Rates and Outcomes of Breast Lesions of Uncertain Malignant Potential (B3) benchmarked against the National Breast Screening Pathology Audit; Improving Performance in a High Volume Screening Unit.

INTRODUCTION: Our breast screening unit was identified as high outlier for B3 lesions with a low positive predictive value (PPV) compared to the England average. This prompted a detailed internal audit and review of B3 lesions and their outcomes to identify causes and address any variation in practice. PATIENTS AND METHODS: The B3 rate was calculated in 4168 breast core biopsies from 2019, using the subsequent excision to determine the PPV. Atypical intraductal epithelial proliferation (AIDEP) cases were subject to microscopic review to reassess the presence of atypia against published criteria. The B3 rate was re-audited in 2021, and the results compared. RESULTS: Screening cases had a high B3 rate of 12.4% (30% above the national average), and a PPV of 7.7% (9.7% with atypia). AIDEP was identified as a possible cause of this outlier status. On review and by consensus, AIDEP was confirmed in only 66% of cases reported as such, 17% were downgraded, and 16% did not reach consensus, the latter highlighting the difficulty and subjectivity in diagnosis of these lesions. Repeat audit of B3 rates after this extended review revealed a reduction from 12.4% to 9.11%, which is more in line with national standards. CONCLUSION: Benchmarking against national reporting standards is critical for service improvement. Through a supportive environment, team working, rigorous internal review and adherence to guidelines, interobserver variation and outlier status in breast pathology screening outliers can both be addressed. This study can serve as a model to other outlier units to identify and tackle underlying causes.

Cytomegalovirus proctitis mimicking rectal cancer in an immunocompetent elderly patient: a case report.

BACKGROUND: Cytomegalovirus infection is associated with significant morbidity and mortality in immunocompromised patients, but its impact on immunocompetent patients is still poorly understood. Furthermore, there is increasing evidence implying that chronic infection may contribute to a heightened cardiovascular risk. CASE PRESENTATION: We describe the case of incidental diagnosis of Cytomegalovirus proctitis in an immune-competent white British elderly gentleman, admitted following a stroke and investigated for rectal cancer following the development of bloody diarrhoea and persistent systemic inflammatory response. CONCLUSION: This raised some several interesting points; firstly that we must revise our approach to investigating the immunocompetent elderly patient, secondly, could chronic Cytomegalovirus infection have contributed to the presentation of stroke in this patient and lastly what are the existing evidence for treatment in this population? We use this opportunity to try and address some of these questions and feel that this would be of benefit to the wider audience.We discuss the risk factors for disease in immune-competent patients and also a brief overview of the benefits of treatment in this population.

Towards online, continuous monitoring for rheometry of complex fluids.

This paper presents an overview of the developments that have been made towards the design of an inline rheometer that has the capabilities for monitoring in real time the viscous constitutive parameters of non-Newtonian fluids in a pipe flow. This has potential applications for a wide range of fluids, including hydrocolloid solutions and polymer solutions. This is of relevance to many industries, for example the pharmaceutical, lubrication, food and printing industries. The use of mathematical algorithms for inferring rheological parameters from properties of flow field statistics is explored. Particular focus is given to the development of a flow cell rheometer containing a T-junction geometry with the capacity to induce a range of shear rates in the vicinity of the bend, and a distribution of elongational viscosities along the back-wall. Such features create an information-rich flow field that is beneficial for the development of a rheometer with a fast response time that is suitable for commercial purposes.

Intramural ectopic pregnancy: a case and review of the literature.

An intramural ectopic is a rare type of ectopic pregnancy in which the gestational sac is implanted within the myometrium, separate from the endometrial cavity and Fallopian tubes. There are only 53 cases in the published literature. We report a case of intramural ectopic pregnancy treated surgically and review the published data on this rare type of ectopic pregnancy, with respect to aetiology, diagnosis and management.

Adaptation of wavelet transform analysis to the investigation of biological variations in speech signals.

The purpose of this study was to adapt wavelet analysis as a tool for discriminating speech samples taken from healthy subjects across two biological states. Speech pressure waveforms were drawn from a study on effects of hormone fluctuations across the menstrual cycle on language functions. Speech samples from the vowel portion of the syllable 'pa', taken at the low- and high-hormone phases of the menstrual cycle, were extracted for analysis. Initial analysis applied Fourier transforms to examine the fundamental and formant frequencies. Wavelet analysis was used to investigate spectral differences at a more microbehavioural level. The key finding showed that wavelet coefficients for the fundamental frequency of speech samples taken from the high-hormone phase had larger amplitudes than those from the low-hormone phase. This study provided evidence for differences in speech across the menstrual cycle that affected the vowel portion of syllables. This evidence complements existing data on the temporal features of speech that characterise the consonant portion of syllables. Wavelet analysis provides a new tool for examination of behavioural differences in speech linked to hormonal variation.