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Al-Ishaq Z, Taj S, Jones C, Hajiesmaeli H, Rahman E, Bullows S, Vidya R, Sircar T. Effectiveness of a novel consultant nurse-led breast pain clinic in secondary care. Ir J Med Sci 2024:10.1007/s11845-024-03642-4. [PMID: 38407698 DOI: 10.1007/s11845-024-03642-4] [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: 10/14/2023] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Patients with breast pain are usually seen in 'one-stop clinic' (OSC) with breast imaging. In the absence of associated red flag features, the incidence of breast cancer is extremely low. With increase in referrals the OSC capacity is over-stretched. We developed a consultant nurse-led dedicated 'breast pain clinic' in September 2021 without routine breast imaging. After meticulous history and examination, patients obtained detailed counselling and advice regarding breast pain management. If any abnormality was noted then appointment was given for OSC. AIM To assess the effectiveness of a consultant nurse-led dedicated 'breast pain clinic'. METHODS A prospective study of all consecutive patients seen in 'breast pain clinic' from September 2021 until September 2022. Feedback was sought from all patients. RESULTS Altogether 429 patients were seen. The mean age was 48.7 years (range 18-86). 87.6% (n = 376) patients required no breast imaging. Only 12.4% (n = 53) patients needed referral to OSC and subsequently 2 patients (0.46%) were diagnosed with breast cancer. Ninety-eight percent of patients felt reassured and 99.2% patients were extremely likely/likely to recommend this service to family and friends. Out of 376 patients who were discharged from breast pain clinic, 12 patients were referred again over a median follow-up period of 15 months, and 2 out of them were diagnosed with breast cancer. CONCLUSION A consultant nurse-led 'breast pain clinic' provides service improvement as it eases the pressure on the OSC. Most patients were managed without breast imaging with high level of patient satisfaction and low rereferral rate.
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Affiliation(s)
- Zaid Al-Ishaq
- Sultan Qaboos Comprehensive Cancer Research and Care Centre, Muscat, Oman.
| | - Saima Taj
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | | | | | | | | | - Tapan Sircar
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Vidya R, Khosla M, Baek K, Vinayagam R, Thekkinkattil D, Laws S, Douvetzemis S, Sircar T, Mullapudi A, Murphy J. Prophylactic Use of Negative Pressure Wound Therapy in High-risk Patients Undergoing Oncoplastic and Reconstructive Breast Surgery. Plast Reconstr Surg Glob Open 2023; 11:e5488. [PMID: 38115832 PMCID: PMC10730037 DOI: 10.1097/gox.0000000000005488] [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: 05/24/2023] [Accepted: 10/24/2023] [Indexed: 12/21/2023]
Abstract
Background Negative pressure wound therapy (NPWT) has emerged as an adjunct to reduce wound complication rates in many surgical domains. This study investigated the prophylactic use of PICO NPWT in high-risk patients undergoing oncoplastic and reconstructive breast surgery. Methods This was a prospective multicenter national audit. The findings were compared against Association of Breast Surgery/British Association of Plastic, Reconstructive and Aesthetic Surgeons (ABS/BAPRAS) Oncoplastic Guidelines for best practice. Results Data from 267 patients were included from seven centers. All patients had at least one high-risk factor for postoperative wound complications, whereas 78 patients (29.2%) had more than one. Thirty-six patients (13.5%) developed postoperative wound complications. An estimated 16 (6%) developed skin flap necrosis, wound dehiscence occurred in 13 patients (4.9%), and 15 patients (5.6%) developed postoperative wound infection. Eleven patients (4.1%) required further surgery due to wound complications. In total, 158 patients underwent mastectomy with immediate implant reconstruction. Postoperative wound complication rate was comparable in this subgroup (n = 22; 13.9%). Implant loss rate was 3.8%, which was within the 5% target mentioned in the ABS/BAPRAS guidelines. The estimated total cost saving was US $105,600 (£84,613) and US $395.50 (£316.90) per patient. Wound infection rate (5.6%) was much lower than the 25% reported by both iBRA study and National Mastectomy and Breast Reconstruction Audit. Conclusions Our study suggests that prophylactic use of NPWT in oncoplastic and reconstructive breast surgery results in low rates of wound-related complications with associated healthcare cost benefits in patients with high-risk factors for wound-related complications. However, a prospective randomized control trial is required.
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Affiliation(s)
- Raghavan Vidya
- From The Royal Wolverhampton NHS Trust, Wolverhampton, U.K
| | - Muskaan Khosla
- From The Royal Wolverhampton NHS Trust, Wolverhampton, U.K
| | - Kim Baek
- St. James’s University Hospital, Leeds, U.K
| | - R. Vinayagam
- Wirral Breast Centre, Clatterbridge Hospital, Wirral, U.K
| | | | | | | | - Tapan Sircar
- From The Royal Wolverhampton NHS Trust, Wolverhampton, U.K
| | | | - John Murphy
- Nightingale Breast Centre, Manchester University NHS Foundation Trust, Manchester
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Shirazi S, Hajiesmaeili H, Khosla M, Taj S, Sircar T, Vidya R. Comparison of Wire and Non-Wire Localisation Techniques in Breast Cancer Surgery: A Review of the Literature with Pooled Analysis. Medicina (Kaunas) 2023; 59:1297. [PMID: 37512107 PMCID: PMC10383802 DOI: 10.3390/medicina59071297] [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] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Wide local excision is a common procedure in the treatment of breast cancer. Wire-guided localisation (WGL) has been the gold standard for many years; however, several issues have been identified with this technique, and therefore, wire-free techniques have been developed. This scoping review synthesises the available literature comparing wire-guided localisation with the wire-free techniques used in breast-conserving cancer surgery. Materials and Methods: Multiple databases including Pubmed and MEDLINE were used to search articles between 1 January 2000 and 31 December 2022. Terms included "breast neoplasms", "margins of excision", and "reoperation". In total, 34/256 papers were selected for review. Comparisons were made between positive margins and re-excision rates of WGL with wire-free techniques including SAVI SCOUT, Magseed, ROLL, and RSL. Pooled p-values were calculated using chi-square testing to determine statistical significance. Results: Pooled analysis demonstrated statistically significant reductions in positive margins and re-excision rates when SAVI SCOUT, RSL, and ROLL were compared with WGL. When SAVI SCOUT was compared to WGL, there were fewer re-excisions {(8.6% vs. 18.8%; p = 0.0001) and positive margins (10.6% vs. 15.0%; p = 0.0105)}, respectively. This was also the case in the ROLL and RSL groups. When compared to WGL; lower re-excision rates and positive margins were noted {(12.6% vs. 20.8%; p = 0.0007), (17.0% vs. 22.9%; p = 0.0268)} for ROLL and for RSL, respectively {(6.8% vs. 14.9%),(12.36% vs. 21.4%) (p = 0.0001)}. Magseed localisation demonstrated lower rates of re-excision than WGL (13.44% vs. 15.42%; p = 0.0534), but the results were not statistically significant. Conclusions: SAVI SCOUT, Magseed, ROLL, and RSL techniques were reviewed. Pooled analysis indicates wire-free techniques, specifically SAVI SCOUT, ROLL, and RSL, provide statistically significant reductions in re-excision rates and positive margin rates compared to WGL. However, additional studies and systematic analysis are required to ascertain superiority between techniques.
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Affiliation(s)
- Shahram Shirazi
- Specialist Registrar in Breast Surgery, Princess Royal University Hospital, Kings College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Hamed Hajiesmaeili
- Specialist Registrar in Breast Surgery, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - Muskaan Khosla
- Senior Clinical Fellow in Breast Surgery, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - Saima Taj
- Senior Clinical Fellow in Breast Surgery, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - Tapan Sircar
- Consultant in Oncoplastic and Reconstructive Breast Surgery, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - Raghavan Vidya
- Consultant in Oncoplastic and Reconstructive Breast Surgery, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
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Al-Ishaq Z, Rahman E, Salem F, Taj S, Mula-Hussain L, Mylvaganam S, Vidya R, Matey P, Sircar T. Is Using Closed Incision Negative Pressure Therapy in Reconstructive and Oncoplastic Breast Surgery Helpful in Reducing Skin Necrosis? Cureus 2023; 15:e38167. [PMID: 37122978 PMCID: PMC10146378 DOI: 10.7759/cureus.38167] [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: 04/25/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Skin necrosis is a major concern of morbidity in patients undergoing reconstructive and oncoplastic breast surgery (ROBS) as it may lead to a poor aesthetic outcome, necessitate further surgery, and delay adjuvant chemotherapy and radiotherapy if required postoperatively. Some studies have reported that closed incision negative pressure therapy (ciNPT) immediately after surgery can reduce the incidence of wound complications. Our study aimed to investigate the effect of ciNPT on skin necrosis rate after ROBS. Methods Our study included 82 patients in a single center who underwent 121 ROBS procedures. We used conventional dressing in 42 patients (62 procedures, group A), while we used ciNPT in 40 patients (59 procedures, group B). When ciNPT dressing was introduced in our breast unit, 40 patients with 59 ROBS procedures who had ciNPT dressing were studied prospectively. The risk factors recorded were age, body mass index (BMI), history of previous radiotherapy, history of smoking, type of incision, type of operation, breast tissue specimen weight, use of neoadjuvant chemotherapy, and implant size. Skin necrosis was classified as "minor" if it was managed conservatively with regular dressings and "major" if surgical debridement in theater and/or exchange or implant removal was necessary. Results The incidence of overall skin necrosis in the conventional dressing group was 17.7% (11/62), while in the ciNPT group, it was higher at 25.4% (15/59), although this was not statistically significant (p = 0.51). ciNPT also did not show a statistically significant difference from the conventional dressing in the rate of minor necrosis (18.6% versus 11.2%, respectively; p = 0.44) and major necrosis (6.7% versus 6.4%, respectively; p = 1.00) Conclusion Our data has shown no superiority of ciNPT in reducing skin necrosis rate in a patient undergoing reconstructive and oncoplastic breast surgery, contrary to many other published reports. However, it may have reduced rates of other wound complications such as wound dehiscence, wound infection, and hypertrophic scar formation, which were not studied in our cohort. Further studies are needed to confirm its benefits, especially in high-risk patients.
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Affiliation(s)
- Zaid Al-Ishaq
- Breast Surgery, Sultan Qaboos Comprehensive Cancer Center, Muscat, OMN
| | - Ehsanur Rahman
- Breast Surgery, The Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
| | - Fathi Salem
- Breast Surgery, The Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
| | - Saima Taj
- Breast Surgery, The Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
| | - Layth Mula-Hussain
- Radiation Oncology, Sultan Qaboos Comprehensive Cancer Center, Muscat, OMN
| | - Senthurun Mylvaganam
- Breast Surgery, The Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
| | - Raghavan Vidya
- Breast Surgery, The Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
| | - Pilar Matey
- Breast Surgery, The Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
| | - Tapan Sircar
- Breast Surgery, The Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
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Al-Ishaq Z, Hajiesmaeili H, Rahman E, Khosla M, Sircar T. Upgrade Rate of Ductal Carcinoma In Situ to Invasive Carcinoma and the Clinicopathological Factors Predicting the Upgrade Following a Mastectomy: A Retrospective Study. Cureus 2023; 15:e35735. [PMID: 37016659 PMCID: PMC10067020 DOI: 10.7759/cureus.35735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/06/2023] Open
Abstract
Background The rate of upgrading ductal carcinoma in situ (DCIS) to invasive cancer varies widely in the literature with no consensus regarding sentinel lymph node biopsy (SLNB) for DCIS; however, some guidelines do recommend it in the event of a mastectomy. The primary aim of this study was to determine the upgrade rate of DCIS to invasive carcinoma (IC) in patients undergoing mastectomy for DCIS and identify the clinicopathological predicting factors for the upgrade. The secondary aim was to determine the SLNB positivity rate. Methodology We retrospectively analysed consecutive patients with DCIS diagnosed through a biopsy who then underwent mastectomy over a 10-year period (2010 to 2020). Clinical, radiological, and histological variables were collected from medical records. Results We studied 143 women (mean age = 57.4 years, range = 26-85 years) who underwent mastectomy for DCIS identified on biopsy. Almost two-thirds (62.9%, 90/143) of the patients were detected on screening mammography, while 35.6% (51/143) were diagnosed following presentation with either an area of palpable concern or nipple discharge. The most common mammographic presentation of DCIS was calcification (83.9%, 120/143), and, in 85.9% of the patients, the mammographic lesion was more than 20 mm. High-grade DCIS was noted in 76.9% of preoperative biopsy results, while the rest was either low or intermediate-grade DCIS. Overall, 24.5% (35/143) were upgraded to IC (upgraded group) on postoperative histology, whereas 108/143 remained DCIS postoperatively (pure DCIS group). The positivity rate of SLNB was 4.8%. Multifocality was the only significant predictor of IC on multivariate analyses of clinicopathological predictors (odds ratio = 3.0, 95% confidence interval = 1.0-8.7). The presence of comedonecrosis was higher in the upgraded group compared to the pure DCIS group (42.9% vs. 27.8%), but this was not statistically significant. Conclusions In our study cohort, nearly one in four (24.5%) patients were upgraded from DCIS to IC on postoperative histology, with an SLNB positivity rate of 4.8%. This is important when counselling patients regarding the risk of coincident occult IC and the importance of SLNB at the time of mastectomy. Multifocality on preoperative imaging was the only significant predictive factor. Based on this result, we recommend that SLNB should also be considered if patients have multifocal DCIS and planned for oncoplastic breast-conserving surgery. However, further studies are required to investigate the association between multifocal DCIS and the risk of upgrading to IC.
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Badr NM, McMurray JL, Danial I, Hayward S, Asaad NY, Abd El-Wahed MM, Abdou AG, Serag El-Dien MM, Sharma N, Horimoto Y, Sircar T, Vidya R, Hoar F, Rea D, Jones JL, Stevens A, Spooner D, Merard R, Lewis P, Hunter KJ, Berditchevski F, Shaaban AM. Characterization of the Immune Microenvironment in Inflammatory Breast Cancer Using Multiplex Immunofluorescence. Pathobiology 2022; 90:31-43. [PMID: 35705026 DOI: 10.1159/000524549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/01/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Inflammatory breast cancer (IBC) is an aggressive form of breast cancer with a poorly characterized immune microenvironment. METHODS We used a five-colour multiplex immunofluorescence panel, including CD68, CD4, CD8, CD20, and FOXP3 for immune microenvironment profiling in 93 treatment-naïve IBC samples. RESULTS Lower grade tumours were characterized by decreased CD4+ cells but increased accumulation of FOXP3+ cells. Increased CD20+ cells correlated with better response to neoadjuvant chemotherapy and increased CD4+ cells infiltration correlated with better overall survival. Pairwise analysis revealed that both ER+ and triple-negative breast cancer were characterized by co-infiltration of CD20 + cells with CD68+ and CD4+ cells, whereas co-infiltration of CD8+ and CD68+ cells was only observed in HER2+ IBC. Co-infiltration of CD20+, CD8+, CD4+, and FOXP3+ cells, and co-existence of CD68+ with FOXP3+ cells correlated with better therapeutic responses, while resistant tumours were characterized by co-accumulation of CD4+, CD8+, FOXP3+, and CD68+ cells and co-expression of CD68+ and CD20+ cells. In a Cox regression model, response to therapy was the most significant factor associated with improved patient survival. CONCLUSION Those results reveal a complex unique pattern of distribution of immune cell subtypes in IBC and provide an important basis for detailed characterization of molecular pathways that govern the formation of IBC immune landscape and potential for immunotherapy.
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Affiliation(s)
- Nahla M Badr
- Institute of Cancer and Genomic Sciences, The University of Birmingham, Birmingham, UK
- Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Jack L McMurray
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Irini Danial
- Institute of Cancer and Genomic Sciences, The University of Birmingham, Birmingham, UK
| | - Steven Hayward
- Institute of Cancer and Genomic Sciences, The University of Birmingham, Birmingham, UK
| | - Nancy Y Asaad
- Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | | | - Asmaa G Abdou
- Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Marwa M Serag El-Dien
- Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Nisha Sharma
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Yoshiya Horimoto
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Tapan Sircar
- Breast Department, The Royal Wolverhampton Hospital, Wolverhampton, UK
| | - Raghavan Vidya
- Breast Department, The Royal Wolverhampton Hospital, Wolverhampton, UK
| | - Fiona Hoar
- City Hospital, Sandwell and West Birmingham Hospitals, Department of General and Breast Surgery, Birmingham, UK
| | - Daniel Rea
- Institute of Cancer and Genomic Sciences, The University of Birmingham, Birmingham, UK
| | - J Louise Jones
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | | | | | - Paul Lewis
- School of Management, Bay Campus, Swansea University., Swansea, UK
- Medical School, Institute of Life Science, Swansea University, Swansea, UK
| | | | - Fedor Berditchevski
- Institute of Cancer and Genomic Sciences, The University of Birmingham, Birmingham, UK
| | - Abeer M Shaaban
- Institute of Cancer and Genomic Sciences, The University of Birmingham, Birmingham, UK
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Lefroy R, Rahman E, Isgar B, Mylvaganam S, Vidya R, Matey P, Sircar T. Should we follow the guidance of association of breast surgery on gynaecomastia? European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2022.03.174] [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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Al-Ishaq Z, Asif U, Roy M, Sikdar O, Bhatnagar A, Sircar T. Glomus tumour of the nipple in a male patient. Ann R Coll Surg Engl 2021; 104:e60-e63. [PMID: 34821523 DOI: 10.1308/rcsann.2021.0141] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A glomus tumour is a benign mesenchymal tumour. It is extremely rare in the breast. We report a case of glomus tumour of the nipple in a 54-year-old man. To the best of the authors' knowledge, this is the first case report of a glomus tumour of the nipple. We describe the different presenting symptoms, method of diagnosis and treatment.
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Affiliation(s)
| | - U Asif
- The Royal Wolverhampton NHS Trust, UK
| | - M Roy
- Medical School, University of Birmingham, UK
| | - O Sikdar
- Imperial College School of Medicine, UK
| | | | - T Sircar
- The Royal Wolverhampton NHS Trust, UK
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Sikdar O, Roy M, Al-Ishaq Z, Shinde V, Sircar T. A rare case of primary carcinoma of axillary accessory breast tissue. J Surg Case Rep 2021; 2021:rjab473. [PMID: 34691386 PMCID: PMC8531245 DOI: 10.1093/jscr/rjab473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/22/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
Carcinomas of primary accessory breast tissue are rare, comprising 0.3–0.6% of all breast cancers and occur most commonly in the axilla. We report the unusual case of a 50-year-old lady with mucinous adenocarcinoma of axillary accessory breast tissue. In this report we review the presentation, key investigations and treatment of this condition.
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Affiliation(s)
| | - Meghna Roy
- University of Birmingham, Birmingham, UK
| | - Zaid Al-Ishaq
- Department of General Surgery, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Veena Shinde
- Department of Pathology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Tapan Sircar
- Department of General Surgery, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
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Vatish J, Wilkinson B, Al-Ishaq Z, Pujji O, Isgar B, Vidya R, Matey P, Sircar T, Mylvaganam S. The use of genomic assays reduces rates of chemotherapy: a single-institution experience. Ir J Med Sci 2021; 191:687-690. [PMID: 33993406 DOI: 10.1007/s11845-021-02650-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/13/2021] [Accepted: 05/10/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The National Institute for Clinical Excellence recommends the use of tumour profiling tests to guide adjuvant chemotherapy in breast cancer. The Oncotype DX™ score (Genomic Health) has superseded more traditional tools such as PREDICT in appropriate patients (ER + ve, HER2-ve, lymph node negative and with a Nottingham Prognostic Index [NPI] ≥ 3.4). The aim of this study was to see whether the introduction of Oncotype DX within our institution resulted in an overall reduction in rates of chemotherapy. METHOD Data was collected retrospectively using the Somerset Cancer Register, Pathology department databases and the institution's own online medical records system. Two groups were compared: (1) pre-oncotype (Jan 2012-Dec 2014) and (2) post-oncotype (Jan 2016-July 2018). RESULTS During the pre-oncotype period, 28/82 (34%) patients who would have been eligible for testing (patients who were ER + ve, HER2-ve, and a NPI ≥ 3.4) received chemotherapy compared to 34/135 (25%) who were sent for oncotype during the second study period (p = 0.157). For grade 3 cancers, and those aged under 50, the results were more marked: grade 3 pre-oncotype 23/43 (53%), post-oncotype 29/76 (38%) (p = 0.101), aged under 50 pre-oncotype 8/15 (53%), post-oncotype 10/31 (32%) (p = 0.197). CONCLUSION Within our institution, overall rates of chemotherapy have reduced since the introduction of Oncotype DX with the results more marked in subgroups of traditional indicators of tumour aggression. As genomic assays provide a more accurate prediction of the benefit of chemotherapy, its overall reduction has potential cost saving implications as well as reducing risk in patients who will derive little benefit.
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Affiliation(s)
- Jamie Vatish
- Corporate Services Centre, Royal Wolverhampton NHS Trust 12, New Cross Hospital, Wolverhampton, WV10 0QP, UK.
| | - Ben Wilkinson
- Corporate Services Centre, Royal Wolverhampton NHS Trust 12, New Cross Hospital, Wolverhampton, WV10 0QP, UK
| | - Zaid Al-Ishaq
- Corporate Services Centre, Royal Wolverhampton NHS Trust 12, New Cross Hospital, Wolverhampton, WV10 0QP, UK
| | - Ojas Pujji
- Corporate Services Centre, Royal Wolverhampton NHS Trust 12, New Cross Hospital, Wolverhampton, WV10 0QP, UK
| | - Brian Isgar
- Corporate Services Centre, Royal Wolverhampton NHS Trust 12, New Cross Hospital, Wolverhampton, WV10 0QP, UK
| | - Raghavan Vidya
- Corporate Services Centre, Royal Wolverhampton NHS Trust 12, New Cross Hospital, Wolverhampton, WV10 0QP, UK
| | - Pilar Matey
- Corporate Services Centre, Royal Wolverhampton NHS Trust 12, New Cross Hospital, Wolverhampton, WV10 0QP, UK
| | - Tapan Sircar
- Corporate Services Centre, Royal Wolverhampton NHS Trust 12, New Cross Hospital, Wolverhampton, WV10 0QP, UK
| | - Senthuran Mylvaganam
- Corporate Services Centre, Royal Wolverhampton NHS Trust 12, New Cross Hospital, Wolverhampton, WV10 0QP, UK
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Singh N, Rahman E, Isgar B, Sircar T. P028. Medications associated with gynaecomastia in current practice. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2021.03.032] [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] Open
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12
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Al-Ishaq Z, Al-Ishaq Z, Sikdar O, Roy M, Bhatnagar A, Sircar T. Lipomodelling of the Breast Following Excision of a Giant Juvenile Fibroadenoma. Surg Case Rep 2020. [DOI: 10.31487/j.scr.2020.08.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Giant juvenile fibroadenomas form 1-8% of breast lesions in the adolescent population. We report a case of
giant fibroadenoma in a 17-year-old girl who underwent simple lump excision through a lateral breast fold
incision followed by lipomodelling to correct the dimpling of the breast. With this dual approach, excellent
cosmetic outcome can be achieved for average-sized giant fibroadenoma without the need for more complex
technique.
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13
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Al-Ishaq Z, Al-Ishaq Z, Roy M, Bickley B, Bhatnagar A, Isgar B, Sircar T. A Rare Case of Metastatic Mucinous Breast Carcinoma as a First Presentation of Colon Cancer in a Male Patient: Case Report and Review of the Literature. Surg Case Rep 2020. [DOI: 10.31487/j.scr.2020.08.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The majority of breast tumors are primary; however metastatic tumor to the breast from extramammary sites
has an incidence of 0.5 to 3% and can be misinterpreted clinically as a primary breast tumor. We report a
case of metastatic mucinous breast carcinoma as a first presentation from colon cancer in a male patient
who hasn’t had any bowel symptoms. The immunohistochemical study helped in suspecting the diagnosis,
which was then confirmed by CT scan abdomen and pelvis and endoscopic biopsy of the colonic lesion.
Management of such patients usually by palliative chemotherapy due to the aggressive nature of the disease
however, surgical intervention may be indicated in symptomatic patient or risk of tumor ulceration as in our
patient.
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Mullapudi NA, Laws S, Kaushik M, Harvey J, Sircar T, Michalak S, Vidya R. 06. SENTINEL LYMPH NODE IDENTIFICATION USING SUPER PARAMAGNETIC IRON OXIDE VERSUS RADIOISOTOPE: THE UK SENTIMAG TRIAL (SMART STUDY). Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2020.03.013] [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: 11/28/2022] Open
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15
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Vatish J, Wilkinson B, Al-Ishaq Z, Pujji O, Matey P, Isgar B, Vidya R, Sircar T, Mylvaganam S. P142: Does the use of genomic assays reduce rates of chemotherapy? A single institution experience. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2020.03.181] [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: 10/24/2022] Open
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16
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Mullapudi NA, Vinayagam R, Clayden-Lewis C, Kothari A, Douvetzemis S, Sircar T, Vidya R, Laws S. P137: Negative pressure wound therapy in high risk breast procedures (negative pressure PICO study group). Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2020.03.176] [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] Open
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17
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Al Ishaq Z, Pujji O, Vatish J, Rahman E, Isgar B, Mylvaganam S, Matey P, Vidya R, Sircar T. P023. Is axillary clearance needed for all node-positive patients who are having neoadjuvant chemotherapy? Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2019.01.045] [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: 10/27/2022] Open
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18
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Vatish J, Pujji O, Al-Ishaq Z, Vidya R, Isgar B, Matey P, Mylvaganam S, Sircar T. P089. Neoadjuvant Pertuzumab in the treatment of HER2+ve breast cancer: Increased Pathological Complete Response, but at a cost? Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2019.01.111] [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: 11/16/2022] Open
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19
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Al-Ishaq Z, Green M, Salem F, Sircar T, Vidya R. prepectoral breast reconstruction: do we need to use the chest wall muscle at all? Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.357] [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: 10/27/2022] Open
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20
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Al-Ishaq Z, Salem F, Sircar T, Vidya R. Dedicated under 35 breast clinic: is this the answer? Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.358] [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] Open
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21
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Copson E, Shaaban AM, Maishman T, Moseley PM, McKenzie H, Bradbury J, Borley A, Brzezinska M, Chan SYT, Ching J, Cutress RI, Danial I, Dall B, Kerin M, Lowery AJ, Macpherson IR, Romics L, Sawyer E, Sharmat N, Sircar T, Vidya R, Pan Y, Rea D, Jones L, Eccles DM, Berditchevski F. The presentation, management and outcome of inflammatory breast cancer cases in the UK: Data from a multi-centre retrospective review. Breast 2018; 42:133-141. [PMID: 30278369 DOI: 10.1016/j.breast.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/22/2018] [Accepted: 09/10/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Inflammatory Breast cancer (IBC) is a rare but aggressive form of breast cancer. Its incidence and behaviour in the UK is poorly characterised. We collected retrospective data from hospitals in the UK and Ireland to describe the presentation, pathology, treatment and clinical course of IBC in the UK. MATERIALS AND METHODS Patients with IBC diagnosed between 1997-2014 at fourteen UK and Irish hospitals were identified from local breast unit databases. Patient characteristics, tumour pathology and stage, and details of surgical, systemic and radiotherapy treatment and follow-up data were collected from electronic patient records and medical notes. RESULT This retrospective review identified 445 patients with IBC accounting for 0.4-1.8% of invasive breast cancer cases. Median follow-up was 4.2 years. 53.2% of tumours were grade 3, 56.2% were oestrogen receptor positive, 31.3% were HER2 positive and 25.1% were triple negative. 20.7% of patients had distant metastases at presentation. Despite trimodality treatment in 86.4%, 40.1% of stage III patients developed distant metastases. Five-year overall survival (OS) was 61.0% for stage III and 21.4% for stage IV patients. CONCLUSIONS This is the largest series of UK IBC patients reported to date. It indicates a lower incidence than in American series, but confirms that IBC has a high risk of recurrence with poor survival despite contemporary multi-modality therapy. A national strategy is required to facilitate translational research into this aggressive disease.
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Affiliation(s)
- E Copson
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK.
| | - A M Shaaban
- Department of Histopathology and University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B152GW, UK
| | - T Maishman
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - P M Moseley
- Clinical Oncology Department, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - H McKenzie
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - J Bradbury
- Department of Oncology, Salisbury NHS Foundation Trust, Salisbury District Hospital, Odstock Road, Salisbury, Wiltshire, SP2 8BJ, UK
| | - A Borley
- Velindre Cancer Centre, Whitchurch, Cardiff, CF14 2TL, UK
| | - M Brzezinska
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Crewe Road South Edinburgh, EH4 2XU, UK
| | - S Y T Chan
- Clinical Oncology Department, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - J Ching
- Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, BH15 2JB, UK
| | - R I Cutress
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - I Danial
- Department of Histopathology and University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B152GW, UK
| | - B Dall
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Leeds Teaching Hospitals NHS Trust, Becket Street, Leeds, LS9 7TF, UK
| | - M Kerin
- The Lambe Institute for Translational Research, National University of Ireland & University Hospital Galway, Galway, Ireland
| | - A J Lowery
- The Lambe Institute for Translational Research, National University of Ireland & University Hospital Galway, Galway, Ireland
| | - I R Macpherson
- Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, G61 1QH, UK
| | - L Romics
- Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, G61 1QH, UK
| | - E Sawyer
- Research Oncology, Division of Cancer Studies, Guy's Hospital, King's College London, London, SE1 9RT, UK
| | - N Sharmat
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Leeds Teaching Hospitals NHS Trust, Becket Street, Leeds, LS9 7TF, UK
| | - T Sircar
- Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton Road, Wolverhampton, WV10 0QP, UK
| | - R Vidya
- Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton Road, Wolverhampton, WV10 0QP, UK
| | - Y Pan
- Centre for Computational Biology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - D Rea
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - L Jones
- Barts NHS Trust and Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - D M Eccles
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - F Berditchevski
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Abstract
Breast abscess is a common clinical condition mostly caused by Staphylococcus aureus However, infections due to mixed organisms are observed in non-lactational women, mostly in smokers. Salmonella infection causing breast abscess is extremely rare in developed countries. We report a case of Salmonella enterica subsp enterica (I) serovar Enteritidis breast abscess in a 48-year-old woman, a UK citizen, who had recently travelled abroad. She was treated successfully with a combination of surgery and ciprofloxacin. Unusual causative organisms should be kept in mind in patients with recent travel abroad and pus should be sent for microbiology. Mastitis caused by Salmonella spp can present with a severely indurated area that may take a few weeks to resolve. Complete assessment with biopsy of the indurated area and breast imaging is mandatory to exclude malignancy.
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Affiliation(s)
- Zaid Al-Ishaq
- Department of Surgery, New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, West Midlands, UK
| | | | - Donald Dobie
- Department of microbiology, New cross hospital,Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, West Midlands, UK
| | - Tapan Sircar
- Department of Surgery, New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, West Midlands, UK
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Reid J, Allen C, Green M, Bowen N, Mylvaganam S, Matey P, Bickley B, Isgar B, Sircar T, Vidya R. Wire guided impalpable breast lesion localisation: Old is gold? Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.02.115] [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: 10/16/2022] Open
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24
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Al-Ishaq Z, Gupta S, Collins MA, Sircar T. Chyle leak following an axillary sentinel lymph node biopsy for breast cancer in a patient with superior vena caval thrombosis - a case report and review of the literature. Ann R Coll Surg Engl 2018; 100:e147-e149. [PMID: 29658338 DOI: 10.1308/rcsann.2018.0074] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chyle leak is a very rare complication following an axillary lymph node dissection. We report a case of chyle leak following sentinel lymph node biopsy in a patient with breast cancer with superior vena caval thrombosis. To our knowledge, this is the first case report of chyle leakage following axillary sentinel lymph node biopsy. We describe the aetiology, prevention and treatment strategy that can be adopted in these patients.
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Affiliation(s)
- Z Al-Ishaq
- Department of Surgery, New Cross Hospital, Royal Wolverhampton NHS Trust , Wolverhampton, West Midlands , UK
| | - S Gupta
- University of Liverpool School of Medicine , Liverpool, Merseyside , UK
| | - M A Collins
- Department of Radiology, New Cross Hospital, Royal Wolverhampton NHS Trust , Wolverhampton, West Midlands , UK
| | - T Sircar
- Department of Surgery, New Cross Hospital, Royal Wolverhampton NHS Trust , Wolverhampton, West Midlands , UK
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26
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Vidya R, Smith AH, Salem F, Garg N, Dhespande A, Bhaskar P, Sircar T, Cawthorn S. 1. Outcome following 150 prepectoral implant based breast reconstruction using Braxon ® (ADM): UK experience. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.01.020] [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: 11/16/2022] Open
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27
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Salem F, Jones C, Athwal R, Sircar T, Vidya R. Dedicated under 35 breast clinic: Is this the answer? Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.01.026] [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: 11/16/2022] Open
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28
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Parvaiz MA, Yang P, Razia E, Mascarenhas M, Deacon C, Matey P, Isgar B, Sircar T. Breast
MRI
in Invasive Lobular Carcinoma: A Useful Investigation in Surgical Planning? Breast J 2016; 22:143-50. [PMID: 26841281 DOI: 10.1111/tbj.12566] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Muhammad Asad Parvaiz
- Department of Breast & Oncoplastic Surgery Peterborough and Stamford Hospitals NHS Foundation Trust Peterborough Cambridgeshire UK
| | - Peiming Yang
- Department of Breast & Oncoplastic Surgery The Royal Wolverhampton Hospitals NHS Trust West Midlands UK
| | - Eisha Razia
- Department of Breast & Oncoplastic Surgery The Royal Wolverhampton Hospitals NHS Trust West Midlands UK
| | - Margaret Mascarenhas
- Department of Breast & Oncoplastic Surgery The Royal Wolverhampton Hospitals NHS Trust West Midlands UK
| | - Caroline Deacon
- Department of Radiology The Royal Wolverhampton Hospitals NHS Trust West Midlands UK
| | - Pilar Matey
- Department of Breast & Oncoplastic Surgery The Royal Wolverhampton Hospitals NHS Trust West Midlands UK
| | - Brian Isgar
- Department of Breast & Oncoplastic Surgery The Royal Wolverhampton Hospitals NHS Trust West Midlands UK
| | - Tapan Sircar
- Department of Breast & Oncoplastic Surgery The Royal Wolverhampton Hospitals NHS Trust West Midlands UK
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29
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Howles S, Sircar T, Matey P. P151. Is intraoperative assessment for sentinel lymph node metastases really beneficial in the post-AMAROS era? Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2015.03.189] [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: 10/23/2022] Open
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Parvaiz A, Yang P, Razia E, Sircar T, Matey P, Deacon C, Isgar B. P163. Is breast MRI useful in invasive lobular carcinoma? Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2015.03.201] [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: 11/24/2022] Open
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32
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Bradbury C, Parvaiz MA, Sircar T. Innovative postoperative bra for patients with drains following breast surgery. Ann R Coll Surg Engl 2014; 96:241. [PMID: 24780798 DOI: 10.1308/rcsann.2014.96.3.241] [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] [Indexed: 11/22/2022] Open
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33
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Parvaiz A, Sircar T. Dual assessment instead of the triple assessment for under 25s: Time for a change in practice? Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.01.188] [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: 11/28/2022] Open
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34
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Bradbury C, Sircar T, Isgar B, Matey P. Innovative post-operative 'Bra' for patients discharged home with drains following breast surgery - does it improve the patient's experience? Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.02.062] [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: 11/29/2022] Open
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35
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Katerinaki E, Sircar T, Fatah F. Pre-expansion before risk reducing mastectomy combined with lipomodelling to enhance results from implant based reconstruction. J Plast Reconstr Aesthet Surg 2012; 65:182-6. [DOI: 10.1016/j.bjps.2011.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 08/31/2011] [Accepted: 09/06/2011] [Indexed: 10/17/2022]
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Katerinaki E, Sircar T, Sterne GD. The C-V flap for nipple reconstruction after previous skin-sparing mastectomy and immediate breast reconstruction: refinements of donor-site closure. Aesthetic Plast Surg 2011; 35:624-7. [PMID: 21359991 DOI: 10.1007/s00266-011-9658-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 08/10/2010] [Accepted: 12/24/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND The C-V flap including its modifications is very popular flap used for nipple reconstruction. METHODS This report describes a refinement of the C-V flap used in nipple reconstruction for patients who previously have undergone skin-sparing mastectomy and immediate breast reconstruction. Closure of the V flap donor sites is facilitated by means of designing two opposing advancement "areolar" skin flaps. RESULTS Our modification ensures that no "dog ears" remain after the donor sites of the two V flaps are closed and that all scarring remains within the skin paddle of the neo-areola without any extensions on the mastectomy skin flaps. CONCLUSION Our refinement of the closure for the donor site of the C-V flap used in nipple reconstruction produces an aesthetically pleasing result without unnecessary donor-site scar extensions on the mastectomy skin flaps.
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Affiliation(s)
- E Katerinaki
- Department of Plastic and Reconstructive Surgery, Birmingham City Hospital, Birmingham B18 7QH, UK
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37
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Richardson C, Sircar T, Matey P. Oncoplastic surgical techniques can reduce the need for mastectomy for periareolar tumours of the breast. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.03.056] [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: 10/18/2022] Open
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38
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Sircar T, Brown H, Rea D, Hoar F. Can ER/PR and HER2 receptor status predict complete pathological response after neo adjuvant chemotherapy in patients with breast cancer? Eur J Surg Oncol 2010. [DOI: 10.1016/j.ejso.2010.08.058] [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: 11/26/2022] Open
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39
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Sircar T, Brown H, Athwal R, Dea D, Hoar F. O-29 Can ER/PR and HER2 receptor status predict complete pathological response after neo-adjuvant chemotherapy in patients with breast cancer? EJC Suppl 2010. [DOI: 10.1016/j.ejcsup.2010.06.030] [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: 10/19/2022] Open
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40
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Sircar T, Choudhry A, Katerinaki E, Sterne G. O-1 Breast skin envelope necrosis after skin sparing mastectomy and immediate breast reconstruction – How common is it? EJC Suppl 2010. [DOI: 10.1016/j.ejcsup.2010.06.002] [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: 10/19/2022] Open
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41
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Affiliation(s)
- Tapan Sircar
- Breast and Oncoplastic Surgery Department, Birmingham City Hospital, Birmingham, UK.
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42
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Affiliation(s)
- Tapan Sircar
- Breast and Oncoplastic Surgery Department, Birmingham City Hospital Birmingham, UK
| | - Ashok Chouhan
- West Sussex Breast Centre, Worthing Hospital West Sussex, UK
| | - Akhil Johri
- West Sussex Breast Centre, Worthing Hospital West Sussex, UK
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Sircar T, Mistry P, Harries S, Clarke D, Jones L. Seat-belt trauma of the breast in a pregnant woman causing milk-duct injury: a case report and review of the literature. Ann R Coll Surg Engl 2010; 92:W14-5. [PMID: 20529454 DOI: 10.1308/147870810x12659688851799] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Injury to the milk-duct following a road traffic accident has not been reported in the literature. This case report describes a 25-year-old postpartum lady with massive swelling of the breast due to milk-duct injury and collection of milk within the breast. We describe the possible mechanism of milk-duct injury, its presentation and management, and also review the literature on seat-belt injury to the breast.
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Affiliation(s)
- T Sircar
- Department of Breast Surgery, Warwick Hospital, Warwick, UK.
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44
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Sircar T, Mistry P, Eyers A, Preece T, Davis N, Harries S, Clarke D, Jones L. 308 Does ‘intra-operative assessment’ of sentinel lymph node biopsy increase patient's anxiety? EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70334-7] [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] Open
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45
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Soumian S, Sircar T, Whisker L, Skillman J, Abbott N, Winter H, Kaur V, Kearins O, Lawrence G. Should the Age of Breast Cancer Screening for Ethnic Minorities Be Reduced? Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-4008] [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
IntroductionThe National Health Service Breast Screening Programme (NHSBSP) offers breast screening every three years for all women aged 50 and over in the United Kingdom (UK). Women aged between 50 and 70 are routinely invited. The NHSBSP will extend the age range of women invited for breast screening from ages 47 to 73 in the future. However, the ideal age for screening should take into consideration the relative risk of the population. The UK has a significant population of ethnic minority groups, mainly Asian and Afro-Caribbean, comprising of about 8% of the total population. The ethnic minority groups have remained geographically concentrated in specific regions especially London and West Midlands, where they comprise 30% and 14% of the population respectively. It has been reported that ethnic minorities present with relatively advanced breast cancer at a younger age. These groups could potentially benefit from early screening. We wanted to test this hypothesis by assessing the age and route of presentation of breast cancer across ethnic groups in the West Midlands region.MethodsThe West Midlands Cancer Intelligence Unit (WMCIU), a population based registry, collects prospective data on breast cancer diagnosed and treated in this region. Data on patients treated for breast cancer from 2001 to 2007 was obtained from the WMCIU. The age and route of presentation (screening or symptomatic) of Asian, Afro-Caribbean and Caucasian patients were analysed and compared.Results.A total of 27,444 female patients were diagnosed during this period. Data regarding ethnicity was available for 18,941 Caucasians, 528 Asians and 274 Afro-Caribbean's. Diagnosis through screening was 37%, 26% and 29% for Asian, Afro-Caribbean and the Caucasian population respectively. In the symptomatic group, 26.5% of Asians and 35% of Afro-Caribbeans presented below the age of 47 years compared to 13% of the Caucasian population. Furthermore, 13.5% of Asians, 16.5%of Afro-Caribbeans and 5.9% of Caucasians presented at or below the age of 40 years.ConclusionA significant percentage of breast cancers diagnosed within ethnic groups will still be missed despite revising the screening age to 47 years. Unless the participation of ethnic groups in screening is targeted, the benefits (detecting disease at an earlier stage and potentially reduced mortality) will be lost.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4008.
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Affiliation(s)
- S. Soumian
- 1Breast Steering Group, West Midlands Research Collaborative, Russells Hall Hospital, Birmingham, United Kingdom
| | - T. Sircar
- 1Breast Steering Group, West Midlands Research Collaborative, Russells Hall Hospital, Birmingham, United Kingdom
| | - L. Whisker
- 1Breast Steering Group, West Midlands Research Collaborative, Russells Hall Hospital, Birmingham, United Kingdom
| | - J. Skillman
- 1Breast Steering Group, West Midlands Research Collaborative, Russells Hall Hospital, Birmingham, United Kingdom
| | - N. Abbott
- 1Breast Steering Group, West Midlands Research Collaborative, Russells Hall Hospital, Birmingham, United Kingdom
| | - H. Winter
- 1Breast Steering Group, West Midlands Research Collaborative, Russells Hall Hospital, Birmingham, United Kingdom
| | - V. Kaur
- 1Breast Steering Group, West Midlands Research Collaborative, Russells Hall Hospital, Birmingham, United Kingdom
| | - O. Kearins
- 2West Midlands Cancer Intelligence Unit, United Kingdom
| | - G. Lawrence
- 2West Midlands Cancer Intelligence Unit, United Kingdom
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Sircar T, Thomas G, Chachlani N, Simon J, Harries S, Jones L, Clarke D. Intra-Operative Assessment of Sentinel Lymph Nodes with Touch Imprint Cytology – Experience on 232 Patients with Breast Cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-1030] [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
IntroductionSentinel lymph nodes (SLNs) are generally evaluated by histology which takes about 3-5 days and axillary clearance is then carried out if SLN is positive for metastasis. This second operation to perform axillary clearance can be avoided, if a reliable intraoperative assessment is available. This will allow the surgeon to proceed to axillary clearance during the primary operation if intra-operative assessment of SLNs is positive. Touch imprint cytology (TIC), is a relatively new technique for intraoperative assessment. This study aimed to evaluate the accuracy and feasibility of TIC in our practice.MethodsThis was a prospective study of 232 patients with breast cancer. SLN biopsy was performed first and sent for TIC while surgeon proceeded with wide local excision or mastectomy. In pathology, nodes less than 5mm were bisected and others were sliced at 2mm intervals.Each cut surface was touched onto a slide allowing the weight of the node to release the cells onto the slide. The slides were assessed by dedicated breast pathologists and the results telephoned to theatre. If TIC was positive, axillary clearance was performed. Permanent histological sections were evaluated with hematoxylin and eosin stain and immuno-histochemical staining. The TIC results were compared with the final histology of the SLN. We calculated the accuracy, sensitivity, specificity, positive predictive and negative predictive value of TIC. The time required for intra-operative assessment was recorded prospectively in the last 30 patients. We also calculated the percentage of patients who were spared from having a second operation for axillary clearance based on the results of TIC.ResultsAccuracy of TIC was 90%. Sensitivity and specificity was 54% and 100% respectively. Positive and negative predictive value was 100% and 88% respectively. On final histology, 52 patients (22%) were node positive. TIC diagnosed metastasis in 28(54%) patients (95% Confidence Interval 0.39-0.67). Thus 28 patients (54%) avoided a second operation. Among patients with falsely negative TIC, micrometastasis was seen in 6/24(25%) patients and isolated tumour cells in 1/24(4%) patient. Average time from harvesting of the nodes to receiving of result of the TIC for each patient was 32 minutes (range 15-53). This was proportional to the number of nodes sent. Average time taken by cytopathologist was 15 minutes. Prolongation of operation time was seen in only 22% patients on an average by 7 minutes (range 2-15).ConclusionsTIC is a simple and feasible technique with prolongation of operation time seen in only 22% patients on an average by 7 minutes. It is a reliable technique with an accuracy of 90%. No patient was subjected to unnecessary axillary clearance. Patients should however be counseled preoperatively about chance of false negative results on TIC and need for a second operation. TIC avoided a second operation for axillary lymph node clearance in 54% patients and thus also avoided delay in the adjuvant treatment of these patients.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1030.
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Affiliation(s)
- T. Sircar
- 1Warwick Hospital, Warwickshire, United Kingdom
| | - G. Thomas
- 1Warwick Hospital, Warwickshire, United Kingdom
| | | | - J. Simon
- 2Warwick Hospital, Warwickshire, United Kingdom
| | - S. Harries
- 1Warwick Hospital, Warwickshire, United Kingdom
| | - L. Jones
- 1Warwick Hospital, Warwickshire, United Kingdom
| | - D. Clarke
- 1Warwick Hospital, Warwickshire, United Kingdom
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Sircar T, Chaudhry S, Francis A. Effect of neoadjuvant chemotherapy on oestrogen, progesterone and HER 2 receptor expression in breast cancer. Eur J Surg Oncol 2009. [DOI: 10.1016/j.ejso.2009.07.096] [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: 10/20/2022] Open
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Sircar T, Eyers A, Flavin D, Harries S, Clarke D, Jones L. Does ‘intra-operative assessment’ of sentinel lymph node biopsy increase patient's anxiety? Eur J Surg Oncol 2009. [DOI: 10.1016/j.ejso.2009.07.099] [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: 10/20/2022] Open
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Sircar T, Chachlani N, Thomas G, Jones L, Harries S, Clarke D. Intra-operative assessment of sentinel lymph nodes with touch imprint cytology- experience on 232 patients with breast cancer. Eur J Surg Oncol 2009. [DOI: 10.1016/j.ejso.2009.07.044] [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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Sircar T, Clarke D, Chachlani N, Simon J, Thomas G, Eyers A, Flavin D, Jones L, Harries S. 5123 Intra-operative assessment of sentinel lymph nodes in breast cancer with touch imprint cytology – a cost effective and reliable method. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71015-8] [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: 11/26/2022] Open
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