been performed with conflicting results. This study is an updated meta-analysis to determine whether there is a causal relationship between different fertility treatments and breast cancer. Methods The study report is based on the guidelines of PRISMA and Meta-Analysis of Observational Studies in Epidemiology. Studies published within the last 20 years were included to reflect up to date in vitro fertilization (IVF) practice. This study was prospectively registered on PROSPERO on 07/04/2021, registration identification CRD42021247706. The primary outcome of the study was to determine whether there is an increased incidence of breast cancer in women treated with hormonal fertility treatment. The secondary outcomes were to determine whether fertility treatments were individually associated with excess breast-cancer risk. Results Overall, 25 studies, including 617 479 participants, were eligible for inclusion. There was no significant breast-cancer risk association with fertility treatment (compared with general and subfertility reference groups). Summary odds ratio of all included studies was 0.97 (95 per cent c.i. 0.90 to 1.04). Women who received six or more IVF cycles did not have an increased risk of breast cancer. Similarly, there was no excess breast-cancer risk associated with clomiphene, human chorionic gonadotropin, gonadotropin analogues and progesterone when examined individually. Comparably, there was no significant association between fertility treatment and excess breast-cancer risk in patients with more than 10 years’ follow-up. Summary odds ratio was 0.97 (95 per cent c.i. 0.85 to 1.12). Conclusion This meta-analysis did not find a significant association between fertility treatments and excess breast-cancer risk. Women considering IVF should be informed that it does not appear to increase breast-cancer risk.
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Affiliation(s)
- Carolyn Cullinane
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
- Department of Surgical Research, University of College Cork, Cork T12 K8AF, Ireland
- Correspondence to: Carolyn Cullinane, Department of Breast Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (e-mail: )
| | - Hannah Gillan
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - James Geraghty
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Denis Evoy
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Jane Rothwell
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Damian McCartan
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Enda W. McDermott
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Ruth S. Prichard
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
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Earley H, Denis E, Geraghty J, McDermott E, Prichard R, McCartan D. EP.TH.930Contemporary trends in the management of micrometastatic axillary disease in the setting of mastectomy – a 5 year single institution experience. Br J Surg 2021. [DOI: 10.1093/bjs/znab309.095] [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]
Abstract
Abstract
Background
Since the ACOSOG Z0011 trial, rates of axillary node clearance (ANC) for micrometastatic axillary disease have declined among women undergoing breast conservation surgery (BCS). However, for women undergoing mastectomy, it remains unclear whether omission of ANC is a safe and feasible option.
Aims
Identify current practice relating to management of the axilla in women with early stage, clinically node negative breast cancer, found to have micrometastatic disease on SNB, who undergo mastectomy
Methods
From 2013 to 2017 patients with clinical T1-T2Nmi breast cancer undergoing upfront surgery were identified from a prospective institutional database. Receipt of adjuvant radiotherapy or subsequent ANC were assessed. Patients who received neoadjuvant chemotherapy or BCS were excluded.
Results
47 patients undergoing mastectomy for ESBC had micrometastasis identified on SNB. The majority of tumours had invasive ductal histology. 16/27 women underwent completion ANC (34%). Six patients had further nodal disease identified in the ANC specimen. 2 had >5 nodes positive. During the study period 31 patients (65%) received adjuvant radiotherapy. Of the patients who did not undergo ANC, 21 (67.7%) received adjuvant radiotherapy.
Conclusion
At this institution the majority of patients requiring mastectomy with micrometastatic disease on SNB do not undergo subsequent ANC (>60%). Although this is a small patient cohort, these data indicate the rate of residual axillary disease is low, and are in keeping with trends in the literature, and may help inform management decisions in this patient group.
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Shrestha A, Cullinane C, Evoy D, Geraghty J, Rothwell J, McCartan D, McDermott E, Prichard R. P173. The Clinical Treatment Score post 5 years (CTS5) as a predictor of the oncotype DX-21 recurrence score (ODX); A retrospective review of a prospectively maintained database. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2021.03.177] [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: 11/25/2022] Open
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Doyle S, Hanley G, Boland MR, Balasubramanian I, McCartan D, Geraghty J, Evoy D, Prichard RS, McDermott EW. O79: THE ROLE OF SENTINEL LYMPH NODE BIOPSY IN BREAST CANCER PATIENTS OVER THE AGE OF 80 – HOW MUCH IS ENOUGH? Br J Surg 2021. [DOI: 10.1093/bjs/znab117.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Recent studies have suggested that sentinel lymph node biopsy (SLNB) can be omitted in newly diagnosed elderly breast cancer (BC) patients as it may not influence decisions regarding further therapeutic intervention. The aim of this study was to assess the impact of SLNB on further surgical intervention as well as adjuvant treatments in patients over the age of 80.
Method
A retrospective study was performed involving all BC patients over the age of 80 diagnosed between 2008 and 2017 who underwent SLNB as part of their initial surgery. Patient/tumour characteristics and adjuvant treatments were recorded.
Result
127 patients underwent SLNB in the study period. The median age was 82 (Range: 80-95). 91/127 (71.6%) had ductal pathology, median tumour grade was 2, and oestrogen receptor positivity was seen in 89% of patients. The median number of sentinel nodes removed was 2 (Range: 1-6). 45 patients (35.4%) had a positive sentinel node (median positive nodes = 1). Of the 45 patients, 11 proceeded to axillary lymph node dissection (ALND) (11/127; 8.6%). The median number of nodes excised during ALND was 14 (Range:7-25) and 6 patients (6/11) had further positive nodes. 9% of patients with a positive node received adjuvant chemotherapy, 87% received adjuvant radiotherapy and 79% received hormonal therapy.
Conclusion
Although SLNB positivity is still used in the elderly patients, only a few patients (<10%) proceed to ALND or receive adjuvant chemotherapy. Hence performing a SLNB should be carefully considered when treating patients over the age of 80
Take-home message
The use of SLNB in elderly patients needs to be considered in node negative patients
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Boland MR, Al-Maksoud A, Ryan ÉJ, Balasubramanian I, Geraghty J, Evoy D, McCartan D, Prichard RS, McDermott EW. Value of a 21-gene expression assay on core biopsy to predict neoadjuvant chemotherapy response in breast cancer: systematic review and meta-analysis. Br J Surg 2021; 108:24-31. [PMID: 33640948 DOI: 10.1093/bjs/znaa048] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/02/2020] [Accepted: 09/19/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND A recurrence score based on a 21-gene expression assay predicts the benefit of adjuvant chemotherapy in oestrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer. This systematic review aimed to determine whether the 21-gene expression assay performed on core biopsy at diagnosis predicted pathological complete response (pCR) to neoadjuvant chemotherapy. METHODS The study was performed according to PRISMA guidelines. Relevant databases were searched to identify studies assessing the value of the 21-gene expression assay recurrence score in predicting response to neoadjuvant chemotherapy in patients with breast cancer. The Newcastle-Ottawa Scale was used to assess the quality of the studies. Results are reported as risk ratio (RR) with 95 per cent confidence interval using the Cochrane-Mantel-Haenszel method for meta-analysis. Sensitivity analyses were carried out where appropriate. RESULTS Seven studies involving 1744 patients reported the correlation between pretreatment recurrence score and pCR. Of these, 777 patients (44.6 per cent) had a high recurrence score and 967 (55.4 per cent) a low-intermediate score. A pCR was achieved in 94 patients (5.4 per cent). The pCR rate was significantly higher in the group with a high recurrence score than in the group with a low-intermediate score (10.9 versus 1.1 per cent; RR 4.47, 95 per cent c.i. 2.76 to 7.21; P < 0.001). A significant risk difference was observed between the two groups (risk difference 0.10, 0.04 to 0.15; P = 0.001). CONCLUSION A high recurrence score is associated with higher pCR rates and a low-intermediate recurrence score may indicate chemoresistance. Routine assessment of recurrence score by the 21-gene expression assay on core biopsy might be of value when considering neoadjuvant chemotherapy in patients with ER-positive, HER2-negative breast cancer.
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Affiliation(s)
- M R Boland
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - A Al-Maksoud
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - É J Ryan
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - I Balasubramanian
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - J Geraghty
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - D Evoy
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - D McCartan
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - R S Prichard
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - E W McDermott
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
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Cullinane C, Shrestha A, Al Maksoud A, Rothwell J, Evoy D, Geraghty J, McCartan D, McDermott EW, Prichard RS. Optimal timing of surgery following breast cancer neoadjuvant chemotherapy: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 47:1507-1513. [PMID: 33589241 DOI: 10.1016/j.ejso.2021.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/10/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Administration of chemotherapy before breast surgery has the potential to reduce the risk of distant recurrence by targeting micrometastasis as well as allowing a more minimalistic approach to surgical intervention. We performed a systematic review to determine the optimum timing of surgery post breast cancer neoadjuvant chemotherapy (NACT). METHODS The primary outcome was to determine whether the timing of surgery post NACT impacted overall survival (OS) and disease-free survival (DFS). We compared patient outcomes between those who had surgery within 8 weeks of completion of NACT to those that had surgery after 8 weeks. An outcome comparison between <4 weeks and 4-8 weeks was also performed. Secondary outcome included complete pathological response (pCR) post NACT. A meta-analysis was performed using the Mantel-Haenszel method. RESULTS Five studies, including 8794 patients were eligible for inclusion. Patients that had surgery within 8 weeks of completion of NACT had a statistically significant improved OS(OR 0.47, 95% c. i 0.34-0.65) and DFS(OR 0.71 (95% c. i 0.52-0.98, P = 0.04). There were no survival advantages associated with having surgery less than 4 weeks post completion of NACT (OR 0.78, 95% c. i 0.46-1.33, P = 0.37). There was no difference in pCR rate between those that had surgery <4 weeks and 4-8 weeks (OR 1.01, 95% c. i 0.80-1.28, P = 0.93). CONCLUSION This meta-analysis shows that the optimum timing of surgery post completion of NACT is 4-8 weeks as it is associated with increased OS and DFS.
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Affiliation(s)
- Carolyn Cullinane
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Amber Shrestha
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Ahmed Al Maksoud
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Jane Rothwell
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Denis Evoy
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - James Geraghty
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Damian McCartan
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Enda W McDermott
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Ruth S Prichard
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
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14
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Balasubramanian I, Harding T, Boland MR, Ryan EJ, Geraghty J, Evoy D, McCartan D, McDermott EW, Prichard RS. The Impact of Postoperative Wound Complications on Oncological Outcomes Following Immediate Breast Reconstruction for Breast Cancer: A Meta-analysis. Clin Breast Cancer 2020; 21:e377-e387. [PMID: 33451964 DOI: 10.1016/j.clbc.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/20/2020] [Revised: 12/08/2020] [Accepted: 12/13/2020] [Indexed: 12/21/2022]
Abstract
The association between immediate breast reconstruction (IBR)-related wound complications and breast cancer recurrence (BCR) remains uncertain. This study aimed to investigate the oncological outcomes in patients with wound complications following mastectomy and IBR. A comprehensive search was undertaken for all studies describing complications in patients with breast cancer following IBR. Studies were included if they reported on complications and investigated their relationship with BCR. A meta-analysis was performed using a random-effects model, with data presented as odds ratios and 95% confidence intervals. A total of 1418 patients from five studies were included in the final analysis. The mean age of patients included was 47.2 years. A total of 382 (26.9%) patients had postoperative complications following a majority of implant-based IBR (929/1418). A total of 158 (11.1%) recurrences, which included 63 locoregional and 106 distant recurrences, was noted at a mean follow-up of 66 months. Although there was an increase in recurrence rates in the complication group (n = 66/382; 17.3% vs. n = 92/1036; 8.9%), there was no significant association between complications and BCR (17.3% vs. 8.9%; P = .18) or mortality (3.6% vs. 2.3%; P = .15). Time to adjuvant therapy was significantly increased in patients with complications (mean difference, 8.69 days; range, 1.18-16.21 days; P = .02; I2 = 0.02). This meta-analysis demonstrated a higher incidence of wound complications following IBR and a statistically significant increased time to adjuvant therapy. However, this did not translate into adverse oncological outcomes in patients with breast cancer undergoing IBR.
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Affiliation(s)
| | - Tim Harding
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Michael R Boland
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Eanna J Ryan
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - James Geraghty
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Denis Evoy
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Damian McCartan
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Enda W McDermott
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Ruth S Prichard
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
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15
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Boland MR, Nugent T, Nolan J, O'Mahony J, O'Keeffe S, Gillham CC, Maguire A, Geraghty J, McCartan D, Evoy D, Prichard RS, McDermott EW, Alazawi D, Boyle TJ, Connolly EM. Fibromatosis of the breast: a 10-year multi-institutional experience and review of the literature. Breast Cancer 2020; 28:168-174. [PMID: 32780320 DOI: 10.1007/s12282-020-01145-5] [Citation(s) in RCA: 4] [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: 04/03/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Breast fibromatosis is a rare clinical entity, but poses significant diagnostic and therapeutic challenges. In light of recent changes in management practices, the aim was to review our institutional experience of breast fibromatosis and provide a review of current available literature on such management. METHODS A search of pathological databases within two tertiary institutions for all patients diagnosed with fibromatosis of the breast over a 10-year period (2007-2016) was performed. Clinicopathological characteristics and modes of treatment were recorded for each patient. Concurrently a comprehensive literature search was performed and studies relating to breast fibromatosis and its management were identified and reviewed. RESULTS Sixteen patients were identified. Median age at diagnosis was 42 (range 21-70) and all patients were diagnosed with core biopsy. The most useful imaging modality in diagnosis was ultrasonography and magnetic resonance imaging. 13/16 were treated surgically whilst 3/16 were treated using a watch-and-wait approach. 6/13 (46%) required re-excision of margins and 2/13 (15%) had recurrence after surgery. On review of the literature, there is no dedicated guideline in place for the management of breast fibromatosis. Currently a 'watch and wait' approach is favoured over surgical intervention due to high levels of recurrence and associated surgical morbidity. All cases should be discussed at a sarcoma multidisciplinary team meeting and tyrosine kinase inhibitors should be considered in advanced cases. CONCLUSIONS Breast fibromatosis is rare but affects young patients. Active surveillance is now favoured over surgical resection due to high recurrence rates and extensive morbidity. Dedicated guidelines are required to ensure best outcomes.
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Affiliation(s)
- Michael R Boland
- Departments of Breast Surgery, St James' Hospital, Dublin, 8, Ireland.
| | - Timothy Nugent
- Departments of Breast Surgery, St James' Hospital, Dublin, 8, Ireland
| | - Jack Nolan
- Department of Breast Surgery, St Vincents Hospital, Dublin, 4, Ireland
| | - Johnny O'Mahony
- Departments of Radiology, St James' Hospital, Dublin, 8, Ireland
| | - Sylvia O'Keeffe
- Departments of Radiology, St James' Hospital, Dublin, 8, Ireland
| | - Charles C Gillham
- Departments of Radiation Oncology, St James' Hospital, Dublin, 8, Ireland
| | - Aoife Maguire
- Departments of Pathology, St James' Hospital, Dublin, 8, Ireland
| | - James Geraghty
- Department of Breast Surgery, St Vincents Hospital, Dublin, 4, Ireland
| | - Damian McCartan
- Department of Breast Surgery, St Vincents Hospital, Dublin, 4, Ireland
| | - Denis Evoy
- Department of Breast Surgery, St Vincents Hospital, Dublin, 4, Ireland
| | - Ruth S Prichard
- Department of Breast Surgery, St Vincents Hospital, Dublin, 4, Ireland
| | - Enda W McDermott
- Department of Breast Surgery, St Vincents Hospital, Dublin, 4, Ireland
| | - Dhaffir Alazawi
- Departments of Breast Surgery, St James' Hospital, Dublin, 8, Ireland
| | - Terence J Boyle
- Departments of Breast Surgery, St James' Hospital, Dublin, 8, Ireland
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Harding T, Boland MR, Kennedy N, Ryan EJ, Balasubramanian I, Geraghty J, Evoy D, McDermott EW, Prichard RS, McCartan D. 18. DOES POST-OPERATIVE MORBIDITY AFFECT ONCOLOGICAL OUTCOMES IN BREAST CANCER PATIENTS UNDERGOING MASTECTOMY AND RECONSTRUCTION? A SYSTEMATIC REVIEW AND META-ANALYSIS. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2020.03.025] [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: 11/15/2022] Open
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17
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Boland MR, Heneghan HM, Ryan ÉJ, Ain Q, Skehan SJ, McCartan D, Evoy D, Geraghty J, McDermott EW, Prichard RS. A systematic review and meta-analysis of the utility of lymphoscintigraphy in the management of clinically node-negative breast cancer. Breast J 2020; 26:1452-1454. [PMID: 32091643 DOI: 10.1111/tbj.13791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/01/2020] [Accepted: 02/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michael R Boland
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Helen M Heneghan
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Éanna J Ryan
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Qurat Ain
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Stephen J Skehan
- Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Damian McCartan
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Denis Evoy
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - James Geraghty
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Enda W McDermott
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Ruth S Prichard
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
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Kane G, Fleming C, Heneghan H, McCartan D, James P, Trueick R, Harrington L, Nally F, Quinn C, O'Doherty A, McNally S, Rothwell J, Evoy D, Geraghty J, McDermott E, Prichard R. False‐negative rate of ultrasound‐guided fine‐needle aspiration cytology for identifying axillary lymph node metastasis in breast cancer patients. Breast J 2019; 25:848-852. [DOI: 10.1111/tbj.13402] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/29/2018] [Accepted: 06/29/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Gavin Kane
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Christina Fleming
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Helen Heneghan
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Damian McCartan
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Philip James
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Robert Trueick
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Luke Harrington
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Fionn Nally
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Cecily Quinn
- Department of Histopathology St. Vincent's University Hospital Dublin 4 Ireland
| | - Ann O'Doherty
- Department of Radiology St. Vincent's University Hospital Dublin 4 Ireland
| | - Sorcha McNally
- Department of Radiology St. Vincent's University Hospital Dublin 4 Ireland
| | - Jane Rothwell
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Denis Evoy
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - James Geraghty
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Enda McDermott
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Ruth Prichard
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
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19
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Tee SR, Devane LA, Evoy D, Rothwell J, Geraghty J, Prichard RS, McDermott EW. Meta-analysis of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with initial biopsy-proven node-positive breast cancer. Br J Surg 2019; 105:1541-1552. [PMID: 30311642 DOI: 10.1002/bjs.10986] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/18/2018] [Accepted: 07/26/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy for breast cancer has the potential to achieve a pathological complete response in up to 40 per cent of patients, converting disease that was initially node-positive to node-negative. This has raised the question of whether sentinel lymph node biopsy could be an alternative to axillary lymph node dissection in these patients. The aim was to undertake a systematic review and meta-analysis of the accuracy and reliability of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with initial biopsy-proven node-positive breast cancer. METHODS A literature search was conducted using PubMed, Ovid MEDLINE, Embase and Web of Science databases up to 30 April 2017. Inclusion criteria for studies were pathological confirmation of initial node-positive disease, and sentinel lymph node biopsy performed after neoadjuvant chemotherapy followed by axillary lymph node dissection. RESULTS A total of 13 studies met the inclusion criteria and were included in the analysis (1921 patients in total). The pooled estimate of identification rate was 90 (95 per cent c.i. 87 to 93) per cent and the false-negative rate was 14 (11 to 17) per cent. In subgroup analysis, the false-negative rate with use of dual mapping was 11 (6 to 15) per cent, compared with 19 (11 to 27) per cent with single mapping. The false-negative rate was 20 (13 to 27) per cent when one node was removed, 12 (5 to 19) per cent with two nodes removed and 4 (0 to 9) per cent with removal of three or more nodes. CONCLUSION Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with biopsy-proven node-positive breast cancer is accurate and reliable, but requires careful patient selection and optimal surgical techniques.
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Affiliation(s)
- S R Tee
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - L A Devane
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D Evoy
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J Rothwell
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J Geraghty
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - R S Prichard
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - E W McDermott
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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20
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O'Connell L, Walsh S, Evoy D, O'Doherty A, Quinn C, Rothwell J, Geraghty J, McDermott EW, Prichard R. The approach to an isolated close anterior margin in breast conserving surgery. Ann R Coll Surg Engl 2019; 101:268-272. [PMID: 30855173 DOI: 10.1308/rcsann.2019.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Although close radial margins after breast-conserving surgery routinely undergo re-excision, appropriate management of patients with close anterior margins remains a topic of controversy. An increasing body of literature suggests that re-excision of close anterior margins yields low rates of residual malignancy and may only be necessary in selected patients. The aim of this study was to examine the management of close anterior margins after breast conserving surgery in a single institution and to analyse the rate of residual disease in re-excised anterior margins. METHODS All patients having breast conserving surgery at St Vincent's University Hospital from January 2008 to December 2012 were reviewed retrospectively. Data collected included patient demographics, tumour characteristics, margin positivity, re-excision rates and definitive histology of the re-excision specimens. A close margin was defined as les than 2 mm. RESULTS A total of 930 patients were included with an average age of 65 years (range 29-94 years). Of these, 121 (13%) had a close anterior margin. Further re-excison of the anterior margin was carried out in 37 patients (30.6%) and a further 16 (13.2%) proceeded to mastectomy. Residual disease was found in 18.5% (7/36) of those who underwent re-excision and 7/16 (43.75%) of those who underwent mastectomy. Overall, 11.57% (14/121) of patients with close anterior margins were subsequently found to have residual disease. CONCLUSION The low yield of residual disease in re-excised anterior margins specimens supports the concept that routine re-excision of close anterior margins is not necessary. Further research is required to definitively assess its influence on the risk of local recurrence.
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Affiliation(s)
- L O'Connell
- Department of Breast, Endocrine and General Surgery, St Vincent's University Hospital , Dublin , Ireland
| | - S Walsh
- Department of Breast, Endocrine and General Surgery, St Vincent's University Hospital , Dublin , Ireland
| | - D Evoy
- Department of Breast, Endocrine and General Surgery, St Vincent's University Hospital , Dublin , Ireland
| | - A O'Doherty
- Department of Radiology, St Vincent's University Hospital , Dublin , Ireland
| | - C Quinn
- Department of Pathology, St Vincent's University Hospital , Dublin , Ireland
| | - J Rothwell
- Department of Breast, Endocrine and General Surgery, St Vincent's University Hospital , Dublin , Ireland
| | - J Geraghty
- Department of Breast, Endocrine and General Surgery, St Vincent's University Hospital , Dublin , Ireland
| | - E W McDermott
- Department of Breast, Endocrine and General Surgery, St Vincent's University Hospital , Dublin , Ireland
| | - R Prichard
- Department of Breast, Endocrine and General Surgery, St Vincent's University Hospital , Dublin , Ireland
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21
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O'Cearbhaill RM, Devane L, Baban C, McCartan D, Evoy D, Rothwell J, Geraghty J, Quinn C, Walshe J, McDermott E, Prichard RS. Validation of a nomogram using readily available clinicopathologic variables to predict Oncotype DX score in the preoperative setting. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.02.040] [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: 11/16/2022] Open
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22
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Gullo G, Walsh N, Fennelly D, Bose R, Walshe J, Tryfonopoulos D, O'Mahony K, Hammond L, Silva N, McDonnell D, Ballot J, Quinn C, McDermott EW, Evoy D, Prichard R, Geraghty J, Amstrong J, Crown J. Impact of timing of trastuzumab initiation on long-term outcome of patients with early-stage HER2-positive breast cancer: the "one thousand HER2 patients" project. Br J Cancer 2018; 119:374-380. [PMID: 29773838 PMCID: PMC6070916 DOI: 10.1038/s41416-018-0114-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/30/2018] [Accepted: 04/19/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The optimal timing of (neo)adjuvant trastuzumab initiation with respect to chemotherapy and surgery remains undefined. METHODS Retrospective analysis of a large institutional database of HER2-positive patients who received anti-HER2 therapy. We included all Stage I to III patients treated with trastuzumab with a minimum follow up of 3 years. The date of first breast biopsy was recorded as initial diagnosis. RESULTS A total of 506 patients [adjuvant: 386 (76%)-neo-adjuvant: 120 (24%)] were included. The median time-to-first-trastuzumab (TFT) from diagnosis was 12 weeks (range 1.9-122.3). Median follow-up is 73.3 months (range 1.4-176.3). TFT was significantly shorter in the neo-adjuvant than in the adjuvant cohort (median: 4.4 vs. 14 weeks, p < 0.00001). Despite the neo-adjuvant cohort having significantly more node-positive patients (75 vs. 53%, p < 0.0001), DFS rate (neo-adjuvant: 12.5 vs. adjuvant: 18%, p = 0.094) was numerically superior in neo-adjuvant patients. A TFT ≤ 12 weeks was associated with significantly superior DFS and OS over TFT > 12 weeks. Early concomitant regimens were associated with superior DFS over delayed-concomitant and sequential regimens. CONCLUSIONS Initiating trastuzumab more than 12 weeks from diagnosis has a negative impact on clinical outcome. Neo-adjuvant anti-HER2 therapy could be the optimal strategy to treat early stage HER2-positive breast cancer.
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Affiliation(s)
- Giuseppe Gullo
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland. .,School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Naomi Walsh
- National Institute for Cellular Biotechnology, Dublin City University (DCU), Dublin, Ireland
| | - David Fennelly
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Reetesh Bose
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Janice Walshe
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | | | - Kate O'Mahony
- Aseptic Unit-Pharmacy Department, St Vincent's University Hospital, Dublin, Ireland
| | - Lisa Hammond
- Aseptic Unit-Pharmacy Department, St Vincent's University Hospital, Dublin, Ireland
| | - Nuno Silva
- Aseptic Unit-Pharmacy Department, St Vincent's Private Hospital, Dublin, Ireland
| | - Deirdre McDonnell
- Cancer Clinical Research Trust, St Vincent's University Hospital, Dublin, Ireland
| | - Josephine Ballot
- Cancer Clinical Research Trust, St Vincent's University Hospital, Dublin, Ireland
| | - Cecily Quinn
- Department of Pathology, St Vincent's University Hospital, Dublin, Ireland
| | - Enda W McDermott
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Denis Evoy
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Ruth Prichard
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - James Geraghty
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - John Amstrong
- Department of Radiation Oncology, St Luke's Hospital, Dublin, Ireland
| | - John Crown
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
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O’Cearbhaill RM, Hembrecht S, Devane LA, Rothwell J, Evoy D, Geraghty J, McCartan DP, McNally S, O’Doherty A, McDermott EW, Prichard RS. Breast screening in symptomatic women over 35 years of age: improvements in service efficiency. Ir J Med Sci 2018; 188:55-58. [DOI: 10.1007/s11845-018-1794-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
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Geraghty J, Shawihdi M, Devonport E, Sarkar S, Pearson MG, Bodger K. Reduced risk of emergency admission for colorectal cancer associated with the introduction of bowel cancer screening across England: a retrospective national cohort study. Colorectal Dis 2018; 20:94-104. [PMID: 28736972 DOI: 10.1111/codi.13822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/13/2017] [Indexed: 02/08/2023]
Abstract
AIM We wanted to find out if roll-out of the bowel cancer screening programme (BCSP) across England was associated with a reduced risk of emergency hospital admission for people presenting with colorectal cancer (CRC) during this period. METHOD This is a retrospective cohort study of 27 763 incident cases of CRC over a 1-year period during the roll-out of screening across parts of England. The primary outcome was the number of emergency (unplanned) hospital admissions during the diagnostic pathway. The primary exposure was to those living in an area where the BCSP was active at the time of diagnosis. Patients were categorized into three exposure groups: BCSP not active (reference group), BCSP active < 6 months or BCSP active ≥ 6 months. RESULTS The risk of emergency admission for CRC in England was associated with increasing age, female gender, comorbidity and social deprivation. After adjusting for these factors in logistic regression, the odds ratio (OR) for emergency admission in patients diagnosed ≥ 6 months after the start-up of local screening was 0.83 (CI 0.76-0.90). The magnitude of risk reduction was greatest for cases of screening age (OR 0.75; CI 0.63-0.90) but this effect was apparent also for cases outside the 60-69-year age group (OR 0.85; CI 0.77-0.94). Living in an area with active BCSP conferred no reduction in risk of emergency admission for people diagnosed with oesophagogastric cancer during the same period. CONCLUSION The start-up of bowel cancer screening in England was associated with a substantial reduction in the risk of emergency admission for CRC in people of all ages. This suggests that the roll-out of the programme had indirect benefits beyond those related directly to participation in screening.
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Affiliation(s)
- J Geraghty
- Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - M Shawihdi
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - E Devonport
- Aintree Health Outcomes Partnership, Aintree University Hospital, Liverpool, UK
| | - S Sarkar
- Gastroenterology Department, Royal Liverpool Hospital, Liverpool, UK
| | - M G Pearson
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - K Bodger
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Baban C, Mc Kiernan J, Devane L, Rothwell J, Evoy D, Geraghty J, O’Doherty A, Quinn C, D’Arcy C, McDermott E, Prichard R. The incidence and consequences of escape from hormonal manipulation in elderly breast cancer patients. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.01.089] [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: 10/19/2022] Open
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Paluch-Shimon S, Pagani O, Partridge AH, Bar-Meir E, Fallowfield L, Fenlon D, Friedman E, Gelmon K, Gentilini O, Geraghty J, Harbeck N, Higgins S, Loibl S, Moser E, Peccatori F, Raanani H, Kaufman B, Cardoso F. Second international consensus guidelines for breast cancer in young women (BCY2). Breast 2016; 26:87-99. [DOI: 10.1016/j.breast.2015.12.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/19/2015] [Indexed: 11/12/2022] Open
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McCartan DP, Prichard RS, MacDermott RJ, Rothwell J, Geraghty J, Evoy D, Quinn CM, Skehan SJ, O'Doherty A, McDermott EW. Role of bone scan in addition to CT in patients with breast cancer selected for systemic staging. Br J Surg 2016; 103:839-44. [DOI: 10.1002/bjs.10124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/04/2015] [Accepted: 01/05/2016] [Indexed: 01/05/2023]
Abstract
Abstract
Background
The majority of women with breast cancer present with localized disease. The optimal strategy for identifying patients with metastatic disease at diagnosis remains unclear. The aim of this study was to evaluate the additional diagnostic yield from isotope bone scanning when added to CT staging of the thorax, abdomen and pelvis (CT-TAP) in patients with newly diagnosed breast cancer.
Methods
All patients diagnosed with breast cancer who underwent staging CT-TAP and bone scan between 2011 and 2013 were identified from a prospective database of a tertiary referral breast cancer centre that provides a symptomatic and population-based screening breast service. Criteria for staging included: biopsy-proven axillary nodal metastases; planned neoadjuvant chemotherapy or mastectomy; locally advanced or inflammatory breast cancer and symptoms suggestive of metastases.
Results
A total of 631 patients underwent staging by CT-TAP and bone scan. Of these, 69 patients (10·9 per cent) had distant metastasis at presentation, with disease confined to a single organ in 49 patients (71 per cent) and 20 (29 per cent) having metastatic deposits in multiple organs. Bone metastasis was the most common site; 39 of 49 patients had bone metastasis alone and 12 had a single isolated metastatic deposit. All but two of these were to the axial skeleton. No preoperative histological factors identified a cohort of patients at risk of metastatic disease. Omission of the bone scan in systemic staging would have resulted in a false-negative rate of 0·8 per cent.
Conclusion
For patients diagnosed with breast cancer, CT-TAP is a satisfactory stand-alone investigation for systemic staging.
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Affiliation(s)
- D P McCartan
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - R S Prichard
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - R J MacDermott
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - J Rothwell
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - J Geraghty
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - D Evoy
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - C M Quinn
- Department of Pathology, St Vincent's University Hospital, Dublin, Ireland
| | - S J Skehan
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - A O'Doherty
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - E W McDermott
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
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Aloraifi F, McCartan D, McDevitt T, Green AJ, Bracken A, Geraghty J. Protein-truncating variants in moderate-risk breast cancer susceptibility genes: a meta-analysis of high-risk case-control screening studies. Cancer Genet 2015; 208:455-63. [PMID: 26250988 DOI: 10.1016/j.cancergen.2015.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 12/05/2014] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 01/08/2023]
Abstract
Several "moderate-risk breast cancer susceptibility genes" have been conclusively identified. Pathogenic mutations in these genes are thought to cause a two to fivefold increased risk of breast cancer. In light of the current development and use of multigene panel testing, the authors wanted to systematically obtain robust estimates of the cancer risk associated with loss-of-function mutations within these genes. An electronic search was conducted to identify studies that sequenced the full coding regions of ATM, CHEK2, BRIP1, PALB2, NBS1, and RAD50 in a general and gene-targeted approach. Inclusion was restricted to studies that sequenced the germline DNA in both high-risk cases and geographically matched controls. A meta-analysis was then performed on protein-truncating variants (PTVs) identified in the studies for an association with breast cancer risk. A total of 10,209 publications were identified, of which 64 studies comprising a total of 25,418 cases and 52,322 controls in the 6 interrogated genes were eligible under our selection criteria. The pooled odds ratios for PTVs in the susceptibility genes were at least >2.6. Additionally, mutations in these genes have shown geographic and ethnic variation. This comprehensive study emphasizes the fact that caution should be taken when identifying certain genes as moderate susceptibility with the lack of sufficient data, especially with regard to the NBS1, RAD50, and BRIP1 genes. Further data from case-control sequencing studies, and especially family studies, are warranted.
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Affiliation(s)
- Fatima Aloraifi
- School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland; Smurfit Institute of Genetics, Trinity College Dublin, College Green, Dublin, Ireland.
| | - Damian McCartan
- St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Trudi McDevitt
- National Centre for Medical Genetics, Our Lady's Hospital, Crumlin, Dublin, Ireland
| | - Andrew J Green
- School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland; National Centre for Medical Genetics, Our Lady's Hospital, Crumlin, Dublin, Ireland
| | - Adrian Bracken
- Smurfit Institute of Genetics, Trinity College Dublin, College Green, Dublin, Ireland.
| | - James Geraghty
- School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland; St. Vincent's University Hospital, Elm Park, Dublin, Ireland
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Lanigan F, Brien GL, Fan Y, Madden SF, Jerman E, Maratha A, Aloraifi F, Hokamp K, Dunne EJ, Lohan AJ, Flanagan L, Garbe JC, Stampfer MR, Fridberg M, Jirstrom K, Quinn CM, Loftus B, Gallagher WM, Geraghty J, Bracken AP. Delineating transcriptional networks of prognostic gene signatures refines treatment recommendations for lymph node-negative breast cancer patients. FEBS J 2015; 282:3455-73. [DOI: 10.1111/febs.13354] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/02/2015] [Accepted: 06/17/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Fiona Lanigan
- The Smurfit Institute of Genetics; Trinity College Dublin; Ireland
| | - Gerard L. Brien
- The Smurfit Institute of Genetics; Trinity College Dublin; Ireland
| | - Yue Fan
- UCD School of Biomolecular and Biomedical Science; UCD Conway Institute; University College Dublin; Ireland
| | - Stephen F. Madden
- UCD School of Biomolecular and Biomedical Science; UCD Conway Institute; University College Dublin; Ireland
| | - Emilia Jerman
- The Smurfit Institute of Genetics; Trinity College Dublin; Ireland
| | - Ashwini Maratha
- UCD School of Biomolecular and Biomedical Science; UCD Conway Institute; University College Dublin; Ireland
| | - Fatima Aloraifi
- The Smurfit Institute of Genetics; Trinity College Dublin; Ireland
| | - Karsten Hokamp
- The Smurfit Institute of Genetics; Trinity College Dublin; Ireland
| | - Eiseart J. Dunne
- The Smurfit Institute of Genetics; Trinity College Dublin; Ireland
| | - Amanda J. Lohan
- UCD School of Biomolecular and Biomedical Science; UCD Conway Institute; University College Dublin; Ireland
| | - Louise Flanagan
- Department of Histopathology; St Vincent's University Hospital; Dublin Ireland
| | - James C. Garbe
- Life Science Division; Lawrence Berkeley National Laboratory; Berkeley CA USA
| | - Martha R. Stampfer
- Life Science Division; Lawrence Berkeley National Laboratory; Berkeley CA USA
| | - Marie Fridberg
- Department of Clinical Sciences, Division of Oncology and Pathology; Lund University; Sweden
| | - Karin Jirstrom
- Department of Clinical Sciences, Division of Oncology and Pathology; Lund University; Sweden
| | - Cecily M. Quinn
- Department of Histopathology; St Vincent's University Hospital; Dublin Ireland
| | - Brendan Loftus
- UCD School of Biomolecular and Biomedical Science; UCD Conway Institute; University College Dublin; Ireland
| | - William M. Gallagher
- UCD School of Biomolecular and Biomedical Science; UCD Conway Institute; University College Dublin; Ireland
| | - James Geraghty
- Department of Histopathology; St Vincent's University Hospital; Dublin Ireland
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Leidhin CN, Heeney A, Connolly C, Swan N, Foster A, Geraghty J. A Rare Case of BRCA2-Associated Breast Cancer in Pregnancy. Ir Med J 2015; 108:217-218. [PMID: 26349355] [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
A 30-year old woman was referred to our department with symptomatic breast cancer at 35 weeks gestation. Genetic testing revealed a pathogenic BRCA2 mutation. Labour was induced at 38 weeks. Mastectomy and axillary clearance were performed with a view to adjuvant chemotherapy, radiation and hormonal therapy. Multidisciplinary involvement is crucial for management of BRCA-associated breast cancer, especially in the context of pregnancy. Bilateral mastectomy may be indicated given the increased risk of ipsilateral and contralateral breast cancers. Tamoxifen may lower contralateral breast cancer risk in those in whom risk-reducing surgery is not performed.
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Connell LO, Walsh S, Cheung C, Al Hilli Z, Rothwell J, Evoy D, Geraghty J, Quinn C, Doherty A, McDermott E, Prichard R. P164. The approach to involved anterior margins after breast conserving surgery; whether or not to re-excise. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2015.03.202] [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: 10/23/2022] Open
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Boland MR, Lowery AJ, Evoy D, Geraghty J, Rothwell J, Quinn C, Gullo G, Crown J, Walshe J, O'Doherty A, McDermott EW, Prichard RS. P176. Tumour biology affects nodal burden and complete pathological response after neoadjuvant chemotherapy in breast cancer patients with axillary nodal metastases. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2015.03.214] [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: 11/30/2022] Open
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Boland M, Prichard R, Daskalova I, Lowery A, Evoy D, Geraghty J, Rothwell J, Quinn C, O'Doherty A, McDermott E. Axillary nodal burden in primary breast cancer patients with positive pre-operative ultrasound guided fine needle aspiration cytology: Management in the era of ACOSOG Z011. Eur J Surg Oncol 2015; 41:559-65. [DOI: 10.1016/j.ejso.2015.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/22/2014] [Accepted: 01/10/2015] [Indexed: 01/17/2023] Open
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Britton EJ, Sidhu S, Geraghty J, Psarelli E, Sarkar S. The 5-year outcome of patients having incomplete colonoscopy. Colorectal Dis 2015; 17:298-303. [PMID: 25605376 DOI: 10.1111/codi.12901] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/06/2014] [Indexed: 12/16/2022]
Abstract
AIM Incomplete colonoscopy indicated for the detection of neoplasia occurs in 2-23% of patients, but there is little information on the long-term outcome of such patients. METHOD All patients who underwent colonoscopy over 5 years at the Royal Liverpool University Hospital with a follow-up of up to 5 years were identified. RESULTS The risk of colorectal cancer (CRC) was 2.9% (312/10 580) for all patients undergoing colonoscopy. For a failed colonoscopy, the risk was five-fold higher [14.3% (99/693)]. The mean age of the patients was 61 years and 58% were female. Following incomplete colonoscopy the risk of finding additional CRC, advanced colonic neoplasia and extracolonic neoplasia on subsequent investigation was 6.2%, 3.2% and 1.9%. The diagnostic yield on subsequent investigation for CRC or colonic polyps was 7% for repeat colonoscopy, 13.4% for computed tomography colonography, 10.3% for standard computed tomography and 1.8% for barium enema. In the 363 patients who were not offered a subsequent investigation, there was no further instance of CRC or CRC-related mortality over a 36-month period. CONCLUSION Although the risk of CRC is higher in patients who have had a failed colonoscopy, a protocol approach of subsequent investigation should not replace clinical assessment on whether another test is necessary in the light of the good outcome of patients who were not subsequently investigated.
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Affiliation(s)
- E J Britton
- Department of Gastroenterology and Hepatology, Royal Liverpool University Hospital, Liverpool, UK
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Meshkat B, Prichard RS, Al-Hilli Z, Bass GA, Quinn C, O'Doherty A, Rothwell J, Geraghty J, Evoy D, McDermott EW. A comparison of clinical-pathological characteristics between symptomatic and interval breast cancer. Breast 2015; 24:278-82. [PMID: 25771080 DOI: 10.1016/j.breast.2015.02.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 09/22/2014] [Revised: 02/09/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND An association between interval breast cancers (cancer detected after a normal mammogram and before the next scheduled mammogram) and tumour aggressiveness has been postulated which may reflect their relatively poor overall prognosis. The aim of this study was to evaluate known prognostic features of screen detected breast cancers compared to interval breast cancers. METHODS Patients diagnosed with breast cancer between January 2010 and 2013 at a single unit of the National Breast Screening Program (NBSP) in Ireland and those between the ages of 50 and 65 diagnosed at a symptomatic breast clinic were included in the study. Patients who had not had a screening mammogram within the proceeding two years or had a previous history of breast cancer were excluded. Data were retrospectively collected on patient demographics, tumour type, grade, hormone receptor status and stage of disease at presentation. RESULTS There were 915 patients included in the study, with 92% (n = 844) diagnosed through the NBSP. Ductal carcinoma in-situ accounted for 19% (n = 160) of screen-detected breast cancers but only 2.8% of interval cancers (p < 0.05). The most common type of invasive cancer was invasive ductal carcinoma. Tumour grade was significantly higher in interval breast cancers (p < 0.05). Interval cancers were identified at a significantly higher stage (Stage 1 versus 2; p < 0.001) than screen-detected cancers. Interval breast cancers were less likely to be ER positive (76% versus 81%; p < 0.05) and significantly more likely to over-express HER2 (20% vs 10%, p < 0.05) than screen-detected cancers. CONCLUSION This study highlights the fact that interval cancers appear to have a number of adverse prognostic markers for overall breast cancer survival when compared to women with screen-detected breast cancers. Interval cancers were more likely to be invasive, of a higher grade and stage and with a greater predominance of HER2 and triple negative molecular subtypes. Therefore this heterogeneous group of tumours may be biologically more aggressive and account disproportionately to overall breast cancer mortality.
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Affiliation(s)
- B Meshkat
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland.
| | - R S Prichard
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - Z Al-Hilli
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - G A Bass
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - C Quinn
- Department of Histopathology, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - A O'Doherty
- Department of Radiology, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - J Rothwell
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - J Geraghty
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - D Evoy
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - E W McDermott
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
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Aasen Bunæs J, Espenes A, Geraghty J, Duffy C, Hess P. 3. Uptake of AZAs in minipigs, toxicological evaluation. Toxicon 2014. [DOI: 10.1016/j.toxicon.2014.08.011] [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: 11/26/2022]
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Walsh SM, Lowery AJ, Prichard RS, McDermott EW, Evoy D, Geraghty J. Postmastectomy radiotherapy: indications and implications. Surgeon 2014; 12:310-5. [PMID: 25037652 DOI: 10.1016/j.surge.2014.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 12/15/2013] [Revised: 04/14/2014] [Accepted: 04/16/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although breast conservation surgery, when combined with radiotherapy, has been shown to provide excellent locoregional control for breast cancer, approximately one third of women with breast cancer require mastectomy. Many of these women are offered immediate reconstruction. Postmastectomy radiotherapy (PMRT) is indicated in some cases, but is associated with side-effects, including its impact on the reconstructed breast. OBJECTIVE To review the pertinent issues surrounding PMRT, including patient selection for radiotherapy and the effect of radiotherapy on reconstructive decisions. METHODS A literature review was performed using the Medline database. CONCLUSIONS PMRT is indicated in patients who are deemed to have a high risk of loco-regional recurrence. Although PMRT is strongly recommended for patients with four or more positive lymphnodes, other indications for PMRT remain controversial. Immediate reconstruction post mastectomy has been shown to have favorable outcomes. However, PMRT may increase the need for revision surgery post immediate reconstruction. There are few randomized trials looking at these key issues, and the evidence is largely derived from observational retrospective studies. Patients should be carefully counseled before a decision is made to proceed with immediate reconstruction, where there is a high chance that PMRT may be indicated.
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Affiliation(s)
- S M Walsh
- Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A J Lowery
- Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - R S Prichard
- Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - E W McDermott
- Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D Evoy
- Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J Geraghty
- Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Geraghty J, Sarkar S, Cox T, Lal S, Willert R, Ramesh J, Bodger K, Carlson GL. Management of large bowel obstruction with self-expanding metal stents. A multicentre retrospective study of factors determining outcome. Colorectal Dis 2014; 16:476-83. [PMID: 24506142 DOI: 10.1111/codi.12582] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/18/2013] [Indexed: 12/12/2022]
Abstract
AIM UK cancer guidelines recommend patients with colonic obstruction due to suspected malignancy be considered for stenting with a self-expanding metal stent (SEMS). Considerable variation in practice exists due to a lack of expertise, technical difficulties and other, as yet ill-defined features. This retrospective multi-centre study aims to determine the outcome following colonic stenting for large bowel obstruction and identify factors associated with successful intervention. METHOD A regional programme of colonic stenting for large bowel obstruction, in five UK centres from 2005 to 2010 was evaluated for outcome including technical and clinical success, survival, complications and reoperation. RESULTS A SEMS was inserted in 334 patients, including 264 (79.0%) for palliation and 52 (15.6%) as a bridge to surgery. Technical success was achieved in 292 (87.4%) patients, with 46 (13.8%) experiencing a complication or technical failure. Reoperation was required in 39 (14.8%) patients stented for palliation of colorectal cancer of whom 16 (6.1%) subsequently required a colostomy. A one-stage primary anastomosis was achieved in 35 (67.3%) of the 52 patients undergoing stenting as a bridge to resection. Technical success did not vary by indication or site of obstruction (P = 0.60) but was higher for operators who had performed more than 10 procedures (OR 3.34, P = 0.001). ASA grade ≥3 predicted a worse clinical outcome (OR 0.43, P = 0.04). The through-the-scope (TTS) endoscopy technique was more successful than radiological placement alone (90.3% vs 74.8%, P < 0.001). CONCLUSION Experienced operators using a TTS technique achieved a better outcome for the emergency management of large bowel obstruction. Older, sicker patients and those with extracolonic and benign strictures fared less well.
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Affiliation(s)
- J Geraghty
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
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Aloraifi F, McGreevy J, McDevitt T, Green A, Bracken A, Geraghty J. Next-Generation Sequencing of Epigenetically Silenced Genes in Brcax Cases and Ancestry Matched Controls. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu065.5] [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: 11/14/2022] Open
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40
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Boland MR, Prichard RS, Daskalova I, Lowery AJ, Maguire A, Evoy D, Geraghty J, Rothwell J, Quinn CM, Doherty AO, McDermott EW. Axillary nodal burden in breast cancer patients with a positive pre-operative ultrasound guided fine needle aspiration cytology. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.02.144] [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: 11/16/2022] Open
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O'Reilly EA, Aucharaz N, Kelly G, Al Azawi D, Prichard RS, Evoy D, Rothwell J, Geraghty J, O'Doherty A, Skehan S, Quinn C, McDermott E. Abstract P1-01-01: The value of isosulphan blue dye in addition to isotope scanning in the identification of the sentinel lymph node in breast cancer patients with a positive lymphoscintigraphy: A randomised controlled trial (ISRCTN 98849733). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-01-01] [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: 11/16/2022]
Abstract
Abstract
Introduction
The advent of multimodal and targeted breast cancer treatment has seen a radical shift from aggressive surgical intervention to a more minimalist approach, both within the breast and axilla. Primary among these changes is the utilisation of the sentinel lymph node biopsy (SLNB) to detect disease within the axilla and a move away from an obligatory axillary clearance when the sentinel node is positive. This depends on the accurate identification of the SLN and initial studies describe a higher identification rate and a lower false negative rate with a dual tracer identification technique. This encompasses a combination of a blue / green dye and radio-labelled isotope. The use of blue dye has been, of itself, associated with significant morbidity and therefore many clinicians may opt for single tracer identification.
Aims
The aim of the current study was to determine whether the addition of blue dye to radio-isotope increased the positive SLN detection rate, where the SLN was identified pre-operatively on a lymphoscintigram.
Methods
A prospective randomised controlled trial comparing the combined techniques of isosulphan blue dye and isotope scanning versus isotope scanning alone was performed at a single tertiary referral centre. Ethical approval was obtained prior to commencing the study from the hospital ethics committee. Enrolment commenced in March 2010 and ceased in September 2012. The study design was a randomised open label controlled parallel group trial. The primary outcome measure was the effect of the omission of the blue dye on the identification of SLN if the lymphoscintigram was positive (1 -3 nodes identified).
Results
A total of 673 patients were included in the final analysis with 344 patients receiving the combination (blue dye and radio-isotope) and 329 patients who received radio-isotope scanning alone. The groups were evenly matched both demographically and pathologically. The mean age was 48 years (48.3 versus 47.7 years; P = 0.47), the mean tumour size was 23.1mm (23.2mm versus 23.0mm; p = 0.89) and there was no statistically significant difference in the grade of the tumours between the two groups (p = 0.58). Overall, there was no difference in the number of nodes retrieved between the two groups (563 versus 523; p = 0.30). Similarly, there was no difference in the number of positive lymph nodes that were identified between the two groups (107 versus 98; 23.8% versus 22%; p = 0.65).
Conclusions
The addition of isosulphan blue dye does not aid in the identification of the SLN in patients who have a positive lymphoscintigram when radioisotope colloid is used.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-01.
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Affiliation(s)
- EA O'Reilly
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - N Aucharaz
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - G Kelly
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - D Al Azawi
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - RS Prichard
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - D Evoy
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - J Rothwell
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - J Geraghty
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - A O'Doherty
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - S Skehan
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - C Quinn
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - E McDermott
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
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Boland MR, Prichard RS, Daskalova I, Lowery AJ, Maguire A, Evoy D, Geraghty J, Rothwell J, Quinn CM, O'Doherty A, McDermott EW. Abstract P2-18-05: Axillary nodal burden in patients with a positive pre-operative ultrasound guided fine needle aspiration cytology. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p2-18-05] [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: 11/16/2022]
Abstract
Abstract
Introduction
Recent years have seen a dramatic shift to more conservative management of the axilla and the presence of a positive sentinel lymph node biopsy does not now automatically mandate an axillary clearance. This is based largely on data from the American College of Surgeons Oncology Group (ACOSOG) Z11 study, which failed to demonstrate a difference in local recurrence or overall survival when an axillary clearance was omitted in a highly selective group of patients with a positive sentinel lymph node. However, the presence of a positive pre-operative ultrasound guided axillary FNAC(Fine Needle Aspiration Cytology) may be representative of a higher burden of axillary disease.
Aim
Therefore, the aims of this study were firstly to quantify the actual nodal burden in breast cancer patients with a positive pre-operative ultrasound guided axillary FNAC and secondly to identify the number of patients who may have been spared an axillary clearance based on Z11 eligibility criteria.
Methods
A retrospective review of a prospectively maintained database within a tertiary breast cancer referral centre was performed. All patients with a positive pre-operative axillary FNAC were identified within a five year period (2007 – 2011). Demographic, tumour and biological characteristics and final nodal status were analysed. Eligibility for randomisation according to the Z11 criteria was assessed based on the final pathology and the number of patients who could have been spared an axillary clearance was identified.
Results
A total of 360 patients were identified with a positive axillary ultrasound guided FNAC. Sixty-three patients had no axillary surgery and three patients had recurrent disease, leaving a total of 294 for analysis. The mean age was 56 years (range 22 – 87). The mean size of the tumour was 31.3mm (range 4mm – 132mm) and the majority were an invasive grade 3 (57%) ductal carcinoma (84%). Luminal A (63%) was the commonest sub-type. The mean number of nodes removed at axillary clearance was 24 (range 7 – 58) while the mean number of positive nodes excised was 6 (range 0 – 47). Of these, the mean number of level I positive nodes was 4, level II was 1 and level III nodes was <1.
Overall a total of 78 patients had less than three positive nodes identified in the axilla and potentially may have been eligible for the Z11 study. However, when patients who had a mastectomy, neo-adjuvant chemotherapy were excluded and the presence of extra-capsular nodal involvement was accounted for only 19 (6.4%) patients may have been spared an axillary clearance.
Conclusions
The presence of nodal positivity on a pre-operative FNAC is associated with a higher burden of axillary disease. Only a minority of these patients would be able to avoid an axillary clearance in the setting of the recent Z11 study. Performing an axillary ultrasound and FNAC of suspicious nodes allows patients to avoid an unnecessary sentinel lymph node biopsy and proceed directly to an axillary clearance.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-18-05.
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Affiliation(s)
- MR Boland
- St Vincent's Healthcare Group, Dublin, Ireland
| | - RS Prichard
- St Vincent's Healthcare Group, Dublin, Ireland
| | - I Daskalova
- St Vincent's Healthcare Group, Dublin, Ireland
| | - AJ Lowery
- St Vincent's Healthcare Group, Dublin, Ireland
| | - A Maguire
- St Vincent's Healthcare Group, Dublin, Ireland
| | - D Evoy
- St Vincent's Healthcare Group, Dublin, Ireland
| | - J Geraghty
- St Vincent's Healthcare Group, Dublin, Ireland
| | - J Rothwell
- St Vincent's Healthcare Group, Dublin, Ireland
| | - CM Quinn
- St Vincent's Healthcare Group, Dublin, Ireland
| | - A O'Doherty
- St Vincent's Healthcare Group, Dublin, Ireland
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Francis E, Lowery A, Prichard R, Geraghty J, Dermott EM, Evoy D. Mitotic rate and clinico-pathological parameters associated with a positive sentinel lymph node biopsy in malignant melanoma. Int J Surg 2013. [DOI: 10.1016/j.ijsu.2013.06.494] [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]
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Francis E, Lowery A, Prichard R, Geraghty J, Evoy D, Dermott EM. Predicting response to neoadjuvant chemotherapy in an Irish population of patients with breast cancer. Int J Surg 2013. [DOI: 10.1016/j.ijsu.2013.06.101] [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]
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45
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Aloraifi F, McDevitt T, Cody N, Meany M, de Baroid C, Kelly R, Bracken A, Green A, Geraghty J. When should we consider contralateral prophylactic mastectomy in BRCA1/BRCA2 negative familial breast cancer patients? A study of histopathological patterns. Int J Surg 2012. [DOI: 10.1016/j.ijsu.2012.06.070] [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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46
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Aloraifi F, McDevitt T, Cody N, Meanie M, de Baroid C, Kelly R, Bracken A, Green A, Geraghty J. Could a proportion of familial breast cancer patients testing negative to BRCA1 and BRCA2 in fact be false negatives in the Republic of Ireland? Int J Surg 2012. [DOI: 10.1016/j.ijsu.2012.06.071] [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: 11/16/2022]
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Lal A, Evoy D, Geraghty J, McDermott E. Role of mammography in the triple assessment of single-quadrant breast symptoms ( Br J Surg 2011; 98: 951–955). Br J Surg 2011; 98:1673; author reply 1673. [DOI: 10.1002/bjs.7724] [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: 11/10/2022]
Abstract
Abstract
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length.
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Affiliation(s)
- A Lal
- St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D Evoy
- St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J Geraghty
- St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - E McDermott
- St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Affiliation(s)
- Emmeline Nugent
- Department of Surgery, The Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin, Ireland.
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49
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Mulsow J, Jeffers M, McDermott R, Geraghty J, Rothwell J. Complete clinical response to neoadjuvant chemotherapy in a 54-year-old male with Askin tumor. Thorac Cardiovasc Surg 2010; 58:306-8. [PMID: 20680911 DOI: 10.1055/s-0029-1186198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Askin tumor is a tumor of the thoracopulmonary region that most commonly affects children and adolescents. These rare tumors are a form of primitive neuroectodermal tumor and typically carry a poor prognosis. Treatment is multimodal and consists of a combination of neoadjuvant chemotherapy, radical resection, and adjuvant chemo- and radiotherapy or all of the above. Surgery is advocated in most cases. We report a case of Askin tumor in a 54-year-old male who showed rapid and complete response to neoadjuvant chemotherapy. This allowed potentially radical surgery to be avoided. At one-year follow-up he remains disease-free.
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Affiliation(s)
- J Mulsow
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.
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Gallagher P, Buckmaster A, O'Carroll S, Kiernan G, Geraghty J. External breast prostheses in post-mastectomy care: women's qualitative accounts. Eur J Cancer Care (Engl) 2009; 19:61-71. [PMID: 19708927 DOI: 10.1111/j.1365-2354.2008.00942.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A good-quality external breast prosthesis and prosthesis-fitting service is an integral part of the recovery process post-mastectomy. However, this is an area of care that has minimal information or research available. The aim of this research was to investigate women's experience of the provision, fitting, supply and use of breast prostheses in Ireland. To ascertain women's own personal and subjective experiences, five focus groups with 47 women recruited through national cancer advocacy/support organizations and four Follow-up Breast Clinics throughout Ireland were conducted. As a result, five main themes emerged: (1) The fitting experience--Fitting? (2) Post-mastectomy products--Having? (3) Cost--Affording? (4) Information--Knowing? and (5) Adaptation--Accepting? The emerging themes pinpointed the impact of the fitting experience, fitting environment and the qualities of a prosthesis fitter on a woman's experience in obtaining a first or replacement breast prosthesis; the importance of the physical characteristics of the prosthesis and mastectomy bras; cost, affordability and entitlements; a lack of and perceived difficulty in getting information; and the myriad of personal and social impacts of a breast prosthesis for the woman. These findings are integral for the development of standards of practice in the fitting and supply of external breast prostheses in post-mastectomy care.
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Affiliation(s)
- P Gallagher
- Faculty of Science and Health, School of Nursing, Dublin City University, Dublin 9, Ireland.
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