Magseed wide local excisions - The first 50

Introduction: Prior to 2021, impalpable tumours in our unit were localised with Somatex wires. During the COVID pandemic we introduced Magseed due to its logistical advantages in allowing surgery on a site distant from our breast unit. We wanted to ensure our clinical outcomes with this new system were equivalent to those using wire localisation. Method(s): Electronic records for the first 50 consecutive Magseed localised wide local excisions and the preceding 50 consecutive wire localised wide local excisions were compared. Excision biopsies, palpable lesions, bracketed lesions and post neoadjuvant treatment patients were excluded. Patient demographics, tumour size, inadequate radial margin involvement rate, reoperation rate for margins, specimen weight, number of cavity shaves and operative time were recorded. [Formula presented] Results: Results are shown in table 1. There were no preoperative differences in the two groups. There were no significant differences in outcomes between the two groups, with a trend towards lower margin involvement rates but more shaves in the Magseed group. The mean operative time was slightly shorter in the Magseed group despite more axillary procedures being performed in this group. Conclusion(s): The change to the Magseed system led to logistical advantages with patient outcomes at least equivalent to wire guided excision.Copyright © 2023

Unilateral multiple facial angiofibromas as a solitary manifestation of tuberous sclerosis

We describe the case of a 12-year-old boy who presented via teledermatology with a 5-6-year history of multiple lesions on the right side of his face. They were unchanged since their initial appearance at 6 years of age but were slowly increasing in number across his right cheek and extending onto the chin. Although the lesions were asymptomatic, growing older had made him feel increasingly self-conscious. He was otherwise fit and well, and attended mainstream school, with no past medical history or family history of note. Perinatal and birth history were also uneventful. On examination, he had multiple, 1-2-mm, erythematous papules confined to the right cheek and right chin. Dermoscopy showed an unusual pattern of vessels with nonspecific globules in between. The rest of the skin, hair and nails were entirely normal in appearance. There were no systemic symptoms and a detailed general and systemic examination, as well as radiological imaging, did not reveal any abnormality. An excisional biopsy was taken of one of the lesions, with histological examination demonstrating focal superficial telangiectasia with associated bland round-tospindle cell proliferation, appearances most in keeping with an angiofibroma. This correlated well clinically, apart from unilateral facial angiofibromas being the solitary finding in our patient. Facial angiofibromas - also called adenoma sebaceum - are well described as part of the cutaneous manifestations of tuberous sclerosis (TSC). Classically, these appear as a facial rash in the form of small pink or red spots across the cheeks and nose in a butterfly distribution, at between 3 and 10 years of age, increasing in size and number until adolescence. TSC is an autosomal dominant disorder with defective mammalian target of rapamycin (mTOR) signalling, characterized by hamartomas in many organs, particularly the skin, central nervous system, renal and cardiovascular systems. The clinical presentation is variable, with other well known and frequently reported cutaneous findings such as shagreen patches, ash-leaf macules and periungual fibromas. Unilateral multiple facial angiofibromas in the absence of other cutaneous or systemic manifestations of TSC - as in our patient - are rare, with only 13 reported cases. These may form part of the clinical spectrum of TSC as a probable consequence of cutaneous mosaicism in which a postzygotic genetic mutation has occurred. Our patient was referred for genetic testing, but this has been delayed as a result of the COVID-19 pandemic. Topical sirolimus 1% - an mTOR inhibitor - has been used with good effect for facial angiofibromas, and our patient also responded well to this.

Multidisciplinary management of a quickly growing pediatric atypical Spitz nevus, mimicking melanoma, during the COVID-19 pandemic

Spitzoid melanoma is very rare tumour in the pediatric population, with clinical and non-uniform behaviour, different from adult melanoma [1]. It can be difficult to differentiate an atypical Spitz nevus from a Spitzoid melanoma, resulting in diagnostic problems. In addition, in our clinical case, the COVID-19pandemiccaused significant delays both in the diagnosis and in the surgical treatment of our patient. We present the clinical case of a 4-year-old child suffering from a localized polypoid cutaneous neoformation on the dorsum of the left hand, which started immediately before the lockdown and steadily increased during the COVID-19 pandemic. After a general clinical framing, the child underwent an excisional biopsy at our Department of Plastic and Reconstructive Surgery, at the Policlinico of Foggia. Subsequently, two independent anatomic pathology groups examined the specimen. Definitive diagnosis was made only after careful genetic analysis in combination with supporting histological and immunohistochemical examinations. This clinical case shows how during the pandemic we have been facing advanced forms of tumours, compared to the previous period and highlight show an interdisciplinary and multicenter collaboration allowed a quick diagnosis of certainty, demonstrating the utility of molecular pathology as a fundamental aid in clinical/surgical practice. © 2022 The Authors

Evaluation of the reproducibility of the sentinel lymph node study in breast cancer, melanoma and cervical cancer

Aim/Introduction: Sentinel lymph node (SLN) biopsy is widely accepted for lymph node staging in breast cancer, intermediaterisk melanoma and low-grade cervical cancer. The reproducibility of lymphatic drainage is a fundamental premise behind this procedure, but it has not been sufficiently studied yet. The aim is to evaluate the reproducibility of the lymphoscintigraphy for SLN detection in breast cancer, melanoma and cervical cancer using SPECT/CT images. Material(s) and Method(s): Retrospective study from February/2009 to October/2021 that included 64 consecutive patients (36-81 y.o., 62+/-11 years, 60 female) who underwent SLN study on two consecutive occasions due to suspension of the surgical procedure for different reasons (insufficient fasting, respiratory infection, hypertension, coordination problems, COVID-19). Fifty-six had breast cancer, 6 had melanoma and 2 cervical cancer. The interval between the two studies was 1-112 days. Patients with previous breast surgery or excisional biopsy were excluded. The radiopharmaceutical used was 99mTc-nanocolloid by subdermal periareolar injection in breast cancer, in 4 points surrounding the surgical scar in melanoma and in 4 points in the cervix in cervical cancer. Planar images followed by SPECT/CT of the region were acquired. Result(s): In the 56 patients with breast cancer, 115 SLNs were detected in the first procedure (85 level I, 20 level II and level III and 2 in the internal mammary chain) and 120 SLNs in the second procedure (87 level I, 24 level II, 8 level III and 1 internal mammary chain). One patient did not show SLN uptake in the first study and 2 level I SLNs were observed in the second. Ninety-eight percent concordance was observed in the topography of the SLNs of the level I. In the 6 patients with melanoma (2 of the upper limbs, 2 of the lower limbs, one from the back and one from the head) 21 SLNs were detected. The topography of the SLN was concordant in all cases. In the 2 patients with cervical cancer, 6 nodes were detected (4 bilateral external iliac and 2 obturator nodes). One patient had bilateral SLNs in the first study and unilateral in the second. Conclusion(s): The technique showed high reproducibility in breast cancer and melanoma. Concordance was maintained even in patients who showed several SLNs, suggesting that the main determining factor is the individual variability of the lymphatic drainage, beyond possible differences in the technical conditions of the procedure. More data are needed for cervical cancer.

Development of a Novel Near-peer Surgical Simulation-based Teaching Programme for Intern Doctors

Background: Trends in healthcare have caused a shift in training towards more competency based programmes. The COVID-19 pandemic has reduced time available for direct exposure and clinical learning, necessitating incorporation of simulation in training. The objectives of this study were to develop, pilot and evaluate a four week simulation based surgical teaching programme. Method(s): Interns pursuing a career in Surgery joined a near-peer surgical training programme delivered by NCHDs. A survey established a baseline competency. Four skills workshops were delivered. Outcomes were measured using data from pre and post course surveys as well as a surgical skills competition. Result(s): Of The 12 trainees, 71% had scrubbed in theatre before. 50% were already confident to scrub independently, increased to 75% post training. 28% were confident gowning/gloving, increased to 75% post training. 28% were confident to place a Simple suture in theatre, this did not increase despite training. 42% were confident performing an instrument tie, increased to 75% post training. 14% were confident hand tying knots, this increased to 62%. 14% of participants were comfortable performing excisional biopsy in theatre, increased to 62% post training. Preparation and administration of local anaestetic could be performed confidently by 14% before training, this increased to 87%. on completion, a surgical skills competition showed that 100% were able to satisfactorily perform basic skills. Conclusion(s): Near-peer delivery of surgical training has enhanced The basic surgical skills of interns. Similar programmes in other sites would ensure that interns have The skills required to safely care for surgical patients.

Cervical and Axillary Lymphadenopathy after Administrating mRNA BNT-162b2 Vaccine against COVID-19: Clinical and Sonographic Findings, Outcomes of Short-term Follow-up

Introduction: Vaccination plays an important role in all strategic actions against the COVID-19 pandemic. Despite the high safety and efficacy of vaccination, side effects of the vaccines may also occur. The purpose of this study was to evaluate the clinical and sonographic findings and short-term results of cervical and axillary lymphadenopathy after the BNT-162b2 mRNA vaccine. Materials and Methods: The patients who received at least one dose of BNT-162b2 mRNA vaccine between July-September 2021 and were detected to have ipsilateral axillary and cervical lymphadenopathy related closely to the vaccination period, were included in the study. Clinical characteristics, sonographic findings of lymphadenopathies, and short-term results were analyzed retrospectively. Results: A total of 13 patients [six females (46.2%), seven males (53.8%)] were evaluated in the present study. Mean age of the patients was 41.9 years (min-max= 20-56). Median time-lapse between vaccination and presentation to hospital was six days, and seven (53.8%) patients presented with symptoms and findings after the first dose, and six patients (46.2%) after the second dose. Three (23.1%) axillary lymphadenopathies, and 10 (76.9%) cervical lymphadenopathies were detected. Sonographic examination revealed lymphadenopathies predominantly oval morphology (69.2%), asymmetric cortical thickening (61.5%), and hilar-type vascularization (69.2%). Mean time of regression was found 19.2 days (min-max= 10-35). Conclusion: Ipsilateral cervical and axillary lymphadenopathies may occur because of vaccines against COVID-19. The sonographic findings of these lymphadenopathies may not be distinguished clearly from malignant lymph nodes;and for this reason, close clinical and radiological follow-up would be appropriate to elucidate the process.

MULTISYSTEM SARCOIDOSIS ASSOCIATED WITH THE COVID-19 MRNA VACCINE

SESSION TITLE: Unusual Presentations of Sarcoidosis SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: COVID-19 infection has brought high morbidity and strain on hospitals. Multiple vaccines have been developed against COVID and are now widely available. These vaccines have been linked to various side effects listed by the Centers for Disease Control and prevention (CDC) website- https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html. We present a case of multisystem sarcoidosis after receiving an mRNA COVID-19 vaccine. CASE PRESENTATION: Our patient is a 42-year-old African American woman who reported low grade fever after her first dose of the BNT162b2 mRNA COVID-19 vaccine (Pfizer). After her second dose, the fever continued, and fatigue and lethargy were noted. She denied any respiratory symptoms and other review of systems were negative. She was referred for autoimmune workup by her PCP. Then, she received her booster dose (~6 months after the second dose) and 2 weeks later, she noticed a right posterior calf mass that was firm and non-tender on exam. Rest of the exam was unremarkable. Orthopedic surgery was involved, and an excision-biopsy was done. Pathology demonstrated non-necrotizing granulomatous inflammation (Figure 1A). Her blood counts and metabolic panel were normal. Other labs showed elevated C-reactive protein of 19 mg/L (normal < 5 mg/L), angiotensin-converting enzyme level of 93 U/L (normal is 9-67 ) and Vitamin D level of 8.4 ng/mL (normal is 20-50 ng/mL). She was referred to pulmonary clinic for further evaluation. Pulmonary function test showed mild restrictive physiology. CT chest revealed enlarged mediastinal and hilar lymph nodes (Figure 2) and lung parenchymal involvement (Figure 3). EBUS-guided TBNA was performed and showed granulomatous inflammation. (Figure 1B). DISCUSSION: We present a case of multisystem sarcoidosis with mediastinal and soft tissue compromise in a temporal association with Pfizer mRNA COVID-19 vaccine. This is an uncommon adverse reaction and has not been reported by the CDC. In our case, there is a strong temporal relationship between the vaccination schedule and onset of symptoms, starting with fever and tiredness as common side effects that progressed to mass-like lesion in leg and mediastinal adenopathy. Cutaneous sarcoidosis might occur with COVID-19 vaccines (#1), however only 3 cases of multisystem sarcoidosis have been reported so far. Two cases developed Lofgren syndrome after the COVID-19 vaccination (#2) and one case with uveitis and parotid compromise (#3). To the best of our knowledge, this is the first case reporting sarcoidosis with soft tissue involvement in association with Pfizer mRNA COVID-19 vaccine. CONCLUSIONS: Our patient met criteria for multisystem sarcoidosis and there is a strong temporal relationship between the onset of symptoms/disease and COVID-19 vaccine. Immunological adverse events related to vaccines are uncommon. Our case elucidates to consider the diagnosis in right clinical context. Reference #1: Niebel D, Novak N, Wilhelmi JZ, Wilsmann-Theis D, Bieber T et al. Cutaneous adverse reactions to COVID-19 vaccines: Insights from an immune-dermatological perspective. Vaccines 2021,9,944. Reference #2: Rademacher J, Tampe B and Korsten P. First Report of Two Cases of Löfgren's Syndrome after SARS-CoV-2 Vaccination-Coincidence or Causality? Vaccines 2021, 9, 1313. https://doi.org/10.3390/ vaccines9111313 Reference #3: Matsuo T, Honda H, Tanaka T, Uraguchi K, Kawahara M et al. COVID-19 mRNA vaccine-associated uveitis leading to diagnosis of Sarcoidosis: case report and review of literature. J Investig Med High Impact Case Rep. 2022 Jan-Dec;10: 23247096221086450. DISCLOSURES: No relevant relationships by Chien Chen No relevant relationships by Eleonora Fiorletta Quiroga No relevant relationships by Manish Joshi No relevant relationships by Angel Mitma No relevant relationships by PRACHI SALUJA

The effect of delay of excisional biopsy on upstage rate for atypical ductal hyperplasia, flat epithelial atypia, intraductal papilloma, and radial scar.

PURPOSE: When Core Needle Biopsy (CNB) demonstrates Atypical Ductal Hyperplasia (ADH), Flat Epithelial Atypia (FEA), Intraductal Papilloma (IDP), or Radial Scar/Complex Sclerosing Lesion (RS), excisional biopsy (EB) is often performed to rule out underlying malignancy with upstage rates (UR) ranging between 1 and 20%. The COVID-19 pandemic led to delayed EB for many patients. We sought to evaluate whether this delay was associated with higher UR. METHODS: We performed a retrospective analysis of women who underwent CNB and then EB for ADH, FEA, IDP, or RS between 2017 and 2021 using an IRB-approved repository. UR was evaluated by days between CNB and EB. RESULTS: 473 patients met inclusion. 55 were upstaged to cancer (11.6%). 178 patients had pure ADH on CNB and 37 were upstaged (20.8%). 50 patients had pure FEA and 3 were upstaged (6%). 132 had pure IDP and 7 were upstaged (5.3%). 98 had pure RS and 1 was upstaged (1%). 7/15 (46.7%) had a combination of diagnoses or diagnosis with palpable mass and were upstaged. Days between CNB and EB were < 60 for 275 patients (58.1%), 60-90 for 108 (22.8%), 91-120 for 43 (9.1%), and > 120 for 47 (9.9%). There was no significant difference in UR (10.9% for < 60, 14.8% for 60-90, 7% for 90-120, and 12.8% for > 120, p = 0.54). UR for ADH was clinically increased after 60 days (27.8 vs. 17.5%), but this did not reach statistical significance (p = 0.1). CONCLUSION: Surgical delay was not associated with an increased UR.

Effect of the COVID-19 Pandemic on the Diagnosis of Non-Melanoma Skin Cancers: A Retrospective Case Control Study

Objective: The coronavirus disease-2019 (COVID-19) pandemic has caused delays in the diagnosis and treatment of some oncological diseases. This study aimed to reveal the effect of the COVID-19 pandemic on the frequency of diagnosis of non-melanoma skin cancers (NMSC) and the demographic characteristics of patients. Material and Methods: Patients aged over 18 years, who were histopathologically diagnosed with basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) between March 12, 2019 and March 11, 2021 were included in the study. The demographic characteristics of these patients, the number of total skin biopsies, and the number of BCC and SCC biopsies were compared between the pre-pandemic and pandemic periods, based on the date of March 12, 2020, when the pandemic measures began to be implemented in Turkey. Results: With the pandemic, there was a 26.7% decrease in the total skin biopsies and a 21% decrease in the total NMSC biopsies. Despite a 34% decrease in the number of biopsies for the diagnosis of BCC, a 15.8% increase was observed in the number of biopsies for the diagnosis of SCC. The frequency of excisional biopsies was observed to increase among the patients with BCC and SCC during the pandemic period (p=0.004 and p=0.001, respectively). Conclusion: The number of total skin biopsies and total NMSC biopsies significantly decreased during the pandemic period. The health system should be reorganized to effectively handle pandemics and similar crisis periods, and new strategies should be determined regarding patient education, early diagnosis, and treatment approaches for NMSC.

Beware of TB amid COVID 19 pandemic

Background: Tubercolosis has a worrisome connection with novel corona virus.Lingering respiratory symptoms in people who have recovered from Covid could well be mistaken as residual issues of Covid or secondary bacterial infections, missing TB diagnosis totally. Methods: A 28 year old female doctor by profession, initially asymptomatic tested Covid -19 positive as a part of contact tracing. On the 15th day, she developed fever, dry cough and fatigue which persisted even after taking symptomatic treatment. Repeat Covid testing was negative.HRCT chest was normal.Sputum CBNAAT was negative and other relevant blood investigations were normal. On examination she was febrile and matted subcentimetric right cervical lyphnodes(LN) were palpable.Excision Biopsy of cervical LN was done and report suggested Kikuchi's disease.As a part of work up of Pyrexia of Unknown Origin, she undertwent 18-FDG PET whole body CT scan and showed mediastinal lymph node uptake(2R,4R LN station). Mediastinoscopic biopsy report showed tuberculosis and Gene Expert showed mycobacterium complex with Rifampicin resistance. Results: Based on clinical, radiological and laboratory findings, MDR LN tuberculosis was diagnosed.Patient wad started on MDR TB regimen and symptoms got improved. Conclusion: There is an increased likelihood of tuberculosis in post COVID patients due to many factors like lung inflammation, altered immunity and stress due to COVID, use of steroids and uncontrolled diabetes.Therefore active tuberculosis should be vigorously ruled out in any post covid patients with continuous fever.

A Case of Angioimmunoblastic T-cell Lymphoma Hidden in Plain Sight: A Delay in Diagnosis and Management.

Angioimmunoblastic T-cell lymphoma (AITL) is an uncommon type of cluster of differentiation (CD)4 T-cell peripheral lymphoma. The varied clinical presentations of AITL present a challenge for accurate diagnosis. We present a case of a 57-year-old female with a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in May 2020, who presented to the hospital in the summer of 2021 with shortness of breath for 3 months. She underwent an extensive workup for lymphadenopathy while in Canada involving multiple core lymph node biopsies, which were inconclusive. Here in our institution, several tests for infectious diseases were unremarkable. Imaging tests revealed bilateral pleural effusion, lymphadenopathies, and rectal thickening. Results from rectal biopsy and excisional cervical lymph node biopsy revealed findings typical of AITL. Due to worsening hypoxia with pleural fluid accumulation, bilateral chest tubes (PleurX catheter) were placed. Steroids and chemotherapy were started. She was discharged in stable condition to follow-up care. An integrated and persistent approach comprising clinical, morphologic, excisional biopsy, immunophenotyping, and molecular tests is essential in reaching a correct diagnosis of AITL. Through our consistent effort to obtain further imaging and tissue biopsies, we came to the diagnosis which allowed her to begin appropriate life-saving treatments.

In the covid aftermath, using an innovative collaborative approach to improve wait times for skin cancer patients

COVID-19 led to drastic reductions in non-urgent medical visits and cancer care. Surgical patient backlogs mean new strategies are required to decrease wait times and administrative costs whilst improving patient outcomes. We review the impact of combined speciality Plastic Surgery and Dermatology 2 week-wait (2ww) clinics on wait times and hospital attendances and associated cost implications when compared to the single speciality clinics. Retrospective analysis comparing Plastic surgery (PS) and Dermatology (DM) 2ww clinics against combined Dermatology and Plastic surgery (DP) clinics across the same 3-month period in 2018 and 2019 at a single UK tertiary centre. 283 patients reviewed across the same 3-month period in 2018 and 2019 (PS n=53, DM n=158, PD n=72). PD reviewed most patients per clinic (Averages: PD n=18.0, PS n=8.8, DM n=12.1). Hospital attendance decreased from 1.84 to 1.51 visits. 42.9% of excisional biopsies were performed on the same day as initial assessment compared to 18.0% in PS/DM clinics. Referral to surgery time decreased from 67.7days to 50.4 days, and tertiary assessment to surgery from 49.5days to 36.9days. PD attracted tariffs of up to £29.78 more per patient. Combined clinics see more patients and attract higher tariffs per patient, whilst reducing outpatient attendances and wait times to surgery. This has significant cost-saving implications whilst optimising cancer care.

Rapid diagnosis of tuberculous lymphadenitis using polymerase chain reaction with IS6110. A 5 year meta-analytic study with special emphasis on predicted impact of COVID-19 associated social stigma and guidance for the implementation of the End TB Strategies

Background: Tuberculosis remains one of the major cause of morbidity and mortality in developing countries like India despite intense health campaigning and Government Programmes. Tuberculous lymphadenitis being the most common extra pulmonary manifestation of tuberculosis the incidence still on higher margin especially in resource poor areas which often goes unnoticed and remains as a diagnostic challenge to General Pathologists and sometimes even to Cytopathologists. Moreover the sequelae of COVID-19 pandemic had drastically impacted the management of TB, World Health Organisation had insisted to maintain continuity of essential services for people affected with TB during the COVID-19 outbreak worldwide. Aims & Objectives: To document the prevalence of tuberculous lymphadenitis among various patient groups and also to advocate the best method in early and prompt diagnosis of tuberculous lymphadenitis with an novel objective of proposing operational guidelines in the strategy of eradicating Tuberculosis. Materials & Methodology: In the prospective study conducted in SBV University Hospital, Puducherry a total number of 151 cases clinically suspected of tuberculous LN were included and patients with neoplastic lesion were excluded from this study. The lymph node aspirate collected were analysed for tuberculous cytomorphological changes by using routine cytological stains and observations were correlated with results of various ancillary diagnostic procedures. Results & Observations: Among 151 cases studied, 120 cases showed tuberculosis indicating high prevalence. 31 aspirates showed classical tuberculous pattern on cytomorphology, correlating well with histopathology (100%), Polymerase chain reaction (PCR) (100%) and culture (92%) respectively. In rest of the 119 cases carrying non tuberculous pattern on cytology, further exploration by ancillary diagnostic procedures revealed up tuberculosis in 79 cases with confirmation by culture, Histopathology and PCR. Conclusion: Our study showed prevalence of tuberculous lymphadenitis is on higher margin especially among low sociodemographic group and cytological procedure in adjunction with ancillary procedures proved to be reliable and helpful to Cytopathologists. PCR procedure could be widely employed by the Government especially in endemic regions with resource poor diagnostic facilities with scope for creating platform of multiplexing with additional resources so that PCR instruments can serve multipurpose testing tool.

Changing practice in the management of non-palpable breast lesion during pandemic;Early experience using Magseed markers

Background: The Covid Pandemic has influenced how cancer surgeries are performed and their pre-operative management to allow appropriate social distancing and self-isolation prior to Surgery. With the requirement of wire localisation of non-palpable breast cancers/ lesions on the day of surgery and non-availability of mammogram and ultrasound machine in an isolated zone, we embarked on localisation of non-palpable breast lesions using MagseedR markers and SentimagR localisation system. We describe our initial experience in the management of these cancers and diagnostic excision biopsies using Magseed. Materials and Methods: Forty consecutive female patients, median age 61 (range 36-84) years underwent Magseed insertion for diagnostic excision biopsy (n=4) and breast conservation surgery (WLE;n= 36). Check mammograms were performed following Magseed insertion to confirm appropriate localisation. During the initial audit of 16 patients, one Magseed guided WLE and sentinel node biopsy was abandoned due to erratic signal strength on the day of surgery and underwent surgery with wire localisation on a later date. Subsequently all cases had Magseed signals confirmed following insertion in the radiology department along with check mammograms. Results: Thirty-nine patients underwent successful breast surgery (Magseed in intra-operative specimen X-ray) with standard axillary procedures (29 sentinel node biopsy, 2 axillary node clearance). The median time from magseed insertion to surgery was 13 (range 3-38) days. The lesions were invasive neoplasm +/- insitu (DCIS) disease (n= 32), DCIS (n=5), and papilloma (n=3). The median overall tumour size was 20 (range 3-38) mm and on postop histology was 17 (2-50) mm. Six patients required further re-excision for margin positivity with DCIS;margins were clear after single cavity shave(n=4) and two patients underwent mastectomy subsequently. Conclusions: Magseed localisation have given us significant flexibility in the management of non-palpable breast cancer and indeterminate lesions requiring diagnostic biopsy during the Covid pandemic. Initial audit suggests usefulness of confirming adequate Magseed signal in the radiology department along with check mammogram during the early learning curve.

Kikuchi-Fujimoto Disease: A Case Report

[Formula presented] Kikuchi-Fujimoto: A Case Report Hickman, JD. MD LT MC USN and An, Joseph, DO. LCDR MC USN Naval Medical Center Portsmouth 620 Johns Paul John Cir, Portsmouth VA 757-953-2223 The views expressed in this are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. We are military service members and employees of the U.S. Government. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person's official duties. Kikuchi-Fujimoto disease is a rare benign disorder often presenting with tender cervical lymphadenopathy, fever, and malaise. While first described in Japan, its distribution is worldwide and predominantly seen in young adults. Diagnosis is based on characteristic histopathologic findings of patchy necrosis occupied by karyorrhectic debris and abundant histiocytes on node biopsy. The origin is unclear but associated with a preceding viral illness as well as cutaneous lupus erythematosus. Treatment is generally supportive and focused on managing tender lymph nodes. We present a case of a 28-year-old female presenting with a 2 month history of night sweats, fever, and weight loss in the setting of painful neck swelling. CT and PET/CT imaging demonstrated numerous hypermetabolic and enlarged nodes in the bilateral cervical and axillary regions. Lab studies were notable for leukopenia, anemia, and elevated inflammatory markers. A COVID-19 screening was negative. Excisional biopsy of a cervical node revealed extensive cortical necrosis and apoptotic debris with scattered histiocytes and plasmacytoid dendritic cells in absence of neutrophils or a monoclonal B cell or T cell population. Treatment was initiated with NSAIDs and close monitoring. The patient exhibited a complete response after two months. Our case is an important reminder that lymphadenopathy, fever, and night sweats in a young adult are not pathognomonic for lymphoma. Nonetheless, a high suspicion for lymphoma should be maintained and followed with an expedited workup. Kikuchi-Fujimoto can certainly mimic Hodgkin lymphoma or other serious conditions like lupus erythematosus and tuberculosis. The diagnosis is largely one of exclusion following a careful examination of a lymph node histopathology and must be considered in young previously healthy adults to avoid misdiagnosis and unnecessary escalation of treatment. Disclosures: No relevant conflicts of interest to declare.

The new normal for breast cancer surgery during COVID-19 pandemic: An international survey conducted by SENATURK

Purpose: The COVID-19 pandemic has changed the way many health institutions approach their workload. Physicians managing patients with cancer now have to deal not only with the disease but also the restrictions and limitations imposed because of the global pandemic. We aimed to determine how surgical preferences in breast cancer management were affected globally using a questionnaire-based survey. Methods: Under the auspices of the Turkish Senology Society (SENATURK) we asked 122 surgeons from 27 countries to reply to a 26-question survey designed to measure the impact of COVID-19 on their surgical practice when treating patients with breast cancer. Results: The characteristics of participant surgeons were statistically similar when comparing the participants' answers from Turkey and other countries. From the responses given to our questionnaire, it was understood that breast cancer surgery decreased by 25% (p<0.05) in institutions all over the world, including Turkey, but there was no change in the approach technique to the axilla. Conclusions: Globally breast surgeons have adapted to the new normal due to the COVID-19 pandemic. Many surgical approaches and some follow up protocols have been changed, although the degree of change has varied from country to country. In addition, the availability of multidisciplinary case conferences has been reduced in some centers which may affect the quality of services provided to patients.