Four randomized trials encompassing 449 patients of non-palpable breast cancer undergoing with radio-guided occult lesion localization (ROLL) or wire guided localization (WGL). In the fixed effects model, accurate localization, peri-procedural complications, and reoperation rate were comparable between two techniques. Risk of having positive resection margins following WGL was higher. Duration of localization and surgical excision was shorter for ROLL. Volume and weight of the excised occult breast lesion was similar in WGL and ROLL groups.
To systematically analyze published randomized trials on the effectiveness of preoperative prophylactic antibiotics in patients undergoing breast surgical procedures. Trials on the effectiveness of preoperative prophylactic antibiotics in patients undergoing breast surgery were selected and analyzed to generate summated data (expressed as risk ratio [RR]) by using RevMan 5.0. Nine randomized controlled trials encompassing 3720 patients undergoing breast surgery were retrieved from the electronic databases. The antibiotics group comprised a total of 1857 patients and non-antibiotics group, 1863 patients. There was no heterogeneity [χ(2) = 7.61, d.f. = 7, p < 0.37; I(2) = 8%] amongst trials. Therefore, in the fixed-effects model (RR, 0.64; 95% CI, 0.50-0.83; z = 3.48; p < 0.0005), the use of preoperative prophylactic antibiotics in patients undergoing breast surgical procedures was statistically significant in reducing the incidence of surgical site infection (SSI). Furthermore, in the fixed-effects model (RR, 1.30; 95% CI, 0.89-1.90; z = 1.37; p < 0.17), adverse reactions secondary to the use of prophylactic antibiotics was not statistically significant between the two groups. Preoperative prophylactic antibiotics significantly reduce the risk of SSI after breast surgical procedures. The risk of adverse reactions from prophylactic antibiotic administration is not significant in these patients. Therefore, preoperative prophylactic antibiotics in breast surgery patients may be routinely administered. Further research is required, however, on risk stratification for SSI, timing and duration of prophylaxis, and the need for prophylaxis in patients undergoing breast reconstruction versus no reconstruction.
IntroductionThe commonest ultrasound guided surgical procedure performed worldwide is biopsy of breast lumps. This diagnostic procedure for carcinoma of the breast requires the utmost precision, and that is why extensive skill development employing simulation is required before surgeons or radiologists perform this procedure on patients. Commercial models are available priced at several hundred pounds, but unfortunately is not suitable for high fidelity simulation training due to needle tract development and difficulty in accommodating the large bore biopsy needles that is generally used obtain specimens for definitive tissue diagnosis of breast malignancy.Cheaper homemade phantoms suffer from similar limitations, are usually perishable and might not accurately resemble breast tissue. Animal tissue looks visually and ultrasonically different because it comes from different body parts. The latter two groups is perishable, and animal tissue have infection control and cultural issues. When we developed a material that achieved all the criteria for the perfect US medium,1 and felt like breast tissue, we resolved to see whether we could manufacture a low cost high fidelity simulation breast phantom.MethodWe prepared 700 ml ADAMgel (Aqueous Dietary fibre Antifreeze Mix gel) and poured it into a section of a nylon stocking and suspended it to cool down.ResultThis formed a breast phantom of the correct shape and texture, with similar ultrasonographic, tactile and haptic characteristics, resistant to needle tract formation even with large bore biopsy needles. As the substance is selfhealing it was possible to insert/remove/change various targets in the phantom as often as needed. This material is non-perishable and has shown no deterioration since its invention. The nylon stocking section would have to be replaced periodically. The total cost was <£1.ConclusionHigh fidelity reusable breast phantoms are not only possible, but can be done at a reasonable cost.ReferenceSultan S, Shorten G, Iohom G. Simulators for training in ultrasound guided procedures. Med Ultrasound 2013;5(2):125–131
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.