With advances in the sensitivity of mammographic screening and the broader population of women screened via national programmes. More than 50% of all new breast cancers in the United Kingdom are screen-detected and of the 11,110 invasive breast cancers (78.7 per cent of all UK cancers) detected in the year 2007-2008, 5814 (52.3 per cent) measured 15 mm or less in diameter and were deemed clinically non-palpable. For excision of non-palpable lesions, localisation techniques are currently largely limited to wire-guided localisation with the associated risks of migration, transection and scheduling conflicts. In this review we will describe the current gold-standard of wire-guided localisation (WGL), its associated merits and limitations before reporting on the data available for Radioguided Occult Lesion Localisation (ROLL) and Radiolabeled Seed Localisation (RSL) trials.
Background
The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions.
Methods
This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting.
Findings
Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey.
Conclusions
The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.
Providing the numbers of procedures are within defined limits, the radiation risks posed to pregnant surgeons undertaking sentinel node procedures are limited and within the regulatory guidelines for pregnancy.
Henoch-Schonlein purpura is a vasculitis affecting small arterial vessels. Occasionally, cases are referred for a general surgical opinion due to bowel involvement in the form of abdominal pain with or without rectal bleeding. However, surgical intervention is rarely required. We describe a case of Henoch-Schonlein purpura in a young man who went on to develop ischaemic bowel requiring resection.
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