Necrotising fasciitis is a rare but rapidly progressive soft tissue disease which can lead to extensive necrosis, systemic sepsis and death. Including this case, only 7 other cases have been reported in the world literature with only 2 others affecting the patient post mastectomy.This 59 year old Caucasian lady presented with severe soft tissue infection soon after mastectomy, which was successfully treated with a combination of debridement, triangulation, VAC© dressing and skin grafting.Necrotising soft tissue infections following mastectomy are rapidly progressive and potentially extremely serious. It is essential that a high index of clinical suspicion is maintained together with prompt aggressive treatment in a multidisciplinary environment to prevent worsening physical and psychological sequelae.
Contrast-enhanced special CT permits accurate morphologic assessment (size, infiltration) of pharyngeal and supraglottic laryngeal squamous cell carcinoma, while pathologic lymph nodes already have a sufficient contrast enhancement for the detection.
#1003 Introduction: Rapid intraoperative molecular analysis of sentinel lymph nodes (SLNs) in breast cancer (BC) patients has the advantage of providing the surgeon with an immediate automated result, without the opinion of a consultant histopathologist, allowing axillary dissection to proceed in SLN positive patients. We undertook a multicentre, prospective evaluation of the OSNA system (One Step Nucleic Acid Amplification) for molecular analysis, to evaluate this new diagnostic technique's accuracy and feasibility for use in our hospital system. This abstract reports our 'Phase 2 - Intraoperative' experience.
 Method: Four study centres, both district general and major teaching hospitals took part in the evaluation. SLNs from breast cancer patients were excised using standard surgical techniques. Fresh SLNs were defatted and cut into 4 x 1 or 2mm slices depending on size and weight. Alternate slices underwent lysate preparation and immediate OSNA molecular analysis (detection and amplification of CK19 mRNA); remaining slices were processed for permanent section - intensive haematoxylin & eosin and immunohistochemistry (CK19 and AE1/AE3) examination (25μm multistep sections, 5 levels). OSNA results were correlated with final histopathology findings. Processing times were also recorded. No clinical decision was made based on the intraoperative OSNA result.
 Results: 396 lymph node samples were included in the analysis. Concordance with histopathology was 96.2% overall with all sites reaching concordance >95%. Overall sensitivity was 91.5%, specificity 97.2%, positive predictive value 87.7%, negative predictive value 98.1%. Concordance of OSNA with histopathology for lobular carcinoma (34 SLN samples) was >95%. There were 14 cases of tissue allocation bias confirmed on repeated molecular and histology testing that were excluded from overall results. Minimum time to reach a result on a single node was 22 minutes.
 Conclusion: The OSNA molecular system for SLN diagnosis provides an accurate and feasible intraoperative assessment of SLN status, achieving consistent results across multiple centres. This system may replace current histopathology-based techniques for intraoperative SLN analysis due to high concordance with histology and that it does not require input from a consultant pathologist. OSNA could allow more breast cancer patients in the UK access to one step axillary surgery. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1003.
Background: NEW START-a structured, validated multi-professional surgical training programme, was established to allow rapid transfer of appropriate knowledge and technical skills to ensure safe and competent practice of sentinel lymph node biopsy (SLNB) across the UK. Methods: Multi-professional teams attended a theory/skills-lab course delivering a standardized educational package, following which they performed SLNB in 30 consecutive patients, either concurrently with their standard axillary staging procedure — mentorship training model-or as stand-alone SLNB — apprenticeship training model. An accredited NEW START trainer mentored the first 5 procedures in the participants’ hospital, or all 30 if stand-alone. Validation standards were a localization rate of ≥90% and in the mentorship program where a minimum of 10 cases were node positive, a false-negative rate of ≥10%. SLNB was performed according to a standardised protocol using the combined technique of isotope (0.05-0.1ml of 99mTc-albumin colloid — Nanocoll®) and blue dye (Patent blue V) injected into the tumour quadrant peri-areolar tissue. Isotope was injected intra-dermally and static scintigraphic images were obtained, blue dye was injected sub-dermally after anaesthetic induction. Results: From October 2004 to December 2008, 210 SLNB naive surgeons, in 103 centres, performed 6,685 SLNB procedures of which 31% (2,098/6,685) were node positive. The mentorship training model was followed in 87% (5,849/6,685). Scintigraphy identified axillary lymph node drainage in 85% (5,564/6,511) with an overall SLN localization rate of 98.9% (6,610/6,685, 95% CI 98.6% to 99.1%). Node positivity was higher (P<0.001) for failed (58.7%, 44/75) than successful (31.1%, 2054/6610) localizations. The mentorship false negative rate (FNR) was 8.9% (163/1821, 95% CI 7.7% to 10.4%). The median SLN yield was 2.0 (range 1-11). SLN localization and FNR improved with surgeon caseload so that after 20 procedures the FNR fell below 10% but no statistically significant learning curve was identified. The FNR patients who had one SLN harvested was 14.8%. The FNR rate declined to 9.4%, 6.3%, 4.5% and 4.0% for those patients with 2, 3, 4 and more than 4 SLNs removed. Conclusion: NEW START demonstrates that a standardized injection protocol and structured multi-professional training can abolish learning curves so ensuring patient safety during national adoption of a new technique. Tumor quadrant injection using both isotope and dye has a high localization rate and low false-negative rate. Failed localization indicates higher probability of axillary nodal involvement. It is not necessary to remove more than 4 SLNs to achieve a FNR of less than 5%. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-01.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.