Kimura disease of the breast: Case report and literature review of current management.

We report a rare case of Kimura disease in a 50-year old female patient who attended our tertiary level Breast Surgery Clinic.

Management of Early Node-Positive Breast Cancer in Australia: A Multicentre Study.

To examine practice patterns for breast cancer patients with limited sentinel node (SN) disease in light of the ACOSOG Z0011 results. Retrospective analysis of patients with T1-2 breast cancer and positive sentinel lymph node biopsy (SLNB) admitted between January 2009 and December 2012. Patient demographics, tumor characteristics, and treatments were recorded. Eight hundred positive SLNBs were identified. A total of 452 (56.5%) proceeded to completion axillary lymph node dissection (cALND). cALND rate decreased from 65.1% to 49.7% from 2009-2010 to 2011-2012. cALND was performed for micrometastasis or isolated tumor cells in 39.3% in 2009-2010 and 22.2% in 2011-2012, whereas for macrometastases the rates were 83.1% and 68.6%, respectively. cALND rates diminished for both Z0011-eligible and -ineligible patients. The ACOSOG Z0011 trial presentation and publication coincided with a reduction in cALND for breast cancer with limited nodal disease. There appears equipoise regarding management of macrometastatic SN disease.

Preoperative breast MR imaging influences surgical management in patients with invasive lobular carcinoma.

INTRODUCTION: The purpose of the study is to assess the role of preoperative magnetic resonance (MR) imaging on the surgical management of invasive lobular carcinoma (ILC) and to evaluate whether breast density and background parenchymal enhancement (BPE) influence surgical treatment. METHODS: This retrospective study was conducted on 56 patients who were diagnosed with ILC between 2014 and 2020. All patients had mammogram and ultrasound. Preoperative MRI was available in 34 patients. Age, menopausal status, breast density, BPE, multifocality/multicentricity and surgical treatment were collected. RESULTS: Mean pathological tumour size was 36.4 mm (range 5-140 mm). Dense breasts had larger tumours compared to non-dense breasts (P = 0.072). Of the 34 patients with MRI, 6 opted for mastectomy. Of the remaining 28 cases, MRI findings upgraded surgery to mastectomy in 54% (15/28) because mammogram/ultrasound underestimated tumour extent in 25% (7/28), or multifocal/multicentric disease was identified in 29% (8/28). Tumour size was underestimated by MRI in 7% (2/28). In the non-MRI subgroup, 64% (14/22) of patients underwent breast-conserving surgery, but 29% of them (4/14) required a second-stage mastectomy due to extensive margin involvement. There was no difference in mastectomy rate between patients with MRI (62%) and without MRI (55%) (P = 0.061). Tumour size correlation between MRI and histopathology demonstrated an excellent intraclass correlation coefficient (P < 0.001). Surgical treatment recommendation was not significantly impacted by breast density or BPE. CONCLUSION: Breast MRI improves surgical management of patients with ILC in providing additional diagnostic information often missed with standard imaging modalities, and without increasing mastectomy rate. Surgical treatment is not impacted by breast density or BPE.

Laparoscopic transabdominal preperitoneal repair of lumbar hernia.

Lumbar hernias are rare and its posterior location presents challenges in its repair. This article provides a pictorial description of the approach to repairing a lumbar hernia demonstrating a laparoscopic transabdominal preperitoneal technique that is easy to follow and take up.

Closed Incision Negative Pressure Therapy vs Standard of Care Dressing in Breast Surgery: A Systematic Review.

The implementation of closed incision negative pressure therapy (CINPT) is widely seen in many surgical subspecialties including orthopaedics, vascular surgery, and abdominal surgery. However, research on its use in breast surgery is still in its infancy. We conducted a systematic review on the use of CINPT vs standard of care dressings (SOC) in wound management of post-operative breast surgery. A literature search was conducted on PubMed, MedLine, and Google Scholar for studies that compared CINPT against SOC. Seven studies were included in this systematic review. The results of our systematic review have shown that CINPT has a positive outcome in reducing post-operative wound complication rates as compared to SOC dressings (commonly Steri-Strips and waterproof dressings), which was 1-8% vs 1-30% in CINPT and SOC, respectively. Furthermore, CINPT has the potential to confer additional cost-savings of up to USD218 per patient for a health institution with regards to reduced complications rates that might have required extended management. The use of CINPT in breast surgery remains highly promising. It has many advantages over SOC, including better wound outcomes and added cost savings. Further studies are required to delineate the potential benefits in different sub-sets of patients.

Australian breast surgeons and ultrasound usage: Have practices changed?

BACKGROUND: A recent survey of surgeon performed ultrasound usage was conducted amongst registered members of the Breast Surgeons of Australia and New Zealand Society (BreastSurgANZ) and was compared with a previous survey undertaken in 2010 to determine whether patterns of utilization had changed. METHODS: From July to September 2019, members of BreastSurgANZ were invited to complete an electronic online survey of personal usage of breast ultrasound focusing on ultrasound equipment access, use of office and intraoperative ultrasound, biopsy interventions and training expectations. RESULTS: There were 73 respondents to the survey with 45 (61.6%) members indicating access to ultrasound within their practices. Whilst current regular ultrasound usage (68.1%) was only slightly greater than in 2010 (66%), the proportion of respondents not performing any form of needle intervention had increased (62.5% compared to 53% in 2010) and with the proportion of surgeons currently performing >10 biopsies per month decreasing from 10% to only 5.56%. However the percentage of surgeons utilizing intraoperative ultrasound had notably increased since 2010 with 49.3% currently using ultrasound in the operating room compared with only 17% previously. The majority of respondents believed that breast ultrasound training should be conducted through BreastSurgANZ post fellowship training programs. CONCLUSION: The overall utilization of surgeon-performed ultrasound amongst BreastSurgANZ members has remained similar over the past 9 years with the performance of needle interventions declining slightly, but with the application of intraoperative ultrasound having increased. An ultrasound training curriculum as part of the BreastSurgANZ post fellowship training program is a necessary imperative.

Supraglottic immunoglobulin-G4 related plasma cell granuloma: case report and literature review.

BACKGROUND: Granuloma of the upper aerodigestive tract is a rare presentation of immunoglobulin-G4 (IgG4)-related disease. Since the disease process was defined in 2003, only 2 cases affecting the laryngopharynx have been reported in the literature. METHODS AND RESULTS: A 62-year-old white man presented with persistent productive cough of brown sputum, globus symptoms, dysphagia, odynophagia, dysphonia, otalgia, and general malaise over a period of 2 months. Investigations revealed IgG4-positive plasma cell granuloma of the supraglottic region. This was successfully treated with oral corticosteroids. CONCLUSION: Because IgG4 testing is not performed routinely, management recommendations have been poorly defined. We reviewed the literature and discuss herein the clinical characteristics, pathology, diagnosis, and management. The authors theorize that IgG4-related disease involving the larynx and pharynx may be more common than suggested by the paucity of reported cases.

Spontaneous pneumomediastinum with severe subcutaneous emphysema secondary to prolonged labor during normal vaginal delivery.

A healthy 33-year-old primiparous woman developed sudden central, nonradiating chest pain and right-sided neck and facial swelling during a prolonged second stage of labor. The main finding was subcutaneous emphysema involving the neck and face. Spontaneous pneumomediastinum (SPM) is a rare cause of chest pain and can lead to subcutaneous emphysema during labor. It is probable that SPM occurred during the second stage, due to prolonged and strenuous valsalva maneuvers. Subcutaneous emphysema can accumulate, enlarge, and cause upper-airway obstruction in the neck.