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AIM: Oncoplastic techniques are increasingly used to facilitate breast conservation and maintain breast aesthetics but evidence with regards to the oncological safety of oncoplastic breast conservation surgery (oBCS) remains limited. The aim of this study was to compare re-excision and local recurrence rates for oBCS with standard breast conserving surgery (sBCS). METHODS: From June 2003 to Feb 2010 data was obtained from contemporaneously recorded electronic patient records on patients who had oBCS and sBCS within a single breast cancer centre. Re-excision rates and local recurrence rates were compared. RESULTS: A total of 440 sBCS and 150 oBCS (in 146 women) were included in this study. Median tumour size and specimen weight was 21 mm and 67 g for oBCS and 18 mm and 40 g in the sBCS group (p < 0.001). Re-excision was 2.7% (4/150) and 13.4% (59/440) for oBCS and sBCS respectively (p < 0.001). At a median follow-up of 28 months, local relapse was 2.7% (4) and 2.2% (10) and distant relapse 1.3% (2) and 7.5% (33) for oBCS and sBCS respectively. CONCLUSIONS: Oncoplastic breast conserving techniques decrease re-excision rates. Early follow up data suggests oncological outcomes of oncoplastic breast conservation surgery are similar to standard breast conservation.

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There remain several outstanding questions relating to management of the axilla in women with early stage breast cancer. This paper summarises the outcome of a national debate aimed at discussing certain key issues including a) whether axillary dissection has any survival advantage b) is an axillary staging procedure always necessary c) what is the optimum method of staging the axilla and d) whether an axillary dissection is always necessary in cases of a positive sentinel node. Electronic voting was undertaken at the beginning and end of the debate and results are compared and presented herein.

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The concept of "the sentinel node" is false. In the axilla, the lymphatic system usually first drains into a group of low axillary nodes (level 1). The validity, as a staging procedure, of a 4 node axillary sample was demonstrated 30 years ago by Prof. Sir Patrick Forrest. Sentinel node biopsy (SNB) should not become the standard of care for all breast cancer patients. All the various options (axillary sampling, SNB, axillary dissection or simply a watchful attitude) are acceptable and to be advised according to the patient's wishes and conditions and to the tumour characteristics. We would also propose the change of the terminology from SNB to "guided axilary sampling" (GAS).

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The aim of this study was to determine whether a 27 gauge needle could be used to obtain adequate cytology with less discomfort to the patient. Two types of needles were compared-23 gauge (blue) needle versus 27 gauge very fine needle. The cytology specimen was assessed for quality in terms of adequacy for diagnosis. Ninety samples were randomised into this study. The quality of samples was similar in both groups; there was no statistical difference in the quality of samples obtained. The 27 gauge needle produced two inadequate samples (4.4%), whereas there were no inadequate samples with the 23 gauge needle. There was no statistical difference in the amount of blood on the slide between the two groups. The pain scores were significantly better with the finer needle (P=0.004). This study provides evidence that the 27 gauge FNAC is suitable for obtaining cytology in palpable breast lumps.

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UNLABELLED: Lymphoedema is reported to occur in approximately one in four women following curative treatment for breast cancer. Reported rates are almost exclusively for level 1,2,3 axillary clearance with few data for the current practice of level 1,2 dissections. Swelling can affect the whole upper limb but frequently will remain restricted to hand, forearm or upper arm. The aims of this study were to determine incidence after level 1,2 dissection, degree and site of swelling and risk factors which might determine such incidences. Results were available on 198 patients. The cumulative prevalence of lymphoedema after level 1,2 dissections was 14% in the arm, 12% in the forearm and 16% in the hand, assuming a circumference difference of more than 5% indicated lymphoedema. Moderate lymphoedema representing more than 10% circumference difference was found in 1% (arm), 3.5% (forearm) and 0.5% in the hand. Risk factors for lymphoedema were experience of the surgeon (upper arm only), dominant limb (forearm only) and right-sided cancer treatment (for hand only). When lymphoedema in any site was considered, right-sided treatment and nodal status were independently significant. CONCLUSIONS: This study demonstrates that lymphoedema is a common complication following level 1,2 dissection. Whole limb volume is often considered the main outcome measure for detecting lymphoedema and determining success of treatment, yet swelling may be restricted to regions of the limb and site specific circumference measurements are therefore recommended. Pre- and postoperative circumference measurements are likely to be the most sensitive way of determining presence of lymphoedema following surgery for breast cancer.

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Lymphadenopathy is common, affecting patients of all ages. The current referral pattern for investigating patients with lymphadenopathy varies widely with no universally practised pathway. Our institution set up a lymph node diagnostic clinic (LNDC) accepting direct referrals from primary care physicians. Details of clinical presentation and investigations were recorded prospectively. Between December 1996 and July 2001, 550 patients were referred (M: 203; F:347). The median age was 40 years (range 14-90). The median time between initial referral and the first clinic visit was 6 days. Of 95 patients diagnosed to have malignant diseases, the median time from the first clinic visit to reaching malignant diagnosis was 15 days. Multivariate logistic regression analysis identified five significant predictors for malignant nodes: male gender (risk ratio (RR)=2.72; 95% confidence interval (CI): 1.63-4.56), increasing age (RR=1.05; 95% CI: 1.04-1.07), white ethnicity (RR=3.01; 95% CI: 1.19-7.6) and sites of lymph nodes: supraclavicular region (RR=3.72; 95% CI: 1.52-9.12) and > or = 2 regions of lymph nodes (RR=6.41; 95% CI: 2.82-14.58). Ultrasound and fine-needle aspiration cytology of palpable lymph nodes were performed in 154 and 289 patients, respectively. An accuracy of 97 and 84% was found, respectively. In conclusion, a multidisciplinary lymph node diagnostic clinic enables a rapid, concerted approach to a common medical problem and patients with malignant diseases were diagnosed in a timely fashion.

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Factors which can predict an increased risk of axillary metastases in cases of T1 breast cancer could help to identify those patients most likely to benefit from axillary surgery. This pragmatic study aimed to examine the ability of commonly reported tumour pathological features to predict axillary metastases. All cases of T1 infiltrating ductal carcinoma excised with ipsilateral axillary nodes over a 7 year period were reviewed retrospectively. Of the 639 cases, 197 (30.8%) had positive nodes. Axillary metastases were found with 66.3% of tumours showing vascular invasion but only 16.0% of those without vascular invasion. Following multivariate analysis, vascular invasion and tumour size were found to be independent predictors of positive nodes but tumour grade was not. The decision to perform axillary dissection in T1 breast cancer could be based on the presence of vascular invasion and the size of the primary tumour.

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We report a case of bladder cancer developing in a patient after renal transplantation in whom it was possible to demonstrate DNA evidence for infection of the tumour with HPV Type 11. The significance of the observation is discussed in relation to the hypothesis that immunosurveillance can control the development of malignancy.

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A case of pleomorphic lipoma is described. The neoplastic tissue developed exclusively within the dermis and characteristically involved the fibrous root sheaths of hair follicles, where several layers of lamellar collagen encircled the follicles and entrapped atypical spindle and multinucleated cells. A possible origin of this tumour in the adventitial dermis is postulated.

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The incidence of lymphoedema was studied in 200 patients following a variety of treatments for operable breast cancer. Lymphoedema was assessed in two ways: subjective (patient plus observer impression) and objective (physical measurement). Arm volume measurement 15 cm above the lateral epicondyle was the most accurate method of assessing differences in size of the operated and normal arm. Arm circumference measurements were inaccurate. Subjective lymphoedema was present in 14 per cent whereas objective lymphoedema (a difference in limb volume greater than 200 ml) was present in 25.5 per cent. Independent risk factors contributing towards the development of subjective late lymphoedema were the extent of axillary surgery (P less than 0.05), axillary radiotherapy (P less than 0.001) and pathological nodal status (P less than 0.10). The risk of developing late lymphoedema was unrelated to age, menopausal status, handedness, early lymphoedema, surgical and radiotherapeutic complications, total dose of radiation, time interval since presentation, drug therapy, surgery to the breast, radiotherapy to the breast and tumour T stage. The incidence of subjective late lymphoedema was similar after axillary radiotherapy alone (8.3 per cent), axillary sampling plus radiotherapy (9.1 per cent) and axillary clearance alone (7.4 per cent). The incidence after axillary clearance plus radiotherapy was significantly greater (38.3 per cent, P less than 0.001). Axillary radiotherapy should be avoided in patients who have had a total axillary clearance.

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