Publications (25) View all
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Article: The efficacy of ultrasound, stereotactic and clinical core biopsies in the diagnosis of breast cancer, with an analysis of false negative cases
Irish Journal of Medical Science 04/2012; 174:32-33. · 0.58 Impact Factor -
Article: Oesophageal carcinoma in a married couple following long-term exposure to dry cleaning agents.
Occupational and environmental medicine 12/2011; 69(7):525. · 3.64 Impact Factor -
Article: Factors Affecting Successful Breast Conservation for Ductal Carcinoma in Situ
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ABSTRACT: BackgroundSuccessful breast-conserving therapy in DCIS is restricted by high rates of residual disease resulting in the need for radiotherapy and/or re-excision. This study identifies patients with DCIS who are most at risk of compromised margins and of residual disease. MethodsAll patients undergoing breast-conserving surgery for DCIS over a 6-year period were included. Method of diagnosis, mammographic size, pathological size, DCIS-margin distance and residual disease on re-excision were analysed. ResultsOne hundred and thirty-five patients underwent initial breast-conserving surgery for DCIS. The compromised margin rate was 72%, and the rate of residual disease on re-operation was 54%. On univariate analysis, underestimation of pathological size by mammography by >1cm occurred in 40% of those with compromised margins undergoing a therapeutic operation compared to only 14% of those with clear margins (P=0.02). However, on multivariate analysis only pathological size (P<0.0001, OR=1.0,95% CI 1.037–1.128) and lack of a preoperative diagnosis by core biopsy (P<0.0001, OR=5.3,95% CI 1.859–15.08) were predictive of compromised margins. The presence of residual disease on re-excision was associated with increasing pathological size (P<0.0001, OR=1.085,95% CI 1.038–1.134) and decreasing DCIS-margin distance (P=0.03, OR=6.694,95% CI 1.84–37.855). Twenty-nine percent (n=13/45) of lesions ≤3cm compared to 84% (n=27/32) of lesions >3cm had residual disease on re-operation (P<0.0001). Residual disease was present in 62% (n=34/55), 64% (n=7/11) and 17% (n=2/12) of patients with DCIS-margin distances ≤1, 1–2 and 2–5mm, respectively. ConclusionConsiderable underestimation of DCIS extent by mammography occurs in a high proportion of patients with compromised margins in breast conservation. Patients at particularly high risk of residual disease on re-excision are those with lesions >3cm and those with DCIS-margin distances of ≤2mm.Annals of Surgical Oncology 04/2012; 14(5):1618-1628. · 4.17 Impact Factor -
Article: Acid suppression increases rates of Barrett's esophagus and esophageal injury in the presence of duodenal reflux.
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ABSTRACT: The contribution of gastric acid to the toxicity of alkaline duodenal refluxate on the esophageal mucosa is unclear. This study compared the effect of duodenal refluxate when acid was present, decreased by proton pump inhibitors (PPI), or absent. We randomized 136 Sprague-Dawley rats into 4 groups: group 1 (n = 33) were controls; group 2 (n = 34) underwent esophagoduodenostomy promoting "combined reflux"; group 3 (n = 34) underwent esophagoduodenostomy and PPI treatment to decrease acid reflux; and group 4, the 'gastrectomy' group (n = 35) underwent esophagoduodenostomy and total gastrectomy to eliminate acid in the refluxate. Esophaguses were examined for inflammatory, Barrett's, and other histologic changes, and expression of proliferative markers Ki-67, proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR). In all reflux groups, the incidence of Barrett's mucosa was greater when acid was suppressed (group C, 62%; group D, 71%) than when not suppressed (group B, 27%; P = 0.004 and P < .001). Erosions were more frequent in the PPI and gastrectomy groups than in the combined reflux group. Edema (wet weight) and ulceration was more frequent in the gastrectomy than in the combined reflux group. Acute inflammatory changes were infrequent in the PPI group (8%) compared with the combined reflux (94%) or gastrectomy (100%) groups, but chronic inflammation persisted in 100% of the PPI group. EGFR levels were greater in the PPI compared with the combined reflux group (P = .04). Ki-67, PCNA, and combined marker scores were greater in the gastrectomy compared with the combined reflux group (P = .006, P = .14, and P < .001). Gastric acid suppression in the presence of duodenal refluxate caused increased rates of inflammatory changes, intestinal metaplasia, and molecular proliferative activity. PPIs suppressed acute inflammatory changes only, whereas chronic inflammatory changes persisted.Surgery 03/2012; 151(3):382-90. · 3.10 Impact Factor -
Article: The Extent of Axillary Lymph Node Clearance Required Following Detection of Sentinel Node Micrometastases.
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ABSTRACT: Sentinel node (SN) micrometastases are an indication to proceed to axillary clearance. The aim of this study is to determine the extent and level of axillary clearance required for patients with SN micrometastases. All patients with SN micrometastases which were followed by axillary clearances from 1999 to 2007 were identified. Slides were reviewed by a histopathologist to detail characteristics of SN micrometastases including size and site. The SN micrometastases and primary tumor characteristics were correlated with the presence and level of non-SN micrometastases. Fifty patients who had micrometastases followed by axillary clearances were identified. Of those 18% (n = 9) had non-SN metastases. Seven patients had metastases to level I, one patient had metastases to level I and III and one patient had non-SN metastases to level III only. No patient had metastases to level II. Patients with non-SN metastases had very limited number of non-SNs involved (maximum 2 non-SNs). No variable, including site of the micrometastasis, was predictive of non-SN metastases. In patients with SN micrometastases, a limited level I axillary clearance can be justified in view of the low number of additional nodes involved and in particular, the low (4%) rate of spread to level II/III nodes.The Breast Journal 07/2010; · 1.64 Impact Factor
