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Schembari E, Richardson C, King AT, Layfield DM. Mesh mediated fascial traction in the management of the open abdomen: A video vignette. Colorectal Dis 2024; 26:207-210. [PMID: 38030879 DOI: 10.1111/codi.16816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Elena Schembari
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carl Richardson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew T King
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David M Layfield
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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2
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Layfield DM, Flashman KG, Benitez Majano S, Senapati A, Ball C, Conti JA, Khan JS, O’Leary DP. Changing patterns of multidisciplinary team treatment, early mortality, and survival in colorectal cancer. BJS Open 2022; 6:6762514. [PMID: 36254731 PMCID: PMC9577547 DOI: 10.1093/bjsopen/zrac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/18/2022] [Accepted: 06/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background This study reports early mortality and survival from colorectal cancer in relation to the pattern of treatments delivered by the multidisciplinary team (MDT) meeting at a high-volume institution in England over 14 years. Methods All patients diagnosed with colorectal cancer and discussed during MDT meetings from 2003 to 2016 at a single institution were reviewed. Three time intervals (2003–2007, 2008–2012, and 2013–2016) were compared regarding initial surgical management (resection, local excision, non-resection surgery, and no surgery), initial oncological therapy, 90-day mortality, and crude 2-year survival for the whole cohort. Sub-analyses were performed according to age greater or less than 80 years. Results The MDT managed 4617 patients over 14 years (1496 in the first interval and 1389 in the last). Over this time, there was a reduction in emergency resections from 15.5 per cent to 9.0 per cent (P < 0.0001); use of oncological therapies increased from 34.6 per cent to 41.6 per cent (P < 0.0001). The 90-day mortality after diagnosis of colorectal cancer dropped from 14.8 per cent to 10.7 per cent (P < 0.001) and 2-year survival improved from 58.6 per cent to 65 per cent (P < 0.001). Among patients aged 80 years or older (425 and 446, in the first and last intervals respectively) there was, in addition, a progressive increase in ‘no surgery’ rate from 33.6 per cent to 50.2 per cent (P < 0.0001) and a reduction in elective resections from 42.4 per cent to 33.9 per cent (P = 0.010). The 90-day mortality after elective resection fell from 10.0 per cent (18 of 180) to 3.3 per cent (5 of 151; P = 0.013). Conclusions Survival from colorectal cancer improved significantly over 14 years. Among patients aged ≥80 years, major changes in the type of treatment delivered were associated with a decrease in postoperative mortality.
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Affiliation(s)
- David M Layfield
- Colorectal Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Karen G Flashman
- Colorectal Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Sara Benitez Majano
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Asha Senapati
- Colorectal Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Christopher Ball
- Colorectal Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - John A Conti
- Colorectal Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Jim S Khan
- Colorectal Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Daniel P O’Leary
- Correspondence to: Daniel P. O’Leary, Consultant surgeon, E Level, Queen Alexandra Hospital, Cosham, Portsmouth, PO6 3LY, UK (e-mail: daniel.o')
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Waise S, Parker R, Rose-Zerilli MJJ, Layfield DM, Wood O, West J, Ottensmeier CH, Thomas GJ, Hanley CJ. An Optimized Method to Isolate Human Fibroblasts from Tissue for ex vivo Analysis. Bio Protoc 2019; 9:e3440. [PMID: 33654935 PMCID: PMC7853986 DOI: 10.21769/bioprotoc.3440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 11/02/2022] Open
Abstract
Despite their involvement in many physiological and pathological processes, fibroblasts remain a poorly-characterized cell type. Analysis of primary fibroblasts while maintaining their in vivo phenotype is challenging: standard methods for fibroblast isolation require cell culture in vitro, which is known to alter phenotypes. Previously-described protocols for the dissociation of primary tissues fail to extract sufficient numbers of fibroblasts, instead largely yielding immune cells. Here, we describe an optimized method for generating a fibroblast-enriched single-cell suspension from human tissues using combined mechanical and enzymatic dissociation. This allows analysis of ex vivo fibroblasts without the need for culture in vitro.
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Affiliation(s)
- Sara Waise
- Cancer Sciences Unit, University of Southampton, UK
| | | | | | | | - Oliver Wood
- Cancer Sciences Unit, University of Southampton, UK
| | - Jonathan West
- Cancer Sciences Unit, University of Southampton, UK
- Institute for Life Sciences, University of Southampton, UK
| | - Christian H. Ottensmeier
- Cancer Sciences Unit, University of Southampton, UK
- Cancer Research UK and NIHR Southampton Experimental Cancer Medicine Centre, UK
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Waise S, Parker R, Rose-Zerilli MJJ, Layfield DM, Wood O, West J, Ottensmeier CH, Thomas GJ, Hanley CJ. An optimised tissue disaggregation and data processing pipeline for characterising fibroblast phenotypes using single-cell RNA sequencing. Sci Rep 2019; 9:9580. [PMID: 31270426 PMCID: PMC6610623 DOI: 10.1038/s41598-019-45842-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/13/2019] [Indexed: 02/06/2023] Open
Abstract
Single-cell RNA sequencing (scRNA-Seq) provides a valuable platform for characterising multicellular ecosystems. Fibroblasts are a heterogeneous cell type involved in many physiological and pathological processes, but remain poorly-characterised. Analysis of fibroblasts is challenging: these cells are difficult to isolate from tissues, and are therefore commonly under-represented in scRNA-seq datasets. Here, we describe an optimised approach for fibroblast isolation from human lung tissues. We demonstrate the potential for this procedure in characterising stromal cell phenotypes using scRNA-Seq, analyse the effect of tissue disaggregation on gene expression, and optimise data processing to improve clustering quality. We also assess the impact of in vitro culture conditions on stromal cell gene expression and proliferation, showing that altering these conditions can skew phenotypes.
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Affiliation(s)
- Sara Waise
- Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - Rachel Parker
- Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - Matthew J J Rose-Zerilli
- Cancer Sciences Unit, University of Southampton, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - David M Layfield
- Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - Oliver Wood
- Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - Jonathan West
- Cancer Sciences Unit, University of Southampton, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Christian H Ottensmeier
- Cancer Sciences Unit, University of Southampton, Southampton, UK
- Cancer Research UK and NIHR Southampton Experimental Cancer Medicine Centre, Southampton, UK
| | - Gareth J Thomas
- Cancer Sciences Unit, University of Southampton, Southampton, UK
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Layfield DM, Luvisetto F, Celentano V. Fistulating Crohn's terminal ileitis involving sigmoid colon, left salpinx and urinary bladder: a laparoscopic approach - a video vignette. Colorectal Dis 2017; 19:783-784. [PMID: 28603931 DOI: 10.1111/codi.13759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 04/12/2017] [Indexed: 12/31/2022]
Affiliation(s)
- D M Layfield
- Colorectal Unit, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - F Luvisetto
- Colorectal Unit, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - V Celentano
- Colorectal Unit, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
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Layfield DM, See H, Stahnke M, Hayward L, Cutress RI, Oeppen RS. Radiopathological features predictive of involved margins in ductal carcinoma in situ. Ann R Coll Surg Engl 2017; 99:137-144. [PMID: 27659365 PMCID: PMC5392827 DOI: 10.1308/rcsann.2016.0299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2016] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Ductal carcinoma in situ (DCIS) usually manifests as microcalcification on mammography but may be uncalcified. Consequently, a quarter of patients undergoing excision of a presumed pure DCIS require further surgery to re-excise margins. Patients at highest risk of margin involvement may benefit from additional preoperative assessment. METHODS A retrospective review was carried out of patients treated for screen detected, biopsy proven DCIS in a single centre over a ten-year period (1999-2009). Logistic regression analysis identified factors predictive of need for further surgery to clear margins. RESULTS Overall, 248 patients underwent surgery for DCIS (low/intermediate grade: 82, high grade: 155) and 49 (19.8%) required further surgery. High grade disease was associated with greater mammographic extent (mean: 32mm [range: 5-120mm] vs 25mm [range: 2-100mm]), p=0.009) and higher incidence of mastectomy (38% vs 24%, p=0.034). Factors predictive of involvement of surgical margins necessitating further surgery included negative oestrogen receptor status (OR: 5.2, 95% CI: 2.1-12.8, p<0.001) and mammographic extent (odds ratio [OR]: 1.6, 95% confidence interval [CI]: 1.2-2.1, p=0.004). Once size exceeded 30mm, more than 50% of patients required secondary breast surgery for margins. CONCLUSIONS Reoperation rates for DCIS increase with preoperative size on mammography and negative oestrogen receptor status on core biopsy. Patients with these risk features should be counselled accordingly and consideration should be given to the role of additional preoperative imaging.
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Affiliation(s)
| | - H See
- University of Southampton , UK
| | - M Stahnke
- University Hospital Southampton NHS Foundation Trust , UK
| | | | - R I Cutress
- University of Southampton , UK
- University Hospital Southampton NHS Foundation Trust , UK
- Contributed equally
| | - R S Oeppen
- University Hospital Southampton NHS Foundation Trust , UK
- Contributed equally
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Li Causi E, Parikh SC, Chudley L, Layfield DM, Ottensmeier CH, Stevenson FK, Di Genova G. Vaccination Expands Antigen-Specific CD4+ Memory T Cells and Mobilizes Bystander Central Memory T Cells. PLoS One 2015; 10:e0136717. [PMID: 26332995 PMCID: PMC4557947 DOI: 10.1371/journal.pone.0136717] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/07/2015] [Indexed: 12/24/2022] Open
Abstract
CD4+ T helper memory (Thmem) cells influence both natural and vaccine-boosted immunity, but mechanisms for their maintenance remain unclear. Pro-survival signals from the common gamma-chain cytokines, in particular IL-7, appear important. Previously we showed in healthy volunteers that a booster vaccination with tetanus toxoid (TT) expanded peripheral blood TT-specific Thmem cells as expected, but was accompanied by parallel increase of Thmem cells specific for two unrelated and non cross-reactive common recall antigens. Here, in a new cohort of healthy human subjects, we compare blood vaccine-specific and bystander Thmem cells in terms of differentiation stage, function, activation and proliferative status. Both responses peaked 1 week post-vaccination. Vaccine-specific cytokine-producing Thmem cells were predominantly effector memory, whereas bystander cells were mainly of central memory phenotype. Importantly, TT-specific Thmem cells were activated (CD38High HLA-DR+), cycling or recently divided (Ki-67+), and apparently vulnerable to death (IL-7RαLow and Bcl-2 Low). In contrast, bystander Thmem cells were resting (CD38Low HLA-DR- Ki-67-) with high expression of IL-7Rα and Bcl-2. These findings allow a clear distinction between vaccine-specific and bystander Thmem cells, suggesting the latter do not derive from recent proliferation but from cells mobilized from as yet undefined reservoirs. Furthermore, they reveal the interdependent dynamics of specific and bystander T-cell responses which will inform assessments of responses to vaccines.
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Affiliation(s)
- Eleonora Li Causi
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Suraj C. Parikh
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Lindsey Chudley
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - David M. Layfield
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Christian H. Ottensmeier
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Freda K. Stevenson
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Gianfranco Di Genova
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Layfield DM, Mohamud M, Odofin O, Walsh C, Royle GT, Cutress RI. Tumour grade on core biopsy and evidence of axillary involvement on ultrasound predicts response in elderly co-morbid patients treated with primary hormone therapy for oestrogen receptor positive breast carcinoma. Surgeon 2014; 13:61-8. [PMID: 24411703 DOI: 10.1016/j.surge.2013.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/01/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Treatment of women with oestrogen-receptor positive breast cancer who are high risk for general anaesthetic remains controversial. Current guidance is based on studies pre-dating aromatase inhibitors (AIs) which may have also included hormone-receptor negative patients. Such studies have demonstrated improved disease-free survival and local disease control following surgery when compared with primary hormone therapy (PHT) alone. However uncertainty persists regarding benefit of surgery over optimal hormone treatment in patients with significant co-morbidity. METHOD Retrospective cohort study comparing efficacy of PHT in oestrogen-receptor positive breast cancer patients considered unsuitable for surgery. Co-morbidity was scored retrospectively using the Charlson Index. Overall survival and disease specific survival were noted and multivariate analysis performed to identify predictors of treatment failure. RESULTS 106 patients treated for breast cancer at Southampton University Hospital with PHT without surgery were identified (Mean age 84.1 years, range 48-101). 94.3% had a probability of 10 year survival of 2.25% or less according to the age-weighted Charlson score. Kaplan-Meier analysis demonstrated a four-year survival of 30% and breast cancer specific survival of 60%. Cox proportional hazards model demonstrated high-grade disease (grade III vs. grade I/II: HR = 2.007; 95% Confidence Interval (CI) = 1.004-4.014. P = 0.049) and ultrasound axillary staging (indeterminate/definite lymphatic involvement vs. no involvement: HR = 1.944; 95% CI = 1.010-3.742. P = 0.047) independently predicted early failure of PHT. CONCLUSION A high proportion of elderly and comorbid patients die with breast cancer rather than from breast cancer. Elderly comorbid patients who initially respond to primary hormone therapy have a less than 30% incidence of delayed treatment failure during their life time; however patients with grade III disease or an abnormal axillary ultrasound are twice as likely to fail first choice PHT.
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Affiliation(s)
- D M Layfield
- University of Southampton, UK; Southampton Breast Surgical Unit, University Hospitals Southampton, UK.
| | | | - O Odofin
- Southampton Breast Surgical Unit, University Hospitals Southampton, UK
| | - C Walsh
- Southampton Breast Surgical Unit, University Hospitals Southampton, UK
| | - G T Royle
- Southampton Breast Surgical Unit, University Hospitals Southampton, UK
| | - R I Cutress
- University of Southampton, UK; Southampton Breast Surgical Unit, University Hospitals Southampton, UK
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Hilal MA, Layfield DM, Di Fabio F, Arregui-Fresneda I, Panagiotopoulou IG, Armstrong TH, Pearce NW, Johnson CD. Postoperative Chyle Leak After Major Pancreatic Resections in Patients Who Receive Enteral Feed: Risk Factors and Management Options. World J Surg 2013; 37:2918-26. [DOI: 10.1007/s00268-013-2171-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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10
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Abu Hilal M, Di Fabio F, Wiltshire RD, Hamdan M, Layfield DM, Pearce NW. Laparoscopic liver resection for hepatocellular adenoma. World J Gastrointest Surg 2011; 3:101-5. [PMID: 21860698 PMCID: PMC3158885 DOI: 10.4240/wjgs.v3.i7.101] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 07/12/2011] [Accepted: 07/18/2011] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the role of laparoscopy in the surgical management of hepatocellular adenoma (HA). METHODS We reviewed a prospectively collected database of consecutive patients undergoing laparoscopic liver resection for HA. RESULTS Thirteen patients underwent fifteen pure laparoscopic liver resections for HA (male/female: 3/10; median age 42 years, range 22-72 years). Two patients with liver adenomatosis required two different laparoscopic operations for ruptured adenomas. Indications for surgery were: symptoms in 12 cases, need to rule out malignancy in 2 cases and preoperative diagnosis of large HA in one case. Symptoms were related to bleeding in 10 cases, sepsis due to liver abscess following embolization of HA in one case and mass effect in one case (shoulder tip pain). Five cases with ruptured bleeding adenoma required emergency admission and treatment with selective arterial embolization. Laparoscopic liver resection was then semi-electively performed. Eight patients (62%) required major hepatectomy [right hepatectomy (n = 5), left hepatectomy (n = 3)]. No conversion to open surgery occurred. The median operative time for pure laparoscopic procedures was 270 min (range 135-360 min). The median size of the excised lesions was 85 mm (range 25-180 mm). One patient with adenomatosis developed postoperative bleeding requiring embolization. Mortality was nil. The median hospital stay was 4 d (range 1-18 d) with a median high dependency unit stay of 1 d (range 0-7 d). CONCLUSION The laparoscopic approach represents a safe option for the management of HA in a semi-elective setting and when major hepatectomy is required.
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Affiliation(s)
- Mohammed Abu Hilal
- Hepatobiliary and Pancreatic Surgical Unit, Southampton University Hospitals NHS Trust, Tremona Road, Southampton SO16 6YD, United Kingdom
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Layfield DM, Agrawal A, Roche H, Cutress RI. Intraoperative assessment of sentinel lymph nodes in breast cancer. Br J Surg 2010; 98:4-17. [DOI: 10.1002/bjs.7229] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2010] [Indexed: 01/10/2023]
Abstract
Abstract
Background
Sentinel lymph node biopsy (SLNB) reduces the morbidity of axillary clearance and is the standard of care for patients with clinically node-negative breast cancer. The ability to analyse the sentinel node during surgery enables a decision to be made whether to proceed to full axillary clearance during primary surgery, thus avoiding a second procedure in node-positive patients.
Methods
Current evidence for intraoperative sentinel node analysis following SLNB in breast cancer was reviewed and evaluated, based on articles obtained from a MEDLINE search using the terms ‘sentinel node’, ‘intra-operative’ and ‘breast cancer’.
Results and conclusion
Current methods for evaluating the sentinel node during surgery include cytological and histological techniques. Newer quantitative molecular assays have been the subject of much recent clinical research. Pathological techniques of intraoperative SLNB analysis such as touch imprint cytology and frozen section have a high specificity, but a lower and more variably reported sensitivity. Molecular techniques are potentially able to sample a greater proportion of the sentinel node, and could have higher sensitivity.
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Affiliation(s)
- D M Layfield
- Southampton Breast Surgical Unit, Southampton University Hospitals Trust, Southampton, UK
| | - A Agrawal
- Portsmouth Breast Surgical Unit, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - H Roche
- Department of Cellular Pathology, Southampton General Hospital, Southampton, UK
| | - R I Cutress
- Southampton Breast Surgical Unit, Southampton University Hospitals Trust, Southampton, UK
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