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Purpose To evaluate the efficacy of a BLES procedure as a primary excisional biopsy rather than a surgical wide local excision for treatment of a high risk or a malignant lesion. Methods 41 patients underwent a BLES procedure in order to attempt to remove a small breast lesion using a 15 mm or 20 mm wand from August 2007 to January 2009. The lesions were either proven on prior core biopsy to show high risk or malignant pathology or were considered to be indeterminate or suspicious on ultrasound or mammography. The pathology was reviewed to include the final status of lesion excision. If margin involvement was demonstrated then a formal surgical excision was subsequently recommended. Follow up mammography or ultrasound was performed annually in patients following the final pathological diagnosis. Results 9 patients had a primary diagnosis of atypia (columnar cell change with atypia or atypical ductal hyperplasia (ADH)), 23 patients had ductal carcinoma in situ (DCIS) and 9 had an invasive carcinoma (IC) at the original BLES pathology. Clear BLES margins of >1 mm were obtained in 3/9 atypia lesions, 15/23 DCIS and 0/9 IC. 12/13 low grade DCIS were completely excised. Subsequent surgical margin excisions were undertaken in 20 patients. After at least 5 years of follow up (mean 66 months), 1 lesion had recurred on imaging. Conclusion A BLES excision has potential as an alternative technique to traditional surgical wide local excision in the management of certain small breast lesions with high risk and low grade malignant potential.

s / International Journal of Surgery 8 (2010) 501–578 532 Introduction: Touch Imprint Cytology (TIC) allows intra-operative assessment of axillary lymph nodes, determining progression to axillary lymph node dissection at the same operation and requires specialist cytopathologists. We present our experience in a District General Hospital. Methods: A prospective study of consecutive series of patients undergoing level II or III axillary lymph node dissection, from October 2006 to September 2007, was undertaken. One surgeon and three cytopathologists were involved. TIC of a random level I lymph node was compared with imprint node histology. Cytopathologists were blinded to the use of coated and uncoated slides, used for each case. Results: 38/42 consecutive cases were analysed (4 exclusions as uninterpretable).Mean axillary yield 13.7. 12 TIC nodes were positive, all imprint nodes positive in these cases. 26 TIC nodes negative, all imprint nodes negative in these cases. Sensitivity 1⁄4 100%, specificity 1⁄4 100%, false negative rate 0, P