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Kelly C, Fitzpatrick P, Quinn C, Flanagan F, Connors A, Larke A, Mooney T, O'Doherty A. Ductal Carcinoma in Situ in Ireland, 2008-2020: Screening Data related to Low-Risk Management Trials. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Four clinical trials are on-going to determine if active surveillance is a feasible management option for patients with low-risk ductal carcinoma in situ (DCIS), in response to concerns that breast cancer screening programmes have increased the incidence of DCIS, some of which may never progress to invasive cancer. This study aimed to describe the epidemiology of screen-detected DCIS in Ireland through the BreastCheck, the national breast screening programme in Ireland (commenced 2000 but fully national since 2008).
Methods
This was a cross-sectional analysis of anonymised BreastCheck data provided by the National Screening Service, including all cases of screen-detected DCIS between 2008 and 2020. Statistical tests included Mann-Whitney U, Chi square, and multivariable logistic regression.
Results
2,240 women were diagnosed with DCIS through BreastCheck between 2008 and 2020 (1353 (60.4%) high-grade and 876 (39.1%) low/intermediate grade). The overall rate of screen-detected DCIS incidence has remained relatively stable during this time. Women with high- grade DCIS were older than women with low/intermediate DCIS (57 (IQR 53-61) years v 56 (IQR 56-61) years; p < 0.001). They were also more likely to have been diagnosed at a subsequent screening episode than at an initial episode (71.0% v 57.5%; p < 0.001). After adjustment (deprivation score, screening unit and year) the odds ratio for high-grade was 1.62 (95% CI 1.30-2.03; p < 0.001) for subsequent compared with initial screening episode.
Conclusions
When trial results are available, these data will assist with service planning should active surveillance be approved as a management option. Based on trial inclusion criteria, up to 40% of women diagnosed with DCIS through BreastCheck may be eligible for consideration for active surveillance. These women are younger and often diagnosed on initial screening episode, so may require longer active follow-up.
Key messages
Majority of DCIS in national screening programme is high grade. Randomised controlled trial evidence will provide guidance on management of low-risk DCIS.
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Affiliation(s)
- C Kelly
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Department of Public Health North East, Health Service Executive, Navan, Ireland
| | - P Fitzpatrick
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- National Screening Service, Dublin, Ireland
| | - C Quinn
- BreastCheck, National Screening Service, Dublin, Ireland
| | - F Flanagan
- BreastCheck, National Screening Service, Dublin, Ireland
| | - A Connors
- BreastCheck, National Screening Service, Dublin, Ireland
| | - A Larke
- BreastCheck, National Screening Service, Dublin, Ireland
| | - T Mooney
- National Screening Service, Dublin, Ireland
| | - A O'Doherty
- BreastCheck, National Screening Service, Dublin, Ireland
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Devane LA, Baban CK, O'Doherty A, Quinn C, McDermott EW, Prichard RS. The Impact of Neoadjuvant Chemotherapy on Margin Re-excision in Breast-Conserving Surgery. World J Surg 2021; 44:1547-1551. [PMID: 32002582 DOI: 10.1007/s00268-020-05383-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) can improve cosmesis by reducing resection volume. Breast-conserving surgery (BCS) aims to achieve clear excision margins while optimizing cosmesis. However, the influence of NAC on margin re-excision after BCS is unclear. This study examines the rate and determinants of margin re-excision in patients undergoing BCS following NAC in our institution. METHODS From 2011-2015, all patients treated with NAC prior to BCS were identified from a prospectively maintained database. Mann-Whitney and Fisher's exact test tests were used to compare variables in patients who did and did not require re-excision. Patients undergoing primary surgical treatment in 2015 comprised an unmatched comparison group. RESULTS Of 211 patients treated with NAC, 69 initially underwent BCS. The re-excision rate was 32% (n = 22) compared to 17% in the primary operable group (38 of 221, p = 0.02). Re-excision rates were lowest in triple-negative and HER2+ tumors (0% and 10%, respectively). Lobular carcinoma and ER+ tumors had a significantly higher rate of re-excision (100% and 42%, respectively). Of 22 patients undergoing re-excision, 9 had further BCS and 13 had a mastectomy. CONCLUSION The re-excision rate following NAC is almost twice that of patients who underwent primary operative management. Her2+ and triple-negative tumors have lower re-excision rates and may represent a selected cohort most suitable for BCS. Patients with invasive lobular carcinoma or ER+ disease have significantly higher rates of margin positivity, and these patients should be considered for a cavity shave during primary surgery to reduce the rates of re-excision.
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Affiliation(s)
- Liam A Devane
- Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Chwanrow K Baban
- Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A O'Doherty
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Cecily Quinn
- Department of Pathology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Enda W McDermott
- Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Ruth S Prichard
- Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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3
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Oikawa M, Simeone A, Hormanseder E, Teperek M, Gaggioli V, O'Doherty A, Falk E, Sporniak M, D'Santos C, Franklin VNR, Kishore K, Bradshaw CR, Keane D, Freour T, David L, Grzybowski AT, Ruthenburg AJ, Gurdon J, Jullien J. Epigenetic homogeneity in histone methylation underlies sperm programming for embryonic transcription. Nat Commun 2020; 11:3491. [PMID: 32661239 PMCID: PMC7359334 DOI: 10.1038/s41467-020-17238-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/20/2020] [Indexed: 02/06/2023] Open
Abstract
Sperm contributes genetic and epigenetic information to the embryo to efficiently support development. However, the mechanism underlying such developmental competence remains elusive. Here, we investigated whether all sperm cells have a common epigenetic configuration that primes transcriptional program for embryonic development. Using calibrated ChIP-seq, we show that remodelling of histones during spermiogenesis results in the retention of methylated histone H3 at the same genomic location in most sperm cell. This homogeneously methylated fraction of histone H3 in the sperm genome is maintained during early embryonic replication. Such methylated histone fraction resisting post-fertilisation reprogramming marks developmental genes whose expression is perturbed upon experimental reduction of histone methylation. A similar homogeneously methylated histone H3 fraction is detected in human sperm. Altogether, we uncover a conserved mechanism of paternal epigenetic information transmission to the embryo through the homogeneous retention of methylated histone in a sperm cells population.
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Affiliation(s)
- Mami Oikawa
- Wellcome Trust/Cancer Research UK Gurdon Institute, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QN, UK
- Department of Zoology, University of Cambridge, Downing Street, Cambridge, CB2 3EJ, UK
| | - Angela Simeone
- Wellcome Trust/Cancer Research UK Gurdon Institute, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QN, UK
- Department of Zoology, University of Cambridge, Downing Street, Cambridge, CB2 3EJ, UK
| | - Eva Hormanseder
- Wellcome Trust/Cancer Research UK Gurdon Institute, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QN, UK
- Department of Zoology, University of Cambridge, Downing Street, Cambridge, CB2 3EJ, UK
| | - Marta Teperek
- Wellcome Trust/Cancer Research UK Gurdon Institute, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QN, UK
- Department of Zoology, University of Cambridge, Downing Street, Cambridge, CB2 3EJ, UK
| | - Vincent Gaggioli
- Wellcome Trust/Cancer Research UK Gurdon Institute, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QN, UK
- Department of Zoology, University of Cambridge, Downing Street, Cambridge, CB2 3EJ, UK
| | - Alan O'Doherty
- UCD School of Agriculture and Food Science, University College Dublin, Dublin 4, D04 V1W8, Ireland
| | - Emma Falk
- CRTI, INSERM, UNIV Nantes, Nantes, France
| | | | - Clive D'Santos
- Cancer Research UK Cambridge Institute, University of Cambridge, Robinson Way, Cambridge, CB2 0RE, UK
| | | | - Kamal Kishore
- Cancer Research UK Cambridge Institute, University of Cambridge, Robinson Way, Cambridge, CB2 0RE, UK
| | - Charles R Bradshaw
- Wellcome Trust/Cancer Research UK Gurdon Institute, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QN, UK
- Department of Zoology, University of Cambridge, Downing Street, Cambridge, CB2 3EJ, UK
| | - Declan Keane
- ReproMed Ireland, Rockfield Medical Campus, Northblock, Dundrum, Dublin 16, D16 W7W3, Ireland
| | - Thomas Freour
- Service de Biologie de la Reproduction, CHU Nantes, Nantes, France
| | | | - Adrian T Grzybowski
- Department of Molecular Genetics and Cell Biology, The University of Chicago, 920 East 58th Street, Chicago, IL, 60637, USA
| | - Alexander J Ruthenburg
- Department of Molecular Genetics and Cell Biology, The University of Chicago, 920 East 58th Street, Chicago, IL, 60637, USA
| | - John Gurdon
- Wellcome Trust/Cancer Research UK Gurdon Institute, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QN, UK
- Department of Zoology, University of Cambridge, Downing Street, Cambridge, CB2 3EJ, UK
| | - Jerome Jullien
- Wellcome Trust/Cancer Research UK Gurdon Institute, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QN, UK.
- Department of Zoology, University of Cambridge, Downing Street, Cambridge, CB2 3EJ, UK.
- CRTI, INSERM, UNIV Nantes, Nantes, France.
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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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5
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Bebbere D, Mossa F, Paula-Lopes F, O'Doherty A. Special Issue: "Environmentally induced epigenetic variation during germ cell and embryo development: A programming perspective". Mol Reprod Dev 2018; 85:805-806. [PMID: 30351504 DOI: 10.1002/mrd.23077] [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: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Daniela Bebbere
- Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | - Francesca Mossa
- Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | | | - Alan O'Doherty
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
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Redmond CE, Healy GM, Murphy CF, O'Doherty A, Foster A. The use of ultrasonography and digital mammography in women under 40 years with symptomatic breast cancer: a 7-year Irish experience. Ir J Med Sci 2016; 186:63-67. [PMID: 27271165 DOI: 10.1007/s11845-016-1472-0] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/27/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast cancer in women under 40 years of age is rare and typically presents symptomatically. The optimal imaging modality for this patient group is controversial. Most women undergo ultrasonography with/without mammography. Young women typically have dense breasts, which can obscure the features of malignancy on film mammography, however, initial studies have suggested that digital mammography may have a more accurate diagnostic performance in younger women. Ultrasound generally performs well in this age group, although it is poor at detecting carcinoma in situ (DCIS). AIMS To evaluate the comparative diagnostic performance of ultrasonography and digital mammography in the initial diagnostic evaluation of women under 40 years of age with symptomatic breast cancer. METHODS Retrospective review of all women under the age of 40 years managed at our symptomatic breast cancer unit from January 2009 to December 2015. RESULTS There were 120 patients that met the inclusion criteria for this study. The sensitivity of ultrasonography and digital mammography for breast cancer in this patient group was 95.8 and 87.5 %, respectively. The patients with a false negative mammographic examination were more likely to have dense breasts (p < 0.01). Five patients had a false negative ultrasonographic examination, withal of whom were diagnosed with DCIS detected by mammography. CONCLUSION This study demonstrates the superior sensitivity of ultrasound for breast cancer in women under the age of 40 years, however, the results show that digital mammography has an important complimentary role in the comprehensive assessment of these patients, particularly in the diagnosis of DCIS.
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Affiliation(s)
- C E Redmond
- Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - G M Healy
- Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - C F Murphy
- Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A O'Doherty
- Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A Foster
- Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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7
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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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8
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Aloraifi F, Alshehhi M, McDevitt T, Cody N, Meany M, O'Doherty A, Quinn C, Green A, Bracken A, Geraghty J. Phenotypic analysis of familial breast cancer: Comparison of BRCAx tumors with BRCA1-, BRCA2-carriers and non-familial breast cancer. Eur J Surg Oncol 2015; 41:641-6. [DOI: 10.1016/j.ejso.2015.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 01/05/2015] [Accepted: 01/15/2015] [Indexed: 01/21/2023] 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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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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O'Doherty A, Koziel M, De Barra L, Corcoran D, Bullman S, Lucey B, Sleator RD. Development of nalidixic acid amphotericin B vancomycin (NAV) medium for the isolation of Campylobacter ureolyticus from the stools of patients presenting with acute gastroenteritis. Br J Biomed Sci 2014; 71:6-12. [PMID: 24693569 DOI: 10.1080/09674845.2014.11669956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Recently, Campylobacter ureolyticus has been detected for the first time in the faeces of patients with acute gastroenteritis using polymerase chain reaction (PCR) techniques. Cultural isolation of C. ureolyticusis is not possible using the established selective methods for the isolation of thermophilic Campylobacter spp. from faeces. The aim of the current study is to develop a new selective medium capable of isolating C. ureolyticus from faecal samples. The newly-developed medium consists of Anaerobe Basal Agar with 10 g/L additional agar, 2 g/L sodium formate and 3 g/L sodium fumarate dibasic, to which 10 mg/L nalidixic acid, 10 mg/L amphotericin B and 20 mg/L vancomycin (NAV) are added as selective agents. Validation studies have shown that this experimental selective medium completely inhibits growth of Candida spp. and of Enterococcus spp. and permits reduced growth of selected coliforms and Proteus spp. Growth of Campylobacter ureolyticus on NAV medium is optimal in anaerobic and enriched hydrogen atmospheres. Additionally, an overnight enrichment step using Bolton broth to which 2 g/L sodium formate, 3 g/L sodium fumarate dibasic and the NAV supplement are added, in place of the commercial Bolton broth supplement, allows improved recovery of C. ureolyticus from patients' faeces.
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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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Abstract
BACKGROUND Women younger than 30 years with a focal breast finding have a low incidence of malignancy. Targeted ultrasound is an accurate primary imaging test. MATERIALS AND METHODS All breast ultrasounds performed from July 1, 2011 to September 30, 2011 were reviewed. All ultrasounds in patients under 25 years were reviewed with regard to indication, imaging findings, and pathology results. RESULTS Over a 3-month period, 855 breast ultrasounds were performed; 4.1 % breast ultrasounds were performed in a patient under 25 years. Twenty patients had imaging features consistent with a fibroadenoma. Pathology confirmed the diagnosis of fibroadenomas in 15 of the patients. Five patients did not have biopsies performed due to young age or presence of bilateral fibroadenoma. CONCLUSION A breast nodule in a patient under the age of 25 years with benign clinical findings and imaging features consistent with a fibroadenoma does not require biopsy.
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Affiliation(s)
- A C O'Neill
- Department of Breast Radiology, St. Vincent's University Hospital, Dublin 4, Ireland.
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Leszczynsk A, O'Doherty A, Farrell E, O'Brien F, O'Brien T, Murphy M. ENHANCED ENDOCHONDRAL OSSIFICATION IN VESSEL DERIVED STEM CELLS BY ATHEROSCLEROTIC ENVIRONMENT. Heart 2012. [DOI: 10.1136/heartjnl-2012-303148a.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Keavey E, Phelan N, O'Connell AM, Flanagan F, O'Doherty A, Larke A, Connors AM. Comparison of the clinical performance of three digital mammography systems in a breast cancer screening programme. Br J Radiol 2012; 85:1123-7. [PMID: 22096222 PMCID: PMC3587096 DOI: 10.1259/bjr/29747759] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 09/14/2011] [Accepted: 09/19/2011] [Indexed: 11/05/2022] Open
Abstract
This study compares the clinical performance of three digital mammography system types in a breast cancer screening programme. 28 digital mammography systems from three different vendors were included in the study. The retrospective analysis included 238 182 screening examinations of females aged between 50 and 64 years over a 3-year period. All images were double read and assigned a result according to a 5-point rating scale to indicate the probability of cancer. Females with a positive result were recalled for further assessment imaging and biopsy if necessary. Clinical performance in terms of cancer detection rate was analysed and the results presented. No statistically significant difference was found between the three different mammography systems in a population-based screening programme, in terms of the overall cancer detection rate or in the detection of invasive cancer and ductal carcinoma in situ. This was shown in both prevalent and subsequent screening examination categories. The results demonstrate comparable cancer detection performance for the three imaging system types operational in the screening programme.
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Affiliation(s)
- E Keavey
- BreastCheck, National Cancer Screening Service, Western Unit, Galway, Ireland.
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Mulcahy P, O'Doherty A, Paucard A, O'Brien T, Kirik D, Dowd E. Development and characterisation of a novel rat model of Parkinson's disease induced by sequential intranigral administration of AAV-α-synuclein and the pesticide, rotenone. Neuroscience 2011; 203:170-9. [PMID: 22198020 DOI: 10.1016/j.neuroscience.2011.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/05/2011] [Accepted: 12/05/2011] [Indexed: 12/21/2022]
Abstract
Modeling Parkinson's disease remains a major challenge for preclinical researchers, as existing models fail to reliably recapitulate all of the classic features of the disease, namely, the progressive emergence of a bradykinetic motor syndrome with underlying nigrostriatal α-synuclein protein accumulation and nigrostriatal neurodegeneration. One limitation of the existing models is that they are normally induced by a single neuropathological insult, whereas the human disease is thought to be multifactorial with genetic and environmental factors contributing to the disease pathogenesis. Thus, in order to develop a more relevant model, we sought to determine if administration of the Parkinson's disease-associated pesticide, rotenone, into the substantia nigra of rats overexpressing the Parkinson's disease-associated protein, α-synuclein, could reliably model the triad of classic features of the human disease. To do so, rats underwent stereotaxic surgery for unilateral delivery of the adeno-associated virus (AAV)-α-synuclein into the substantia nigra. This was followed 13 weeks later by delivery of rotenone into the same site. The effect of the genetic and environmental insults alone or in combination on lateralised motor performance (Corridor, Stepping, and Whisker Tests), nigrostriatal integrity (tyrosine hydroxylase immunohistochemistry), and α-synucleinopathy (α-synuclein immunohistochemistry) was assessed. We found that rats treated with either AAV-α-synuclein or rotenone developed significant motor dysfunction with underlying nigrostriatal neurodegeneration. However, when the genetic and environmental insults were sequentially administered, the detrimental impact of the combined insults on motor performance and nigrostriatal integrity was significantly greater than the impact of either insult alone. This indicates that sequential exposure to relevant genetic and environmental insults is a valid approach to modeling human Parkinson's disease in the rat.
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Affiliation(s)
- P Mulcahy
- Department of Pharmacology and Therapeutics, National University of Ireland, Galway, Ireland
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Hayes BD, O'Doherty A, Quinn CM. Correlation of needle core biopsy with excision histology in screen-detected B3 lesions: the Merrion Breast Screening Unit experience. J Clin Pathol 2009; 62:1136-40. [DOI: 10.1136/jcp.2009.067280] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Doyle B, Al-Mudhaffer M, Kennedy MM, O'Doherty A, Flanagan F, McDermott EW, Kerin MJ, Hill AD, Quinn CM. Sentinel lymph node biopsy in patients with a needle core biopsy diagnosis of ductal carcinoma in situ: is it justified? J Clin Pathol 2009; 62:534-8. [PMID: 19190009 DOI: 10.1136/jcp.2008.061457] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The incidence of ductal carcinoma in situ (DCIS) has increased markedly with the introduction of population-based mammographic screening. DCIS is usually diagnosed non-operatively. Although sentinel lymph node biopsy (SNB) has become the standard of care for patients with invasive breast carcinoma, its use in patients with DCIS is controversial. AIM To examine the justification for offering SNB at the time of primary surgery to patients with a needle core biopsy (NCB) diagnosis of DCIS. METHODS A retrospective analysis was performed of 145 patients with an NCB diagnosis of DCIS who had SNB performed at the time of primary surgery. The study focused on rates of SNB positivity and underestimation of invasive carcinoma by NCB, and sought to identify factors that might predict the presence of invasive carcinoma in the excision specimen. RESULTS 7/145 patients (4.8%) had a positive sentinel lymph node, four macrometastases and three micrometastases. 6/7 patients had invasive carcinoma in the final excision specimen. 55/145 patients (37.9%) with an NCB diagnosis of DCIS had invasive carcinoma in the excision specimen. The median invasive tumour size was 6 mm. A radiological mass and areas of invasion <1 mm, amounting to "at least microinvasion" on NCB were predictive of invasive carcinoma in the excision specimen. CONCLUSIONS SNB positivity in pure DCIS is rare. In view of the high rate of underestimation of invasive carcinoma in patients with an NCB diagnosis of DCIS in this study, SNB appears justified in this group of patients.
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Affiliation(s)
- B Doyle
- Irish National Breast Screening Programme and Department of Histopathology, St Vincent's University Hospital, Dublin, Ireland.
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21
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Sen S, Conroy S, Hynes SO, McMahon J, O'Doherty A, Bartlett JS, Akhtar Y, Adegbola T, Connolly CE, Sultan S, Barry F, Katusic ZS, O'Brien T. Gene delivery to the vasculature mediated by low-titre adeno-associated virus serotypes 1 and 5. J Gene Med 2008; 10:143-51. [PMID: 18067196 DOI: 10.1002/jgm.1133] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Vascular gene therapy requires safe and efficient gene transfer in vivo. Recombinant adeno-associated virus (AAV) is a promising viral vector but its use in the vasculature has produced conflicting results and serotypes other than AAV2 have not been intensively studied. We investigated the efficiency of alternative AAV serotypes for vascular gene delivery in vitro and in vivo. METHODS Vascular cell lines were transduced in vitro with AAV vectors. Rabbit carotid arteries were transduced with AAV1, 2 and 5 encoding enhanced green fluorescent protein (eGFP) ( approximately 1.4 x 10(9) DNAse-resistant particles (drp)). Gene transfer in vivo was assessed at 14 and 28 days. High-titre doses of AAV2 encoding beta-galactosidase in vivo were also studied. RESULTS In vitro, transgene expression was not observed in endothelial cells using AAV2 whereas the use of serotypes 1 and 5 resulted in detectable levels of transgene expression. Coronary artery smooth muscle cells (CASMCs) transduced with AAV2 demonstrated higher levels of GFP expression than AAV1 or 5. Transgene expression in vivo was noted using low-titre AAV1 and AAV5 ( approximately 1.4 x 10(9) drp) in the media and adventitia. Only delivery of AAV1eGFP resulted in neointimal formation (3/7 vessels examined), with transgene expression noted in the neointima. Transgene expression with AAV2 was not detected in any layer of the blood vessel wall using low titre ( approximately 10(9) drp). However, high-titre ( approximately 10(11) drp) AAV2 resulted in transduction of cells in the media and adventitia but not the endothelium. CONCLUSIONS AAV1 and AAV5 have advantages over AAV2 for vascular gene delivery at low titres.
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Affiliation(s)
- S Sen
- Regenerative Medicine Institute, National University of Ireland, Galway, Ireland
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22
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O'Connell AM, O'Doherty A, Malone DE. Can ultrasound evaluate axillary lymph node status in patients with breast cancer? Can Assoc Radiol J 2008; 59:19-21. [PMID: 18386753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- A M O'Connell
- Department of Radiology, St Vincents Hospital, Merrion Rd, Dublin, Ireland.
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Doyle EM, Banville N, Quinn CM, Flanagan F, O'Doherty A, Hill ADK, Kerin MJ, Fitzpatrick P, Kennedy M. Radial scars/complex sclerosing lesions and malignancy in a screening programme: incidence and histological features revisited. Histopathology 2007; 50:607-14. [PMID: 17394497 DOI: 10.1111/j.1365-2559.2007.02660.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Radial scars (RS) are benign entities, frequently identified on screening mammography, which may be associated with malignancy. Much debate has been generated with regard to the optimum management of RS. We present our experience of RS in the first 5 years of a screening programme. The aim was to evaluate (i) the incidence of atypia and malignancy and (ii) the value of the preoperative core biopsy. We also further characterize the histological features. METHODS AND RESULTS One hundred and twenty-five histologically confirmed cases of RS were reviewed (111 had preoperative biopsies). Thirty-one (24.8%) patients had a final malignant diagnosis (11 with invasive malignancy) and 28 (22.4%) showed atypia (including lobular carcinoma in situ). In those with core biopsies and a final malignant diagnosis, 12 cases were categorized as B5 (41.3%), three as B4 (10.3%), 12 as B3 (41.3%) and two as B2 (7%). Common histological features included obliterated ducts and chronic inflammation with, less frequently, neural hyperplasia (16.8%) and perineural invasion (3.2%). CONCLUSIONS The high incidence of atypia and malignancy identified in our study justifies our policy of removing all mammographically detected RS. We emphasize the utility of preoperative core biopsy evaluation in permitting one-stage surgical therapy in those with B5 diagnoses.
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Affiliation(s)
- E M Doyle
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
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24
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Affiliation(s)
- E Ofo
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Nethermayne, Basildon SS16 5NL.
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25
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Dillon M, Quinn C, Mc Dermott E, O'Doherty A, Hill A, O'Higgins N. 320 POSTER The predictive value of breast lesions of ‘uncertain malignant potential’ and ‘suspicious for malignancy’ determined by needle core biopsy. Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70755-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Shovlin TC, Bourc'his D, La Salle S, O'Doherty A, Trasler JM, Bestor TH, Walsh CP. Sex-specific promoters regulate Dnmt3L expression in mouse germ cells. Hum Reprod 2006; 22:457-67. [PMID: 17060371 DOI: 10.1093/humrep/del379] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dnmt3L, a member of the DNA methyltransferase 3 family, lacks enzymatic activity but is required for de-novo methylation of imprinted genes in oocytes and for transposon repression in male germ cells. METHODS We used northern blots, RT-PCR, 5' rapid amplification of complementary DNA (cDNA) ends (RACE), RNase H mapping, real-time/quantitative RT-PCR and in situ hybridization to identify and characterize Dnmt3L transcripts produced during germ cell development. RESULTS Mouse Dnmt3L uses three sex-specific promoters, not the single promoter previously thought. A promoter active in prospermatogonia drives transcription of an mRNA encoding the full-length protein in perinatal testis, where de-novo methylation occurs. Late pachytene spermatocytes activate a second promoter in intron 9 of the Dnmt3L gene. After this stage, the predominant transcripts are three truncated mRNAs, which appear to be non-coding. We could also detect similar adult testis transcripts in humans. In the mouse ovary, an oocyte-specific promoter located in an intron of the neighbouring autoimmune regulator (Aire) gene produces a transcript with the full open reading frame (ORF). This is the only Dnmt3L transcript found in growing oocytes and is absent in the oocytes of Dnmt3L-/- females. CONCLUSIONS Sex-specific promoters control Dnmt3L expression in the mouse germ line, mirroring the situation at the Dnmt1 and Dnmt3A loci.
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Affiliation(s)
- T C Shovlin
- Stem Cells and Epigenetics Research Group, Centre for Molecular Biosciences, School of Biomedical Sciences, University of Ulster, Coleraine, UK
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Dillon MF, Quinn CM, McDermott EW, O'Doherty A, O'Higgins N, Hill ADK. Diagnostic accuracy of core biopsy for ductal carcinoma in situ and its implications for surgical practice. J Clin Pathol 2006; 59:740-3. [PMID: 16803949 PMCID: PMC1860430 DOI: 10.1136/jcp.2005.034330] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Core biopsy is considered to be a highly accurate method of gaining a preoperative histological diagnosis of breast cancer. Ductal carcinoma in situ (DCIS) is often impalpable and is a more subtle form of breast cancer. AIM To investigate the accuracy of core biopsy in the diagnosis of cancer in patients with DCIS. METHODS All patients who had invasive cancer (n = 959) or DCIS (n = 92) that was confirmed by excision between 1999 and 2004 were identified. The diagnostic methods, histology of the core biopsy specimen and excision histology were reviewed in detail. RESULTS Core biopsy was attempted in 88% (81/92) of patients with DCIS and in 91% (874/959) of those with invasive disease. Of those patients who underwent core biopsy, a diagnosis of carcinoma on the initial core was made in 65% (53/81) of patients with DCIS compared with 92% (800/874) of patients with invasive disease (p<0.0001). Smaller lesion size (p = 0.005) and lower grade (p = 0.03) were associated with increased risk for a negative or non-diagnostic core in patients with DCIS. The nature of the mammographic lesion or the method of biopsy did not affect the probability of an accurate core biopsy. Patients who had a preoperative diagnosis of DCIS by core biopsy had a reoperation rate of 36% compared with 65% of those that did not have a preoperative diagnosis (p = 0.007). CONCLUSION Although core biopsies are highly accurate forms of obtaining a preoperative diagnosis in patients with invasive breast cancer, this is not the case in DCIS. As the number of surgical procedures can be reduced by core biopsy, it is still of considerable value in the management of DCIS.
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Affiliation(s)
- M F Dillon
- Department of Surgery, St Vincent's University Hospital, Dublin
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Doyle JM, O'Doherty A, Coffey L, Pender S, Hill A, Quinn C. Can the radiologist accurately predict the adequacy of sampling when performing ultrasound-guided core biopsy of BI-RADS category 4 and 5 lesions detected on screening mammography? Clin Radiol 2005; 60:999-1005. [PMID: 16124982 DOI: 10.1016/j.crad.2005.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 12/02/2004] [Revised: 04/26/2005] [Accepted: 05/05/2005] [Indexed: 11/30/2022]
Abstract
AIM To investigate in mammography screening the correlation between the confidence level of the radiologist, in sampling BI-RADS assessment category 4 and 5 lesions using a single ultrasound-guided 14-gauge needle core biopsy, and the final histological diagnosis. METHODS In a prospective study, 389 consecutive ultrasound-guided 14-gauge needle core biopsies were performed on 131 BI-RADS assessment category 4 and 5 breast lesions in 126 women. On average, 3 passes were made through each lesion; for each pass, the radiologist rated confidence in adequacy of sampling at <50%, 50% to 90% or >90%. This was compared with the final histological diagnosis. RESULTS The radiologist was >90% confident in 293 biopsies; diagnostic results were confirmed at histology in 283 (97%). In 70 biopsies the radiologist was 50% to 90% confident; diagnostic results were confirmed in 60 (86%). Of 26 samples where confidence was <50%, 13 were diagnostic (50%) (p<0.0001). CONCLUSION If, at the time of ultrasound-guided needle core biopsy of BI-RADS assessment category 4 and 5 breast lesions, the radiologist is >90% confident that the lesion has been adequately sampled, a single pass is usually sufficient for diagnosis.
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Affiliation(s)
- J M Doyle
- Department of Radiology, St Vincent's University Hospital, Dublin 4, Ireland.
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Dillon MF, Hill ADK, Quinn CM, O'Doherty A, Crown J, Fleming FJ, McDermott EW, O'Higgins N. Surgical intervention in screen-detected patients versus symptomatic patients with breast cancer. J Med Screen 2005; 11:130-4. [PMID: 15333271 DOI: 10.1258/0969141041732238] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The impact of population-based screening for breast cancer on the rate of breast-conserving surgery has not been established. We sought to evaluate whether surgical intervention in patients with screen-detected breast cancer differed from those with clinically detected tumours. SETTINGS St Vincent's University Hospital and the BreastCheck Merrion Unit, part of the Irish National Breast Screening Programme, were the setting for the study. METHODS A total of 902 patients referred for surgery to St Vincent's University Hospital over a four-year period (2000-2003) were studied. Patients with breast cancers detected during the prevalent round of screening (n=325) were compared with patients presenting with symptomatic disease (n=577). The operative procedure, nature of axillary surgery and histopathological findings were recorded in each case. RESULTS There was an increase in breast-conserving therapy in the screened population compared with symptomatic cases (68% screened versus 53% symptomatic; p<0.0001), with a corresponding reduction in axillary clearance rates (65% screened versus 81% symptomatic; p<0.0001). Nodal positivity was similar following correction for size in all tumours >1 cm, regardless of method of detection. Sentinel node biopsy was successfully undertaken in 39% of tumours <2 cm (T1 tumours) [corrected] in the screening population. CONCLUSIONS The screened population was statistically more likely to have breast-conserving therapy than the symptomatic group. Sentinel node biopsy has evolved into an acceptable alternative to axillary clearance in T1 cancers, particularly in screen-detected cases.
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Affiliation(s)
- M F Dillon
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
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Power C, Kavanagh D, Hill ADK, O'Doherty A, O'Higgins N, McDermott E. Needle-localised biopsy of impalpable breast lesions: A novel adjunct to surgical technique and specimen mammography. Surgeon 2004; 2:343-5. [PMID: 15712575 DOI: 10.1016/s1479-666x(04)80034-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Successful screening programmes have resulted in the more frequent detection of early impalpable breast tumours. Effective surgical management of impalpable lesions demands a precise approach to excision which is currently aided by radiologically guided needle-localisation of the lesion prior to operative removal. The surgical specimen procured is most commonly evaluated for tumour presence by specimen mammography intra-operatively or by histological analysis. The latter is more accurate but requires lengthy laboratory processing, which may result in re-operation if the primary excision is inadequate. Although advocated as the standard of care, specimen mammography remains an imperfect technique. In this article we describe a piece of surgical apparatus which attempts to address some of the concerns associated with specimen mammography. It is an inexpensive compression device which reduces operative time, avoids portable fluoroscopy, increased radiation and the necessity for specialised equipment
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Affiliation(s)
- C Power
- St Vincent's University Hospital, Dublin 4, Ireland.
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Lees-Murdock DJ, McLoughlin GA, McDaid JR, Quinn LM, O'Doherty A, Hiripi L, Hack CJ, Walsh CP. Identification of 11 pseudogenes in the DNA methyltransferase gene family in rodents and humans and implications for the functional loci. Genomics 2004; 84:193-204. [PMID: 15203217 DOI: 10.1016/j.ygeno.2004.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [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: 10/21/2003] [Accepted: 02/06/2004] [Indexed: 11/15/2022]
Abstract
DNA (cytosine-5-)-methyltransferase genes are important for normal development in mice and humans. We describe here 11 pseudogenes spread among human, mouse, and rat belonging to this gene family, ranging from 1 pseudogene in humans to 7 in rat, all belonging to the Dnmt3 subfamily. All except 1 rat Dnmt3b pseudogene appear to be transcriptionally silent. Dnmt3a2, a transcript variant of Dnmt3a starting at an alternative promoter, had the highest number of processed pseudogenes, while none were found for the canonical Dnmt3a, suggesting the former transcript is more highly expressed in germ cells. Comparison of human, mouse, and rat Dnmt3a2 sequences also suggests that human exon 8 is a recent acquisition. Alignment of the 3'UTR of Dnmt3a2 among the functional genes and the processed pseudogenes suggested that a second polyadenylation site downstream of the RefSeq poly(A) was being used in mice, resulting in a longer 3'UTR, a finding confirmed by RT-PCR in mouse tissues. We also found conserved cytoplasmic polyadenylation elements, usually implicated in regulating translation in oocytes, in Dnmt3b and Dnmt1. Expression of DNMT3B in the mouse oocyte was confirmed by immunocytochemistry. These results clarify the structure of a number of loci in the three species examined and provide some useful insights into the structure and evolution of this gene family.
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Fleming FJ, Hill ADK, Mc Dermott EW, O'Doherty A, O'Higgins NJ, Quinn CM. Intraoperative margin assessment and re-excision rate in breast conserving surgery. Eur J Surg Oncol 2004; 30:233-7. [PMID: 15028301 DOI: 10.1016/j.ejso.2003.11.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2003] [Indexed: 10/26/2022] Open
Abstract
AIM The aim of this study was to assess the efficacy of intraoperative margin assessment in obtaining clear margins in conserving surgery for breast cancer. METHODS Two hundred and twenty patients undergoing wide local excision (WLE) for core biopsy proven primary invasive breast cancer, during a 30 months period, were included in the study. Following surgical excision the breast specimen was orientated with sutures, inked using India ink and coloured pigments and incised to identify the tumour, maintaining orientation. The distance to the individual radial margins were estimated macroscopically by the pathologist and conveyed intraoperatively to the surgeon. A macroscopic tumour-margin distance of less than 10 mm was considered compromised and the margin(s) in question was then excised if feasible. RESULTS Eighty-one patients (37%) were judged to have compromised margins following intraoperative macroscopic evaluation and had at least one margin re-excised. Sixteen of the 81 patients (20%) in this subgroup had compromised margins on microscopy and required a second operation. One hundred and thirty-nine patients (63%) were deemed to have clear margins intraoperatively, subsequently confirmed on microscopic examination in 135 patients (97%). Intraoperative macroscopic assessment of margin status was associated with 9.1% of patients requiring a second operation. In the absence of intraoperative assessment of margin status a further 47 patients (21.4%) would have required a second operation. CONCLUSION Intraoperative macroscopic margin assessment is an effective technique in reducing the number of second operative procedures in patients undergoing conserving surgery for primary invasive breast cancer.
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MESH Headings
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- Humans
- Intraoperative Period
- Mastectomy, Segmental/methods
- Middle Aged
- Neoplasm, Residual
- Reoperation
- Treatment Outcome
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Affiliation(s)
- F J Fleming
- Department of Surgery, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland
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Fleming FJ, Hill ADK, Kavanagh D, Quinn C, O'Doherty A, Collins CD, McDermott EW, O'Higgins NJ. Intradermal radioisotope injection optimises sentinel lymph node identification in breast cancer. Eur J Surg Oncol 2004; 29:835-8. [PMID: 14624773 DOI: 10.1016/j.ejso.2003.08.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM Currently there is no consensus on the optimal technique for sentinel lymph node (SLN) identification in patients with breast cancer. The aim was to compare the efficacy of intraparenchymal and intradermal isotope injection in sentinel lymph node mapping for breast cancer. METHODS One hundred and twenty-five patients with histologically confirmed invasive breast cancer underwent SLN mapping using radioisotope and isosulphan blue dye followed by a back-up axillary dissection. The first 80 patients had intraparenchymal (IP) injection of radioisotope given in four portions around the tumor. The remaining 45 patients had an intradermal (ID) injection given at a single site over the tumour. Both groups had isosulphan blue dye injected around the tumour. Sentinel node(s) were identified using a combination of lymphoscintigraphy, blue dye and an intra-operative hand held gamma probe. RESULTS The preoperative lymphoscintigram (LSG) demonstrated a SLN significantly more often in the ID isotope group compared to the IP isotope group (P=0.002). A combination of blue dye and isotope successfully located the SLN in 96% of the intraparenchymal group and 100% of the intradermal group. CONCLUSION Our results suggest that intradermal isotope injection in combination with intraparenchymal blue dye optimises the localization of the sentinel lymph node in breast cancer.
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Affiliation(s)
- F J Fleming
- Departments of Surgery, St Vincent's University Hospital and Conway Institute of Biomolecular and Biomedical Research University College Dublin, Dublin, Ireland
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Abstract
AIM To investigate the significance of abnormal axillary lymph nodes detected at mammographic screening in the absence of a concomitant breast lesion. METHODS Twenty-three thousand, seven hundred and seven women were screened at the Merrion Unit as part of the Irish National Breast Screening Programme ("BreastCheck") in the period June 2000 to July 2002. Nine women (0.4 per 1000 women screened) were found to have an abnormal axillary lymph node(s) in the absence of a mammographic breast lesion and were recalled for assessment. The radiological criteria for recall included: size greater than or equal to 15 mm, round or irregular shape, increased node density and absence of hilar lucency. Each woman underwent further mammographic views, ultrasound examination of axilla and breast, clinical examination and lymph node biopsy either by 14G needle core biopsy (NCB) or open excision. RESULTS The final pathological diagnoses in the nine patients were oestrogen receptor (OR) positive metastatic breast carcinoma (two patients), metastatic malignant melanoma (one patient), malignant lymphoma (two patients), caseating granulomatous lymphadenitis suggestive of tuberculosis (one patient), and other benign conditions (three patients). CONCLUSION Abnormal axillary lymph nodes, in the absence of an accompanying breast lesion, are rarely identified on screening mammogram, but may harbour significant pathology and their presence on screening mammogram merits further investigation including biopsy.
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Affiliation(s)
- E T Lim
- Department of Histopathology, Merrion Unit, St Vincent's University Hospital, Elm Park, 4, Dublin, Ireland
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Affiliation(s)
- A O'Doherty
- Central Veterinary Research Laboratory, Abbotstown, Castleknock, Dublin, Ireland
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Hyland MA, Lawson JT, O'Doherty A, Kennedy J, Biggart D. MRI findings in a rare cause of bladder outlet obstruction. Ulster Med J 1996; 65:81-3. [PMID: 8686107 PMCID: PMC2448747] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- M A Hyland
- Department of Radiology, Belfast City Hospital
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Kee F, Telford AM, Donaghy P, O'Doherty A. Enhancing mammography uptake: who do women listen to? Eur J Cancer Prev 1993; 2:37-42. [PMID: 8428174] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Previous work has established that women who attend for mammography differ from non-attenders in a number of socio-demographic and attitudinal characteristics. The present study was conducted to determine whether women who attended for mammography differed from non-attenders in a number of key areas: (1) in how they obtained information about screening; (2) in their understanding of the disease and basic screening precepts; and (3) in the extent to which they perceived their general practitioners (GPs) and other members of the primary case team, such as practice nurses, had actively promoted the programme. Three hundred attenders and 300 non-attenders were interviewed in their own homes using a structured questionnaire. Only 5% of women interviewed had ever asked their GP for any advice about breast screening, and only 18% recalled their family doctor every discussing or raising the subject with them. Although attenders and non-attenders differed significantly in their understanding of the scope and purpose of screening, both groups obtained information more often from friends and relatives and broadcast media than from official sources. Attenders were more likely to cite material in the GP's surgery as an important source of information (chi 2 = 5.1, p = 0.02). Attenders were marginally more likely than non-attenders to have previously attended a well-woman clinic in primary care (chi 2 = 3.1, p = 0.08) and were more likely to say that such clinics were being offered by their family doctor (chi 2 = 9.8, p = 0.008).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F Kee
- Department of Public Health Medicine, Northern Health and Social Services Board, Ballymena, N Ireland
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Kee F, Telford AM, Donaghy P, O'Doherty A. Attitude or access: reasons for not attending mammography in Northern Ireland. Eur J Cancer Prev 1992; 1:311-5. [PMID: 1467780] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Maximizing the uptake of mammography among the eligible population will be critical to the success of the national breast cancer screening programme. Although compliance may vary for different reasons from area to area, it has been suggested that making screening clinics more accessible may be an effective means of enhancing uptake. In the present study we undertook 600 interviews with women who had been invited for mammography to determine the main reasons given by women in Northern Ireland for not attending for mammography when invited, how these may have related to access factors and to discover their views on how the service might be improved. The most frequently cited reasons for non-attendance were related to feelings of indifference or ignorance of screening issues and to fear of pain or embarrassment. Although more non-attenders did not have access to private transport, few women (23/600) expressed a preference for more accessible clinics. The fact that non-attenders were more likely not to have had a recent cervical smear, adds weight to the notion that attitudes rather than access played the predominant role in influencing uptake in this sample. We have concluded that investment in flexible mobile screening units cannot replace the continued need for delivering effective advocacy to eligible women.
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Affiliation(s)
- F Kee
- Department of Public Health Medicine, Northern Health and Social Services Board, Ballymena
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Burke CM, O'Doherty A, Flanagan A, O'Connell BM, Devlin JG. Autonomic neuropathy in a diabetic clinic. Ir Med J 1984; 77:202-5. [PMID: 6469533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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