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Urooj N, Abubakar M, Asghar K, Hassan M, Malik AA, Rehman B, Sajjad B, Farooqi N, Chaudhry Z, Parvaiz A, Khan A. Impact of SSO-ASTRO Margin Guidelines on Re-excision Rate in Breast-conserving Surgery: A Single-center Experience. J Cancer Allied Spec 2024; 10:559. [PMID: 38259677 PMCID: PMC10793721 DOI: 10.37029/jcas.v10i1.559] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/22/2023] [Indexed: 01/24/2024]
Abstract
Introduction Breast-conserving surgery (BCS) has been historically linked with a high rate of re-excision. To address this issue, the Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) developed consensus guidelines in 2014 to standardize practices and improve clinical outcomes for BCS patients. In our tertiary cancer care hospital, we assessed the impact of these guidelines on the re-excision rate following BCS. Materials and Methods We conducted a retrospective study on breast cancer patients who underwent BCS at the Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan. The study compared the re-excision rate before the implementation of the SSO-ASTRO consensus guidelines (November 2015-July 2017) and after the implementation (January 2018-August 2019). Margins were considered positive if "ink on tumor" was present and negative if "no ink on tumor" was present. Fisher's exact test or Chi-square test was used to compare the re-excision rates between the pre- and post-guideline periods. Results A total of 919 patients were identified, with 533 from the pre-guideline period and 386 from the post-guideline period. Of the 919 patients, 31 with ductal carcinoma in situ (DCIS) were excluded from the re-excision analysis because the guidelines were not implemented on the DCIS. Furthermore, the overall rate of re-excision in our data was 4.3%. The re-excision rate decreased from 71.1% to 28.9% (P ≤ 0.05) following the adoption of the guidelines. We observed a statistically significant decrease in the re-excision rate after implementing the SSO-ASTRO guidelines. Conclusion Implementation of the SSO-ASTRO margin guidelines led to a notable decrease in the overall re-excision rate in our data set. These findings suggest that continued adherence to the guidelines may lead to a further reduction in the re-excision rate in the future.
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Affiliation(s)
- Namra Urooj
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Muhammad Abubakar
- Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Kashif Asghar
- Department of Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Muhammad Hassan
- Department of Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | | | - Bushra Rehman
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Bakra Sajjad
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Nifasat Farooqi
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Zulqarnain Chaudhry
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Asad Parvaiz
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Amina Khan
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
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Vohra LM, Farooqi N, Jiwani U, Ali D. Outcomes of oncoplastic breast surgery compared to breast-conserving surgery in breast cancer patients in a developing country: a retrospective cohort study. Pak J Med Sci 2024; 40:8-13. [PMID: 38196478 PMCID: PMC10772441 DOI: 10.12669/pjms.40.1.7360] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/07/2023] [Accepted: 09/26/2023] [Indexed: 01/11/2024] Open
Abstract
Background and Objective Breast-conserving surgery (BCS) with adjuvant radiotherapy remains the standard of care for early breast cancers in Pakistan. We sought to compare the outcomes of BCS with oncoplastic surgery (OPS), a relatively infrequent approach to breast cancer treatment in the country. Methods This retrospective cohort study was conducted at Aga Khan University Hospital and Ziauddin Hospital in Karachi. Patients who had biopsy-proven Stage-I to III breast cancer and underwent either OPS or BCS between August 1, 2016, and December 31, 2021, were identified and followed for 30 days. Data were collected by reviewing patient files and electronic records. Results A total of 481 patients were included in the study, where 204 (42.4%) underwent BCS and 277 (57.6%) underwent OPS. Mean tumor volume (146.8 vs. 90.4 cm3), and postoperative complications (2.2 % vs. 0%) were higher in OPS while the frequency of positive margins was greater in the BCS group (15.7 % vs. 2.2 %). There were no significant differences in the histologic type of tumor between the two groups. Conclusion OPS is a valid alternative approach to breast cancer treatment that can be offered to women with early stage, locally advanced, multifocal or tumors at complex locations owing to the reduced occurrence of positive margins and thus lowered re-excision rates.
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Affiliation(s)
- Lubna M. Vohra
- Lubna M. Vohra, FCPS, Department of Surgery, Aga Khan University Hospital Karachi, Pakistan
| | - Nifasat Farooqi
- Nifasat Farooqi, FCPS, Department of Surgery, Aga Khan University Hospital Karachi, Pakistan
| | - Uswa Jiwani
- Uswa Jiwani, MBBS, Department of Surgery, Aga Khan University Hospital Karachi, Pakistan
| | - Danish Ali
- Danish Ali, MBBS, Department of Surgery, Aga Khan University Hospital Karachi, Pakistan
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Kanwal MA, Khalid U, Amir M, Sajjad B, Zeeshan R, Urooj N, Farooqi N, Parvaiz MA, Iqbal Khan A, Chaudhry MZ. Benchmarking Excellence: Evaluating Advanced Breast Carcinoma Care in Pakistan's Largest Cancer Hospital Against the National Institute for Health and Care Excellence (NICE) Guidelines. Cureus 2023; 15:e44332. [PMID: 37779814 PMCID: PMC10538803 DOI: 10.7759/cureus.44332] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Breast cancer is the most common type of cancer worldwide, and even with all the screening and education, great numbers of diagnoses are made in advanced stages. Additionally, patients in remission always remain at risk of relapse and metastasis. Pakistan has the highest incidence of breast cancer among Asian countries. The purpose of this clinical audit was to compare data from the largest cancer hospital in Pakistan with international standards to provide room for quality improvement. Methods A retrospective review of patients with advanced breast carcinoma over a period of six months was done. Permission was obtained from the Quality Assurance and Patent Safety Department before the commencement of the audit. Standards Data obtained were audited against nine standards of four different categories from the National Institute for Health and Care Excellence (NICE) guidelines on advanced breast carcinoma. Results For the diagnosis and assessment category, for which a target of 100% was set, 99.66% was achieved; for disease monitoring, for which a target of 100% was set, 91.8% was achieved; for systemic disease-modifying therapy, for which the majority was the target, only 1% was achieved; for managing complications, for which a target of 100% was set, 71.8% was achieved. Conclusion Continuous research and breakthrough advancements have made health care an ever-evolving field. Clinical audits like these that compare international standards with local data are beneficial and lead to quality improvement. They highlight issues that may be overlooked otherwise, raise questions that may never be asked, and may inspire prospective research studies. Limitations of the audit were that this clinical audit was conducted outside of the NHS where NICE guidelines are not followed and local guidelines differ from NICE guidelines.
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Affiliation(s)
- Muhammad Awais Kanwal
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Umaisa Khalid
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Momina Amir
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Barka Sajjad
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Rana Zeeshan
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Namra Urooj
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Nifasat Farooqi
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad Asad Parvaiz
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Amina Iqbal Khan
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Urooj N, Rehman B, Sajjad B, Farooqi N, Chaudhary Z, Parvaiz A, Khan A. P227 Prospective Randomized controlled trial evaluation safety of Breast conserving surgery in multicentric/multifocal breast cancer. Breast 2023. [DOI: 10.1016/s0960-9776(23)00345-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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Sajjad B, Farooqi N, Rehman B, Khalid IB, Urooj N, Sajjad S, Mumtaz A, Tariq T, Iqbal khan A, Parvaiz MA. Correlation of Breast Density Grade on Mammogram With Diagnosed Breast Cancer: A Retrospective Cross-Sectional Study. Cureus 2022; 14:e27028. [PMID: 35989768 PMCID: PMC9386336 DOI: 10.7759/cureus.27028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/05/2022] Open
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Ali D, Zeeshan S, Farooqi N, Vohra L. Breast surgery super-specialization: Impact on advanced surgical training and research. Pak J Med Sci 2022; 38:2345-2349. [PMID: 36415238 PMCID: PMC9676618 DOI: 10.12669/pjms.38.8.6045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/17/2022] [Revised: 07/18/2022] [Accepted: 09/07/2022] [Indexed: 01/25/2023] Open
Abstract
The earliest records of breast cancer (BC) date back to 3,000 - 2,500 B.C., ever since multiple curative options have been explored. First known wide margin excision was performed around 1st Century AD and a prototype of the modern-day BC surgery, Halsted radical mastectomy, was performed in the 20th Century. BC is the most common cancer in Pakistan accounting for up to 14.5% of the total cancer incidences. Accredited breast surgery fellowships were established in the UK and USA in 2002 and 2003, respectively. In Pakistan, the movement was delayed and the two-year College of Physicians and Surgeons Pakistan (CPSP) accredited breast surgery fellowship program started in 2019. The increasing annual incidence and changes in demands have led to an increased percentage of General Surgery graduates taking up specialty training. PubMed search from 1990 to 2021 showed a rising trend in the number of breast cancer publications from Pakistan; from almost no papers before 1990 to 615 between 2012 to 2021. This remarkable surge in BC-related research can be explained by the commencement of fellowship programs in breast surgery and related fields. An increase in specialist training will yield better results in the management of patients, improve clinical trials and help produce more meaningful publications from the country.
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Affiliation(s)
- Danish Ali
- Dr. Danish Ali, MBBS. Dean’s Clinical Research Fellow, Aga Khan University Hospital, Karachi, Pakistan
| | - Sana Zeeshan
- Dr. Sana Zeeshan; MBBS, FCPS, FACS. Assistant Professor of Breast Surgery, Aga Khan University Hospital, Karachi, Pakistan,Correspondence: Dr. Sana Zeeshan Assistant Professor, Department of Surgery, Aga Khan University, Stadium Road, Karachi, Pakistan.
| | - Nifasat Farooqi
- Dr. Nifasat Farooqi, MBBS, FCPS. Senior Medical Officer, COVID ICU, Aga Khan University Hospital, Karachi, Pakistan
| | - Lubna Vohra
- Dr. Lubna Vohra, MBBS, FCPS, FACS. Assistant Professor of Breast Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Vohra L, Siddiqui T, Farooqi N. Oncoplastic breast conserving surgery in developing country: Challenges, promises and outcome. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Farooqi N, Slinde F, Håglin L, Sandström T. Assessment of energy intake in women with chronic obstructive pulmonary disease: a doubly labeled water method study. J Nutr Health Aging 2015; 19:518-24. [PMID: 25923480 DOI: 10.1007/s12603-014-0575-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To maintain energy balance, reliable methods for assessing energy intake and expenditure should be used in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to validate the diet history and 7-day food diary methods of assessing energy intake (EI) using total energy expenditure (TEE) with the doubly labeled water (DLW) method (TEEDLW) as the criterion method in outpatient women with COPD. METHODS EI was assessed by diet history (EIDH) and a 7-day food diary (EIFD) in 19 women with COPD, using TEEDLW as the criterion method. The three methods were compared using intra-class correlation coefficients (ICC) and Bland-Altman analyses. The participants were classified according to their reporting status (EI/TEE) as valid-reporters 0.79-1.21, under-reporters < 0.79 or over-reporters > 1.21. RESULTS Diet history underestimated reported EI by 28%, and 7-day food diary underestimated EI by approximately 20% compared with TEEDLW. The ICC analysis showed weak agreement between TEEDLW and EIDH (ICC=-0.01; 95%CI-0.10 to 0.17) and between TEEDLW and EIFD (ICC=0.11; 95%CI -0.16 to 0.44). The Bland-Altman plots revealed a slight systematic bias for both methods. For diet history, six women (32%) were identified as valid-reporters, and for the 7-day food diary, twelve women (63%) were identified as valid-reporters. The accuracy of reported EI was only related to BMI. CONCLUSION The diet history and 7-day food diary methods underestimated energy intake in women with COPD compared with the DLW method. Individuals with higher BMIs are prone to underreporting. Seven-day food diaries should be used with caution in assessing EI in women with COPD.
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Affiliation(s)
- N Farooqi
- Nighat Farooqi, Department of Respiratory Medicine and Allergy, Umeå University Hospital, SE-901 85, Umea, Sweden; tel. + 46 90 7852269; fax. + 49 90 773817;e-mail:
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Tilford S, Clifton J, Brice L, Wiggins-Smith J, Penrose L, Farooqi N. Influence of sex education on condom knowledge and use proficiency among Texas college students. Contraception 2013. [DOI: 10.1016/j.contraception.2013.05.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Miyazaki Y, Misirliyan H, Farooqi N, Solis M, de Faria Junior O, Colman D, Dhaunchak A, Bar-Or A. microRNAs Regulate Effector Cytokine Secretion by Human B Cells - Implication for B Cell Cytokine Dysregulation in Multiple Sclerosis (S40.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s40.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Van-Gheem A, Martin J, Penrose L, Farooqi N, Prien S. Short-term exposure to cell phone levels of radio frequency radiation do not appear to to influence semen parameters in vitro. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.07.610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Prien S, Hill J, Welch L, Shaffer D, Farooqi N. Reproductive cells appear more sensitive to electromagnetic fields than other cell types. Fertil Steril 2009. [DOI: 10.1016/j.fertnstert.2009.07.1209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Farooqi N, Jesurasa A, Zaki H, McMullen J, Patel U. O.074 Management of post haemorrhagic hydrocephalus with external ventricular drain. Clin Neurol Neurosurg 2008. [DOI: 10.1016/s0303-8467(08)70079-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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