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Abstract: Introduction: The use of specimen radiographs to confirm the presence of the radiological abnormality in a breast specimen after localisation biopsy is standard practice. This study aims to show that a trained surgeon may assess breast specimen radiographs with similar efficacy as a radiologist. Methods: This retrospective study assessed all patients who had localisation breast surgery using wire or ultrasound (US) techniques between January 2002 and March 2003. Histopathological records and mammographic details were recorded from the hospital notes. A consultant radiologist and surgeon reviewed the specimen radiographs, identifying mammographic abnormalities and assessing margins. Results: Localisation surgery was performed on 101 patients with US used to localize 68. The median specimen weight was 64g. A malignant diagnosis was made in 86 patients. In 23, the histological resection margins were considered to be close or involved by tumour and re-excision was performed in eight patients. Sixty-one specimen radiographs were reviewed. The radiologist identified every mammographic abnormality, and the surgeon identified the lesion in 58. The positive predictive value of specimen radiographs to identify histologically involved margins was 75 and 74% by the radiologist and the surgeon, respectively. Where good radiograph margins were reported in 40 and 35 patients by the radiologist and surgeon, respectively, 11 and 7 had histologically involved margins. Conclusions: This study shows that a suitably trained or experienced surgeon can assess specimen radiographs effectively without the need for intraoperative radiological input although complete histological resection is not guaranteed despite specimen radiographs demonstrating clear margins. [Copyright &y& Elsevier]

This paper examines the correlation between axillary lymph node status and primary tumour characteristics in breast cancer and whether this can be used to select patients for axillary lymphadenectomy. The results are based on a retrospective analysis of 909 patients who underwent axillary dissection in our unit. Axillary lymph nodes containing metastases were found in 406 patients (44.7%), all with invasive carcinomas, but in none of the 37 carcinomas-in-situ. Nodal status was negative in all T1a tumours, but lymph node metastases were present in 16.3% and 35.7% of T1b and T1c tumours respectively. When histological grade was taken into account, positivity for grade I T1b and T1c tumours fell to 13.6% and 26.7% respectively. Lymph node metastases were found in 85% of patients with lymphovascular invasion in their tumours as compared to only 15.4% of those without and in 45.5% of oestrogen and progesterone receptor-positive tumours. When one or both hormone receptors were absent this figure was much higher. It appears that for T1a breast cancers axillary dissection is not necessary, whereas for T1b, T1c and grade I T2 tumours other histopathological parameters should be taken into consideration in deciding who should undergo axillary lymphadenectomy. [ABSTRACT FROM AUTHOR]

Aim: Investigate the role of BRAF V600 mutation testing in identifying thyroid carcinoma from FNA samples.Methods: Over an 8 month period thyroid fine needle aspirates (FNA's) reported as Thy 3F (neoplasm possible/suggestive of follicular neoplasm equivalent Bethesda Class IV), Thy4 (suspicious of malignancy equivalent Bethesda Class V) & Thy 5 malignant (equivalent Bethesda Class VI) were tested for BRAF V600 mutation & managed as malignant if mutations were present. Results: Of 207 FNA's, 5 were Thy 5, 19 Thy 4, 36 Thy 3f, 13 Thy 3a, 84 Thy 2 & 50 Thy 1. 29 Thy 3f, Thy 4, or Thy 5 FNA's were tested for BRAF V600 mutation and 7 of 29 (24 %) showed evidence of mutation. Four patients with BRAF V600 mutation underwent surgery to remove all thyroid tissue, one patient received a right lobectomy for technical reasons and two patients are awaiting total thyroidectomy. All patients with BRAF V600 mutation were found to have malignancy on final histology, with a diagnostic sensitivity for malignancy excluding co-incidental microcarcinoma of 100% and specificity of 42%. BRAF V600 mutation is 100% specific for thyroid carcinoma, if a lesion is a primary thyroid tumour. Conclusion: BRAF V600 mutational analysis enables single stage total thyroidectomy for carcinoma if gene mutation is present in pre-operative FNA. BRAF V600 testing potentially reduces the need for completion thyroidectomy with significant cost savings and lowers patient morbidity associated with completion thyroidectomy in cases where the cytology does not show definite features of malignancy but where BRAF V600 mutation is identified in pre-operative thyroid FNA. [ABSTRACT FROM AUTHOR]

Examines the accuracy of preoperative ultrasound marking of impalpable breast lesions. Success of the ultrasound scan in identifying lesions; Completion of the excision.

Aims: Mammaglobin (MGB) is a genetic marker of micrometastatic breast cancer; serum tumour markers are being studied in the evaluation of metastatic disease. We wish to determine if MUC1 levels (detected .using CA 27·29 and CA 15·3) are associated with MGB expression in peripheral venous blood, bone marrow and axillary lymph nodes. Methods: Tumour, axillary lymph nodes, venous blood and bone marrow were collected. RNA was extracted and RT PCR assays were performed for expression of MGB. Serum tumour marker levels were taken every 6 months, measured by immunoassay. Results: Of 77 consecutive patients presenting with breast cancer 15 had elevation of CA 15·3 and CA 27·29·2 of these patients are now dead; the patients with serum tumour markers within normal levels are all living. Of these 15 patients 11 had MGB expression in lymph nodes, blood and/or bone marrow, whereas only 2 patients showed lymph node involvement with conventional histological examination. Only 2 of the 15 patients did not express MGB, this difference was significant. Conclusion: The genetic marker mammaglobin is when expressed in regional lymph nodes, peripheral blood or bone marrow, correlated well with serum tumour markers CA 15·3 and CA 27·29 in breast cancer. [ABSTRACT FROM AUTHOR]