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.

Surgery for Pheochromocytoma: A Single-Center Review of 60 Cases from South Africa.

BACKGROUND: There is a paucity of data on the presentation and surgical management of pheochromocytoma in developing nations, particularly in Africa. METHODS: This study was a retrospective review, which included all patients managed by the Groote Schuur Hospital/University of Cape Town Endocrine Surgery unit for pheochromocytoma and abdominal paragangliomas, from January 2002 to June 2019. RESULTS: Sixty patients were included in the study, of which 33% were male and 67% female. The mean age was 47 years (range 14-81). The median tumor size was 6 cm, with 45% larger than 6 cm. 92% were located in the adrenal gland (87% unilateral, 5% bilateral), and 8% were extra-adrenal. The conversion rate for laparoscopic cases was 20%, with 55% of cases overall completed laparoscopically. Eleven patients with tumors > 6 cm were initially attempted laparoscopically, of which 3 were converted to open, without any associated increased morbidity. A major adverse event was recorded for 5 cases (8%), including 1 mortality. Overall morbidity, blood loss, operating time and hospital stay were all significantly reduced in the laparoscopic group. There were 5 patients with malignant disease (8%). CONCLUSION: This large series, from an established academic endocrine surgery unit in Africa, can serve as a benchmark for units with similar settings and resource limitations, to compare their surgical management and perioperative outcomes.

Nodal disease predicts recurrence whereas other traditional factors affect survival in a cohort of South African patients with differentiated thyroid carcinoma.

BACKGROUND AND AIM: Information on patients with differentiated thyroid carcinoma in South Africa is limited. The objective of this study was to review demographics and tumour characteristics in a cohort of patients with differentiated thyroid carcinoma, presenting to Groote Schuur Hospital and evaluate risk factors for recurrence and survival. PATIENTS AND METHODOLOGY: Retrospective demographic and clinical data were collected on all patients referred between January 2003 and December 2013. Prognostic factors for recurrence free survival and cancer specific survival were assessed using univariate and multivariate analyses. RESULTS: The total number of patients was 231.The median age at presentation was 44 years and 82% were female patients. The pathological sub-types were papillary (60.6%), follicular (38.9%) and poorly differentiated (0.5%). Total thyroidectomy was performed in 191 patients and 30 patients required neck dissections. A total of 171 (74%) patients received 131Iodine. The recurrence free and cause specific survival rates at 10 years were 83 and 91%, respectively. Nodal disease at presentation was the only significant risk factor for recurrence (p <  0.001) on multivariate analysis. Significant risk factors for cause specific mortality were age ≥ 45 years (p = 0.006), follicular pathology (p = 0.004), extra-thyroid extension (p = 0.013) and residual tumour (p = 0.004). CONCLUSIONS: Consistent with international trends, patients with differentiated thyroid carcinoma treated at Groote Schuur Hospital had a favourable prognosis. The known risk factors associated with recurrence and survival in this South African cohort were consistent with those reported in developed countries.

Differences in colonisation of five marine bacteria on two types of glass surfaces.

The retention patterns of five taxonomically different marine bacteria after attachment on two types of glass surfaces, as-received and chemically etched, have been investigated. Contact angle measurements, atomic force microscopy (AFM), scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), X-ray fluorescence spectroscopy (XRF) and X-ray photoelectron spectrometry (XPS) were employed to investigate the impact of nanometer scale surface roughness on bacterial attachment. Chemical modification of glass surfaces resulted in a approximately 1 nm decrease in the average surface roughness (R(a)) and the root-mean-squared roughness (R(q)) and in a approximately 8 nm decrease in the surface height and the peak-to-peak (R(max)) and the 10-point average roughness (R(z)). The study revealed amplified bacterial attachment on the chemically etched, nano-smoother glass surfaces. This was a consistent response, notwithstanding the taxonomic affiliation of the selected bacteria. Enhanced bacterial attachment was accompanied by elevated levels of secreted extracellular polymeric substances (EPS). An expected correlation between cell surface wettability and the density of the bacterial attachment on both types of glass surfaces was also reported, while no correlation could be established between cell surface charge and the bacterial retention pattern.

[Calculation of prostatic volume by endorectal ultrasonography. A formula of surgical observation]. / Calcul du volume prostatique par échographie endorectale. Une formule plus proche de l'observation chirurgicale.

UNLABELLED: This study compares ultrasonographic prediction of prostatic volume and surgical exerese. A total of 200 prostates have been measured by the same echographist, operated upon by the same surgeon, and stratified for histology, surgical technique and weight. Adopting the general formula: Surgical volume = D1 x D2 x D3/x the surgical volume is calculated by a simplified and complete definition for a denominator giving the most accurate prediction. CONCLUSIONS: a. the glands of more than 60 cc could be calculated by the classical formula of ellipsoid pi x D1 x D2 x D3/6, simplified to D1 x D2 x D3/2, with a 21% standard deviation error from the surgical volume; b. medium-sized prostates (20-60 cc) could be calculated by the formula: D1 x D2 x D3/3 with a 21% standard deviation; c. prostates smaller than 20 cc, a series which included all reoperations for remnants or recurrence, could be calculated with the same proposed formula with a 22% standard deviation, while the classical ellipsoid formula led to a 56% standard deviation error. No mathematical formula based only on three prostatic diameters is reliable to assess true parenchymal weight.