e12032 Background: Nipple discharge has a known association with breast cancer, determing which c... more e12032 Background: Nipple discharge has a known association with breast cancer, determing which cases to identify as being at high risk is a complex task for the clinician. The current policy at West Herfordshire hospital NHS Trust is to offer microdochectomy to all women who present with unilateral single duct nipple discharge, dominant duct discharge, or peristent duct discharge. The aim of this study was to determine if on basis of the pattern ofnipple discharge, patients could be subselected for microdochectomies, and to create a base line to allow future subselection of patients for survillience only. Methods: All patient with single duct unilateral spontaenous nipple discharge, who underwent microdochectomy, were assessed. Demongraphics, clincial presentation, radilogical assessment, cytology, core biopsy. This group of patients was anlysed and correlated with their final histological assessment. Results: 122 patients were analysed in this study. 7 ( 5.74%) were diagnosed with...
58 Background: Nipple discharge has a known association with breast cancer, but determining which... more 58 Background: Nipple discharge has a known association with breast cancer, but determining which cases to identify as being at high risk is a complex and controversial task for the clinician. The current policy at West Hertfordshire Hospitals Trust is to offer microdochectomies to all women who present with unilateral single duct discharge, dominant duct discharge or persistent duct discharge and negative cytology and pre-operative imaging. The aim of this study is to determine if a more discriminative approach might be applied to women who present with nipple discharge. Methods: All patients who underwent a microdochectomy over a 4-year period (2006-2011) were assessed. Patient demographics, characteristics, presenting complaint, pre-operative imaging, and pathology results were analysed. Results: Of the 122 patients analysed in this study, only 7 (5.74%) were diagnosed with malignant carcinoma: 4 patients had DCIS; 3 patients had DCIS and IDC. Of these, 2 had bloodstained nipple ...
Page 1. SEVENTEENTH SIR PETER FREYER MEMORIAL LECTURE and SURGICAL SYMPOSIUM September 18th &... more Page 1. SEVENTEENTH SIR PETER FREYER MEMORIAL LECTURE and SURGICAL SYMPOSIUM September 18th & 19th, 1992 SESSION I 1 24 HOUR pHMETRY: CONTRIBUTION OF POST-PRANDIAL REFLUX D, O'Gradaigh, P, J. Byrne, P. Gillen. ...
Breast cancer patients who develop bone metastases have an unpredictable clinical course. Numerou... more Breast cancer patients who develop bone metastases have an unpredictable clinical course. Numerous studies have shown that CA15. 3 is elevated in the presence of multiple metastatic sites, including bone. However, little is known about CA15. 3 levels in patients ...
European Journal of Surgical Oncology (EJSO), 2014
Background: Non-operative diagnosis of breast disease is best practice to allow discussion of all... more Background: Non-operative diagnosis of breast disease is best practice to allow discussion of all treatment options prior to surgical intervention. Core biopsy (14G) will in most cases yield a definitive pathological result, however if the result is indeterminate/ inadequate/ normal, with an abnormal imaging, a repeat biopsy should be performed preferably using a large gauge vacuum assisted biopsy (VAC) device (NHSBSP Publication No.20;4) Our aim is to evaluate changes in the management of breast lesions following further VAC biopsy and to review the departmental policy for indeterminate pathological wide bore needle results. Data collection and results: Both symptomatic and screening data were collected from October 2011 to 2013 undergoing stereotactic VAC procedures. 26 women had VAC procedure after initial core biopsy. The histopathology results are shown in Table 1. Of the 26 women 12 were saved from having surgical procedure for benign lesion. 6 had single stage surgical procedure for malignancy. 6 women who had open excision biopsy after VAC yielded B3 results, showed non-invasive cancer in 3 and rest benign. 2 women were unable to tolerate the procedure. Conclusion/Action plan: As a result of performing VAC biopsy 18 out of 26 women were saved at least one surgical procedure which is of benefit to the women and also cost-effective. At the time of this audit, core biopsy showing B3 with atypia used to have surgical excision. Following this audit a new departmental policy has been implemented in discussion with the Breast Pathologist and Surgical team. In that all initial B3 results are to undergo repeat biopsy, preferably VAC.
Annals of the Academy of Medicine, Singapore, 2000
Isolated single-duct nipple discharge is worrying and poses a surgical dilemma. Factors predictin... more Isolated single-duct nipple discharge is worrying and poses a surgical dilemma. Factors predicting malignancy are controversial. Retrospective review of 92 consecutive microdochectomies for single-duct nipple discharge in a tertiary referral centre over 8 years. The commonest causes were ductal papilloma (52%) and fibrocystic diseases of the breast (21%). Five (5%) patients had breast carcinoma, of whom only 1 had an invasive component. The median age of these patients was 43 years (range 26 to 72 years) which was similar to median age of the whole cohort. Sixty-seven (73%) patients presented with blood-stained nipple discharge. The 5 patients with breast carcinoma had blood-stained discharge. Mammography was abnormal in 1 out of 4 patients in the carcinoma group. The incidence of breast carcinoma in patients presenting with isolated single-duct nipple discharge was low (5%) among Singaporean women. There was no reliable predictors of malignancy, though all patients with carcinoma p...
tected groups were compared regarding intraoperative sentinel node detection rates, accuracy, pre... more tected groups were compared regarding intraoperative sentinel node detection rates, accuracy, predictive value of a negative sentinel node, and false negative rates. Results: Intraoperative sentinel node identification was significantly better for symptomatic breast tumours where 112023 (91%) cases were successfully biopsied compared with 89/l 13 (79%) screen detected cases (p < 0.05). The overall accuracy and predictive value of the negative sentinel node was greater for screen detected lesions although this failed to reach statistical significance (98.9% versus 95.8%, 98.6% versus 91.5% respectively). There was one false negative case in the screen detected group compared with five in the symptomatic group, although due to the low prevalence of axillary lymph node involvement in screen detected population, there was no difference in false negative rates (5.9% screening, 7.8% symptomatic). Conclusion: Although the accuracy of sentinel node biopsy is maintained for small screen detected breast cancers, failure to identify the mode in approximately 20% of cases may limit the clinical usefulness of the technique in this important patient subgroup.
e12032 Background: Nipple discharge has a known association with breast cancer, determing which c... more e12032 Background: Nipple discharge has a known association with breast cancer, determing which cases to identify as being at high risk is a complex task for the clinician. The current policy at West Herfordshire hospital NHS Trust is to offer microdochectomy to all women who present with unilateral single duct nipple discharge, dominant duct discharge, or peristent duct discharge. The aim of this study was to determine if on basis of the pattern ofnipple discharge, patients could be subselected for microdochectomies, and to create a base line to allow future subselection of patients for survillience only. Methods: All patient with single duct unilateral spontaenous nipple discharge, who underwent microdochectomy, were assessed. Demongraphics, clincial presentation, radilogical assessment, cytology, core biopsy. This group of patients was anlysed and correlated with their final histological assessment. Results: 122 patients were analysed in this study. 7 ( 5.74%) were diagnosed with...
58 Background: Nipple discharge has a known association with breast cancer, but determining which... more 58 Background: Nipple discharge has a known association with breast cancer, but determining which cases to identify as being at high risk is a complex and controversial task for the clinician. The current policy at West Hertfordshire Hospitals Trust is to offer microdochectomies to all women who present with unilateral single duct discharge, dominant duct discharge or persistent duct discharge and negative cytology and pre-operative imaging. The aim of this study is to determine if a more discriminative approach might be applied to women who present with nipple discharge. Methods: All patients who underwent a microdochectomy over a 4-year period (2006-2011) were assessed. Patient demographics, characteristics, presenting complaint, pre-operative imaging, and pathology results were analysed. Results: Of the 122 patients analysed in this study, only 7 (5.74%) were diagnosed with malignant carcinoma: 4 patients had DCIS; 3 patients had DCIS and IDC. Of these, 2 had bloodstained nipple ...
Page 1. SEVENTEENTH SIR PETER FREYER MEMORIAL LECTURE and SURGICAL SYMPOSIUM September 18th &... more Page 1. SEVENTEENTH SIR PETER FREYER MEMORIAL LECTURE and SURGICAL SYMPOSIUM September 18th &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; 19th, 1992 SESSION I 1 24 HOUR pHMETRY: CONTRIBUTION OF POST-PRANDIAL REFLUX D, O&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#x27;Gradaigh, P, J. Byrne, P. Gillen. ...
Breast cancer patients who develop bone metastases have an unpredictable clinical course. Numerou... more Breast cancer patients who develop bone metastases have an unpredictable clinical course. Numerous studies have shown that CA15. 3 is elevated in the presence of multiple metastatic sites, including bone. However, little is known about CA15. 3 levels in patients ...
European Journal of Surgical Oncology (EJSO), 2014
Background: Non-operative diagnosis of breast disease is best practice to allow discussion of all... more Background: Non-operative diagnosis of breast disease is best practice to allow discussion of all treatment options prior to surgical intervention. Core biopsy (14G) will in most cases yield a definitive pathological result, however if the result is indeterminate/ inadequate/ normal, with an abnormal imaging, a repeat biopsy should be performed preferably using a large gauge vacuum assisted biopsy (VAC) device (NHSBSP Publication No.20;4) Our aim is to evaluate changes in the management of breast lesions following further VAC biopsy and to review the departmental policy for indeterminate pathological wide bore needle results. Data collection and results: Both symptomatic and screening data were collected from October 2011 to 2013 undergoing stereotactic VAC procedures. 26 women had VAC procedure after initial core biopsy. The histopathology results are shown in Table 1. Of the 26 women 12 were saved from having surgical procedure for benign lesion. 6 had single stage surgical procedure for malignancy. 6 women who had open excision biopsy after VAC yielded B3 results, showed non-invasive cancer in 3 and rest benign. 2 women were unable to tolerate the procedure. Conclusion/Action plan: As a result of performing VAC biopsy 18 out of 26 women were saved at least one surgical procedure which is of benefit to the women and also cost-effective. At the time of this audit, core biopsy showing B3 with atypia used to have surgical excision. Following this audit a new departmental policy has been implemented in discussion with the Breast Pathologist and Surgical team. In that all initial B3 results are to undergo repeat biopsy, preferably VAC.
Annals of the Academy of Medicine, Singapore, 2000
Isolated single-duct nipple discharge is worrying and poses a surgical dilemma. Factors predictin... more Isolated single-duct nipple discharge is worrying and poses a surgical dilemma. Factors predicting malignancy are controversial. Retrospective review of 92 consecutive microdochectomies for single-duct nipple discharge in a tertiary referral centre over 8 years. The commonest causes were ductal papilloma (52%) and fibrocystic diseases of the breast (21%). Five (5%) patients had breast carcinoma, of whom only 1 had an invasive component. The median age of these patients was 43 years (range 26 to 72 years) which was similar to median age of the whole cohort. Sixty-seven (73%) patients presented with blood-stained nipple discharge. The 5 patients with breast carcinoma had blood-stained discharge. Mammography was abnormal in 1 out of 4 patients in the carcinoma group. The incidence of breast carcinoma in patients presenting with isolated single-duct nipple discharge was low (5%) among Singaporean women. There was no reliable predictors of malignancy, though all patients with carcinoma p...
tected groups were compared regarding intraoperative sentinel node detection rates, accuracy, pre... more tected groups were compared regarding intraoperative sentinel node detection rates, accuracy, predictive value of a negative sentinel node, and false negative rates. Results: Intraoperative sentinel node identification was significantly better for symptomatic breast tumours where 112023 (91%) cases were successfully biopsied compared with 89/l 13 (79%) screen detected cases (p < 0.05). The overall accuracy and predictive value of the negative sentinel node was greater for screen detected lesions although this failed to reach statistical significance (98.9% versus 95.8%, 98.6% versus 91.5% respectively). There was one false negative case in the screen detected group compared with five in the symptomatic group, although due to the low prevalence of axillary lymph node involvement in screen detected population, there was no difference in false negative rates (5.9% screening, 7.8% symptomatic). Conclusion: Although the accuracy of sentinel node biopsy is maintained for small screen detected breast cancers, failure to identify the mode in approximately 20% of cases may limit the clinical usefulness of the technique in this important patient subgroup.
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Papers by Sanjay Baldota