Ashraf Patel

Radial scars : a review of 30 cases

Radial Scars/Complex Sclerosing Lesions are benign breast lesions that are seen more frequently now with the advent of screening mammography. These lesions need to be excised surgically in the absence of classical diagnostic features.

Role of Axillary Ultrasound in Defining Surgical Management of Breast Cancer Patients with Nodal Disease.

Background:With the introduction of Sentinel Lymph Node Biopsy, breast cancer patients with nodal disease have to undergo second surgical axillary procedure. The aim of our study was to correlate the accuracy of ultrasound in redefining surgery in breast cancer patients.Methods:The records of all breast cancer patients who underwent Axillary Lymph Node Dissection (ALND) from January 2008 to December 2008 were reviewed. Of these, patients who had pre operative axillary ultrasound and/or fine needle aspiration cytology were included. All ultrasound were performed by the radiologist with special interest in breast imaging at our breast centre. Comparison of the ultrasound and FNA findings with ALND findings was performed.Results:Seventy Five patients had axillary ultrasound during this period. Twenty five patients (32.3%) had abnormal ultrasound findings. Of these, 22 patients had positive surgical staging and three patients had negative surgical staging. Ten of the abnormal axilla had FNAC done. Of these, seven patients had metastatic cells and all of these patients have finally proven to have positive axillary lymph nodes. Of the fifty patients (67.7%) with normal axilla, 34 patients had negative surgical staging and 16 had positive staging The sensitivity of ultrasound axilla was 57.89%, and specificity was 96%. The positive predictive value was 88% and the negative predictive value was 78.57%Discussion:Ultrasound examination of axilla is a safe and fast method of assessing the lymph nodal status in the preoperative staging of axilla. The results of our study are mostly in agreement with previous published studies. This will reduce the number of patients having to undergo a second axillary procedure, hence saving resources both financially and operating time. It will reduce the number of hospital admissions for the patient; improve cost effectiveness and the patient pathway. We therefore recommend routine axillary ultrasound with FNAC of suspicious/pathological nodes to avoid sentinel node procedure i.e., proceed directly to axillary clearance. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1033.

A way to reduce the number of benign breast biopsies in a screening programme

Analysis of ductal carcinoma in situ detected at screening has shown bias towards high grade disease; the consensus of opinion amongst pathologists is the detection of high grade DCIS is important in preventing the subsequent development of invasive cancer some years later. Similarly our analysis his shown that identification of high grade DCIS as microcalcitications facilitates the detection of small high grade invasive tumours at a stage when treatment is much more likely to be effective. There is increasing interest in the role of screening in the surveillance of patients at increased risk of breast cancer those with a significant family history and those with previous biopsy showing epithelial changes associated with increased risk. As yet there is no consensus on how the two manage these patients. Women shown to be genetically predisposed as carriers of the BRCAl or BRCA2 gene should be counselled for possible bilateral mastectomies while those with lesser risk may benefit from regular mammographic screening. However, the evidence for any mortality benefit from such screening remains sparse. Achieving pre-operative diagnosis is important for patient well being and the reintroduction of core biopsy using rapid fire guns has allowed many centres to improve their pre-operative diagnosis rates to above 95% and at the same time dramatically reduce the number of diagnosis surgical biopsies performed for what proves to be benign disease. More recently in the UK some analysis of overall breast cancer mortality benefit has suggested that breast cancer screening may be showing early signs in effect with mortality rates falling, particularly in women in the 50 to 70 age range. Analysis has shown that this fall in mortality is associated with improvement in breast cancer stage rather than being attributable to improved treatment. Similarly data in Nottingham over a 20 year period has demonstrated a dramatic fall in breast cancer mortality which correlates closely with a significant fall in tumour size at the time of diagnosis. This data is very encouraging for a predicted significant fall in mortality attributable to earlier diagnosis by screening.