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2. Short-term safety outcomes of mastectomy and immediate implant-based breast reconstruction with and without mesh (iBRA): a multicentre, prospective cohort study

Author

Achuthan, R, Adwan, I, Aggarwal, S, Ahmed, M, Akelund, M, Akolekar, D, Al-Jibury, O, Amanita, M, Appleton, D, Archampong, D, Asgiersson, K, Athwal, R, Augusti, A, Ayaani, S, Bains, S, Baker, B, Baker, E, Baldota, S, Banerjee, D, Barker, S, Barr, L, Barry, P, Basu, N, Bathla, S, Bishop, N, Boland, G, Branford, O A, Bright-Thomas, R, Brindle, R, Brock, L, Brown, V, Bux, F, Byrne, G, Cain, H, Caldon, L, Callaghan, M, Carbone, A, Carpenter, R, Cawthorn, S, Chagla, L, Challoner, T, Chalmers, C, Chalmers, R, Chambers, S, Chana, M, Chand, N, Chandran, V, Chandrashekar, M, Charfare, H, Chatterjee, J, Chatterjee, S, Chattopadhyay, R, Chaudry, A, Chin, K, Chong, K, Chouhan, A, Choy, C, Christopoulos, P, Clarke, D, Clarke, S, Clayton, E, Clifford, R, Cocker, D, Collin, T, Collis, N, Conroy, F, Constantinou, C, Conway, A, Cook, J, Coombs, N, Cox, K, Critchley, A, Dakka, M, Dani, M, Daoud, R, Darragh, L, Darvesh, S, Dash, I, Datta, S, Davies, E, Dawson, S, De Sousa, E, Debnath, D, Deol, H, Devalia, H, Di Micco, R, Dicks, JR, Dickson, J, Dobner, N, Dobson, G, Dunne, N, Egbeare, D, El Sharief, D, Elfadl, D, Eltigani, E, Enver, D, Erel, E, Evans, A, Exarchos, G, Fage, E, Fatayer, H, Fenn, C, Ferguson, D, Foulkes, R, Franks, J, Fung, V, Galea, M, Gandamihardja, T, Gandhi, A, Garnsey, C, Gateley, C, Gattuso, J, Gawne, S, Geerthan, N, Ghattura, A, Giaramadze, A, Gill, J, Godden, AR, Goh, S, Govindarajulu, S, Goyal, S, Graja, T, Granger, S, Green, M, Grover, K, Gui, G, Gurung, R, Gutteridge, E, Hakim, A, Halka, A, Hamilton-Burke, W, Hamo, I, Harding-Mackean, C, Hargreaves, A, Harries, S, Harris, K, Harris, P, Harrison, S, Harvey, J, Hashem, M, Hassan, U, Henderson, J, Henton, J, Hignett, S, Hodgkins, K, Horgan, K, Horn, S, Hu, J, Hussain, A, Iddon, J, Iqbal, A, Irri, R, Irvine, T, Irwin, G, Iskender, A, Ismail, A, Ives, C, James, K, James, R, Jiwa, N, Jobson, M, Joglekar, S, Johnson, L, Johnson, R, Jones, L, Ju Hwang, M, Kalles, V, Kanesalingam, K, Karat, I, Kaushik, M, Kennedy, K, Khalifa, E, Khan, H, Khanbhai, M, Khawaja, S, Khout, H, Kiernan, T, Kim, B, Kirkpatrick, K, Kiruparan, P, Kirwan, C, Kishore, M, Kneeshaw, P, Knight, A, Kohlhardt, S, Krupa, J, Krupa, K, Kuruvilla, R, Laban, C, Lai, LM, Laidlaw, I, Lambert, K, Langlands, F, Lansdown, M, Laurence, N, Laws, S, Ledwidge, S, Lefemine, V, Lennon, H, Linforth, R, Little, K, Luangsomboon, A, Lund, J, Maalo, J, MacLennan, L, Macmillan, RD, MacNeil, F, Mahapatra, TK, Mallidis, E, Mallon, P, Manoloudakis, N, Maraqa, L, Marla, S, Masood, S, Massey, J, Masudi, T, Matey, P, Mazari, F, McCulley, S, McEvoy, K, Mcintosh, J, McIntosh, S, McKenzie, S, McManus, P, McNicholas, J, Michalakis, I, Mills, N, Mitchell, G, Monib, S, Mullan, M, Murphy, C, Murphy, G, Murphy, J, Murthy, B, Musa, S, Nagra, G, Nangalia, R, Narayanan, S, Nasr, R, Navin, C, Newton, R, Nicholson, S, Nuru, N, O'Connell, R, O'Donoghue, J, Ogedegbe, A, Olayinka, OS, Olsen, S, Osborn, G, Osborne, C, Osman, H, Otieno, C, Pakzad, F, Park, A, Parker, S, Partlett, P, Parvaiz, A, Parvanta, L, Patel, G, Peel, A, Peiris, L, Pennick, M, Peppe, A, Perry, D, Pilgrim, S, Piper, J, Poonawalla, S, Popa, E, Pope, V, Pugh, P, Rainsbury, D, Ramsey, K, Rasheed, T, Rathinaezhil, R, Rattay, T, Ravichandran, D, Reed, M, Refsum, S, Remoundos, D, Rigby, K, Robertson, S, Robinson, A, Robinson, J, Roche, N, Roy, PJ, Runkel, M, Rusby, J, Saha, S, Saidan, Z, Salab, M, Saleh, M, Salem, F, Sami, A, Samlalsingh, S, Sarfraz, N, Shah, R, Shaheed, S, Sharaiha, Y, Shetty, G, Shotton, R, Sircar, T, Skene, E, Sloan, S, Smith, B, Smith, J, Soldanova, L, Soliman, F, Soumian, S, Stevens, J, Steventon, C, Stewart-Parker, E, Stringfellow, T, Sutaria, R, Sutton, R, Sweetland, H, Swiech, B, Tadiparthi, S, Tafazal, H, Taheri, N, Tait, C, Tan, M, Tang, S, Tansley, A, Tate, S, Tayeh, S, Taylor, A, Taylor, J, Thawdar, P, Thomas, C, Thomas, S, Thomson, S, Thorne, A, Tillett, R, Tolkien, Z, Tomlins, A, Topps, A, Tsang, F, Turner, EJ, Turton, P, Udayasankar, S, Ugolini, F, Vaughan Williams, E, Vidya, R, Vijaynagar, B, Vinayagam, R, Volleamere, A, Voynov, V, Waheed, S, Walker, T, Walsh, U, Warner, R, Waters, R, Wilkins, A, Williams, K, Wilson, G, Wiltsher, M, Wooler, B, Wright, C, Wright, M, Wyld, L, Youssef, M, Zabkiewicz, C, Zammit, C, Zeidan, B, Zheng, D, Potter, Shelley, Conroy, Elizabeth J, Cutress, Ramsey I, Williamson, Paula R, Whisker, Lisa, Thrush, Steven, Skillman, Joanna, Barnes, Nicola L P, Mylvaganam, Senthurun, Teasdale, Elisabeth, Jain, Abhilash, Gardiner, Matthew D, Blazeby, Jane M, and Holcombe, Chris

Published
2019
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5. MINERVA

Author

Phillips, Eleanor M, Kirwan, C, Melmore, Sharon, and Chagla, L

Published
2012
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13. Short-term safety outcomes of mastectomy and immediate implant-based breast reconstruction with and without mesh (iBRA): a multicentre, prospective cohort study

Author

Potter, Shelley, primary, Conroy, Elizabeth J, additional, Cutress, Ramsey I, additional, Williamson, Paula R, additional, Whisker, Lisa, additional, Thrush, Steven, additional, Skillman, Joanna, additional, Barnes, Nicola L P, additional, Mylvaganam, Senthurun, additional, Teasdale, Elisabeth, additional, Jain, Abhilash, additional, Gardiner, Matthew D, additional, Blazeby, Jane M, additional, Holcombe, Chris, additional, Achuthan, R, additional, Adwan, I, additional, Aggarwal, S, additional, Ahmed, M, additional, Akelund, M, additional, Akolekar, D, additional, Al-Jibury, O, additional, Amanita, M, additional, Appleton, D, additional, Archampong, D, additional, Asgiersson, K, additional, Athwal, R, additional, Augusti, A, additional, Ayaani, S, additional, Bains, S, additional, Baker, B, additional, Baker, E, additional, Baldota, S, additional, Banerjee, D, additional, Barker, S, additional, Barr, L, additional, Barry, P, additional, Basu, N, additional, Bathla, S, additional, Bishop, N, additional, Boland, G, additional, Branford, O A, additional, Bright-Thomas, R, additional, Brindle, R, additional, Brock, L, additional, Brown, V, additional, Bux, F, additional, Byrne, G, additional, Cain, H, additional, Caldon, L, additional, Callaghan, M, additional, Carbone, A, additional, Carpenter, R, additional, Cawthorn, S, additional, Chagla, L, additional, Challoner, T, additional, Chalmers, C, additional, Chalmers, R, additional, Chambers, S, additional, Chana, M, additional, Chand, N, additional, Chandran, V, additional, Chandrashekar, M, additional, Charfare, H, additional, Chatterjee, J, additional, Chatterjee, S, additional, Chattopadhyay, R, additional, Chaudry, A, additional, Chin, K, additional, Chong, K, additional, Chouhan, A, additional, Choy, C, additional, Christopoulos, P, additional, Clarke, D, additional, Clarke, S, additional, Clayton, E, additional, Clifford, R, additional, Cocker, D, additional, Collin, T, additional, Collis, N, additional, Conroy, F, additional, Constantinou, C, additional, Conway, A, additional, Cook, J, additional, Coombs, N, additional, Cox, K, additional, Critchley, A, additional, Dakka, M, additional, Dani, M, additional, Daoud, R, additional, Darragh, L, additional, Darvesh, S, additional, Dash, I, additional, Datta, S, additional, Davies, E, additional, Dawson, S, additional, De Sousa, E, additional, Debnath, D, additional, Deol, H, additional, Devalia, H, additional, Di Micco, R, additional, Dicks, JR, additional, Dickson, J, additional, Dobner, N, additional, Dobson, G, additional, Dunne, N, additional, Egbeare, D, additional, El Sharief, D, additional, Elfadl, D, additional, Eltigani, E, additional, Enver, D, additional, Erel, E, additional, Evans, A, additional, Exarchos, G, additional, Fage, E, additional, Fatayer, H, additional, Fenn, C, additional, Ferguson, D, additional, Foulkes, R, additional, Franks, J, additional, Fung, V, additional, Galea, M, additional, Gandamihardja, T, additional, Gandhi, A, additional, Garnsey, C, additional, Gateley, C, additional, Gattuso, J, additional, Gawne, S, additional, Geerthan, N, additional, Ghattura, A, additional, Giaramadze, A, additional, Gill, J, additional, Godden, AR, additional, Goh, S, additional, Govindarajulu, S, additional, Goyal, S, additional, Graja, T, additional, Granger, S, additional, Green, M, additional, Grover, K, additional, Gui, G, additional, Gurung, R, additional, Gutteridge, E, additional, Hakim, A, additional, Halka, A, additional, Hamilton-Burke, W, additional, Hamo, I, additional, Harding-Mackean, C, additional, Hargreaves, A, additional, Harries, S, additional, Harris, K, additional, Harris, P, additional, Harrison, S, additional, Harvey, J, additional, Hashem, M, additional, Hassan, U, additional, Henderson, J, additional, Henton, J, additional, Hignett, S, additional, Hodgkins, K, additional, Horgan, K, additional, Horn, S, additional, Hu, J, additional, Hussain, A, additional, Iddon, J, additional, Iqbal, A, additional, Irri, R, additional, Irvine, T, additional, Irwin, G, additional, Iskender, A, additional, Ismail, A, additional, Ives, C, additional, James, K, additional, James, R, additional, Jiwa, N, additional, Jobson, M, additional, Joglekar, S, additional, Johnson, L, additional, Johnson, R, additional, Jones, L, additional, Ju Hwang, M, additional, Kalles, V, additional, Kanesalingam, K, additional, Karat, I, additional, Kaushik, M, additional, Kennedy, K, additional, Khalifa, E, additional, Khan, H, additional, Khanbhai, M, additional, Khawaja, S, additional, Khout, H, additional, Kiernan, T, additional, Kim, B, additional, Kirkpatrick, K, additional, Kiruparan, P, additional, Kirwan, C, additional, Kishore, M, additional, Kneeshaw, P, additional, Knight, A, additional, Kohlhardt, S, additional, Krupa, J, additional, Krupa, K, additional, Kuruvilla, R, additional, Laban, C, additional, Lai, LM, additional, Laidlaw, I, additional, Lambert, K, additional, Langlands, F, additional, Lansdown, M, additional, Laurence, N, additional, Laws, S, additional, Ledwidge, S, additional, Lefemine, V, additional, Lennon, H, additional, Linforth, R, additional, Little, K, additional, Luangsomboon, A, additional, Lund, J, additional, Maalo, J, additional, MacLennan, L, additional, Macmillan, RD, additional, MacNeil, F, additional, Mahapatra, TK, additional, Mallidis, E, additional, Mallon, P, additional, Manoloudakis, N, additional, Maraqa, L, additional, Marla, S, additional, Masood, S, additional, Massey, J, additional, Masudi, T, additional, Matey, P, additional, Mazari, F, additional, McCulley, S, additional, McEvoy, K, additional, Mcintosh, J, additional, McIntosh, S, additional, McKenzie, S, additional, McManus, P, additional, McNicholas, J, additional, Michalakis, I, additional, Mills, N, additional, Mitchell, G, additional, Monib, S, additional, Mullan, M, additional, Murphy, C, additional, Murphy, G, additional, Murphy, J, additional, Murthy, B, additional, Musa, S, additional, Nagra, G, additional, Nangalia, R, additional, Narayanan, S, additional, Nasr, R, additional, Navin, C, additional, Newton, R, additional, Nicholson, S, additional, Nuru, N, additional, O'Connell, R, additional, O'Donoghue, J, additional, Ogedegbe, A, additional, Olayinka, OS, additional, Olsen, S, additional, Osborn, G, additional, Osborne, C, additional, Osman, H, additional, Otieno, C, additional, Pakzad, F, additional, Park, A, additional, Parker, S, additional, Partlett, P, additional, Parvaiz, A, additional, Parvanta, L, additional, Patel, G, additional, Peel, A, additional, Peiris, L, additional, Pennick, M, additional, Peppe, A, additional, Perry, D, additional, Pilgrim, S, additional, Piper, J, additional, Poonawalla, S, additional, Popa, E, additional, Pope, V, additional, Pugh, P, additional, Rainsbury, D, additional, Ramsey, K, additional, Rasheed, T, additional, Rathinaezhil, R, additional, Rattay, T, additional, Ravichandran, D, additional, Reed, M, additional, Refsum, S, additional, Remoundos, D, additional, Rigby, K, additional, Robertson, S, additional, Robinson, A, additional, Robinson, J, additional, Roche, N, additional, Roy, PJ, additional, Runkel, M, additional, Rusby, J, additional, Saha, S, additional, Saidan, Z, additional, Salab, M, additional, Saleh, M, additional, Salem, F, additional, Sami, A, additional, Samlalsingh, S, additional, Sarfraz, N, additional, Shah, R, additional, Shaheed, S, additional, Sharaiha, Y, additional, Shetty, G, additional, Shotton, R, additional, Sircar, T, additional, Skene, E, additional, Sloan, S, additional, Smith, B, additional, Smith, J, additional, Soldanova, L, additional, Soliman, F, additional, Soumian, S, additional, Stevens, J, additional, Steventon, C, additional, Stewart-Parker, E, additional, Stringfellow, T, additional, Sutaria, R, additional, Sutton, R, additional, Sweetland, H, additional, Swiech, B, additional, Tadiparthi, S, additional, Tafazal, H, additional, Taheri, N, additional, Tait, C, additional, Tan, M, additional, Tang, S, additional, Tansley, A, additional, Tate, S, additional, Tayeh, S, additional, Taylor, A, additional, Taylor, J, additional, Thawdar, P, additional, Thomas, C, additional, Thomas, S, additional, Thomson, S, additional, Thorne, A, additional, Tillett, R, additional, Tolkien, Z, additional, Tomlins, A, additional, Topps, A, additional, Tsang, F, additional, Turner, EJ, additional, Turton, P, additional, Udayasankar, S, additional, Ugolini, F, additional, Vaughan Williams, E, additional, Vidya, R, additional, Vijaynagar, B, additional, Vinayagam, R, additional, Volleamere, A, additional, Voynov, V, additional, Waheed, S, additional, Walker, T, additional, Walsh, U, additional, Warner, R, additional, Waters, R, additional, Wilkins, A, additional, Williams, K, additional, Wilson, G, additional, Wiltsher, M, additional, Wooler, B, additional, Wright, C, additional, Wright, M, additional, Wyld, L, additional, Youssef, M, additional, Zabkiewicz, C, additional, Zammit, C, additional, Zeidan, B, additional, and Zheng, D, additional

Published
2019
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14. Current practice and short-term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study

Author

O'Connell, R L, primary, Baker, E, additional, Trickey, A, additional, Rattay, T, additional, Whisker, L, additional, Macmillan, R D, additional, Potter, S, additional, Achuthan, R, additional, Aggarwal, S, additional, Basu, N, additional, Brock, L, additional, Fairbrother, P, additional, Gardiner, M D, additional, Holcombe, C, additional, Ives, C, additional, Jain, A, additional, Kim, B, additional, Murphy, J, additional, Remoundos, D, additional, Sutton, R, additional, Turton, P, additional, Williams, K, additional, MacLeod, C, additional, Smyth, E, additional, Depasquale, I, additional, Fuller, M, additional, Saeed, N, additional, Masannat, Y, additional, Tan Mohd Amin, A, additional, Agrawal, A, additional, Irwin, G, additional, Sloan, S, additional, Refsum, S, additional, McIntosh, S, additional, Ibrahim, A, additional, Sahu, A, additional, Govindarajulu, S, additional, Cawthorn, S, additional, Accurso, A, additional, Rathinaezhil, R, additional, Wilkins, A, additional, Khalifa, E, additional, Grover, K, additional, McManus, P, additional, Kneeshaw, P, additional, Mahapatra, T, additional, Azmy, I, additional, Massey, J, additional, Trapszo, P, additional, lane, R, additional, Seetharam, S, additional, Rocco, N, additional, Roshanlall, C, additional, Kokan, J, additional, Amin, K, additional, Leeper, A, additional, Kulkarni, D, additional, Dixon, J M, additional, Young, O, additional, Saleem, T, additional, McIlhenny, J, additional, Malyon, A, additional, Mansell, J, additional, Ogsto, K, additional, Romics, L, additional, Dragoumis, D, additional, Krupa, J, additional, Valassiadou, K, additional, Lambert, K, additional, Kaushik, M, additional, Shokuhi, S, additional, Pilgrim, S, additional, Wei, X, additional, Lee, J, additional, Al Allak, A, additional, Fowler, C, additional, Massey, E, additional, Court, F, additional, Hunt, R, additional, Vestey, S, additional, Khalil, H, additional, Elgammal, M, additional, Parvanta, L, additional, Sami, A S, additional, Gvaramadze, A, additional, Thekkinkattil, D, additional, Kirkpatrick, K, additional, James, R, additional, Noshirwani, A, additional, Arif, T, additional, Kryjak, Z, additional, Taylor, A, additional, Syed, F H, additional, Safdar, G, additional, Chin, K, additional, Soulsby, R, additional, Thorne, A, additional, Guest, F, additional, El Abbar, M, additional, Munnoch, D A, additional, Macaskill, E J, additional, Hogg, F, additional, McGee, P, additional, Pitsinis, V, additional, Smith, J, additional, Makkiyah, S, additional, Mustafa, S, additional, Otieno, C, additional, Photiou, D, additional, Macmillan, D, additional, Gutteridge, E, additional, Mazari, F, additional, Oni, G, additional, Khout, H, additional, Kelsall, J, additional, Hallam, K, additional, Asgeirron, K, additional, D'Auria, M, additional, Al zubaidi, S, additional, McCulley, S, additional, Rasheed, T, additional, Bailey, J, additional, Muhibullah, N, additional, Tenovici, A, additional, Remoundos, D D, additional, Chaidos, N, additional, Predescu, O, additional, Roy, P, additional, Windle, R, additional, Popa, E, additional, Shetty, G, additional, Rezulski, J, additional, Goh, S, additional, Abdullah, T, additional, Khawaja, S, additional, Udayasankar, S, additional, Tebbal, S, additional, Grassi, V, additional, Talbot, A, additional, Singh, J, additional, Smith, A, additional, Volleamere, A, additional, Garnsey, C, additional, Pikoulas, P, additional, Ferguson, D, additional, Tillett, R, additional, Dean, S, additional, Olsen, S, additional, Rainsbury, R M, additional, Peiris, L, additional, Sjokvist, O, additional, Laws, S, additional, Tansley, A, additional, De Sousa, E, additional, Mitchell, G, additional, Henderson, J, additional, Chandrashekar, M, additional, Micha, A, additional, Godden, A, additional, Pereira, B, additional, Constantinou, C, additional, Rusby, J, additional, Krupa, K, additional, To, N, additional, Barry, P, additional, Critchley, A, additional, Cain, H, additional, O'Donoghue, J, additional, Henton, J, additional, Kalra, L, additional, MacLennan, L, additional, Bennett, R, additional, Nicholson, S, additional, Paolini, G, additional, Francesco Renzi, L, additional, Di Pompeo, S, additional, Ria, V, additional, Hu, J, additional, Johnson, L, additional, Lewis, R S, additional, Hadad, S, additional, Sundaramoorthy, S, additional, Sharma, A, additional, Toomey, D, additional, Banerjee, D, additional, Shuk Kay Tang, S, additional, Taylor, L, additional, McKenzie, S, additional, Ahmad, T, additional, Absar, M, additional, Nasir, N, additional, Jerzy Rychlik, I, additional, Darragh, L, additional, Johnston, R, additional, Kirk, S, additional, Rees Lee, J, additional, Green, M, additional, Chong, K, additional, Lai, L M, additional, Choong, J, additional, Ullah, Z, additional, Chagla, L, additional, Koshy, O, additional, Bathla, S, additional, Kiernan, T, additional, Ashok Bhojwani, A, additional, Lund, J, additional, James, K, additional, Callaghan, M, additional, Vinayagam, R, additional, Poonawala, S, additional, Taylor, J, additional, Mullan, M, additional, Bright Thomas, R, additional, Gandhi, A, additional, Byrne, G, additional, Ibrahim, I, additional, Harvey, J, additional, Highton, L, additional, Chrysafi, A, additional, Jones, R Hawley, additional, Barnes, N, additional, Morris, O, additional, Chatterjee, S, additional, Mathen, V, additional, Majeed, Y, additional, Kirwan, C, additional, Jones, B Mancey, additional, El Sharief, D, additional, Munot, K, additional, Nasr, R, additional, and Frame, R, additional

Published
2018
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16. BMJ

Author

Phillips, E. M., primary, Kirwan, C., additional, Melmore, S., additional, and Chagla, L., additional

Published
2012
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24. D2gastrectomy: Lessons from a prospective audit of the learning curve

Author

Parikh, D, Johnson, M, Chagla, L, Lowe, D, and McCulloch, P

Abstract

A 3-year prospective study of the learning curve for D2gastrectomy was carried out by one surgeon beginning to perform the operation independently after intensive specialist training. Some 38 patients were treated; there were four postoperative deaths and 22 patients had complications. Postoperative morbidity decreased significantly with time (rs= -0·38, P = 0·02, 95 per cent confidence interval - 0·62 to - 0·07). The physiological component of POSSUM (Physiological and Operative Severity Score for the enumeration of Mortality and morbidity) was significantly lower in the third year (median value 15, 16 and 14 for years 1, 2 and 3, n= 31, χ2= 7·5, 2 d.f., P= 0·02, Kruskal-Wallis test), but the operative POSSUM scores and the number of lymph nodes found were not decreased (median operative POSSUM score 19, 18 and 21, n= 31, χ2= 0·2, 2 d.f., P= 0·91, Kruskal-Wallis test). The results suggest a learning curve lasting about 18–24 months or 15 to 25 procedures before a plateau is reached. Improved results were associated with changes in case selection and operative tactics but not with reduced extent of lymphadenectomy. D2gastrectomy should be restricted to specialist centres where adequate training and supervision can be provided during the learning curve.

Published
1996
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26. Evidence-based medicine.

Author

Chagla, L S and McCulloch, P G

Subjects
*GASTROINTESTINAL hemorrhage treatment, *RANITIDINE, *BLOOD transfusion, *CLINICAL trials, *GASTROINTESTINAL hemorrhage, *MEDICINE, *ACUTE diseases, *THERAPEUTICS
Published
1995

27. Revisiting surgical margins for invasive breast cancer patients treated with breast conservation therapy - Evidence for adopting a 1 mm negative width.

Author

Rakha EA, Quinn C, Masannat YA, Lee AHS, Tan PH, Karakatsanis A, Matrai ZT, Al Shaibani SHM, Gehani SA, Shaaban A, Khout H, Chagla L, Cserni G, Varga Z, Yong WF, Meattini I, Kulka J, Yang W, Tse GM, Pinder SE, Fox S, and Dixon JM

Subjects
Humans, Female, Neoplasm Invasiveness, Breast Neoplasms pathology, Breast Neoplasms surgery, Breast Neoplasms radiotherapy, Margins of Excision, Mastectomy, Segmental methods, Neoplasm Recurrence, Local pathology
Abstract

Clinical trials have demonstrated conclusively the non-inferiority of breast-conserving surgery followed by breast radiation therapy (BCT) compared with mastectomy for the treatment of early-stage invasive breast cancer (BC). The definition of the required surgical margin to ensure adequate removal of the cancer by BCT to obtain an acceptable low local recurrence (LR) rate remains controversial. Meta-analyses published by Houssami et al. in 2010 and 2014 demonstrated significantly lower LR rates for patients with a negative margin compared with those with positive (ink on tumour) or close (defined as ≤1 mm or ≤2 mm) margins. Neither meta-analysis addressed whether 'no ink on tumour' was adequate to define a negative margin because of a lack of data. Nevertheless, in 2014, the Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) with advice from pathologists reviewed these data together and published guidelines recommending that a margin of 'no ink on tumour' was sufficient to define a clear margin in BCT. Subsequently, clinical practice has varied with some national and international bodies endorsing 'no ink on tumour', whilst others have recommended a ≥1 mm margin as acceptable margins for BCT. A more recent meta-analysis conducted by Bundred and colleagues in 2022 did have sufficient data to compare 'no ink on tumour' and 1 mm and concluded that 1 mm rather than 'no ink on tumour', should be used as a minimum negative margin, and recommended that international guidelines be revised. The current review presents a balanced assessment of the evidence relating margin width and local recurrence after BCT. This review concludes that guidelines should consider re-defining a negative margin as ≥1 mm rather than 'no ink on tumour' in the context of BCT, recognising there will be variation to tailor therapy for any individual patient situation to ensure optimal patient care., Competing Interests: Declaration of competing interest None All authors declare that no financial and personal relationships with other people or organizations that could inappropriately influence (bias) this work., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Published
2024
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28. The association of breast surgery ASPIRE: breast pain pathway rapid evaluation project - study protocol.

Author

Hubbard TJE, Isaac AT, Cui A, Cutress RI, Dave R, Ellis K, Fields J, Halliday S, Hu J, Potter S, Chagla L, Cox K, and Holcombe C

Abstract

Background: Breast pain accounts for 20-40% of new referrals to breast units in the UK and these patients have a very low risk of breast cancer. Patients have previously been assessed in resource-intensive, cancer-exclusion, one stop clinics, which are now failing to meet government targets due to excessive demand. UK Breast units are increasingly piloting Breast Pain-only Pathways (BPP) to assess these patients, and there is no consensus for the optimal pathway. The aim of this prospective multicentre study is to assess the safety and patient satisfaction of different BPPs to inform future BPP design and implementation., Methods: All UK breast units will be invited to join the ASPIRE study between January 2023 and December 2023. Units with a BPP are invited to submit their pathway for evaluation; and those without a BPP who see patients with breast pain-only in a one stop clinics setting are also invited to join the study to evaluate the traditional pathway model concurrently. Patient satisfaction assessments will be collected after their initial consultation and patient outcomes, including subsequent cancer diagnosis, will be followed up at 12 months to determine if they have cancer diagnosis after discharge to assess pathway safety., Competing Interests: RIC receives institutional research funding from SECA and Astra Zeneca. The other authors have no conflicts of interest to declare., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Published
2024
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29. Challenges and Clinical Relevance of Modern Breast Pathology Reporting: Your Questions Answered.

Author

Deb R, Laokulrath N, Chagla L, and Tan PH

Subjects
Humans, Female, Breast pathology, Precision Medicine, Clinical Relevance, Breast Neoplasms pathology, Breast Neoplasms diagnosis
Abstract

Background: Breast pathology reporting, especially for breast cancer, has evolved through the years, from terse succinct diagnostic conclusions with scant histological details to the current comprehensive reporting guidelines issued by major pathology colleges and bodies, including the International Collaboration on Cancer Reporting. Pathology elements included in reporting guidelines are evidence based and contribute significantly to individualised and personalised patient management., Summary: This article is based on the lively interactive question and answer session that followed the breast pathology segment in the symposium jointly organised by the British Association of Urological Pathology, British Association of Gynaecological Pathologists, British Society of Gastroenterology and the Association of Breast Pathology, in November 2022, titled "Personalised histopathology reporting for personalised medicine.", Key Messages: The breast pathology session emphasised the clinical utility of breast pathology data items, incorporating a case-based approach by highlighting the relevance of pathology information in various clinical scenarios. This review included clinico-pathological discussion points on florid lobular carcinoma in situ, atypical apocrine adenosis, post-neoadjuvant chemotherapy reporting, atypical ductal hyperplasia presenting at the margin, flat epithelial atypia versus columnar cell change, papilloma on core needle biopsy, margin status, mucocele-like lesion, total duct excision/microdochectomy specimen, and anterior and nipple margins in skin-sparing mastectomy. Effective communication and regular involvement of pathologists in breast multidisciplinary tumour boards are crucial., (© 2024 S. Karger AG, Basel.)

Published
2024
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30. The frequency and clinical significance of centromere enumeration probe 17 alterations in human epidermal growth factor receptor 2 immunohistochemistry-equivocal invasive breast cancer.

Author

Katayama A, Starczynski J, Toss MS, Shaaban AM, Provenzano E, Quinn CM, Callagy G, Purdie CA, Millican-Slater R, Purnell D, Chagla L, Oyama T, Pinder SE, Chan S, Ellis I, Lee AHS, and Rakha EA

Subjects
Centromere, Chromosomes, Human, Pair 17 genetics, Female, Gene Amplification, Humans, Immunohistochemistry, In Situ Hybridization, Fluorescence methods, Receptor, ErbB-2 analysis, Breast Neoplasms genetics, Breast Neoplasms pathology, Chromosome Aberrations
Abstract

Background and Aims: Chromosome 17 alterations affect the assessment of HER2 gene amplification in breast cancer (BC), but its clinical significance remains unclear. This study aimed to identify the prevalence of centromere enumeration probe 17 (CEP17) alterations, and its correlation with response to neoadjuvant therapy (NAT) in BC patients with human epidermal growth factor receptor 2 (HER2) immunohistochemistry-equivocal score., Methods and Results: A large BC cohort (n = 6049) with HER2 immunohistochemistry score 2+ and florescent in-situ hybridisation (FISH) results was included to assess the prevalence of CEP17 alterations. Another cohort (n = 885) with available clinicopathological data was used to evaluate the effect of CEP17 in the setting of NAT. HER2-amplified tumours with monosomy 17 (CEP17 copy number < 1.5 per nucleus), normal 17 (CEP17 1.5-< 3.0) and polysomy 17 (CEP17 ≥ 3.0) were observed in 16, 59 and 25%, respectively, compared with 3, 74 and 23%, respectively, in HER2-non-amplified tumours. There was no significant relationship between CEP17 alterations and pathological complete response (pCR) rate in both HER2-amplified and HER2-non-amplified tumours. The independent predictors of pCR were oestrogen (ER) negativity in HER2-amplified tumours [ER negative versus positive; odds ratio (OR) = 11.80; 95% confidence interval (CI) = 1.37-102.00; P = 0.02], and histological grade 3 in HER2 non-amplified tumours (3 versus 1, 2; OR = 5.54; 95% CI = 1.61-19.00; P = 0.007)., Conclusion: The impacts of CEP17 alterations are not as strong as those of HER2/CEP17 ratio and HER2 copy number. The hormonal receptors status and tumour histological grade are more useful to identify BC patients with a HER2 immunohistochemistry-equivocal score who would benefit from NAT., (© 2022 The Authors. Histopathology published by John Wiley & Sons Ltd.)

Published
2022
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31. Ethnicity and breast cancer in the UK: Where are we now?

Author

Gathani T, Chaudhry A, Chagla L, Chopra S, Copson E, Purushotham A, Vidya R, and Cutress R

Subjects
Adult, Aged, Breast Neoplasms mortality, Female, Health Services Needs and Demand, Humans, Incidence, Middle Aged, Patient Acceptance of Health Care, Survival Analysis, United Kingdom epidemiology, Breast Neoplasms ethnology
Abstract

Outcomes from breast cancer for women in the UK have improved significantly over recent decades. These gains are largely attributable to a combination of earlier diagnosis and access to treatments delivered to patients by the National Health Service irrespective of cost. Ethnic minority groups make up almost fifteen percent of the UK population and there is concern however that these groups may have poorer outcomes from the disease. In this short report we seek to summarise what the current evidence tells us about the patterns of breast cancer incidence and outcomes in ethnic minority women in the UK in order to raise awareness about this topic and provide consideration for what future research is needed to address the gaps that may exist., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Published
2021
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32. Management of the axilla following neoadjuvant chemotherapy for breast cancer- A change in practice.

Author

Riogi B, Sripadam R, Barker D, Harris O, Innes H, and Chagla L

Subjects
Axilla, Chemotherapy, Adjuvant, Female, Humans, Lymph Node Excision, Lymphatic Metastasis, Mastectomy, Middle Aged, Neoplasm Recurrence, Local, Sentinel Lymph Node Biopsy, Breast Neoplasms drug therapy, Breast Neoplasms surgery, Neoadjuvant Therapy
Abstract

Objectives: Chemotherapy in the neo adjuvant setting has allowed downsizing of breast tumours thus allowing patients to benefit from breast conservation surgery. The effect of neoadjuvant chemotherapy (NAC) has also been observed in the axilla but most units are still treating the axilla with axillary lymph node dissection (ALND)., Materials and Methods: A prospective database of breast cancer patients receiving NAC between 2007 and 2016 at a single breast unit was reviewed. The management of the axilla and outcomes was studied., Results: 165 patients received NAC, 123 (74.5%) were clinically/radiologically node positive and 42 were negative. Median age was 50 years. 26.7% had triple negative disease and 34.5% were HER2 positive. 56/123 (45.5%) patients with positive nodes at the outset responded completely to NAC. 40 patients with positive nodes pre-NAC had post NAC SLNB with 37 requiring adjuvant radiotherapy only. 83/123 went directly to ALND post NAC and of these 27 were node negative and therefore may be considered to have had an unnecessary ALND. Overall mortality was 20.6% (34), local recurrence in the breast or mastectomy scar was 3.6% (6) but there was no recurrence in the axilla (0/165) with a median follow up of 67 months., Conclusion: There is no clear evidence for management of the axilla post NAC. We have used best available evidence to change our practice over the years and our results should encourage others to de-escalate treatment of the axilla in line with the recently published multidisciplinary guidance on axillary surgery following neoadjuvant chemotherapy., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Published
2021
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33. Recurrence after ROLL lumpectomy for invasive breast cancer.

Author

Ramesh HS, Anguille S, Chagla LS, Harris O, Desmond S, Thind R, and Audisio RA

Subjects
Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Mastectomy, Segmental statistics & numerical data, Middle Aged, Neoplasm Metastasis, Neoplasm Recurrence, Local, Treatment Outcome, Breast Neoplasms pathology, Breast Neoplasms surgery, Mastectomy, Segmental methods
Abstract

Background: Impalpable breast lesions are being successfully targeted by means of radio-guided occult lesion localisation (ROLL). Although ROLL allows adequate removal of sub-clinical breast lesions within a smaller volume of glandular tissue no long-term outcomes have been reported., Aim: To evaluate the recurrence of invasive cancer after ROLL lumpectomy., Methods: A consecutive series of impalpable invasive breast cancers excised with ROLL (151 pts; Dec 2002-June 2006) has been followed up for local and/or systemic recurrence with six monthly clinical examinations and 18 monthly mammograms. Bone scan, liver and brain imaging were requested when clinically appropriate. Clinical and/or radiological suspicious lesions for local recurrence were confirmed pathologically., Results: The median follow-up was 33 months with all patients having a minimum 22 months follow-up. Three (out of 151 impalpable invasive cancers) local recurrences occurred (1.98%)., Conclusions: Local recurrence of sub-clinical invasive breast cancer excised with radioisotope guidance compares well with the existing localisation techniques. Its implementation is highly recommended.

Published
2008
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34. Tumour localisation with a metal coil before the administration of neo-adjuvant chemotherapy.

Author

Nadeem R, Chagla LS, Harris O, Desmond S, Thind R, Flavin A, and Audisio RA

Subjects
Adult, Aged, Anthracyclines therapeutic use, Antineoplastic Agents therapeutic use, Chemotherapy, Adjuvant, Female, Humans, Mammography, Mastectomy, Metals, Middle Aged, Neoadjuvant Therapy, Remission Induction, Ultrasonography, Mammary, Breast Neoplasms diagnosis, Breast Neoplasms drug therapy, Carcinoma, Ductal, Breast diagnosis, Carcinoma, Ductal, Breast drug therapy, Carcinoma, Intraductal, Noninfiltrating diagnosis, Carcinoma, Intraductal, Noninfiltrating drug therapy
Abstract

Complete clinical response (CR) with tumour disappearance is not uncommon after neo-adjuvant chemotherapy (NAC) for locally advanced breast cancer, avoiding 25% mastectomies by facilitating breast-conserving procedures. We reviewed our series to understand the feasibility and utility of marking the cancer site before administering NAC. In total, 23 women (median age 47 years) with T2-4, N0-1, M0 tumours were considered unsuitable for breast conserving surgery between January 2002 and November 2003, thus received NAC following a coil placement at the core of tumour. All patients had the coil successfully inserted and no migration or infection was recorded. Eight patients (35%) had a radiological CR (rCR) including 3 (13%) with pathological CR (pCR). In total, 87% patients were managed conservatively. The insertion of a metal coil is a simple mean to provide a landmark for localisation and excision when the breast lump becomes impalpable and radiologically undetectable after the administration of NAC.

Published
2005
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35. Occult breast lesions: A comparison between radioguided occult lesion localisation (ROLL) vs. wire-guided lumpectomy (WGL).

Author

Nadeem R, Chagla LS, Harris O, Desmond S, Thind R, Titterrell C, and Audisio RA

Subjects
Adult, Aged, Aged, 80 and over, Breast Neoplasms pathology, Female, Humans, Mastectomy, Segmental instrumentation, Middle Aged, Radionuclide Imaging, Radiopharmaceuticals, Technetium Tc 99m Aggregated Albumin, Breast Neoplasms diagnostic imaging, Breast Neoplasms surgery, Mastectomy, Segmental methods
Abstract

Mammographic screening increases the number of impalpable breast cancers requiring surgical excision. It is important to optimise the localisation technique to remove the smallest amount of tissue, still adequately excising the lesion. The last 65 wire-guided lumpectomies (WGLs) were compared vs. the first 65 radioguided occult lesion localisations (ROLLs) performed for impalpable breast cancers. Data collection included patient's age, radiological abnormality, pre-operative core biopsy, type of primary surgery, length of localisation and excision, hospital stay, cancer size, weight and volume of the excised specimen, clearance margins. All patients were successfully localised with ROLL and WGL. Localisation time was reduced with ROLL (P<0.001). Clear margins were achieved in 83% ROLLs and 57% WGLs (P=0.001). Pathological cancer size and specimen weight were similar in both groups, although the specimen volume was slightly smaller for ROLL. A total of 74% ROLLs had excellent cosmetic outcomes and 26% good, vs. 55% excellent and 45% good in WGLs. A larger amount of normal breast tissue was excised with WGL, without achieving any better cancer clearance. ROLL provides a feasible alternative to WGL. This quick and simple technique achieves an improved rate of clear margins.

Published
2005
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36. Radio-guided localization of clinically occult breast lesions (ROLL): a DGH experience.

Author

Thind CR, Desmond S, Harris O, Nadeem R, Chagla LS, and Audisio RA

Subjects
Adult, Aged, Aged, 80 and over, Breast Neoplasms surgery, Feasibility Studies, Female, Gamma Cameras, Humans, Middle Aged, Radionuclide Imaging, Sensitivity and Specificity, Ultrasonography, Breast Neoplasms diagnostic imaging, Radiopharmaceuticals, Technetium Tc 99m Aggregated Albumin
Abstract

Aim: Wire-guided localization (WGL) of clinically occult breast lesions is a well established technique. The aim of this study was to evaluate radio-guided localization (ROLL) within the breast screening service of a district general hospital., Method: The study group comprised 70 women who underwent ROLL under US and stereotaxis. This required an injection of Technetium-labelled colloidal albumen into the impalpable breast lesion. The women then proceeded to theatre, where localization was achieved with the use of a gamma probe. The lesion was identified by the presence of a high signal, caused by the injected isotope. The results of 70 consecutive cases in which a breast lesion was localized using ROLL were compared with the results of the latest 70 WGLs., Results: All 140 lesions were successfully localized. However, the change in technique from WGL to ROLL offered significant benefits to patients., Conclusion: Our study demonstrated that ROLL is a practical and reliable localization technique. It can be implemented in hospital units without using valuable gamma camera time. The cost compares well with WGL. There is an improved cosmetic outcome for patients, and the very small quantity of radioactivity used is safe for both patients and staff.

Published
2005
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