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Background: Accurate intraoperative sentinel lymph node (SLN) assessment enables axillary clearance to be completed immediately in node-positive breast cancer patients. This article reports a study of the introduction of intraoperative molecular SLN analysis in routine clinical practice in the Portsmouth Breast Care Centre., Design: There was prospective analysis of 254 consecutive patients who underwent SLN biopsy in a single centre. Nodes were sectioned at 2 mm intervals and alternate slices were analysed using a CE-marked assay for mammaglobin (MG) and cytokeratin 19 (CK19). Remaining slices of node were sent for histological analysis, which included CK19 immunohistochemistry. While the assay was being carried out, the surgeon performed the breast tumour resection. The cost per patient was estimated retrospectively and the cost effects on the hospital and primary care trust for a typical service were also estimated., Results: A total of 491 SLNs from 254 patients were evaluated. The intraoperative assay showed positivity of SLNs for metastatic cells in 78 patients. There was 100% detection of macrometastases within sentinel nodes analysed by GeneSearch. Overall concordance between histological status, including micrometastases and GeneSearch analysis, was 95% (sensitivity 96%, specificity 95%). The cost per procedure was increased for wide local excision with SLN biopsy and intraoperative assessment compared with other models, but fewer procedures were carried out., Conclusion: Intraoperative assessment of SLNs in breast cancer using a molecular assay is a safe, acceptable and accurate technique that allows a reduction in the frequency of delayed axillary clearance surgery. Take-up of this method may be hampered by perverse incentives operating within healthcare funding.

Aim: To examine a model of care for breast cancer patients based on the concept of point of need access and investigate the effectiveness of this model compared to routine 6-monthly clinical reviews., Design: A parallel randomised controlled trial was used to examine point of need access to specialist care via the nurse specialist, compared to routine hospital based 6-monthly clinical review at year two post breast cancer diagnosis. A total of 237 patients were recruited to the study., Methods: Outcome measures at baseline, 9 and 18 months included psychological morbidity using the GHQ12 questionnaire, quality of life using the FACT-B plus endocrine subscale, fear and isolation. An analysis of covariance was used to detect changes over time. Recurrences and methods of detection were recorded as secondary outcome measures., Results: Two hundred and fourteen patients completed the study. Overall patients were not exposed to risks of increased psychological morbidity (p=0.767) or decline of quality of life (p=0.282) when routine review was discontinued and no significant differences were detected during an 18-month period. Patients not receiving regular review did not feel isolated, and at the end of 18 months did not wish to return to 6-monthly clinical reviews. The presentation of recurrences and short symptom history demonstrate that the recurrences observed were unlikely to have been detected at a routine visit., Conclusions: Point of need access is acceptable to the majority of patients. Although a third of patients may wish to maintain a regular review, patient choice is important. Findings suggest that after 2 years following the diagnosis of breast cancer there is no evidence to support the view that regular clinical review improves psychological morbidity or quality of life. Patients do not appear to be compromised in terms of early detection of recurrence. Point of need access can be provided by suitably trained specialist nurses and provides a fast, responsive management system at a time when patients really need it.

This study was aimed at investigating the relationship between serum prolactin levels and the morphology of operable female breast lesions. One hundred fifty-three consecutive patients with operable benign and malignant breast lesions in whom preoperative serum prolactin levels had been determined were stratified into five groups according to their serum prolactin levels. The histologic findings in these groups were analyzed and compared. Most patients (93%) had serum prolactin levels within the normal limits. Of the 54 patients with benign lesions, only 4(7%) had slightly elevated serum prolactin levels. Two of these patients had fibroadenomas, one had a phyllodes tumor and one had fibrocystic change. Of the 99 patients with carcinoma, 7 (7%) had hyperprolactinemia. Five of the seven tumors were invasive and two were in situ. All seven tumors were of low or intermediate grade of malignancy. The two cases with the highest prolactin levels (3057 and 1822 mU/L) were both intermediate-grade ductal carcinoma in situ (DCIS). It is concluded that the great majority of patients presenting with operable breast lesions have normal serum prolactin levels, and that elevated levels, when present, occur with equal frequency in patients with benign and malignant breast lesions. Hyperprolactinemic patients presenting with carcinoma in this study, none of whom had a history of recent pregnancy or lactation, tended to have histologically low- or intermediate-grade tumors, but this needs to be confirmed by investigating more cases.