Utility of Virtual New-Patient Clinics in Women Under 30

Aim: Virtual consultations (VC) in breast surgery have been successfully utilised during the COVID pandemic and have potential to reduce the costs of outpatient clinics as well as increase patient satisfaction. We aimed to assess the utility and safety of VC in new patient clinics in women under 30, which are considered a low-risk subgroup. Method: Data was prospectively collected on 118 women aged under 30 who were referred from primary care to the breast clinic between December 2020 and April 2021. Clinicopathological data was collected on referrals, imaging and follow up. Results: Median age was 24 years (range 17-30). The commonest presenting symptoms were a lump (69%), breast pain (16%) and nipple symptoms (14%). The VC was performed via video in 63 (53%) patients and via telephone alone in 55 (47%). Nineteen patients (16%) were reassured and discharged directly from VC. Ninety-four patients (80%) underwent an outpatient ultrasound with a sonographer trained in clinical palpation. Twenty-six (27%) ultrasounds showed benign pathology with the remainder being normal. Six biopsies were performed, all of which were benign. Seventeen (14%) patients required a face-to-face appointment with a breast surgeon after ultrasound or biopsy. Ninety-four (79%) patients were discharged after VC + ultrasound alone. No patients required surgery. Conclusions: Utilising VC, the majority of new referrals in women under 30 did not require face-to-face appointments. VC have potential to reduce burden on new patient clinics whilst improving patient convenience. Early data suggest a low risk of compromising safety in this subgroup.

Utility of virtual new-patient clinics in women under 30

Aim: Virtual consultations (VC) in breast surgery have been successfully utilised during the COVID pandemic and have potential to reduce the costs of outpatient clinics as well as increase patient satisfaction. We aimed to assess the utility and safety of VC in new patient clinics in women under 30, which is considered a low-risk subgroup. Methods: Data was prospectively collected on 118 women aged under 30 who were referred from primary care to the breast clinic between December 2020 and April 2021. Clinicopathological data was collected on referrals, imaging and follow up. Results: Median age was 24 years (range 17-30). The commonest presenting symptoms were a lump (69%), breast pain (16%) and nipple symptoms (14%). The VC was performed via video in 63 (53%) patients and via telephone alone in 55 (47%). Nineteen patients (16%) were reassured and discharged directly from VC. Ninety-four patients (80%) underwent an outpatient ultrasound with a sonographer trained in clinical palpation. Twenty-six (27%) ultrasounds showed benign pathology with the remainder being normal. Six biopsies were performed, all of which were benign. Seventeen (14%) patients required a face-to-face appointment with a breast surgeon after ultrasound or biopsy. Ninety-four (79%) patients were discharged after VC + ultrasound alone. No patients required surgery. Conclusion: Utilising VC, the majority of new referrals in women under 30 did not require face-to-face appointments. VC have potential to reduce burden on new patient clinics whilst improving patient convenience. Early data suggest a low risk of compromising safety in this subgroup.

Discussing results and breaking bad news in breast video consultations: A pilot questionnaire

Aim: Virtual consultations (VC) in Breast Surgery have become wellestablished during the COVID pandemic. They are successfully utilised in routine follow ups and low-risk new referrals. We aimed to assess the utility of VC in more complex clinical discussions. Methods: We collected feedback anonymously via electronic link from 20 consecutive patients who specifically had more challenging video- VC including: 12 diagnostic MDT results (10 patients received bad news of new cancer diagnosis, 2 had benign results);6 post-operative wound checks with therapeutic MDT outcomes;2 new consultations for chest wall reconstruction. Results: The time saved by patients was between 1 and 3 hours (median=2). All patients felt that booking and joining a VC was either very easy (12) or easy (8). 18 patients were satisfied with the quality of sound and picture and all 18 felt they were able to communicate everything to the clinician during their VCs. Compared to a face-to-face consultation, 14 patients felt that VC was better (70%), 4 felt it was similar (20%) and 2 thought it was worse (10%). Most received comments were themed around VC had allowed patients to get their results, discuss their management plans and ask questions while they were safely at home with other family members, at times when COVID restrictions applied to outpatient clinical settings. Conclusion: VC may be utilised selectively to provide complex consultations including discussing results, breaking bad news and wound inspections. Qualitative studies in this field can be beneficial.

Two decades of experience with sentinel node staging of axilla-is false negative no longera worry?

Aim: To review current literature and standard practices in various techniques of sentinel node biopsy for staging theaxilla for treating early breast cancer. The purpose is to provide evidence based recommendation as guidanceplatform for optimal true sentinel node retrieval irrespective of surgeon expertise. Background: Axillary conservationis the way forward after game changing trials like ACOSOG Z0011, surrogate trials like IBCSG,AMAROS,ALMANAC, ongoing POSNOC, and newbie ATNEC have progressively or plan to decrease the need tounnecessarily fiddle with the axilla thereby increasing the chances of arm related and other morbidities. Axillarysentinel node biopsy entails retrieval of first draining lymph node in the breast-axilla pathway to plan treatment inbreast cancer by appropriate staging of axilla. Current standard is the utilisation of double agent technique withradioactive isotope and blue dye injection to decrease false negative rates for true sentinel node retrieval. Noveltechniques like magnetic and infrared tracing are still being investigated for validation. Method: PMC, Medline,EMBASE, PubMed and Cochrane library searched for clinical trials, randomised trials, systematic reviews and meta-analysis on techniques of axillary sentinel node biopsy in early breast cancer. This covered the last 25 yearsliterature on the topic. Results: The search yielded 197 publications which were subjected to a meticulous reviewand narrowed to a select pertinent body of evidence to extrapolate suggested guidance rationally, the bibliography of which is provided at the end. Conclusion: Single agent preferably radioisotope for lymphatic mapping isrecommended in palpable and good biology tumours. Use of single agent blue dye can be standardised in axillary.tail tumours. It is also recommended as being effective when isotope mapping is logistically not feasible or duringpandemics like COVID 19 where looming infrastructure challenges are prevalent. Dual agent technique should beconsidered in previously treated breast and axilla, neoadjuvant chemotherapy cohort, bad tumour biology, high BMIand macromastia groups for true nodal retrieval. Optimal number of nodes taken out should not be more than three(n=3). Lower axillary sampling of not more than 3 nodes is recommended for troubleshooting with any localisingagent technique. Triple site injection at peri-tumoural, subcutaneous and sub areolar regions and larger volume ofblue dye agent injection of up to 8mls increases the localisation success in the dual technique group for lymphaticmapping. Magnetic tracing can be used as an adjunct to either single agent radioactive isotope or blue dye (RI/BD)technique when there is failure to localise the sentinel node.