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Ang BH, Ho WK, Wijaya E, Kwan PY, Ng PS, Yoon SY, Hasan SN, Lim JMC, Hassan T, Tai MC, Allen J, Lee A, Taib NAM, Yip CH, Hartman M, Lim SH, Tan EY, Tan BKT, Tan SM, Tan VKM, Ho PJ, Khng AJ, Dunning AM, Li J, Easton DF, Antoniou AC, Teo SH. Predicting the Likelihood of Carrying a BRCA1 or BRCA2 Mutation in Asian Patients With Breast Cancer. J Clin Oncol 2022; 40:1542-1551. [PMID: 35143328 PMCID: PMC7614269 DOI: 10.1200/jco.21.01647] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/15/2021] [Accepted: 12/14/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE With the development of poly (ADP-ribose) polymerase inhibitors for treatment of patients with cancer with an altered BRCA1 or BRCA2 gene, there is an urgent need to ensure that there are appropriate strategies for identifying mutation carriers while balancing the increased demand for and cost of cancer genetics services. To date, the majority of mutation prediction tools have been developed in women of European descent where the age and cancer-subtype distributions are different from that in Asian women. METHODS In this study, we built a new model (Asian Risk Calculator) for estimating the likelihood of carrying a pathogenic variant in BRCA1 or BRCA2 gene, using germline BRCA genetic testing results in a cross-sectional population-based study of 8,162 Asian patients with breast cancer. We compared the model performance to existing mutation prediction models. The models were evaluated for discrimination and calibration. RESULTS Asian Risk Calculator included age of diagnosis, ethnicity, bilateral breast cancer, tumor biomarkers, and family history of breast cancer or ovarian cancer as predictors. The inclusion of tumor grade improved significantly the model performance. The full model was calibrated (Hosmer-Lemeshow P value = .614) and discriminated well between BRCA and non-BRCA pathogenic variant carriers (area under receiver operating curve, 0.80; 95% CI, 0.75 to 0.84). Addition of grade to the existing clinical genetic testing criteria targeting patients with breast cancer age younger than 45 years reduced the proportion of patients referred for genetic counseling and testing from 37% to 33% (P value = .003), thereby improving the overall efficacy. CONCLUSION Population-specific customization of mutation prediction models and clinical genetic testing criteria improved the accuracy of BRCA mutation prediction in Asian patients.
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Affiliation(s)
| | - Weang Kee Ho
- Cancer Research Malaysia, Subang Jaya, Malaysia
- Faculty of Science and Engineering, School of Mathematical Sciences, University of Nottingham Malaysia, Jalan Broga, Semenyih, Selangor, Malaysia
| | | | | | - Pei Sze Ng
- Cancer Research Malaysia, Subang Jaya, Malaysia
| | | | | | | | | | | | - Jamie Allen
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Andrew Lee
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Nur Aishah Mohd Taib
- Faculty of Medicine, University Malaya Cancer Research Institute, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
- Department of Surgery, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
| | | | - Mikael Hartman
- Department of Surgery, National University Hospital and NUHS, Singapore, Singapore
| | - Swee Ho Lim
- Breast Department, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Ern Yu Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Institute of Molecular and Cell Biology, Singapore, Singapore
| | - Benita K. T. Tan
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Su-Ming Tan
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore, Singapore
| | - Veronique K. M. Tan
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore
| | - Peh Joo Ho
- Laboratory of Women’s Health and Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Alexis J. Khng
- Laboratory of Women’s Health and Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Alison M. Dunning
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Jingmei Li
- Laboratory of Women’s Health and Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Douglas F. Easton
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Antonis C. Antoniou
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Soo Hwang Teo
- Cancer Research Malaysia, Subang Jaya, Malaysia
- Faculty of Medicine, University Malaya Cancer Research Institute, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
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Lim JSH, Sim Y, Ngeow J, Yuen J, Tan VKM, Tan BKT, Yong WS, Wong CY, Lim SZ, Hamzah JLB, Tan SY, Wong FY, Madhukumar P. Male breast cancer: a Singapore perspective. ANZ J Surg 2022; 92:1440-1446. [PMID: 35470542 DOI: 10.1111/ans.17737] [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: 08/20/2021] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Male breast cancer (MBC) is rare, representing <1% of all breast cancers. Treatment recommendations have been extrapolated from trial data of female breast cancer patients. This study aims to report our institutional experience of MBC across a 20 year period, analyse the survival outcome and prognosis of this group against female breast cancer patients treated at the same centre. METHODS Clinical, histopathological, treatment and survival data of male and female breast cancer patients treated between Jan 1999 and July 2019 at Singapore General Hospital and National Cancer Centre Singapore were identified and analysed. RESULTS Fifty-seven male patients were identified. The median age at diagnosis was 63 years. Majority had invasive ductal carcinoma (86%) and presented at an early disease stage: 70.2% presented as Tis/T1/T2 and 49.1% had no axillary nodal involvement. 84.2% had a simple mastectomy with either a sentinel lymph node biopsy or axillary clearance. The median follow up was 5.69 years for males and 5.83 years for females. The median survival was 11.86 years for males and 16.3 years for females. At 5 years, overall survival (OS) was 69.9% (52.3-82.1%) and disease free survival (DFS) was 62.9% (44.9-76.5%) for males compared with OS 83.8% (83.21-84.39%) and DFS 74.5% (73.91-75.09%) for females. CONCLUSION MBC remains understudied. Our institutional data indicates that good long term survival in South-East Asian patients can be achieved with treatment protocols that are similar to female breast cancer. More prospective studies are required.
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Affiliation(s)
- Joshua S H Lim
- Department of General Surgery, Singapore General Hospital, Singapore
| | - Yirong Sim
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Jeanette Yuen
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Veronique K M Tan
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
| | - Benita Kiat Tee Tan
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore.,Department of General Surgery, Sengkang General Hospital, Singapore
| | - Wei-Sean Yong
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
| | - Chow Yin Wong
- Department of Breast Surgery, Singapore General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
| | - Sue Zann Lim
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
| | - Julie Liana B Hamzah
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
| | - Si Ying Tan
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
| | - Fuh Yong Wong
- Division of Radiation Oncology, National Cancer Centre, Singapore
| | - Preetha Madhukumar
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
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Tison NRR, Leong L, Tan PH, Tan VKM. Extensive Florid Lobular carcinoma in situ presenting as a large breast mass requiring a mastectomy. Breast J 2019; 26:1025-1027. [PMID: 31793132 DOI: 10.1111/tbj.13705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Nicola Raphaela R Tison
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore City, Singapore.,SingHealth-Duke NUS Breast Centre, Singapore City, Singapore
| | - Lester Leong
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore City, Singapore
| | - Puay Hoon Tan
- Department of Anatomical Pathology, Singapore General Hospital, Singapore City, Singapore
| | - Veronique K M Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore City, Singapore.,SingHealth-Duke NUS Breast Centre, Singapore City, Singapore
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Lee WQ, Tan VKM, Choo HMC, Ong J, Krishnapriya R, Khong S, Tan M, Sim YR, Tan BK, Madhukumar P, Yong WS, Ong KW. Factors influencing patient decision-making between simple mastectomy and surgical alternatives. BJS Open 2018; 3:31-37. [PMID: 30734013 PMCID: PMC6354187 DOI: 10.1002/bjs5.50105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 07/11/2018] [Accepted: 08/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background Despite similar survival rates, breast‐conserving therapy (BCT) remains a distant second choice after simple mastectomy for patients with early‐stage breast cancer in Singapore. Uptake of reconstruction after mastectomy is also low (18 per cent). The aim of this study was to explore the factors influencing a patient's choice for mastectomy when eligible for BCT, and why patients decline reconstruction after mastectomy. Methods Patients from the National Cancer Centre Singapore, who were eligible for BCT but chose mastectomy without reconstruction, between December 2014 and December 2015 were included. An interviewer‐administered questionnaire focusing on patients' reasons for choosing mastectomy over BCT and not opting for immediate breast reconstruction after mastectomy was used. Tumour characteristics were retrieved from medical records. Spearman's rank correlation coefficient, Mann–Whitney U and Kruskal–Wallis tests were used to analyse the correlation between the patient's self‐rated influential factors and variables. Statistical significance was taken as P < 0·050. Results Ninety‐one patients were included (90·1 per cent response rate). The main reasons for choosing mastectomy over BCT were: fear of cancer recurrence (considered very important in 74 per cent), the perception that health outweighs breast retention (49 per cent) and the possibility of second surgery for margins (40 per cent). Key factors for rejecting immediate reconstruction after mastectomy were: patient‐perceived ‘old age’ (very important in 53 per cent), concern about two sites of surgery (42 per cent) and financial cost (29 per cent). Given a second chance, 19·8 per cent of patients would undergo BCT instead of mastectomy. Conclusion This study has identified the considerations that women in Singapore have when deciding on breast cancer surgery. Some perceptions need to be addressed for women to make a fully informed decision, especially as one‐fifth regret their initial choice.
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Affiliation(s)
- W Q Lee
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - V K M Tan
- Division of Surgical Oncology National Cancer Centre Singapore Singapore.,Singhealth Duke-NUS Breast Centre National Cancer Centre Singapore Singapore
| | - H M C Choo
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - J Ong
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - R Krishnapriya
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - S Khong
- Division of Surgical Oncology National Cancer Centre Singapore Singapore
| | - M Tan
- Division of Surgical Oncology National Cancer Centre Singapore Singapore
| | - Y R Sim
- Division of Surgical Oncology National Cancer Centre Singapore Singapore
| | - B K Tan
- Singhealth Duke-NUS Breast Centre National Cancer Centre Singapore Singapore.,Department of General Surgery Singapore General Hospital Singapore
| | - P Madhukumar
- Division of Surgical Oncology National Cancer Centre Singapore Singapore.,Singhealth Duke-NUS Breast Centre National Cancer Centre Singapore Singapore
| | - W S Yong
- Division of Surgical Oncology National Cancer Centre Singapore Singapore.,Singhealth Duke-NUS Breast Centre National Cancer Centre Singapore Singapore
| | - K W Ong
- Division of Surgical Oncology National Cancer Centre Singapore Singapore.,Singhealth Duke-NUS Breast Centre National Cancer Centre Singapore Singapore
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Sim Y, Tan VKM, Sidek NAB, Chia DKA, Tan BKT, Madhukumar P, Yong WS, Wong CY, Ong KW. Bilateral breast cancers in an Asian population, and a comparison between synchronous and metachronous tumours. ANZ J Surg 2018; 88:982-987. [PMID: 30141242 DOI: 10.1111/ans.14773] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/17/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women with unilateral breast cancer have an increased risk of developing bilateral breast cancer (BBC). Patients with metachronous BBC (mBBC) usually have an earlier age of onset, and their prognoses have been shown to be either similar or poorer than those with synchronous BBC (sBBC). Given the differing presentation and characteristics of breast cancers in the Asian population and the West, this study aims to characterize Asian patients with BBC. METHODS All patients who had oncological breast surgery between 2001 and 2010 at the Singapore General Hospital and National Cancer Centre Singapore were reviewed. Patients with BBC were identified and studied. RESULTS A total of 5520 Singaporean women had oncological breast surgery, 155 women (2.8%) had BBC. Of those with BBC, 47.1% (n = 73) were synchronous and 52.9% (n = 82) metachronous (mean interval of 39.4 months), and there was no difference in median age in both groups (54 years of age). Patients with sBBC were more likely to have a positive family history and had asymptomatic contralateral tumours. Although patients with sBBCs were more likely to have ER/PR positive and Her2 negative tumours, they had a lower 5-year overall survival than those with mBBC (P = 0.022). CONCLUSION Our study shows that Asian women with BBC have different characteristics to their Western counterparts. In particular, women with sBBC tended to have a lower 5-year overall survival compared to those with mBBC, despite having seemingly biologically favourable tumours, which suggest that there may be more underlying their tumour biology and genetics.
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Affiliation(s)
- Yirong Sim
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Veronique K M Tan
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Nur A B Sidek
- Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Daryl K A Chia
- Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Benita K T Tan
- Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Preetha Madhukumar
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Wei Sean Yong
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Chow Yin Wong
- Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Kong Wee Ong
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
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Iyer NG, Tan DSW, Tan VKM, Wang W, Hwang J, Tan NC, Sivanandan R, Tan HK, Lim WT, Ang MK, Wee J, Soo KC, Tan EH. Randomized trial comparing surgery and adjuvant radiotherapy versus concurrent chemoradiotherapy in patients with advanced, nonmetastatic squamous cell carcinoma of the head and neck: 10-year update and subset analysis. Cancer 2015; 121:1599-607. [PMID: 25639864 DOI: 10.1002/cncr.29251] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [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: 10/20/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND The current study was performed to report the long-term results of a trial comparing concurrent chemotherapy and radiotherapy (CCRT) with surgery and adjuvant radiotherapy (RT) in patients with stage III/IV nonmetastatic head and neck squamous cell carcinoma. METHODS Patients with stage III/IV resectable head and neck squamous cell carcinoma were randomized to surgery followed by RT or CCRT. The trial was halted prematurely due to poor accrual. Human papillomavirus status was tested on archival material using polymerase chain reaction sequencing. RESULTS Of the total of 119 patients, 60 patients were randomized to primary surgery (S arm) and 59 patients were randomized to CCRT (C arm). Human papillomavirus status was tested in 75 patients, and only 3 were found to be positive. The median follow-up for surviving patients was 13 years. Analysis of the entire cohort demonstrated no statistically significant difference in overall survival and disease-specific survival (DSS): 5-year rates were 45% versus 35% for overall survival (P = .262) and 56% versus 46% for DSS (P = .637) for the S arm and C arm, respectively. Analysis by subsites indicated that this difference favoring the S arm was mainly driven by survival data among patients with cancers of the oral cavity and maxillary sinus. For patients with oral cavity cancer, survival was significantly better in those who underwent primary surgery compared with CCRT; the 5-year DSS rate was 68% versus 12% for the S arm and C arm, respectively (P = .038). For patients with cancers of the maxillary sinus, the 5-year DSS rate was 71% for patients on the S arm and 0% for patients on the C arm (P = .05). CONCLUSIONS These long-term results demonstrate a significant advantage for primary surgery in patients with cancers of the oral cavity or maxillary sinus, providing strong support for primary surgery as the main modality of treatment for these subsites. In other subsites, CCRT and surgery with adjuvant RT were found to demonstrate similar efficacy for survival in patients with advanced resectable tumors.
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Affiliation(s)
- N Gopalakrishna Iyer
- Department of Surgical Oncology, National Cancer Centre, Singapore; Cancer Therapeutics Research Laboratory, National Cancer Centre, Singapore
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Tan VKM, Abidin SZ, Tan SG. Medium-term results of ultrasonography-guided, catheter-assisted foam sclerotherapy of the long saphenous vein for treatment of varicose veins. Singapore Med J 2012; 53:91-94. [PMID: 22337181] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION We previously reported our technique of ultrasonography-guided, catheter-assisted foam sclerotherapy of the long saphenous vein for treatment of primary varicose veins. In this study, we present the technical results, based on follow-up duplex images, and patient-reported symptom improvement and satisfaction. METHODS All patients treated with ultrasonography-guided, catheter-assisted foam sclerotherapy between March 2006 and August 2007 were included in this review. Prospectively collected clinical data and follow-up postoperative duplex examinations at one day, six months and 12 months were reviewed. Telephone interviews with a standard questionnaire were conducted. RESULTS During the study period, 66 lower limbs in 62 patients were treated using the described technique. The median follow-up period was 12 months (range one day to 38 months). Successful occlusion rate was 98% at six months and 80% at 12 months for patients who attended follow-up duplex imaging. Seven patients underwent a second procedure. Patient satisfaction was good, with 96% reporting symptom improvement. CONCLUSION Ultrasonography-guided, catheter-assisted foam sclerotherapy is safe, minimally invasive and yields good medium-term occlusion rates of the treated veins.
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Affiliation(s)
- V K M Tan
- Department of General Surgery, Singapore General Hospital, Outram Road, Singapore.
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Tan CH, Thng CH, Low ASC, Tan VKM, Hartono S, Koh TS, Goh BKP, Cheow PC, Tan YM, Chung AYF, Ooi LL, Earnest A, Chow PKH. Wash-out of hepatocellular carcinoma: quantitative region of interest analysis on CT. Ann Acad Med Singap 2011; 40:269-275. [PMID: 21779615] [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
INTRODUCTION This study aims to determine if the quantitative method of region-of-interest (ROI) analysis of lesion attenuation on CT may be a useful adjunct to the conventional approach of diagnosis by visual assessment in assessing tracer wash-out in hepatocellular carcinomas. MATERIALS AND METHODS From a surgical database of 289 patients from 2 institutions, all patients with complete surgical, pathological and preoperative multiphasic CT scans available for review were selected. For each phase of scanning, HU readings of lesion obtained (Lesion(arterial), Lesion(PV) and Lesion(equilibrium)) were analysed using receiver operating curves (ROC) to determine the optimal method and cut-off value for quantitative assessment of tumour wash-out (Lesion(arterial - equilibrium), Lesion(PV - equilibrium) or Lesion(peak - equilibrium)). RESULTS Ninety-four patients with one lesion each met the inclusion criteria. The area under the curve (AUC) values for Lesion(arterial - equilibrium) (0.941) was higher than the AUC for Lesion(pv - equilibrium) (0.484) and for Lesion(peak - equilibrium) (0.667). Based on ROC analysis, a cut-off of 10HU value for Lesion(arterial - equilibrium) would yield sensitivity and specificity of 91.5% and 80.9%, respectively. ROI analysis detected 9/21 (42.9%) of lesions missed by visual analysis. Combined ROI and visual analysis yields a sensitivity of 82/94 (87.2%) compared to 73/94 (77.7%) for visual analysis alone. CONCLUSION Using a cut-off of 10 HU attenuation difference between the arterial and equilibrium phases is a simple and objective method that can be included as an adjunct to visual assessment to improve sensitivity for determining lesion wash-out on CT.
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Affiliation(s)
- Cher Heng Tan
- Department of Oncologic Imaging, National Cancer Centre, Singapore.
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Tan VKM, Goh BKP, Fook-Chong S, Khin LW, Wong WK, Yong WS. The feasibility and accuracy of sentinel lymph node biopsy in clinically node-negative patients after neoadjuvant chemotherapy for breast cancer--a systematic review and meta-analysis. J Surg Oncol 2011; 104:97-103. [PMID: 21456092 DOI: 10.1002/jso.21911] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 02/16/2011] [Indexed: 11/10/2022]
Abstract
The sentinel lymph node biopsy (SLNB) is now an accepted alternative to the axillary lymph node dissection for pathologic evaluation of the axilla in patients with early breast cancer. The use of SLNB after neoadjuvant chemotherapy (NAC) is controversial. This meta-analysis aims to determine the feasibility and the accuracy of SLNB in the population of patients who are clinically node-negative after NAC for breast cancer.
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Affiliation(s)
- Veronique K M Tan
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore.
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Tan VKM, Chow PKH. An approach to the ethical evaluation of innovative surgical procedures. Ann Acad Med Singap 2011; 40:26-29. [PMID: 21369629] [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: 05/30/2023]
Abstract
While there is an ethical obligation to improve clinical outcomes by developing better therapies, surgical innovation has largely progressed without the strict regulations required of novel pharmaceutical products. We explore the reasons why new surgical techniques are frequently introduced without the benefit of randomised controlled trials, and present an approach to the ethical evaluation of novel surgical procedures.
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Affiliation(s)
- Veronique K M Tan
- Department of General Surgery, Singapore General Hospital, Singapore
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Tan VKM, Tan SG. Technique and early results of ultrasound-guided foam sclerotherapy of the long saphenous vein for treatment of varicose veins. Singapore Med J 2009; 50:284-287. [PMID: 19352572] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The aim of this study was to describe an original technique of using ultrasound-guided foam sclerotherapy in the long saphenous veins (LSV) for the treatment of varicose veins, and report the early results. METHODS Only patients with lower limb varicose veins and demonstrable incompetent saphenofemoral junction with reflux down the LSVs underwent ultrasound-guided injection of foam sclerosant into the LSV. Foam sclerosant was made by the Tessari's method using three percent sodium tetradecyl sulphate to air in a 1:3 ratio. The LSV was accessed below the knee with a micropuncture set. A Headhunter angiographic catheter was cut to length and advanced over a guide wire to the saphenofemoral junction (SFJ). With the patient in the Trendelenburg position and the leg raised, the SFJ was manually compressed and foam was injected into the Headhunter catheter while the tip was withdrawn. Direct ultrasound visualisation ensured accurate catheter placement. RESULTS 66 lower limbs in 62 patients were treated in the manner described above. The diameter of the treated LSV ranged from 4 to 13.4 mm. Ultrasound duplex assessment one day post-treatment showed complete occlusion in 62 veins (94 percent). Early complications included superficial thrombophlebitis, skin pigmentation, cellulitis and thrombosis of the superficial femoral vein. CONCLUSION Immediate results using our method of ultrasound-guided foam sclerotherapy showed a high obliteration rate of the LSV.
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Affiliation(s)
- V K M Tan
- Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
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