Melissa A. Bochner

Psychological impact and cosmetic outcome of surgical breast cancer strategies

Background:  Current surgical treatment modalities for breast cancer include breast conserving surgery, mastectomy alone and mastectomy with breast reconstruction. There are recognized benefits of breast conservation and breast reconstruction over mastectomy but there are few studies assessing this area in Australia. The aim of the present study was to compare the various surgical strategies for breast cancer treatment in terms of quality of life, cosmesis and patient satisfaction.

COMPARISON OF VOLUME DISPLACEMENT VERSUS CIRCUMFERENTIAL ARM MEASUREMENTS FOR LYMPHOEDEMA: IMPLICATIONS FOR THE SNAC TRIAL

Background:  The Royal Australasian College of Surgeons Sentinel Node versus Axillary Clearance trial is a randomized controlled trial comparing sentinel node biopsy with axillary clearance in breast cancer patients. Primary study end‐points include arm volume differences with time, which may indicate the development of lymphoedema. The RACS SNAC trial uses circumferential arm measurements in the estimation of arm volume. This study aimed to assess the accuracy of circumferential volume estimation in comparison with water displacement.

QUALITATIVE ASSESSMENT OF BREAST RECONSTRUCTION IN A SPECIALIST BREAST UNIT

Background:  Breast reconstruction is an integral part of the surgical management of women with breast cancer. It is often performed by plastic surgeons but, in some centres, it is performed by breast surgeons trained in breast reconstruction and oncoplastic surgery. We evaluated the objective and subjective outcomes of reconstruction for breast cancer at the Royal Adelaide Hospital Breast Unit (Adelaide, Australia) between 1990 and June 2002.

Breast volume replacement using the latissimus dorsi miniflap

Background:  Mastectomy is often recommended to women with early breast cancer who have large tumours or where the breast volume requiring resection to achieve adequate tumour clearance is too great to allow for a satisfactory cosmetic result after breast conservation surgery. The use of a latissimus dorsi muscular flap (latissimus dorsi miniflap (LDMF)) to replace the volume loss after major breast sector resection is an option where the tumour to breast volume ratio is large. The present study describes the technique and evaluates the experience of the LDMF at Royal Adelaide Hospital, Adelaide, Australia.

Removal of two sentinel nodes accurately stages the axilla in breast cancer.

Assessment of lymph node status in breast cancer is still necessary for staging. Sentinel lymph node biopsy (SNB) may provide accurate staging with less morbidity than axillary clearance. The aim of this study was to assess the effect of the number of sentinel nodes removed on the false‐negative rate.

Intraoperative imprint cytologic assessment of the sentinel node for early breast cancer

Abstract An increasing number of patients are undergoing sentinel node biopsy alone for axillary staging of early breast cancer. A reliable method for evaluating the status of the sentinel node intraoperatively would allow patients with sentinel node metastases to undergo immediate rather than delayed axillary clearance. Sentinel nodes in 53 consecutive patients were examined by intraoperative imprint cytology. When compared with subsequent analysis by hematoxylin-eosin staining and immunohistochemistry, the accuracy of imprint cytology for the detecting nodal metastases was 81.1%; the false negative rate was 47.0%, and there were no false positives. Results were made available to the operating surgeon within a mean time of 25 minutes. All but one of the false negatives involved micrometastatic deposits of less than 0.1 mm. Intraoperative imprint cytologic examination of the sentinel node is a useful technique that can be performed efficiently and without loss of nodal tissue for subsequent analysis. With the use of this technique, more than 50% of lymph node-positive patients would potentially be spared a second operation.

CLINICAL IMPACT OF ONCOPLASTIC SURGERY IN A SPECIALIST BREAST PRACTICE

Background:  Oncoplastic breast surgery is an integral and fundamental component of the clinical management of breast cancer. The aim of this study was to determine the proportion of oncoplastic and reconstructive breast cancer procedures undertaken within a specialist breast practice.

MINIMALLY INVASIVE PARATHYROIDECTOMY USING SURGEON-PERFORMED ULTRASOUND AND SESTAMIBI

Background:  Surgeon‐performed ultrasound (SPU) and 99mTc‐sestamibi (SM) scanning can be used alone or in combination in patients with primary hyperparathyroidism to select cases suitable for minimally invasive parathyroidectomy (MIP). The aim of the study was to evaluate SPU and SM and to determine the reliability they provide the surgeon in planning and carrying out MIP.

Pasieka illness questionnaire: Its value in primary hyperparathyroidism

Background:  A prospective study was undertaken to assess the Pasieka Illness Questionnaire (PIQ) as a clinical evaluation and outcome tool in an Australian setting. The PIQ was specifically designed to assess the impact of surgery on the preoperative symptoms of patients with primary hyperparathyroidism (1° HPT).

A comparison of vitamin D activity in paired non-malignant and malignant human breast tissues.

Links between a low vitamin D status and an increased risk of breast cancer have been observed in epidemiological studies. These links have been investigated in human tissue homogenates and cultured cell lines. We have used non-malignant, malignant and normal reduction mammoplasty breast tissues to investigate the biological and metabolic consequences of the application of vitamin D to intact ex vivo human breast tissue. Tissues were exposed to 1α,25(OH)(2)D(3) (1,25D; active metabolite) and 25(OH)D (25D; pre-metabolite). Changes in mRNA expression and protein expression after vitamin D exposure were analysed. Results indicate that while responses in normal and non-malignant breast tissues are similar between individuals, different tumour tissues are highly variable with regards to their gene expression and biological response. Collectively, malignant breast tissue responds well to active 1,25D, but not to the inactive pre-metabolite 25D. This may have consequences for the recommendation of vitamin D supplementation in breast cancer patients.