Coaxial Layered Fiber Spinning for Wind Turbine Blade Recycling

Plastics' long degradation time and their role in adding millions of metric tons of plastic waste to our oceans annually present an acute environmental challenge. Handling end-of-life waste from wind turbine blades (WTBs) is equally pressing. Currently, WTB waste often finds its way into landfills, emphasizing the need for recycling and sustainable solutions. Mechanical recycling of composite WTB presents an avenue for the recovery of glass fibers (GF) for repurposing as fillers or reinforcements. The resulting composite materials exhibit improved properties compared to the pure PAN polymer. Through the employment of the dry-jet wet spinning technique, we have successfully manufactured PAN/GF coaxial-layered fibers with a 0.1 wt % GF content in the middle layer. These fibers demonstrate enhanced mechanical properties and a lightweight nature. Most notably, the composite fiber demonstrates a significant 24.4% increase in strength and a 17.7% increase in modulus. These fibers hold vast potential for various industrial applications, particularly in the production of structural components (e.g., electric vehicles), contributing to enhanced performance and energy efficiency.

Nanoparticle Assembly: From Self-Organization to Controlled Micropatterning for Enhanced Functionalities

Nanoparticles form long-range micropatterns via self-assembly or directed self-assembly with superior mechanical, electrical, optical, magnetic, chemical, and other functional properties for broad applications, such as structural supports, thermal exchangers, optoelectronics, microelectronics, and robotics. The precisely defined particle assembly at the nanoscale with simultaneously scalable patterning at the microscale is indispensable for enabling functionality and improving the performance of devices. This article provides a comprehensive review of nanoparticle assembly formed primarily via the balance of forces at the nanoscale (e.g., van der Waals, colloidal, capillary, convection, and chemical forces) and nanoparticle-template interactions (e.g., physical confinement, chemical functionalization, additive layer-upon-layer). The review commences with a general overview of nanoparticle self-assembly, with the state-of-the-art literature review and motivation. It subsequently reviews the recent progress in nanoparticle assembly without the presence of surface templates. Manufacturing techniques for surface template fabrication and their influence on nanoparticle assembly efficiency and effectiveness are then explored. The primary focus is the spatial organization and orientational preference of nanoparticles on non-templated and pre-templated surfaces in a controlled manner. Moreover, the article discusses broad applications of micropatterned surfaces, encompassing various fields. Finally, the review concludes with a summary of manufacturing methods, their limitations, and future trends in nanoparticle assembly.

'Dark' CO2 fixation in succinate fermentations enabled by direct CO2 delivery via hollow fiber membrane carbonation

Anaerobic succinate fermentations can achieve high-titer, high-yield performance while fixing CO2 through the reductive branch of the tricarboxylic acid cycle. To provide the needed CO2, conventional media is supplemented with significant (up to 60 g/L) bicarbonate (HCO3-), and/or carbonate (CO32-) salts. However, producing these salts from CO2 and natural ores is thermodynamically unfavorable and, thus, energetically costly, which reduces the overall sustainability of the process. Here, a series of composite hollow fiber membranes (HFMs) were first fabricated, after which comprehensive CO2 mass transfer measurements were performed under cell-free conditions using a novel, constant-pH method. Lumen pressure and total HFM surface area were found to be linearly correlated with the flux and volumetric rate of CO2 delivery, respectively. Novel HFM bioreactors were then constructed and used to comprehensively investigate the effects of modulating the CO2 delivery rate on succinate fermentations by engineered Escherichia coli. Through appropriate tuning of the design and operating conditions, it was ultimately possible to produce up to 64.5 g/L succinate at a glucose yield of 0.68 g/g; performance approaching that of control fermentations with directly added HCO3-/CO32- salts and on par with prior studies. HFMs were further found to demonstrate a high potential for repeated reuse. Overall, HFM-based CO2 delivery represents a viable alternative to the addition of HCO3-/CO32- salts to succinate fermentations, and likely other 'dark' CO2-fixing fermentations.

3D Printing-Enabled Design and Manufacturing Strategies for Batteries: A Review

Lithium-ion batteries (LIBs) have significantly impacted the daily lives, finding broad applications in various industries such as consumer electronics, electric vehicles, medical devices, aerospace, and power tools. However, they still face issues (i.e., safety due to dendrite propagation, manufacturing cost, random porosities, and basic & planar geometries) that hinder their widespread applications as the demand for LIBs rapidly increases in all sectors due to their high energy and power density values compared to other batteries. Additive manufacturing (AM) is a promising technique for creating precise and programmable structures in energy storage devices. This review first summarizes light, filament, powder, and jetting-based 3D printing methods with the status on current trends and limitations for each AM technology. The paper also delves into 3D printing-enabled electrodes (both anodes and cathodes) and solid-state electrolytes for LIBs, emphasizing the current state-of-the-art materials, manufacturing methods, and properties/performance. Additionally, the current challenges in the AM for electrochemical energy storage (EES) applications, including limited materials, low processing precision, codesign/comanufacturing concepts for complete battery printing, machine learning (ML)/artificial intelligence (AI) for processing optimization and data analysis, environmental risks, and the potential of 4D printing in advanced battery applications, are also presented.

Intrinsic Field-Induced Nanoparticle Assembly in Three-Dimensional (3D) Printing Polymeric Composites

Nanoparticles (NPs) are materials considered to be 1-100 nm in size and are available in different dimensional shapes, geometrical sizes, physical morphologies, mechanical robustness, and chemical compositions. Irrespective of the dimensions (i.e., zero-dimensional (0D), one-dimensional (1D), and two-dimensional (2D)), NPs have a tendency to become entangled together, forming aggregations due to high attraction, making it hard to realize their full potential from their ordered counterparts. Many challenges exist to attain high-quality stabilized dispersion and long-range ordered assembly of NPs. Three-dimensional printing (3DP), also known as additive manufacturing (AM), is a technique dependent on layer-by-layer material addition for building 3D structures and encompasses a few categories based on the feedstock material types and printing mechanisms. One benefit from the 3DP procedures is their capability to produce anisotropic microstructural/nanostructural characteristics for desired mechanical reinforcement, transport phenomena, energy management, and biomedical implants. This paper briefly overviews relevant 3DP methods with an embedded nature to assemble nanoparticles without interference with external fields (e.g., magnetic or electrical). Our focus is the shear-field-induced nanoparticle alignment, covering material jetting-, electrohydrodynamic-, filament melting-, and ink writing-based 3DP. A concise summary of photopolymerization and its "optical tweezer" effects on nanoparticle confinement also inspires creative approaches in generating ordered nanostructures. The nanoparticles and polymers involved in this review are diverse, consisting of metallic, ceramic, and carbon nanoparticles in matrices or on surfaces of varying macromolecules. A short statement of challenges (e.g., low resolution, slow printing speed, limited material options) for 3DP-enabled nanoparticle orders provides some perspectives toward the enormous potential of 3DP in directing NPs assembly and fabricating high-performance polymer/nanoparticle composites.

3D Printing-Enabled Nanoparticle Alignment: A Review of Mechanisms and Applications

3D printing (additive manufacturing (AM)) has enormous potential for rapid tooling and mass production due to its design flexibility and significant reduction of the timeline from design to manufacturing. The current state-of-the-art in 3D printing focuses on material manufacturability and engineering applications. However, there still exists the bottleneck of low printing resolution and processing rates, especially when nanomaterials need tailorable orders at different scales. An interesting phenomenon is the preferential alignment of nanoparticles that enhance material properties. Therefore, this review emphasizes the landscape of nanoparticle alignment in the context of 3D printing. Herein, a brief overview of 3D printing is provided, followed by a comprehensive summary of the 3D printing-enabled nanoparticle alignment in well-established and in-house customized 3D printing mechanisms that can lead to selective deposition and preferential orientation of nanoparticles. Subsequently, it is listed that typical applications that utilized the properties of ordered nanoparticles (e.g., structural composites, heat conductors, chemo-resistive sensors, engineered surfaces, tissue scaffolds, and actuators based on structural and functional property improvement). This review's emphasis is on the particle alignment methodology and the performance of composites incorporating aligned nanoparticles. In the end, significant limitations of current 3D printing techniques are identified together with future perspectives.

Aligned Ti3C2Tx MXene for 3D Micropatterning via Additive Manufacturing

Selective deposition and preferential alignment of two-dimensional (2D) nanoparticles on complex and flexible three-dimensional (3D) substrates can tune material properties and enrich structural versatility for broad applications in wearable health monitoring, soft robotics, and human-machine interfaces. However, achieving precise and scalable control of the morphology of layer-structured nanomaterials is challenging, especially constructing hierarchical architectures consistent from nanoscale alignment to microscale patterning to complex macroscale landscapes. This work demonstrated a scalable and straightforward hybrid 3D printing method for orientational alignment and positional patterning of 2D MXene nanoparticles. This process involved (i) surface topology design via microcontinuous liquid interface production (μCLIP) and (ii) directed assembly of MXene flakes via capillarity-driven direct ink writing (DIW). With well-managed surface patterning geometry and printing ink quality control, the surface microchannels constrained MXene suspensions and leveraged microforces to facilitate preferential alignment of MXene sheets via layer-by-layer additive depositions. The printed devices displayed multifunctional properties, i.e., anisotropic conductivity and piezoresistive sensing with a wide sensing range, high sensitivity, fast response time, and mechanical durability. Our fabrication technique shows enormous potential for rapid, digital, scalable, and low-cost manufacturing of hierarchical structures, especially for micropatterning and aligning 2D nanoparticles not easily accessible through conventional processing methods.

Tuning the reactivity of tri-s-triazine, trinitro-tri-s-triazine and ternary tri-s-triazine graphitic C3N4 quantum dots through H-functionalized and B-doped complexes: A density functional study

Modifying the structures and doping are proven to be effective methods to tune the structural and electrical properties of g-C₃N₄ quantum dots. Hence, in this study, tri-s-triazine and tri-nitro tri-s-triazine have been studied by functionalizing their edges with hydrogen. The H-functionalized tri-nitro tri-s-triazine quantum dot displays a buckled structure with a band gap of 1.988 eV, whereas the tri-s-triazine demonstrates a planner structure with a band gap of 1.636 eV. The obtained results have been compared with the previous results. The absorbance spectrum of H-functionalized trinitro tri-s-triazine falls under the visible region with a peak value of 488 nm, and the absorption spectrum of tri-s-triazine falls at 790 nm. The planarity of the tri-nitro tri-s-triazine structure is improved by doping the B atom in the N site, and the band gap of H-functionalized B doped tri-nitro tri-s-triazine is 1.143 eV. The absorbance spectrum of H-functionalized B doped tri-nitro tri-s-triazine is 508 nm. The reactivity of the structure is increased by doping B atoms, and it is confirmed by the electrophilicity index. Similarly, the H-functionalized B doped tri-s-triazine exhibits a band gap of 1.328 eV. Further, the tri-s-triazine structures are arranged in ternary form, and the properties are studied by increasing the number of B atoms in the tri-s-triazine rings. The outcome presents that the structures are planar, and band gap values are reduced further. Also, the reactivity of the sheets is increased, which is confirmed by the electrophilicity index. It is proposed that the sheets with a high reactivity can be used for the removal of hazardous ions and molecules from the industrial wastage.

PMMA-TiO2 Fibers for the Photocatalytic Degradation of Water Pollutants

Titanium dioxide (TiO2) is a promising photocatalyst that possesses a redox potential suitable for environmental remediation applications. A low photocatalytic yield and high cost have thus far limited the commercial adoption of TiO2-based fixed-bed reactors. One solution is to engineer the physical geometry or chemical composition of the substrate to overcome these limitations. In this work, porous polymethyl methacrylate (PMMA) substrates with immobilized TiO2 nanoparticles in fiber forms were fabricated and analyzed to demonstrate the influence of contaminant transport and light accessibility on the overall photocatalytic performance. The influences of (i) fiber porosity and (ii) fiber architecture on the overall photocatalytic performance were investigated. The porous structure was fabricated using wet phase inversion. The core-shell-structured fibers exhibited much higher mechanical properties than the porous fibers (7.52 GPa vs. non-testability) and maintained the same degradation rates as porous structures (0.059 vs. 0.053/min) in removing methylene blue with comparable specific surface areas. The highest methylene blue (MB) degradation rate (kMB) of 0.116 min-1 was observed due to increases of the exposed surface area, pointing to more efficient photocatalysis by optimizing core-shell dimensions. This research provides an easy-to-manufacture and cost-efficient method for producing PMMA/TiO2 core-shell fibers with a broad application in water treatment, air purification, and volatile sensors.

Scalable Alignment and Selective Deposition of Nanoparticles for Multifunctional Sensor Applications

Here reported is the layer-by-layer-based advanced manufacturing that yields a simple, novel, and cost-effective technique for generating selective nanoparticle deposition and orientation in the form of well-controlled patterns. The surface roughness of the three-dimensionally printed patterns and the solid-liquid-air contact line, as well as the nanoparticle interactions in dipped suspensions, determine the carbon nanofiber (CNF) alignment, while the presence of triangular grooves supports the pinning of the meniscus, resulting in a configuration consisting of alternating CNF and polymer channels. The polymer/nanoparticle composites show 10 times lower resistance along with the particle alignment direction than the randomly distributed CNF networks and 6 orders of magnitude lower than that along the transverse direction. The unidirectional alignment of the CNF also demonstrates linear piezoresistivity behavior under small strain deformation along with high sensitivity and selectivity toward volatile organic compounds. The reported advanced manufacturing shows broad applications in microelectronics, energy transport, light composites, and multifunctional sensors.

Fabricating Fibers of a Porous-Polystyrene Shell and Particle-Loaded Core

Polystyrene (PS) polymers have broad applications in protective packaging for food shipping, containers, lids, bottles, trays, tumblers, disposable cutlery and the making of models. Currently, most PS products, such as foams, are not accepted for recycling due to a low density in the porous structure. This poses a challenge for logistics as well as creating a lack of incentive to invest in high-value products. This study, however, demonstrated the use of a dry-jet wet-spinning technique to manufacture continuous PS fibers enabled by an in-house designed and developed spinning apparatus. The manufactured fibers showed porosity in the shell and the capability to load particles in their core, a structure with high potential use in environmentally relevant applications such as water treatment or CO2 collections. A two-phase liquid-state microstructure was first achieved via a co-axial spinneret. Following coagulation procedures and heat treatment, phase-separation-based selective dissolution successfully generated the porous-shell/particle-core fibers. The pore size and density were controlled by the porogen (i.e., PEG) concentrations and examined using scanning electron microscopy (SEM). Fiber formation dynamics were studied via rheology tests and gelation measurements. The shell components were characterized by tensile tests, thermogravimetric analysis, and differential scanning calorimetry for mechanical durability and thermal stability analyses.

In situ alignment of graphene nanoplatelets in poly(vinyl alcohol) nanocomposite fibers with controlled stepwise interfacial exfoliation

Hierarchically microstructured tri-axial poly(vinyl alcohol)/graphene nanoplatelet (PVA/GNP) composite fibers were fabricated using a dry-jet wet spinning technique. The composites with distinct PVA/GNPs/PVA phases led to highly oriented and evenly distributed graphene nanoplatelets (GNPs) as a result of molecular chain-assisted interfacial exfoliation. With a concentration of 3.3 wt% continuously aligned GNPs, the composite achieved a ∼73.5% increase in Young's modulus (∼38 GPa), as compared to the pure PVA fiber, and an electrical conductivity of ∼0.38 S m^-1, one of the best mechanical/electrical properties reported for polymer/GNP nanocomposite fibers. This study has broader impacts on textile engineering, wearable robotics, smart sensors, and optoelectronic devices.

Abstract P4-01-07: Recall for assessment after post-treatment surveillance mammograms in breast cancer

Background: Patients treated for breast carcinoma are usually followed up with regular mammograms. The aims are early diagnosis of locally recurrent disease in the ipsilateral breast or new cancers in the contralateral breast, and to provide reassurance. When the mammograms are considered abnormal patients are recalled for further assessment. The aim of this study is to review all mammographic recalls in a single institution over a 5-year period to study the patient population recalled, reasons for the recall and the outcome.

Materials and Methods: We identified all breast cancer patients who were recalled for assessment following a routine post-treatment surveillance mammogram from April 2010 to March 2015 from the breast unit database. We reviewed their original presentation with breast cancer, treatment received, reason for recall, the assessment process and the outcome. The mammographic follow-up policy of the unit during the study period was as follows; after breast conserving surgery (BCS), yearly bilateral mammograms for 5 years or until the age of 50 whichever the later; following mastectomy, mammogram of the opposite breast at years 1, 3 and 5 post-surgery, and if the patient is aged under 50 after 5 years, 2-yearly till 50 years of age. Patients were then discharged to UK National Breast Screening Programme where mammograms are performed 3-yearly.

Results: During the study period 1809 patients had 3685 surveillance mammograms. 149 patients were recalled (a recall rate of 8% of patients and 4% of mammograms over 5-years). 122 patients had BCS and 27 patients had mastectomy. The original diagnosis was invasive cancer in 131 and DCIS in 18. The reason for recall was a density or mass in 63, microcalcification in 61, distortion in 14 and a mixture of these or other reasons in 11. Eighty one patients were recalled for a problem on the ipsilateral side and 66 for contralateral side (2 patients had bilateral cancer).

Among 149 patients recalled, 50 had further imaging only (further mammographic views, ultrasound or both) after the recall and 79 underwent a needle biopsy under ultrasound or stereo guidance. 8 patients underwent US-guided aspiration of benign cysts. 21 biopsy results were malignant. The final diagnosis was ipsilateral recurrence in 10 patients and contralateral cancer in 11.

Conclusions: There is not much published data in the literature on the outcome of post-treatment surveillance mammograms despite the fact that such mammographic surveillance is commonly practiced. This study shows that over a 5-year period, 8% of the patients and 4% of the mammograms were recalled. A third of patients recalled only required further imaging. Although biopsies were performed in over half the patients, only 14% of patients recalled were proved to have ipsilateral or contralateral carcinoma after the assessment.

Citation Format: Wassermann M, Swinson C, Shrestha D, Kirkpatrick K, Ravichandran D. Recall for assessment after post-treatment surveillance mammograms in breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-01-07.

Triple assessment is not necessary in most young women referred with breast symptoms

INTRODUCTION

A palpable lesion in the breast is usually subjected to triple assessment (clinical examination [CE], imaging and core biopsy [CB] or fine needle aspiration [FNA]) to minimise the risk of missing breast cancer. However, breast cancer is rare in young women, and triple assessment (especially CB) is invasive and expensive. Our aim was to see whether CB/FNA could be avoided in young women with benign findings on CE and imaging.

METHODS

This study analysed data from a prospectively entered database on female patients aged under 25 years who attended a rapid diagnosis breast clinic over a 68-month period.

RESULTS

Among 10,301 patients seen, 955 females (9.3%) were aged <25 years. The most common presenting complaint was a lump, followed by pain and nipple discharge. CE was normal or revealed benign findings in all except 15 patients, in whom it was indeterminate. Ultrasonography was performed in 692 patients (72%) and was normal (n=289) or benign (n=382) in all except 21 patients, in whom it was indeterminate. In six patients, both were indeterminate. A total of 317 patients (35%) had triple assessment: FNA in 106, CB in 239 and both in 9 cases. No cancers were diagnosed.

CONCLUSIONS

It would appear safe to omit FNA/CB in patients aged under 25 years when clinical and ultrasonography findings are normal or benign. This approach would have avoided needle biopsies in all but 30 patients (3%) in the study.

A study on sacral index in Tamil Nadu and andhra pradesh population of southern India

INTRODUCTION

Human sacral bones are of great interest to the anatomists, forensic experts and anthropologists as it is one of the important bones used for identification of sex in skeletal remains. Various parameters and indices are available based on which the sex can be determined using sacrum. One such important parameter is the SI. Studies shows that SI significantly varies among male and female gender and among different populations. The calculation of Demarcation Point (DP) of SI increases the accuracy of identification of sex. A review of literature showed that many studies are available in the North Indian population whereas there is a dearth of information about the normal SI and DP in South Indian population particularly in the Tamil Nadu and Andhra Pradesh, Inida region. Therefore, the present study aims to create a database for the SI in the above mentioned population.

MATERIAL AND METHODS

One hundred twenty three bones of known sex (63 males and 60 females) belonging to Tamil Nadu and Andhra Pradesh, India region were studied. Bones with obvious pathology were excluded. The breadth and length of the sacra were measured using vernier calipers based on standard guidelines. The SI and DP were calculated. The statistical analysis was done using SPSS 15.0 package.

RESULTS

The mean SI for male and female sacra were found to be 96.32 + 5.40 and 102.92 +4.00 respectively. The Demarcating Point was found to be <90.29 in males and >112.43 in females. The mean length of male and female sacra was 97.8 mm and 90.6mm respectively. The mean width was 93.7mm and 92.91mm respectively for males and females.

CONCLUSION

The average SI and DP identified in the present study would be of use to the anatomists, forensic experts and anthropologists of Tamil Nadu and Andhra Pradesh population.

A UK national survey of breast surgeons on primary endocrine therapy of early operable breast cancer

INTRODUCTION

A significant proportion of elderly breast cancer patients in the UK have no surgical treatment recorded and appear to be treated with primary endocrine therapy (PET) only. Despite this, PET remains one of the poorly studied areas in breast cancer therapy and very little is known about the practice of PET in the UK.

METHODS

A questionnaire comprising 14 questions relevant to PET was sent to 489 breast surgeons who were members of the UK Association of Breast Surgery and returned questionnaires were analysed.

RESULTS

Overall, 228 questionnaires (47%) were returned. The vast majority (93%) of surgeons who responded use PET in early operable breast cancer in elderly women unfit for surgery or owing to patient preference but 7% would recommend PET to fit elderly patients. Most (76%) use letrozole. The percentage of elderly patients treated with PET varied from <10% to 70% between surgeons. The majority (77%) of respondents had not formally audited the outcome of their PET patients and over 70% underestimated the expected survival of an 80-year-old woman.

CONCLUSIONS

Most UK breast surgeons use PET in elderly patients with surgically resectable breast cancer. While most use it in unfit, frail patients, a minority would treat even fit elderly women with PET. Most surgeons have not formally audited the outcome of their patients treated with PET and underestimate the expected survival of elderly patients, which might have an impact on their decision to offer PET rather than surgery.

P3-14-12: Local Control of Primary Breast Cancer Treated with Radical Radiotherapy Alone after Neoadjuvant Chemotherapy

Introduction: The aim of this retrospective study was to evaluate the local recurrence rates in a cohort of patients who achieved a complete clinical response (cCR) to neoadjuvant chemotherapy and did not have surgery.

Materials and Methods: 148 women who achieved a cCR to neoadjuvant chemotherapy were identified from a prospectively maintained database (1995-2011) of 667 patients. 122 patients went on to have surgery (either wide local excision or mastectomy) followed by radiotherapy. In 26 patients (median age 49, range 35–72 years; T2-T4, N0-N3, M0), no surgery was performed but all received radical radiotherapy. Surgery was avoided due to either physician or patient choice. Recurrence was defined as first relapse of disease, either local (ipsilateral breast and/or axilla) or distant.

Results: All 26 patients who avoided surgery had neoadjuvant chemotherapy with 20 patients (77%) receiving anthracycline-based (FEC, FAC, ECF), 5 (19%) MMM and 1 (4%) CMF chemotherapy. The median number of cycles was 6 (range 4–8). Chemotherapy was followed by radical external beam radiotherapy to the breast +/− supraclavicular fossa and axilla (median dose delivered, 60Gy in 2Gy fractions). All were identified as operable at diagnosis including 3 patients who had supraclavicular lymphadenopathy. All 26 patients achieved a final cCR in the breast to chemotherapy. 21 patients had imaging with mammography and/or ultrasonography to assess radiological response at the end of neoadjuvant chemotherapy, of which 19 had a complete response and 2, a partial response. After a median follow-up of 144 months, 10/26 (38%) patients experienced local disease recurrence (2 also had distant recurrence) and 4/26 (15%) patients with distant metastases only. Patients with local recurrence only, went on to have a mastectomy whilst those with distant disease received systemic therapy. There were 10 deaths, 9 of which were breast cancer related (33%).

Conclusions: Local recurrence rates were high in patients achieving a cCR following neoadjuvant chemotherapy and who avoided surgery. Our practice has subsequently changed to include clip insertion and surgical excision on completion of chemotherapy. With increasing pathologic complete response rates to more active chemotherapy schedules (including taxanes +/− herceptin), it is being proposed that surgery could be avoided in selected patients. Our study shows that caution should be exercised.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-14-12.

The impact of discussing preoperative fasting with patients

Patients awaiting surgery are often fasted preoperatively well in excess of the recommended fasting times. Educated perioperative practitioners were asked to discuss preoperative starvation with patients. Preoperative starvation period for clear fluids was significantly reduced from a mean of 8 hours 30 minutes in the original audit, to 6 hours 10 minutes in this study of 113 patients (p < 0.001). Improving patient understanding of preoperative fasting can increase compliance with fasting recommendations.

Peritonitis following a bariatric procedure in a young woman

A 22-year-old woman presented with generalised peritonitis from a gastric perforation due to erosion by an intragastric balloon inserted abroad 22 months previously in an attempt to help her lose weight. These balloons are of uncertain long-term benefit in obesity and should be removed after 6 months to avoid complications. This did not happen in this case; thus, leading to this life-threatening complication, which was treated with the removal of the balloon and omental patch repair of the perforation.

Abstract P5-10-20: Breast Cancer Multi Disciplinary Team (MDT)Adjuvant Chemotherapy Decision: Impact of Adjuvant! Online Estimates of 10-Year Risk of Death and Chemotherapy Benefit on the Decision Making Process

Introduction: Breast cancer patients in the UK National Health Service (NHS) are cared for by breast cancer multidisciplinary teams (MDT). The wide range of knowledge and experience available in MDT produce a collective expert opinion on the management strategy for individual patients. Adjuvant! Online is an online computer programme that makes quantitative estimates of the effect of adjuvant chemotherapy (CT) on the 10-year risk of death and relapse. We studied whether the Adjuvant! Online produced numerical estimates would influence the adjuvant CT decision making of a breast cancer MDT.

Methods and Materials: We prospectively monitored a breast cancer MDT for a period of 12 months. Once the MDT had finished discussing a patient and adjuvant therapy decisions were made, Adjuvant! Online produced 10-year risk of breast cancer related death and the reduction of this risk that may be achieved by adjuvant CT were presented to the MDT. Any change to the original MDT recommendations as a result of this information was recorded.

Results: 109 post-operative early breast cancer patients that were suitable for input into Adjuvant! Online discussed in 41 MDT's were included in the study. Adjuvant therapy decisions included chemotherapy (n=56), radiotherapy (n=96) and endocrine therapy (n=89). The numerical estimates from Adjuvant! Online only changed the management of one patient, by showing a marginal (3.8%) survival benefit with CT that made the MDT offer chemotherapy to this patient where the original decision was not to.

Conclusions: Most adjuvant therapy decisions are easy to make without the need for numerical estimates of benefit when the MDT's are staffed by experienced breast cancer clinicians. Regular use of Adjuvant! Online or similar aids may not be necessary during the MDT discussion. These could be used on a selective basis where there is difficulty reaching a consensus.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-10-20.

Abstract P6-14-12: Early Breast Cancer in Elderly Women Treated with an Aromatase Inhibitor (Letrozole) as Sole Therapy

Background: Surgery, followed by appropriate adjuvant therapy, remains the optimal management for women with early breast cancer. However a significant proportion of elderly patients are either unfit, or less commonly, unwilling to undergo surgery. Primary endocrine therapy (PET) is an option in these women when the carcinoma is oestrogen/progesterone receptor positive. Tamoxifen has been shown to be a successful treatment strategy for these patients. Aromatase inhibitors (AI) are better than tamoxifen with regards to disease-free survival in the adjuvant setting, but the role of these drugs as PET in early breast cancer is not well studied. We reviewed our experience of using Letrozole, an AI, as PET with regards to survival and tumour response.

Methods: The records of all patients with newly diagnosed histologically confirmed (by core biopsy) early (non-metastatic) oestrogen and/or progesterone receptor positive breast cancer treated with letrozole from February 2001 to September 2009 were reviewed. Inoperable and locally advanced tumours at presentation were excluded. Reasons for offering PET (rather than surgery), survival, cause of death, time taken to achieve a tumour response, time to achieve the best tumour response obtained with letrozole and failure rate after initial response were studied. Results: 104 patients met the inclusion criteria. Median age was 83 years (58-98). Five cancers were screen-detected and 99 presented symptomatically. The reasons for PET were frailty (n=48), significant comorbidity (n=30), old age (n=9), and patient preference (n=17). Median follow-up (time from diagnosis to death or date of censoring, n=104) was 56 months (4-106) and median overall survival was 35 months (4-103). Fifty five patients were alive at the time of censoring; 38 still on letrozole. Among 49 deaths 12 were from breast cancer, 30 from other causes and cause unknown in 7. 85 cancers (82%) responded to letrozole (stable disease (SD, n=19), partial response (PR, n=42) and complete response (CR, n=24)). The median time to show an initial response (PR or CR) was 4.5 months (2-24). The median time to achieve the best response with letrozole was 8.5 months (3-50). 60 of 85 patients who responded remained on letrozole as sole therapy until death or date of censoring. Letrozole was stopped in others (n= 25) due to progressive disease following an initial response (n=19), side-effects (n=5) and patient choice (n=1). Discussion: Elderly patients with hormone receptor positive breast cancer treated with letrozole as PET have a median survival of approximately 3 years, but breast cancer is not the main cause of death. Most die of associated comorbidity or age, the reason surgery was not offered initially. It takes 4.5 to 8.5 months of treatment to see an initial response and achieve the best response respectively so letrozole therapy should be given for an adequate length of time before its efficacy is assessed. This is one of the first studies examining the effect of letrozole as PET in hormone receptor positive early breast cancer and suggests letrozole is a reasonable alternative to surgery in elderly and unfit patients.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-14-12.

Exemestane after non-steroidal aromatase inhibitors for post-menopausal women with advanced breast cancer

A retrospective analysis was performed on 31 consecutive locally advanced or metastatic breast cancer patients who commenced exemestane 25mg/d orally following previous treatment with Tamoxifen and a non-steroidal third-generation aromatase inhibitor (AI). Patients were seen 3 monthly until clinical or radiological disease progression. Median age was 64 years (range 34-90 yrs). The average number of recurrences before starting exemestane was three (range 1-6). There were two complete responses (CR), four partial responses (PR), 12 with stable disease (SD) and 12 with progressive disease (PD). Objective response rate (CR+PR) was 19.4% and overall clinical benefit (CR+PR+SD >or= 24 weeks) was 54.8%. The median durations of objective response and overall clinical benefit were 18 and 14 months, respectively. This data support the anti-tumour activity of exemestane 25mg daily in patients with locally advanced and/or metastatic breast cancer who have been previously exposed to non-steroidal AIs and Tamoxifen.

Neoadjuvant endocrine therapy in breast cancer

The use of endocrine therapy is well established as a primary treatment for locally advanced breast cancer. However, despite the current popularity of neoadjuvant chemotherapy for operable tumours, there is relatively little published evidence for pre-operative endocrine therapy in operable disease, particularly outside of the elderly population. The wider use of aromatase inhibitors (AIs) has encouraged studies that compare the efficacy of AIs with tamoxifen in the neoadjuvant setting, but there remains a lack of comparison of neoadjuvant with adjuvant endocrine therapies. This review discusses the current evidence regarding primary endocrine therapy, along with the factors involved in choosing appropriate patients for neoadjuvant therapy and the current opinions on length of treatment time and measurement of response prior to surgery.

A study of children and adolescents referred to a rapid diagnosis breast clinic

AIM

Children and adolescents referred to a rapid diagnosis breast clinic were analysed to study the conditions these patients were referred with, their management, and the final outcome.

METHODS

All new patients aged 18 or under seen in a breast clinic over a 39-month period to June 2004 were identified and their case notes were reviewed.

RESULTS

Among 6930 new referrals, 88 (1.3 %) were aged 18 or under and 86 patients were included in the study (median age 16 yrs, range 8 - 18 yrs). Five patients were aged less than 12 and were referred with physiological breast buds. In girls aged 13 - 18 years, most were referred for an apparent palpable abnormality. Thirty percent had a family history of breast carcinoma and 35 % were on the oral contraceptive pill. Thirty-three patients (38 %) had a clinical examination only. Others, in addition to the clinical examination, had an ultrasound (US) (n = 24, 28 %), fine needle aspiration cytology (FNAC)/core biopsy (CB) (n = 5, 6 %) or both US and FNAC/CB (triple assessment) (n = 24, 28 %). No malignant disease was found. No diagnostic biopsies were performed. Only 5 patients had surgery, four for fibroadenoma and one for sebaceous cyst.

CONCLUSIONS

Patients aged 18 years or under do not constitute a major workload problem for rapid diagnosis breast clinics. Malignant disease remains rare. A significant proportion of patients require only clinical examination and reassurance. The diagnosis can usually be made without open biopsies and less invasively using FNAC or CB.

Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma

Core biopsy (CB) has now largely replaced fine-needle aspiration cytology (FNAC) in the preoperative assessment of breast cancer in the UK. We studied the contribution of FNAC and CB in the preoperative diagnosis of screen-detected breast carcinoma. Data were prospectively collected on 150 840 women who underwent breast screening over a 4-year period from 1999 to 2003. Data on women who had both FNAC and CB taken from the same lesion preoperatively and in whom surgical excision of the lesion subsequently confirmed malignancy was analysed. In 763 cancers, FNAC was inadequate (C1) in 8% and benign (C2) in 10%. Most of these cases presented with microcalcification (25% were C1 or C2). Core biopsy was not representative (B1) or benign (B2) in 7%. The absolute and complete sensitivities were 65 and 82% for FNAC and 80 and 93% for CB in the diagnosis of cancer. Core biopsy was abnormal (B3 or above) in 86% of the cancers missed by FNAC and FNAC was abnormal (C3 or above) in 65% of those missed by CB. Core biopsy is better than FNAC at preoperative diagnosis of screen-detected breast cancer as it missed fewer cancers. However, combining FNAC resulted in a better preoperative diagnosis rate.

Mammography in symptomatic women attending a rapid diagnosis breast clinic: a prospective study

INTRODUCTION

We determined whether it is safe to avoid mammograms in a group of symptomatic women with a non-suspicious history and clinical examination.

PATIENTS AND METHODS

Symptomatic women aged 35 years or over newly referred to a rapid-diagnosis breast clinic underwent mammography on arrival in the clinic. A breast radiologist reported on the mammograms. An experienced clinician who was unaware of the mammogram findings examined patients and decided whether a mammogram was indicated or not. If not, a management plan was formulated. Mammogram findings were then provided to the clinician and any change to the original management plan as a result of mammography was recorded.

RESULTS

In two-thirds (67%) of 218 patients, the clinician felt a mammogram was indicated. Half (46%) of these mammograms showed an abnormality; of these abnormal mammograms, 41% were breast cancer. Among the third (n = 71) of mammograms felt not to be indicated, 3 showed abnormalities of which 2 were breast cancer. One cancer was not suspected clinically or mammographically but was diagnosed on cyto/histopathological assessment.

CONCLUSIONS

A significant proportion of patients attending a symptomatic breast clinic have a non-suspicious history and normal clinical findings on examination. However, even in this group avoiding mammograms risks missing clinically occult breast cancers. It would appear sensible to offer mammograms to all symptomatic women over 35 years of age.