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Storan D, Swan N, Swan K, Thuillier R, Skehan S, Gallagher T, O'Shea D, O'Toole D. Clinical features and outcomes of appendiceal neuroendocrine tumours: 10 year audit from the Irish NET Centre of Excellence. J Neuroendocrinol 2023; 35:e13329. [PMID: 37574769 DOI: 10.1111/jne.13329] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023]
Abstract
Appendiceal neuroendocrine tumours (aNETs) are rare neoplasms of the gastrointestinal tract often diagnosed incidentally at the time of appendicectomy. Appendicectomy is considered curative in the majority of cases but guidelines recommend right-sided hemicolectomy (RHC) for those with specific high-risk features despite no data supporting a survival benefit. We performed a retrospective search of multi-disciplinary tumour board and pathology databases from 2012 to 2022 to identify cases of aNET treated at our centre. Follow-up data were obtained from the electronic healthcare records. A total of 142 cases of aNET were included for analysis. Mean age at presentation was 34, of which 76% were female and 92% of aNETs were located in the tip/middle of the appendix; 90% were grade 1, and 93% had R0 resection. Tumour size was <1 cm in 54%, 1-2 cm in 36%, >2 cm in 9%. A total of 43 patients (30%) underwent RHC with lymph node metastases identified in 16 (37%). Lymph node metastases were associated with tumour size >2 cm (p = .008) and higher tumour grade (p = .041) on multivariate analysis. For aNET 1-2 cm, lymph node metastases were identified in 7/22 who had RHC (32%) with tumour grade the only significant risk factor (p = .046). Distant metastases were identified in 2 cases (1%), diagnosed synchronously and associated with grade 2 tumours. Overall survival for those with lymph node metastases was 100% after a median 4 years. Progression-free survival was 93%, with a single case of disease progression associated with synchronous distant metastases at initial diagnosis. Lymph node metastases in aNET are associated with higher tumour grade and tumour size >2 cm. Disease progression in the setting of lymph node metastases is rare. The significance of lymph node metastases and need for completion RHC remains uncertain.
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Affiliation(s)
- Darragh Storan
- National Centre for Neuroendocrine Tumour, St. Vincent's University Hospital, Dublin, Ireland
| | - Niall Swan
- National Centre for Neuroendocrine Tumour, St. Vincent's University Hospital, Dublin, Ireland
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland
| | - Kara Swan
- National Centre for Neuroendocrine Tumour, St. Vincent's University Hospital, Dublin, Ireland
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland
| | - Rhona Thuillier
- National Centre for Neuroendocrine Tumour, St. Vincent's University Hospital, Dublin, Ireland
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland
| | - Stephen Skehan
- National Centre for Neuroendocrine Tumour, St. Vincent's University Hospital, Dublin, Ireland
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Tom Gallagher
- National Centre for Neuroendocrine Tumour, St. Vincent's University Hospital, Dublin, Ireland
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Donal O'Shea
- National Centre for Neuroendocrine Tumour, St. Vincent's University Hospital, Dublin, Ireland
| | - Dermot O'Toole
- National Centre for Neuroendocrine Tumour, St. Vincent's University Hospital, Dublin, Ireland
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Paisant A, Skehan S, Colombié M, David A, Aubé C. Development and validation of core entrustable professional activities for abdominal radiology. Insights Imaging 2023; 14:142. [PMID: 37644337 PMCID: PMC10465426 DOI: 10.1186/s13244-023-01482-x] [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: 06/07/2023] [Accepted: 07/11/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES To develop and validate European entrustable professional activities (EPAs) for sub-specialised hepatobiliary and gastrointestinal (HB/GI) diagnostic imaging. MATERIALS AND METHODS Both European Society of Radiology and national curricula in HB/GI diagnostic radiology were thoroughly reviewed, resulting in preliminary EPAs drafted by a pilot group of expert radiologists in 2 different countries. Each EPA was fully described with 7 components (Specification/limitations; Potential risks of failing; Relevant domains of competence; Required experience, knowledge, skills, attitude and behaviour; Assessment information sources to assess progress and ground a summative entrustment decision; Entrustment for which level of supervision is to be reached; and Expiration date). The modified Delphi method with 3 Delphi rounds was chosen for validation. Content validity index (CVI) and median values were used for validation. RESULTS There were 15 preliminary EPAs, some of them divided according to 2 levels: resident and fellow level. The 37 members of the Delphi group were based in 2 different European countries with a background experience of 10 represented countries. Subsequent to the first Delphi round, 6 EPAs were accepted (CVI ≥ 0.8, median ≥ 4), 6 needed major revisions (CVI 0.7-0.79, median ≥ 4), 3 were rejected (CVI < 0.7) and 1 was added. After the second Delphi round, both the 6 revised EPAs and the additional one met the validation criteria (CVI ≥ 0.8, median ≥ 4). Finally, 13 EPAs were validated during the 3rd Delphi round with an agreement percentage of 95-100%. CONCLUSION This study creates and validates EPAs for sub-specialised HB/GI diagnostic imaging. CRITICAL RELEVANCE STATEMENT Thirteen EPAs for sub-specialised hepatobiliary and gastrointestinal diagnostic imaging were created with a strong methodology, and as a first example set in sub-specialised diagnostic imaging, they provide a template for others to be created. KEY POINTS • The competence-based teaching in medical studies has recently been reintroduced through EPAs. • Thirteen EPAs have been developed for hepatobiliary and gastrointestinal sub-specialised diagnostic imaging. • These EPAs were validated using a Delphi modified method and provide a template for other to be created.
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Affiliation(s)
- Anita Paisant
- Department of Radiology, Abdominal Unit Radiologie A, Angers University Hospital, 4 Rue Larrey, 49933, Angers, France.
- Laboratoire HIFIH, EA 3859, Université d'Angers, 4 Rue Larrey, 49045, Angers, France.
| | - Stephen Skehan
- Department of Radiology, Elm Park Dublin 4 and School of Medicine, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Mathilde Colombié
- Department of Radiology, Elm Park Dublin 4 and School of Medicine, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Arthur David
- Department of Radiology, Nantes University Hospital, Hôtel Dieu, 1 Pl. Alexis-Ricordeau, 44093, Nantes Cedex 1, France
| | - Christophe Aubé
- Department of Radiology, Abdominal Unit Radiologie A, Angers University Hospital, 4 Rue Larrey, 49933, Angers, France
- Laboratoire HIFIH, EA 3859, Université d'Angers, 4 Rue Larrey, 49045, Angers, France
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Liddy S, Mallia A, Collins CD, Killeen RP, Skehan S, Dodd JD, Subesinghe M, Murphy DJ. Vascular findings on FDG PET/CT. Br J Radiol 2020; 93:20200103. [PMID: 32356457 PMCID: PMC7465845 DOI: 10.1259/bjr.20200103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022] Open
Abstract
Since its introduction into clinical practice, 2-deoxy-2-[18F]flu-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) has become firmly established in the field of oncological imaging, with a growing body of evidence demonstrating its use in infectious and inflammatory vascular pathologies. This pictorial review illustrates the utility of FDG PET/CT as a diagnostic tool in the investigation of vascular disease and highlights some of the more common incidental vascular findings that PET reporters may encounter on standard oncology FDG PET/CTs, including atherosclerosis, large vessel vasculitis, complications of vascular grafts, infectious aortitis and acute aortic syndromes.
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Affiliation(s)
| | - Andrew Mallia
- Division of Nuclear Medicine, Department of Medical Imaging, Mater Dei Hospital, Msida, Malta
| | | | | | | | - Jonathan D Dodd
- Department of Radiology, St Vincent’s University Hospital, Dublin, Ireland
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Cawood TJ, Mackay GR, Hunt PJ, O'Shea D, Skehan S, Ma Y. TIRADS Management Guidelines in the Investigation of Thyroid Nodules; Illustrating the Concerns, Costs, and Performance. J Endocr Soc 2020; 4:bvaa031. [PMID: 32285020 PMCID: PMC7138277 DOI: 10.1210/jendso/bvaa031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/21/2019] [Accepted: 03/03/2020] [Indexed: 01/21/2023] Open
Abstract
Context Ultrasound (US) risk-stratification systems for investigation of thyroid nodules may not be as useful as anticipated. Objective We aimed to assess the performance and costs of the American College of Radiology Thyroid Image Reporting And Data System (ACR-TIRADS). Design, Settings and Participants We examined the data set upon which ACR-TIRADS was developed, and applied TR1 or TR2 as a rule-out test, TR5 as a rule-in test, or applied ACR-TIRADS across all nodule categories. We assessed a hypothetical clinical comparator where 1 in 10 nodules are randomly selected for fine needle aspiration (FNA), assuming a pretest probability of clinically important thyroid cancer of 5%. Results The gender bias (92% female) and cancer prevalence (10%) of the data set suggests it may not accurately reflect the intended test population. Applying ACR-TIRADS across all nodule categories did not perform well, with sensitivity and specificity between 60% and 80% and overall accuracy worse than random selection (65% vs 85%). Test performance in the TR3 and TR4 categories had an accuracy of less than 60%. Using TR5 as a rule-in test was similar to random selection (specificity 89% vs 90%). Using TR1 and TR2 as a rule-out test had excellent sensitivity (97%), but for every additional person that ACR-TIRADS correctly reassures, this requires >100 ultrasound scans, resulting in 6 unnecessary operations and significant financial cost. Conclusions Perhaps surprisingly, the performance ACR-TIRADS may often be no better than random selection. The management guidelines may be difficult to justify from a cost/benefit perspective. A prospective validation study that determines the true performance of TIRADS in the real-world is needed.
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Affiliation(s)
- Tom James Cawood
- Department of Endocrinology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Georgia Rose Mackay
- University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Penny Jane Hunt
- Department of Endocrinology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.,University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Donal O'Shea
- Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
| | - Stephen Skehan
- Department of Radiology, St Vincent's University Hospital, Dublin 4 and University College Dublin, Ireland
| | - Yi Ma
- Biostatistician, Department of Medical & Women's Business Management, Canterbury District Health Board, Christchurch, New Zealand
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Tobin-O'Brien C, Skehan S, Swan N, Mcnally M, Butler M, Fabre A. An 8 year- review of granulomatous inflammation in EBUS samples- common in sarcoidosis, rare but identified in the setting of cancer where FDG uptake can be observed on PET scanning. Lung Cancer 2018. [DOI: 10.1183/13993003.congress-2018.pa2770] [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: 11/05/2022]
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Mullen D, Mullins S, Doyle A, Crowley RK, Skehan S, McDermott EW, Prichard RS, Gibbons D. Atypia of Undetermined Significance in Thyroid Fine Needle Aspirates: a 4-Year Audit of Thy3a Reporting. Eur Thyroid J 2017; 6:271-275. [PMID: 29071240 PMCID: PMC5649310 DOI: 10.1159/000478773] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 06/17/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Thyroid nodules are common within the general population. Cytological analysis of fine needle aspirates (FNAs) of these lesions allows for identification of those that require further surgery. A numerical classification system is in place to streamline reporting. The 3a category is used for lesions that are neither benign nor malignant but show atypia of undetermined significance. We reviewed our use and clinical outcomes of Thy3a over a 4-year period. METHODS All thyroid FNAs performed at this institute from January 2012 to December 2015 were identified from our laboratory information system using SNOMED codes. Cytology was correlated with histology. RESULTS Of the 1,259 FNAs reported at this institute, Thy3a constituted only 1.2% (n = 16) of all cases, with a malignancy rate of 7%. Five Thy3a cases had a repeat FNA that was reported as Thy2 (benign), 1 as Thy1c (cyst), 1 as Thy3f (follicular lesion), and 1 as Thy5 (malignant). Six cases without repeat FNA were follicular adenomas at resection. Two cases were lost to follow-up. Within all thyroid cytology categories in this 4-year period, we had a false-positive rate of 1.9% and a false-negative rate of 0.3%. CONCLUSIONS The Thy3a subclassification has varied diagnostic criteria and lacks reproducibility. Despite the rare use of the Thy3a category at our centre, our diagnostic accuracy remained high. At this time, further Thy3a cohort studies are required to assess the real benefits of this category.
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Affiliation(s)
- Dorinda Mullen
- Department of Pathology, St. Vincent's University Hospital, Dublin 4, Ireland
- *Dr. Dorinda Mullen, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4 (Ireland), E-Mail
| | - Sarah Mullins
- Department of Pathology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Aoife Doyle
- Department of Pathology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Rachel K. Crowley
- Department of Endocrinology, St. Vincent's University Hospital, Dublin 4, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland
| | - Stephen Skehan
- Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland
| | - Enda W. McDermott
- Department of Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland
| | - Ruth S. Prichard
- Department of Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland
| | - David Gibbons
- Department of Pathology, St. Vincent's University Hospital, Dublin 4, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland
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O'Connell L, Prichard RS, O'Reilly E, Skehan S, Gibbons D, McDermott EW. Running in the family: A rare diagnosis of familial papillary thyroid cancer. Int J Surg Case Rep 2015; 16:64-6. [PMID: 26432498 PMCID: PMC4643435 DOI: 10.1016/j.ijscr.2015.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Whilst inherited medullary thyroid cancer has been extensively reported, familial non-medullary thyroid cancer is a rare and less well described clinical entity. Familial forms of the disease demonstrate more aggressive features than sporadic non-medullary thyroid cancer. PRESENTATION OF CASE A 54 year old lady was referred with globus on a background of a longstanding goitre. Three first degree relatives had a history of non-medullary thyroid carcinoma. Investigations revealed a papillary thyroid carcinoma and the patient proceeded to total thyroidectomy and ipsilateral Level VI neck dissection, followed by adjuvant radioiodine ablation. DISCUSSION Familial papillary thyroid carcinoma syndrome is defined as three or more first degree relatives diagnosed with the disease in the absence of other known associated syndromes. It is often associated with the presence of benign thyroid disorders, and is characterised by the early onset of multi-focal bilateral locally advanced tumours. CONCLUSION Familial papillary thyroid cancer is a rare clinical entity but should be considered where ≥3 first degree relatives are diagnosed with non-medullary thyroid cancer. It is necessary to exclude other familial tumour syndromes to make the diagnosis. It demonstrates more aggressive features with higher rates of local recurrence than its sporadic counterpart, and therefore mandates more aggressive management than might otherwise be indicated. Screening of first degree relatives should be considered. SUMMARY The case of a 54 year old female diagnosed with familial non-medullary thyroid carcinoma is reported.
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Affiliation(s)
- L O'Connell
- Department of Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - R S Prichard
- Department of Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - E O'Reilly
- Department of Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - S Skehan
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D Gibbons
- Department of Pathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - E W McDermott
- Department of Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Neri E, Bali MA, Ba-Ssalamah A, Boraschi P, Brancatelli G, Alves FC, Grazioli L, Helmberger T, Lee JM, Manfredi R, Martì-Bonmatì L, Matos C, Merkle EM, Op De Beeck B, Schima W, Skehan S, Vilgrain V, Zech C, Bartolozzi C. ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents. Eur Radiol 2015; 26:921-31. [PMID: 26194455 PMCID: PMC4778143 DOI: 10.1007/s00330-015-3900-3] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 06/07/2015] [Accepted: 06/22/2015] [Indexed: 02/06/2023]
Abstract
Objectives To develop a consensus and provide updated recommendations on liver MR imaging and the clinical use of liver-specific contrast agents. Methods The European Society of Gastrointestinal and Abdominal Radiology (ESGAR) formed a multinational European panel of experts, selected on the basis of a literature review and their leadership in the field of liver MR imaging. A modified Delphi process was adopted to draft a list of statements. Descriptive and Cronbach’s statistics were used to rate levels of agreement and internal reliability of the consensus. Results Three Delphi rounds were conducted and 76 statements composed on MR technique (n = 17), clinical application of liver-specific contrast agents in benign, focal liver lesions (n = 7), malignant liver lesions in non-cirrhotic (n = 9) and in cirrhotic patients (n = 18), diffuse and vascular liver diseases (n = 12), and bile ducts (n = 13). The overall mean score of agreement was 4.84 (SD ±0.17). Full consensus was reached in 22 % of all statements in all working groups, with no full consensus reached on diffuse and vascular diseases. Conclusions The consensus provided updated recommendations on the methodology, and clinical indications, of MRI with liver specific contrast agents in the study of liver diseases. Key points • Liver-specific contrast agents are recommended in MRI of the liver. • The hepatobiliary phase improves the detection and characterization of hepatocellular lesions. • Liver-specific contrast agents can improve the detection of HCC.
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Affiliation(s)
- E Neri
- Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy.
| | - M A Bali
- Department of Radiology, Hôpital Erasme, MRI Clinics, Bruxelles, Belgium
| | - A Ba-Ssalamah
- Department of Biomedical Imaging and Image-guided Therapy, The General Hospital of the Medical University of Vienna, Vienna, Austria
| | - P Boraschi
- Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - G Brancatelli
- Department of Radiology, University of Palermo, Palermo, Italy
| | - F Caseiro Alves
- Medical Imaging Department and Faculty of Medicine, University Hospital of Coimbra, Coimbra, Portugal
| | - L Grazioli
- Department of Radiology, Spedali Civili di Brescia, Brescia, Italy
| | - T Helmberger
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Klinikum Bogenhausen, Academic Teaching Hospital of the Technical University, Munich, Germany
| | - J M Lee
- Division of Abdominal Imaging, Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - R Manfredi
- Department of Radiology, University of Verona, Verona, Italy
| | - L Martì-Bonmatì
- Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - C Matos
- Department of Radiology, Hôpital Erasme, MRI Clinics, Bruxelles, Belgium
| | - E M Merkle
- Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Basel, Switzerland
| | - B Op De Beeck
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - W Schima
- Department of Diagnostic and Interventional Radiology, KH Goettlicher Heiland, Krankenhaus der Barmherzigen Schwestern and Sankt Josef-Krankenhaus, Vienna, Austria
| | - S Skehan
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - V Vilgrain
- Radiology Department, Assistance Publique-Hôpitaux de Paris, APHP, Hôpital Beaujon, Clichy, Paris, France
| | - C Zech
- Abteilungsleiter Interventionelle Radiologie, Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Basel, Switzerland
| | - C Bartolozzi
- Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
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O'Reilly EA, Aucharaz N, Kelly G, Al Azawi D, Prichard RS, Evoy D, Rothwell J, Geraghty J, O'Doherty A, Skehan S, Quinn C, McDermott E. Abstract P1-01-01: The value of isosulphan blue dye in addition to isotope scanning in the identification of the sentinel lymph node in breast cancer patients with a positive lymphoscintigraphy: A randomised controlled trial (ISRCTN 98849733). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-01-01] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
The advent of multimodal and targeted breast cancer treatment has seen a radical shift from aggressive surgical intervention to a more minimalist approach, both within the breast and axilla. Primary among these changes is the utilisation of the sentinel lymph node biopsy (SLNB) to detect disease within the axilla and a move away from an obligatory axillary clearance when the sentinel node is positive. This depends on the accurate identification of the SLN and initial studies describe a higher identification rate and a lower false negative rate with a dual tracer identification technique. This encompasses a combination of a blue / green dye and radio-labelled isotope. The use of blue dye has been, of itself, associated with significant morbidity and therefore many clinicians may opt for single tracer identification.
Aims
The aim of the current study was to determine whether the addition of blue dye to radio-isotope increased the positive SLN detection rate, where the SLN was identified pre-operatively on a lymphoscintigram.
Methods
A prospective randomised controlled trial comparing the combined techniques of isosulphan blue dye and isotope scanning versus isotope scanning alone was performed at a single tertiary referral centre. Ethical approval was obtained prior to commencing the study from the hospital ethics committee. Enrolment commenced in March 2010 and ceased in September 2012. The study design was a randomised open label controlled parallel group trial. The primary outcome measure was the effect of the omission of the blue dye on the identification of SLN if the lymphoscintigram was positive (1 -3 nodes identified).
Results
A total of 673 patients were included in the final analysis with 344 patients receiving the combination (blue dye and radio-isotope) and 329 patients who received radio-isotope scanning alone. The groups were evenly matched both demographically and pathologically. The mean age was 48 years (48.3 versus 47.7 years; P = 0.47), the mean tumour size was 23.1mm (23.2mm versus 23.0mm; p = 0.89) and there was no statistically significant difference in the grade of the tumours between the two groups (p = 0.58). Overall, there was no difference in the number of nodes retrieved between the two groups (563 versus 523; p = 0.30). Similarly, there was no difference in the number of positive lymph nodes that were identified between the two groups (107 versus 98; 23.8% versus 22%; p = 0.65).
Conclusions
The addition of isosulphan blue dye does not aid in the identification of the SLN in patients who have a positive lymphoscintigram when radioisotope colloid is used.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-01.
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Affiliation(s)
- EA O'Reilly
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - N Aucharaz
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - G Kelly
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - D Al Azawi
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - RS Prichard
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - D Evoy
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - J Rothwell
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - J Geraghty
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - A O'Doherty
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - S Skehan
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - C Quinn
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - E McDermott
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
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O'Kelly F, Nicholson P, Brennan J, Carroll A, Skehan S, Mulvin DW. A novel case of laparoscopic ureterolithotomy in a partial duplex ureteric collecting system: can open procedures still be justified in the minimally invasive era? Ir J Med Sci 2013; 182:519-22. [PMID: 23361633 DOI: 10.1007/s11845-013-0912-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 01/15/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Impacted ureteric stones can pose a treatment challenge due to the high level of failure of ESWL and endourological approaches. Laparoscopic ureterolithotomy can provide a safe and successful alternative to these and open, invasive procedures. METHODS Interval laparoscopic ureterolithtomy was carried out following placement of a percutaneous nephrostomy. This was performed through an trans-peritoneal approach with the ureterotomy closed by intracorporeal suturing and placement of a JJ stent without the need for an abdominal wound drain. CONCLUSION Laparoscopic ureterolithotomy is a safe, minimally invasive method of managing large, impacted ureteric stones with minimal associated patient morbidity.
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Affiliation(s)
- F O'Kelly
- Department of Urological Surgery, St. Vincent's University Hospital, Dublin 4, Republic of Ireland.
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11
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Prichard RS, Cotter M, Evoy D, Gibbons D, Collins C, McDermott E, Skehan S. Focal thyroid incidentalomas identified with whole-body FDG-PET warrant further investigation. Ir Med J 2011; 104:177-179. [PMID: 22111394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Fluorodeoxyglucose (FDG) whole body positron emission computed tomography (PET-CT) detects clinically occult malignancy. The aim of this study was to assess the prevalence and significance of focal thyroid 18F - fluorodeoxyglucose uptake. A retrospective review of all patients who had FDG PET-CT examinations, in a single tertiary referral centre was performed. PET scan findings and the final pathological diagnosis were collated. 2105 scans were reviewed. Focal uptake was identified in 35 (1.66%) patients. Final surgical histology was available on eight patients, which confirmed papillary carcinoma in four (20%) patients and lymphoma and metastatic disease in two patients respectively. This gave an overall malignancy rate in focal thyroid uptake of at least 33%. Thyroid incidentalomas occurred with a frequency of 2.13%, with an associated malignancy rate of at least 33% in focal thyroid uptake. The high malignancy rate associated with focal thyroid uptake mandates further investigation in medically fit patients.
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Affiliation(s)
- R S Prichard
- St Vincent's University Hospital, Elm Park, Dublin 4
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12
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O'Mahony M, Skehan S, Gallagher C. Percutaneous stenting of the superior vena cava syndrome in a patient with cystic fibrosis. Ir Med J 2005; 98:85-6. [PMID: 15869067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Superior vena cava (SVC) obstruction commonly occurs in the setting of malignancy. Cases of benign SVC obstruction are being seen more frequently with the use of long-term central venous lines. This is the case particularly in Cystic Fibrosis (CF). We describe in this report the successful use of intravascular stenting to treat this distressing condition in the setting of thrombotic occlusion of the SVC in a patient with CF.
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Affiliation(s)
- M O'Mahony
- Departments of Respiratory Medicine, Vincents University Hospital, Dublin.
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13
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Al-shehhi W, Skehan S, Hefferenan E, Hughes F, Veale D, Bresinihan B, Fitzgerald O. Arthritis Res Ther 2005; 7:P15. [DOI: 10.1186/ar1536] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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14
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Abstract
Cirrhotic patients are known to have abnormally high signal principally in the globus pallidus on non-contrast T1-weighted MRI. The purpose of this study was to relate MR changes to clinical and pathological features of chronic liver disease. We confirmed abnormally high signal in the globus pallidus on T1-weighted images in 25 of 28 patients with chronic liver disease, showing that it also occurs in patients who have not yet progressed to cirrhosis. Changes were seen in patients both with and without clinical portosystemic shunting. This abnormality is not responsible for hepatic encephalopathy. Cholestatic disease was more likely to produce marked changes than non-cholestatic disease. No statistically significant correlation was demonstrated between the severity of liver disease and the degree of MR abnormality. However, marked improvement in MR appearances was seen after successful liver transplantation.
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Affiliation(s)
- S Skehan
- Department of Diagnostic Imaging, St. Vincent's Hospital, Elm Park, Dublin 4, Ireland
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Skehan S, Coleman K, Griffin J, Blake M, Thornton J, Murphy SJ, Quinn A, Upton J, Marsh D, Smiddy P, Cahill AM, Morrin M, McGlone B, Hamilton S, McCarthy M, El-Agha G, Murray R, Torreggiani W. Royal academy of medicine in Ireland section of radiology. Ir J Med Sci 1996. [DOI: 10.1007/bf02940255] [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: 11/30/2022]
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