Wireless localisation of breast lesions with MagSeed. A radiological perspective of 300 cases.

OBJECTIVES: The purpose of this article is to review the technical and radiological aspects of MagSeed® localisation, to assess its accuracy based on post-localisation mammograms and excision specimen X-rays and to discuss the radiological experience of our institutions. METHODS: Two-year data were collected retrospectively from three NHS boards from the West of Scotland. A total of 309 MagSeeds® were inserted under mammographic or ultrasonographic guidance in 300 women with unifocal, multifocal and/or bilateral breast lesions at the day of surgery or up to 30 days prior to it. Radiological review of post-localisation mammograms and intraoperative specimen X-rays as well as a review of the surgical outcomes were performed to assess the accuracy and efficacy of the method. Our experience relating to the technique's strengths and downsides were also noted. RESULTS: The MagSeeds® were inserted on average 7.2 days before surgery. The localisation technique was straight forward for the radiologists. In 99% of the cases, the MagSeed® was successfully deployed and 100% of the successfully localised lesions were excised at surgery. There was no difference in the accuracy of the localisation whether this was mammographically or ultrasonographically guided. On post-localisation mammograms, the MagSeed® was radiologically accurately positioned in 97.3% of the cases. No delayed MagSeed® migration was observed. On the specimen X-rays, the lesion was centrally positioned in 45.1%, eccentric within more than 1 mm from the margin in 35.7% and in 14.8% it was at the specimen's margin. The re-excision rate was 18.3%. CONCLUSION: The MagSeed® is an accurate and reliable localisation method in breast conserving surgery with good surgical outcomes. ADVANCES IN KNOWLEDGE: To our knowledge, the radiological aspects of MagSeed® localisation have not been widely described in peer-reviewed journals thus far.

Extreme Oncoplasty: Breast Conservation in Patients with Large, Multifocal, and Multicentric Breast Cancer.

INTRODUCTION: Extreme Oncoplastic Breast Conservation Surgery (EOBCS) is offered in selected patients with multifocal or multicentric breast cancer (MFMC). Recent evidence has suggested that EOBCS may be a valuable resource for patients with MFMC who may avoid the risk associated with mastectomy in favour of the benefits of breast conservation without risking their oncological outcomes. Our study examined the practice of EOBCS in two regional breast units in Glasgow, United Kingdom. MATERIALS AND METHODS: A prospectively collected database of 50 patients treated with EOBC in two breast units in Glasgow between 2007 and 2018 were evaluated, and clinical outcomes were observed. RESULTS: Fifty patients (median age 55) underwent EOBCS, of which 43 (86%) had invasive disease. Median tumour size was 55mm (50-90) and multifocal disease was identified in 22 (44%) patients. Nine patients (18%) were found to have positive margins and underwent a second procedure, with 6 (12%) proceeding to mastectomy. Five-year disease free survival rate was 91.5%, while cancer-specific survival was 95.7%. CONCLUSION: EOBCS is oncologically safe in short-term follow-up. Large scale studies are required to confirm these preliminary results, in order to offer EOBCS as a valid option to patients with advanced or multifocal breast cancer.

Guess the weight: the accuracy of estimated weight for surgical admissions - a comparison study.

BACKGROUND AND AIMS: An accurate body weight is vital for safe dosing of many drugs. Weight is often unavailable for emergency admissions and an estimation is used. Emergency Department staff are poor at estimating patient weight, but no data existed for surgical admissions. This study assesses the reliability of weight estimation by patients and healthcare workers. METHODS AND RESULTS: All emergency surgical patients admitted during one week were approached. If consented, four healthcare workers (consultant, foundation doctor, nurse, support worker) independently estimated their weight. The patients then gave their estimate. Actual weight was measured and data analysed. Seventy-two consecutive surgical admissions were included, aged 16-95 and 52% male. Healthcare workers correctly (within ±10% margin) estimated the weight for only 57% of patients. Further statistical analysis confirmed that staff are inaccurate estimators and patients are better at estimating their own weight (p < 0.006). CONCLUSIONS: Staff are poor at estimating weight and the study was unable to show statistical superiority of any professional group when guessing weights. There was also a tendency for staff to increasingly under-estimate as weight increases. Patients are the most accurate estimators, but self-reporting is still too unreliable for drug dosing and should stop.