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  1. Article ; Online: Monopolar diathermy versus a vessel-sealing device for reducing postoperative drain output after simple mastectomy: randomized clinical trial.

    Keelan, Stephen / Dowling, Gavin P / Roche, Trudi / Hegarty, Aisling / Davey, Matthew G / Dhannoon, Amenah A / O'Grady, Sorcha / Downey, Eithne / Bolger, Jarlath / Boland, Michael / Sorensen, Jan / Power, Colm / Butt, Abeeda / Baban, Chwanrow / Hill, Arnold D K

    The British journal of surgery

    2024  Volume 111, Issue 3

    Abstract: Background: Electrosurgical devices are commonly used during mastectomy for simultaneous dissection and haemostasis, and can provide potential benefits regarding vessel and lymphatic ligation. The aim of this prospective RCT was to assess whether using ... ...

    Abstract Background: Electrosurgical devices are commonly used during mastectomy for simultaneous dissection and haemostasis, and can provide potential benefits regarding vessel and lymphatic ligation. The aim of this prospective RCT was to assess whether using a vessel-sealing device (LigaSure™) improves perioperative outcomes compared with monopolar diathermy when performing simple mastectomy.
    Methods: Patients were recruited prospectively and randomized in a 1 : 1 manner to undergo simple mastectomy using either LigaSure™ or conventional monopolar diathermy at a single centre. The primary outcome was the number of days the drain remained in situ after surgery. Secondary outcomes of interest included operating time and complications.
    Results: A total of 86 patients were recruited (42 were randomized to the monopolar diathermy group and 44 were randomized to the LigaSure™ group). There was no significant difference in the mean number of days the drain remained in situ between the monopolar diathermy group and the LigaSure™ group (7.75 days versus 8.23 days; P = 0.613) and there was no significant difference in the mean total drain output between the monopolar diathermy group and the LigaSure™ group (523.50 ml versus 572.80 ml; P = 0.694). In addition, there was no significant difference in the mean operating time between the groups, for simple mastectomy alone (88.25 min for the monopolar diathermy group versus 107.20 min for the LigaSure™ group; P = 0.078) and simple mastectomy with sentinel lymph node biopsy (107.20 min for the monopolar diathermy group versus 114.40 min for the LigaSure™ group; P = 0.440).
    Conclusion: In this double-blinded single-centre RCT, there was no difference in the total drain output or the number of days the drain remained in situ between the monopolar diathermy group and the LigaSure™ group.
    Registration number: EudraCT 2018-003191-13 BEAUMONT HOSPITAL REC 18/66.
    MeSH term(s) Humans ; Female ; Mastectomy, Simple ; Breast Neoplasms/surgery ; Prospective Studies ; Mastectomy ; Diathermy
    Language English
    Publishing date 2024-03-18
    Publishing country England
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znae029
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    Uk I Zs.66: Show issues Location:
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  2. Article ; Online: Assessing Mode of Recurrence in Breast Cancer to Identify an Optimised Follow-Up Pathway: 10-Year Institutional Review.

    Horan, Jack / Reid, Conor / Boland, Michael R / Daly, Gordon R / Keelan, Stephen / Lloyd, Angus J / Downey, Eithne / Walmsley, Adam / Staunton, Marie / Power, Colm / Butt, Abeeda / Duke, Deirdre / Hill, Arnold D K

    Annals of surgical oncology

    2023  Volume 30, Issue 10, Page(s) 6117–6124

    Abstract: Background: Breast cancer surveillance programmes ensure early identification of recurrence which maximises overall survival. Programmes include annual clinical examination and radiological assessment. There remains debate around the value of annual ... ...

    Abstract Background: Breast cancer surveillance programmes ensure early identification of recurrence which maximises overall survival. Programmes include annual clinical examination and radiological assessment. There remains debate around the value of annual clinical exam in diagnosing recurrent disease/second primaries. The aim was to assess diagnostic modalities for recurrent breast cancer with a focus on evaluating the role of annual clinical examination.
    Patients and methods: A prospectively maintained database from a symptomatic breast cancer service between 2010-2020 was reviewed. Patients with biopsy-proven recurrence/second breast primary were included. The primary outcome was the diagnostic modality by which recurrences/secondary breast cancers were observed. Diagnostic modalities included (i) self-detection by the patient, (ii) clinical examination by a breast surgeon or (iii) radiological assessment.
    Results: A total of 233 patients were identified and, following application of exclusion criteria, a total of 140 patients were included. A total of 65/140 (46%) patients were diagnosed clinically, either by self-detection or clinical examination, while 75/140 (54%) were diagnosed radiologically. A total of 59/65 (91%) of patients clinically diagnosed with recurrence presented to the breast clinic after self-detection of an abnormality. Four (6%) patients had cognitive impairment and recurrence was diagnosed by a carer. Two (3%) patients were diagnosed with recurrence by a breast surgeon at clinical examination. The median time to recurrence in all patients was 48 months (range 2-263 months).
    Conclusion: Clinical examination provides little value in diagnosing recurrence (< 5%) and surveillance programmes may benefit from reduced focus on such a modality. Regular radiological assessment and ensuring patients have urgent/easy access to a breast clinic if they develop new symptoms/signs should be the focus of surveillance programmes.
    MeSH term(s) Female ; Humans ; Ambulatory Care Facilities ; Biopsy ; Breast Neoplasms/diagnosis ; Chronic Disease ; Follow-Up Studies
    Language English
    Publishing date 2023-07-21
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-023-13885-7
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    Zs.A 4042: Show issues Location:
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    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: Value of Long-term Follow-up in Surgically Excised Lesions of Uncertain Malignant Potential in the Breast - Is 5 Years Necessary?

    Hennessy, Grace / Boland, Michael R / Bambrick, Marie / Crone, Lauren / Lloyd, Angus / Abdelwahab, Sami / Downey, Eithne / Staunton, Marie / Hambly, Niamh / Mhuircheartaigh, Neasa Ni / Kerr, Jennifer / Power, Colm / Duke, Deirdre / Hill, Arnold Dk

    Clinical breast cancer

    2022  Volume 22, Issue 7, Page(s) 699–704

    Abstract: Introduction: B3 lesions are a heterogeneous group of breast lesions of uncertain malignant potential which usually require excision. The aim was to assess the efficacy of 5 years routine radiological or clinical follow-up of patients who had "high-risk" ...

    Abstract Introduction: B3 lesions are a heterogeneous group of breast lesions of uncertain malignant potential which usually require excision. The aim was to assess the efficacy of 5 years routine radiological or clinical follow-up of patients who had "high-risk" B3 lesions surgically excised, by analyzing recurrence and subsequent development of invasive/in-situ cancer.
    Patients and methods: A 10-year retrospective review from 2010 to 2019 was performed of B3 lesions diagnosed on core needle biopsy, including patients who proceeded to surgical excision with a high-risk lesion on final histology. The database recorded 6 specific B3 lesion categories: 1. Atypical ductal hyperplasia (ADH), 2. Radial scars/complex sclerosing lesions (CSLs) with epithelial atypia 3. Classical Lobular neoplasia (ALH/LCIS), 4. Papillary lesions with epithelial atypia, 5. Mixed, 6. Flat epithelial atypia (FEA), including radiological and clinical follow-up data.
    Results: Six hundred sixteen patients had a B3 lesion after core biopsy. 110 patients had "high risk" lesions. This included 17 (15.5%) Atypical Ductal Hyperplasia (ADH), 22 (20%) radial scars/CSLs with epithelial atypia, 47 (42.7%) classical lobular neoplasia (LCIS/ALH), 7 (6.4%) papillary lesions with epithelial atypia, 13 (11.8%) mixed lesions & 4 (3.6%) Flat Epithelial Atypia (FEA) lesions. 4 of 110 (3.6%) developed invasive/in-situ disease and 4 of 110 (3.6%) developed recurrence during follow-up. 33 of 616 (5.4%) upgraded to invasive/preinvasive disease after surgical excision.
    Conclusion: Five years of routine radiological surveillance may not be necessary in patients who undergo surgical excision of "high-risk" B3 lesions. Clinical surveillance appears to be of little benefit, especially in patients with radial scars, papillary lesions, and FEA. Subsequent development of invasive/in-situ disease in patients who undergo surgical excision of atypical B3 lesions remains low.
    MeSH term(s) Biopsy, Large-Core Needle ; Breast/diagnostic imaging ; Breast/pathology ; Breast/surgery ; Breast Neoplasms/pathology ; Breast Neoplasms/surgery ; Carcinoma in Situ ; Carcinoma, Intraductal, Noninfiltrating/pathology ; Cicatrix/etiology ; Female ; Fibrocystic Breast Disease/pathology ; Follow-Up Studies ; Humans ; Mammography ; Precancerous Conditions/pathology ; Retrospective Studies
    Language English
    Publishing date 2022-06-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2106734-X
    ISSN 1938-0666 ; 1526-8209
    ISSN (online) 1938-0666
    ISSN 1526-8209
    DOI 10.1016/j.clbc.2022.05.009
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    Zs.A 5800: Show issues Location:
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    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)
    Zs.MO 498: Show issues

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  4. Article ; Online: Breast cancer patients with a negative axillary ultrasound may have clinically significant nodal metastasis.

    Keelan, Stephen / Heeney, Anna / Downey, Eithne / Hegarty, Aisling / Roche, Trudi / Power, Colm / Mhuircheartaigh, Neasa Ni / Duke, Deirdre / Kerr, Jennifer / Hambly, Niamh / Hill, Arnold

    Breast cancer research and treatment

    2021  Volume 187, Issue 2, Page(s) 303–310

    Abstract: Introduction: The non-invasive nature of the preoperative axillary ultrasound (AUS) fits the current trend of increasingly conservative axillary management. Recent publications suggest that early disease patients with clinically and radiologically ... ...

    Abstract Introduction: The non-invasive nature of the preoperative axillary ultrasound (AUS) fits the current trend of increasingly conservative axillary management. Recent publications suggest that early disease patients with clinically and radiologically negative axillae do not require sentinel lymph node biopsy (SLNB). This study aims to determine the true extent of axillary node disease in negative preoperative AUS patients.
    Methods: A 10-year breast cancer registry was reviewed to identify women with pathologically confirmed T1-2 invasive breast cancer and a negative preoperative AUS. Patients who received neoadjuvant chemotherapy were excluded. Combined positive lymph node count of SLNB ± ALND was used to determine total nodal burden (TNB). Axillae were classified into low nodal burden (LNB) defined as 1-2 positive nodes and high nodal burden (HNB) defined as ≥ 3 positive nodes.
    Results: 762 patients with negative AUS were included. There were 46.9% and 53.0% T1 and T2 tumours, respectively. 76.9% were node negative (0 LN +), 18.9% had LNB (1-2 LN +) and 4.2% had HNB (≥ 3LN +). Specifically, HNB disease was seen in 2% of T1 tumours and 6.2 % of T2 tumours with a negative AUS. In multivariate analysis, T2 strongly associated with ≥ 3 positive ALNs (OR 2.66 CI 1.09-6.51 p = 0.03) as did lymphovascular invasion (OR 3.56 CI 1.52-8.30 p =  < 0.01).
    Conclusion: This study shows that AUS in its current form cannot exclude HNB axillary metastasis to the extent of eliminating the need for surgical staging of the axilla. This may impact axillary local-regional recurrence and disease-free survival. We caution that a negative AUS has a rate of 4.2% of HNB. Therefore, in cases of negative AUS with a T2 tumour, we advocate continued use of SLNB.
    MeSH term(s) Axilla/pathology ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/pathology ; Breast Neoplasms/therapy ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes/diagnostic imaging ; Lymph Nodes/pathology ; Lymph Nodes/surgery ; Lymphatic Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Sentinel Lymph Node Biopsy
    Language English
    Publishing date 2021-04-10
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 604563-7
    ISSN 1573-7217 ; 0167-6806
    ISSN (online) 1573-7217
    ISSN 0167-6806
    DOI 10.1007/s10549-021-06194-8
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1655: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  5. Article ; Online: Successful maintenance of process and outcomes for oesophageal cancer surgery in Ireland during the first wave of the COVID-19 pandemic.

    Bolger, Jarlath C / Donlon, Noel E / Butt, Waqas / Neary, Colm / Al Azzawi, Mohammed / Brett, Orla / King, Sinead / Downey, Eithne / Arumugasamy, Mayilone / Murphy, Thomas / Robb, William B / Collins, Chris G / Carroll, Paul A / Donohoe, Claire L / Ravi, Narayanasamy / Reynolds, John V

    Irish journal of medical science

    2021  Volume 191, Issue 2, Page(s) 831–837

    Abstract: Introduction: The emergence of the novel coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the coronavirus disease COVID-19 has impacted enormously on non-COVID-19-related hospital care. Curtailment of intensive care unit (ICU) ...

    Abstract Introduction: The emergence of the novel coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the coronavirus disease COVID-19 has impacted enormously on non-COVID-19-related hospital care. Curtailment of intensive care unit (ICU) access threatens complex surgery, particularly impacting on outcomes for time-sensitive cancer surgery. Oesophageal cancer surgery is a good example. This study explored the impact of the pandemic on process and short-term surgical outcomes, comparing the first wave of the pandemic from April to June in 2020 with the same period in 2019.
    Methods: Data from all four Irish oesophageal cancer centres were reviewed. All patients undergoing resection for oesophageal malignancy from 1 April to 30 June inclusive in 2020 and 2019 were included. Patient, disease, and peri-operative outcomes (including COVID-19 infection) were compared.
    Results: In 2020, 45 patients underwent oesophagectomy, and 53 in the equivalent period in 2019. There were no differences in patient demographics, co-morbidities, or use of neoadjuvant therapy. The median time to surgery from neoadjuvant therapy was 8 weeks in both 2020 and 2019. There were no significant differences in operative interventions between the two time periods. There was no difference in operative morbidity in 2020 and 2019 (28% vs 40%, p = 0.28). There was no in-hospital mortality in either period. No patient contracted COVID-19 in the perioperative period.
    Conclusions: Continuing surgical resection for oesophageal cancer was feasible and safe during the COVID-19 pandemic in Ireland. The national response to this threat was therefore successful by these criteria in the curative management of oesophageal cancer.
    MeSH term(s) COVID-19 ; Esophageal Neoplasms/epidemiology ; Esophageal Neoplasms/surgery ; Humans ; Ireland/epidemiology ; Pandemics ; SARS-CoV-2
    Language English
    Publishing date 2021-03-16
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 390895-1
    ISSN 1863-4362 ; 0021-1265
    ISSN (online) 1863-4362
    ISSN 0021-1265
    DOI 10.1007/s11845-021-02597-0
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    Zs.B 323: Show issues Location:
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  6. Article ; Online: Development and validation of a clinical prediction rule to identify suspected breast cancer: a prospective cohort study.

    Galvin, Rose / Joyce, Doireann / Downey, Eithne / Boland, Fiona / Fahey, Tom / Hill, Arnold K

    BMC cancer

    2014  Volume 14, Page(s) 743

    Abstract: Background: The number of primary care referrals of women with breast symptoms to symptomatic breast units (SBUs) has increased exponentially in the past decade in Ireland. The aim of this study is to develop and validate a clinical prediction rule (CPR) ...

    Abstract Background: The number of primary care referrals of women with breast symptoms to symptomatic breast units (SBUs) has increased exponentially in the past decade in Ireland. The aim of this study is to develop and validate a clinical prediction rule (CPR) to identify women with breast cancer so that a more evidence based approach to referral from primary care to these SBUs can be developed.
    Methods: We analysed routine data from a prospective cohort of consecutive women reviewed at a SBU with breast symptoms. The dataset was split into a derivation and validation cohort. Regression analysis was used to derive a CPR from the patient's history and clinical findings. Validation of the CPR consisted of estimating the number of breast cancers predicted to occur compared with the actual number of observed breast cancers across deciles of risk.
    Results: A total of 6,590 patients were included in the derivation study and 4.9% were diagnosed with breast cancer. Independent clinical predictors for breast cancer were: increasing age by year (adjusted odds ratio 1.08, 95% CI 1.07-1.09); presence of a lump (5.63, 95% CI 4.2-7.56); nipple change (2.77, 95% CI 1.68-4.58) and nipple discharge (2.09, 95% CI 1.1-3.97). Validation of the rule (n = 911) demonstrated that the probability of breast cancer was higher with an increasing number of these independent variables. The Hosmer-Lemeshow goodness of fit showed no overall significant difference between the expected and the observed numbers of breast cancer (χ(2)HL: 6.74, p-value: 0.56).
    Conclusions: This study derived and validated a CPR for breast cancer in women attending an Irish national SBU. We found that increasing age, presence of a lump, nipple discharge and nipple change are all associated with increased risk of breast cancer. Further validation of the rule is necessary as well as an assessment of its impact on referral practice.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms/diagnosis ; Breast Neoplasms/epidemiology ; Early Detection of Cancer/methods ; Evidence-Based Medicine ; Female ; Humans ; Ireland/epidemiology ; Middle Aged ; Prospective Studies ; Regression Analysis ; Risk Assessment ; Risk Factors ; Young Adult
    Language English
    Publishing date 2014-10-03
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1471-2407
    ISSN (online) 1471-2407
    DOI 10.1186/1471-2407-14-743
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