Assessing the accuracy of conventional gadolinium-enhanced breast MRI in measuring the nodal response to neoadjuvant chemotherapy (NAC) in breast cancer.

Management of the axilla in the era of neoadjuvant chemotherapy for breast cancer is evolving. The aim of this study is to determine if conventional gadolinium-enhanced breast MRI can aid in evaluation of the response to neoadjuvant chemotherapy in the axilla. A retrospective review of a prospectively maintained database of patients undergoing neoadjuvant chemotherapy for breast cancer was performed. Pre and post-neoadjuvant chemotherapy MRI reports for node-positive patients were examined in conjunction with demographic data, treatment type, and final histopathology reports. One-hundred and fourteen patients with breast cancer undergoing neoadjuvant chemotherapy were included in the study. The sensitivity of magnetic resonance imaging in detecting nodal response post-neoadjuvant chemotherapy was 33.93% and the specificity was 82.76%. Magnetic resonance imaging had a positive predictive value of 65.52% and a negative predictive value of 56.47%. MRI was found to be most specific in the detection of triple-negative cancer response. Specificity was 100% in this group and sensitivity was 75%. Magnetic resonance imaging has a relatively high specificity in detecting nodal response post-neoadjuvant chemotherapy but has a low sensitivity. Alone it cannot be relied upon to identify active axillary malignancy post-neoadjuvant chemotherapy. However, given its increased specificity among certain subgroups, it may have a role in super-selecting patients suitable for sentinel lymph node biopsy post-neoadjuvant chemotherapy.

Information Needs of Patients With Breast Cancer at Years One, Three, and Five After Diagnosis.

INTRODUCTION: The information needs of breast cancer patients at diagnosis have been studied extensively. However, with cancer survival improving, the era of cancer care has entered a more chronic phase with an associated paucity of data related to longer term information requirements. The aim of the present study was to assess and compare the information needs of breast cancer patients during the first 5 years after the diagnosis. PATIENTS AND METHODS: A total of 105 follow-up consecutive patients presenting to a tertiary referral breast cancer center from August to October 2017 were recruited. The patients were divided into groups by the years after the diagnosis (1, 3, and 5 years). Each patient completed the Toronto Information Needs Questionnaire for Breast Cancer. RESULTS: The number of patients in each group was as follows: 23 at 1 year, 38 at 3 years, and 44 at 5 years after the initial diagnosis. The median Toronto Information Needs Questionnaire for Breast Cancer score was 4.15 on a 5-point Likert scale of breast cancer information needs (1, not important to 5, extremely important). No difference was found in the median scores at 1, 3, and 5 years. Information pertaining to the disease process was rated as most important (median, 4.50), and information regarding the psychosocial aspect of disease was ranked lowest (median, 3.75). CONCLUSION: The information needs of patients with breast cancer remain high throughout the follow-up period after the diagnosis. In an era of prolonged survival, attention to the information needs of patients at follow-up examinations is as important as at the time of diagnosis and treatment.

Patientsmate©: the implementation and evaluation of an online prospective audit system.

INTRODUCTION: Inaccuracy in Hospital Inpatient Enquiry (HIPE)/Casemix-based data has been reported as high as 26%. This results in financial waste and makes effective audit impossible. We aimed to develop a novel web-based outcome audit system. METHODS: A web-based online audit system, Patientsmate©, was developed using an integrated database system written in the programme language PHP. Data were inputted by the surgical team responsible for the patients care. A prospective comparison study of the new Patientsmate© and the standard HIPE systems, was performed over a 1-month period and involving two general surgical teams in April 2010. In addition, a Likert-scale based questionnaire was designed and hosted within the Patientsmate© system. A focus group of those clinicians directly involved in data accessing and input were then invited to complete the questionnaire in order to assess usability of the system. RESULTS: During the study period there were a total of 108 patients and 88 procedures. Our study confirms the accuracy of clinician derived data, with the Patientsmate© system more accurately recording number of patients (83% vs. 80.6%), number of procedures (85.2% vs. 68.1%) and hospital day case rate (52% vs. 47.1%). Inputting data using Patientsmate© for a single patient took 6-7 minutes. Of those using the system, 75% reported feeling comfortable after using it once only and 100% were satisfied with the layout of the online interface. CONCLUSION: The Patientsmate© system allows for increased accuracy in outcome-based data as compared with the HIPE system, facilitating audit, financial savings and the appropriate allocation of services.

The immunohistochemical demonstration of Helicobacter pylori in rectal ectopia.

The finding of heterotopic gastric mucosa in the rectum is rare, with less than 40 reported cases in the literature. A condition of unknown etiology, several hypotheses exist including infectious and congenital. We report a case of ectopic gastric tissue in the rectum of a 47-year-old female, and her subsequent clinical course. Furthermore for the first time, we present immunohistologic evidence of the presence of Helicobacter pylori in rectal ectopic gastric tissue.