Sentinel lymph node biopsy in a resourcelimited setting: a retrospective comparison of sentinel lymph node biopsy before and after the introduction of Sentimag at an academic breast unit.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is performed for staging and prognostication of breast cancer (BC) in cases with a clinically and radiologically negative axilla. Using blue dye and a radioactive colloid injection is considered the gold standard for SLNB. This study aims to evaluate the SLNB outcomes before and after the introduction of Sentimag at an academic breast unit. Sentimag uses an injection of superparamagnetic iron oxide which is then detected in the sentinal lymph node using a magnetometer. METHODS: A retrospective cohort study was performed comparing SLNBs done from 1 January 2017 to 31 December 2018. During 2017, a nuclear medicine technique was used for all SLNBs, while the Sentimag system was used in 2018. RESULTS: There was no difference between the two groups comparing age, T-stage, size of tumour, and molecular status. The only statistically significant difference found was more higher-grade tumours in the group where a nuclear medicine technique was used in 2017 (p = 0.04). There was no difference in the type of surgery performed comparing mastectomy and breast-conserving surgery rates between the two groups. There was an 11% increase in the number of patients who had an SLNB done with the Sentimag technique (2018). In 2017, 42% (58/139) had an SLNB and in 2018, 53% (59/112) had an SLNB. CONCLUSION: This result demonstrates the feasibility of the magnetic technique for SLNB in a resource-limited setting. This new method shows promise as a safe and effective technique for SLNB - it is a valuable alternative in the absence of nuclear medicine (N.Med) facilities.

Magseed placement before neoadjuvant chemotherapy to facilitate subsequent breastconserving surgery - a single-centre audit.

BACKGROUND: A radio-opaque clip is placed in all patients planned for breast-conserving surgery (BCS) receiving neoadjuvant chemotherapy (NACT) to localise the tumour bed in case response to chemotherapy makes later localisation impossible. A tumour that was localised with a radio-opaque clip before NACT will then need a second localisation procedure, after the completion of NACT to aid BCS. The two most commonly used methods are hookwire and radioguided occult lesion localisation. Magseed®, a newly available technology consisting of a small magnetic seed, has now become available. The seed is placed instead of a radio-opaque clip before the start of or during NACT and can remain in place until the time of BCS. METHODS: A retrospective cohort study was performed, collecting data on patients who had a Magseed placed before or during NACT from December 2018 to February 2020. RESULTS: Twenty-one Magseed devices were placed into the breasts of 20 patients, 18 under ultrasound guidance, and three under stereotactic guidance. The average breast volume of individuals who had seeds placed was 1 532 g ± 869 g. The duration that the seeds were in situ was 138 days ± 45 days. All preoperatively placed seeds were retrieved at the surgery with no observed migration outside the tumour bed. CONCLUSION: Magseed placement before NACT is a safe and technically simple technique that can be done under ultrasound guidance in the majority of cases. It has the advantage of being a single procedure with an associated reduction in time off work and travel cost to the patient, as well as flexibility in terms of the time of placement.

Impact of COVID-19 on breast cancer diagnostic and surgical services at a South African academic hospital.

BACKGROUND: The purpose of the study was to describe the impact of the COVID-19 pandemic on diagnostic and surgical breast cancer services at Groote Schuur Hospital (GSH) and affiliated hospitals. METHODS: All patients, newly diagnosed, awaiting surgery, and listed for neoadjuvant chemotherapy (NACT) by the breast surgical service from 23 March - 23 June 2020 were included. A historic control was used where appropriate consisting of patients presenting in the same period in 2019. Clinic attendance records and surgical waiting lists were used to identify patients in the three months and data were extracted from hospital records including hospital admission records and surgical operative notes. RESULTS: The number of patients who presented with a new breast symptom to the diagnostic breast clinic decreased from 1 094 in 2019 to 299 in 2020, representing a 72.6% decrease. Telemedicine use as a function of the total follow-ups increased from 53% (n = 1 350) in 2019 to 75% (n = 735) in 2020. The overall number of new breast cancers diagnosed decreased from 146 in 2019 to 79 in 2020, but the proportion of patients seen with a new breast symptom who were diagnosed with breast cancer increased from 13% (n = 1 094) in 2019 to 26% (n = 299) in 2020. Eighteen per cent (n = 105) fewer breast cancer surgeries were performed in 2020 compared to 2019, with immediate breast reconstructive procedures representing the largest decrease of 40%. CONCLUSION: The impact of COVID-19 on breast cancer services has been both at the diagnostic level and in delays to surgery. A new online referral system improved referral efficacy translating to more cancers being diagnosed as a function of total referrals. The drop in absolute numbers of cancer diagnoses, however, represents an unmet health need. An expansion of our telemedicine service mitigated COVID risk in the outpatient setting. The greatest impact on our treatment decisions was seen in the cohort of patients placed on neo-adjuvant endocrine therapy (NET). We saw a global decrease in breast surgeries performed, with the greatest decrease being in reconstructions.

Primary seromucinous cystadenocarcinoma of the mesentery.

A 72-year-old woman presented with a slow growing mass on the left side of the abdomen, which was found to originate from the mesentery of the descending colon. Histopathology revealed a seromucinous cystadenocarcinoma of the mesentery, a rare clinical entity occurring most often in females. There are only 20 cases reported in the literature. It is postulated that these tumours develop as a result of serous or mucinous metaplasia of pre-existing coelomic mesothelium. Surgical excision remains the mainstay of successful management.

Tests for sensitisation in occupational medicine practice--the soy bean example.

OBJECTIVE: To determine the prevalence of sensitisation to soy bean measured by specific IgE and skin prick tests (SPTs) and to examine the association between evidence of sensitisation to soy bean allergens and symptoms of allergic disease. DESIGN: Cross-sectional study. Questionnaire survey. A venous blood sample was taken for specific IgE testing, and SPTs for common allergens and soy bean dust were performed. SETTING: Soy bean mill. PARTICIPANTS: A volunteer sample of 22 workers exposed to soy bean dust; the first 20 non-exposed workers presenting to the National Centre for Occupational Health clinic formed the control group. MAIN OUTCOME MEASURE: Immunological tests for sensitisation and symptoms of respiratory and allergic disease. RESULTS: Eight of the exposed workers had positive skin reactions to either full-fat or defatted soy bean. None of the controls was SPT-positive. Eight of the exposed workers had increased levels of soy-specific IgE of whom only 4 were SPT-positive and had an increased level of soy-specific IgE. One of the control workers had an increased level of soy-specific IgE. Workers with an increased specific IgE or SPT positive to soy bean did not have more symptoms than workers with negative tests. However, work-related breathlessness was significantly higher in the exposed group (P < 0.05). CONCLUSIONS: The data suggest that the immunological tests for sensitisation were not useful in identifying workers with soy bean-related disease but that tests for sensitisation were linked to exposure.

A survey of a small group of workers exposed to toluene di-isocyanate.

All 20 workers exposed to toluene di-isocyanate (TDI) in a chemical processing and packing factory were tested for TDI-induced asthma. The assessment included a respiratory symptom questionnaire, spirometry, skin prick tests for common allergens and assessment of total and TDI-specific immunoglobulin E (IgE) levels by radio-allergosorbent tests. Six workers had symptoms suggestive of TDI-related asthma. Three of these 6 workers had a significant cross-shift decline in forced expiratory volume in 1 second (FEV1) (10% or greater). Two of the 6 had high levels of TDI-specific IgE. Of the 14 workers without work-related symptoms, 1 had a significant cross-shift decline in FEV1. There was no significant association between the levels of exposure to TDI and symptoms, lung function parameters or immunological findings. This study demonstrates the difficulties in correlating immunological status with clinical and lung function findings in workers exposed to TDI. Recommendations include a stepwise approach to diagnosing TDI-induced asthma in exposed workers.