Amit Agrawal

Amit Agrawal
Cambridge University Hospitals NHS Foundation Trust · Addenbrooke's Hospital

MBBS, MS, FRCSEd, DM (Research), FRCS

About

115
Publications
11,777
Reads
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1,495
Citations
Introduction
Amit Agrawal currently works at the Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust.
Additional affiliations
March 2017 - present
Oxford OncoPlastic Surgery Course, Oxford
Position
  • Faculty Member
September 2016 - April 2020
University of Cambridge
Position
  • Managing Director
Description
  • Cambridge Chest wall perforator flap & Implant reconstruction Course
December 2015 - April 2020
University of East Anglia
Position
  • Faculty & Examiner
Description
  • MSc & MS Oncoplastic Surgery
Education
March 2004 - September 2006
University of Nottingham
Field of study
  • Mechanisms of Cell Signalling & Development of Resistance to Endocrine Therapy in Breast Cancer: Fulvestrant

Publications

Publications (115)
Article
Background: Increasingly, breast surgery is same day or 23-hour day-case surgery. Discharge criteria need to ensure patient safety outside hospital. We explore some of the evolving day-case factors in oncoplastic breast surgery (OBS). Materials and methods: Available data of BMI and drain usage of an OBS practice (Nov 2014-Oct 2019) were reviewe...
Article
FULL TEXT LINK Available 08 April 2021 ( https://authors.elsevier.com/a/1cbqR15X3%7ESyj%7E ) ABSTRACT - The impact of MRI on improving surgical outcomes in DCIS is debated. Here, we explore the utility of MRI in the investigation and management of DCIS in three key areas. Firstly, we highlight that MRI is likely to be a more accurate predictor of...
Article
Background: Neo-adjuvant chemotherapy (NACT) may downsize tumour enabling breast-conserving surgery (BCS), with success rates dependent on tumour biology. We ascertain whether in-breast response correlated with nodal response in pre-NACT node positive disease. Material and Methods: NACT-treated patients over 5-years (August 2013–2018) were identifi...
Article
Background: The indication for Neo-adjuvant chemotherapy (NACT) has expanded from down-staging of locally advanced tumours to routine management of T2 node positive tumours. We ascertain whether in-breast response correlated with nodal response at axillary node clearance (ANC) in ER+ve HER2-ve proven node positive disease. Materials and Methods: Pa...
Article
Background Pre‐operative breast tumour radial dimensions often determine the choice between simple wide local excision (WLE) and oncoplastic breast surgery (OBS). We reviewed the three‐dimensional interplay between tumour and surgical specimen dimensions in the two cohorts. Methods Demographic, tumour and treatment data were collected for all pati...
Article
Introduction Definition of the tumour bed (TB) is currently guided by intra-operatively placed metal clips. However, this traditional planning method may not be sufficient for tumour cavity defect re-filled with modern Oncoplastic Breast Surgery (OBS). In this study, we explore the impact of a close cooperation between surgeon and oncologist on the...
Article
Implant-based breast reconstruction (IBR) is the most common reconstructive procedure after mastectomy .Over the last decade, the introduction of Acellular Dermal Matrices (ADMs)/synthetic meshes has driven a change in practice from total submuscular implants to sub-pectoral implants. In the last 5 years, pre-pectoral approach to IBR with complete...
Article
Background: Therapeutic mammaplasty (TM) may be an alternative to mastectomy, but few well designed studies have evaluated the success of this approach or compared the short-term outcomes of TM with mastectomy with or without immediate breast reconstruction (IBR). Data from the national iBRA-2 and TeaM studies were combined to compare the safety a...
Article
Introduction Therapeutic mammaplasty is a well-established advanced oncoplastic technique for larger tumors in large breasts. However, the larger the breasts are, the greater is the lower outer parenchymal displacement due to weight resulting in relative emptiness in the medial/cleavage part. Therefore, the default practice of excising the medial...
Article
Full-text available
Background: Recommendations for mastectomy by multidisciplinary teams (MDTs) may contribute to variation in mastectomy rates. The primary aim of this multicentre prospective observational study was to describe current practice in MDT decision-making for recommending mastectomy. A secondary aim was to determine factors contributing to variation in...
Article
Multifocal multicentric breast cancer has traditionally been considered a contraindication to breast conserving surgery because of concerns regarding locoregional control and risk of disease recurrence. However, the evidence supporting this practice is limited. Increasingly, many breast surgeons are advocating breast conservation in selected cases....
Article
Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on...
Article
The aim of this paper is to discuss and understand the interplay of surgical and radiotherapy (RT) techniques that potentially affect the aesthetic outcomes following breast conservation treatment. It reviews the reported cosmetic outcomes within the practice‐changing RT trials incorporating varied fractionation regimes as well as sequence (before,...
Article
Introduction Oncoplastic breast surgery (OBS) can be applied in larger tumours or high tumour to breast ratios without compromising oncological safety. Inherent larger excisions may increase the probability of clear margins. We compare post-operative outcomes between simple wide local excision (WLE) and OBS assuming 3 different margin distances. Me...
Conference Paper
Full-text available
Background: The UK National Breast Reconstruction Audit (NMBRA, 2011) and other published data address complications following immediate breast reconstruction (IBR) typically up to 3months. Rates of IBR are increasing especially amongst women with poor prognostic tumours, for whom risk of recurrence is high in the first 24 months. Women should be m...
Conference Paper
Introduction: Lateral chest wall perforator flap (CWPF) provides a non-muscle parenchymal replacement option for partial breast reconstruction following breast conservation surgery (BCS) in high tumour:breast ratio excisions. Since this is the latest oncoplastic procedure in the armamentarium of breast-conserving surgery options, there is not yet a...
Conference Paper
Introduction: Risk assessment for breast reconstruction commencing at the diagnostic clinic regardless of subsequent reconstructive pathway/ type can be under or overestimated subjectively. We performed retrospective objective risk assessment using previously published chart and present post-operative outcomes up to 3 months (consistent with NMBRA...
Conference Paper
Aims: The pre-operative tumour radial dimensions often determine the choice between standard wide local excision (WLE) and oncoplastic breast surgery (OBS). We reviewed the 3-dimensional interplay between the two cohorts. Methods: Single oncoplastic surgeon data for 70 randomly selected WLE or OBS procedures were statistically compared using the Me...
Conference Paper
Full-text available
Background: Recently published preclinical findings provide new insights into the functional 'cross-talk' between the oestrogen receptor (ER) and progesterone receptor (PR) in breast cancer (Mo-hammed et al., Nature, 2015). The addition of a PR-agonist to anti-oestrogens directly modifies ERa chromatin binding and transcrip-tional response in breas...
Article
Due to their clinical advantages, synthetic mono-filament sutures are dominantly used for postoperative wound closures. We present two patients who suffered rare skin reactions to either poliglecaprone 25 or glyconate sutures, following breast cancer lumpectomy. This report aims to make perioperative practitioners and clinicians aware of reactions...
Article
Background: Reconstructive breast surgery has continued to evolve over the last decade with a key change being the adoption of acellular dermal matrices (ADMs) as an adjunct for implant-based procedures. This retrospective observational study assesses the effect of ADMs on post-mastectomy reconstructive practice performed in a single institution....
Article
Aims: To assess the feasibility of undertaking microbubble-guided vacuum-assisted biopsy (VAB) of the sentinel lymph node (SLN) and determine its sensitivity in detecting metastases. Patient experience and the impact of VAB on subsequent axillary surgery were also evaluated. Materials and methods: Patients with a normal axillary ultrasound or be...
Article
AIMS: To assess the feasibility of undertaking microbubble-guided vacuum-assisted biopsy (VAB) of the sentinel lymph node (SLN) and determine its sensitivity in detecting metastases. Patient experience and the impact of VAB on subsequent axillary surgery were also evaluated. MATERIALS AND METHODS: Patients with a normal axillary ultrasound or benig...
Article
Full-text available
Assessment for oncoplastic and reconstructive breast surgery (ORBS) can be time-consuming and subjective with a prolonged learning curve. Further, lack of recognition of options may lead to loss of patient choices whether available locally or not. This article reviews and incorporates essential variables into an author-designed chart with component...
Conference Paper
Introduction: Neo-adjuvant chemotherapy (NACT) may downsize tumour enabling breast-conserving surgery (BCS) dependent however on tumour biology. We present our experience of NACT. Methods: NACT-treated patients over 2-years (March 2013 e February 2015) were identified from a prospective database, and information extracted from electronic medical r...
Conference Paper
Full-text available
Introduction: Currently, there is no validated PROMS instrument for partial breast reconstruction with chest wall perforator flap (CWPF), which spares the latissimus dorsi (LD) muscle. CWPF expands options for breast conserving therapy (BCT ) in high tumour: breast ratio. Methods: The Breast-Q™ provides a Q-score that ranges between 0-100, with 100...
Article
Full-text available
We report the first study of the biological effect of fulvestrant on ER positive clinical breast cancer using sequential biopsies through to progression. Thirty-two locally/systemically-advanced breast cancers treated with first-line fulvestrant (250mg/month) were biopsied at therapy initiation, 6 weeks, 6 months and progression and immunohistochem...
Article
Full-text available
Introduction: The practice of breast surgery in the UK has evolved considerably in recent years, with fewer breast surgeons offering general surgery (GS) on-call. Our aim was to evaluate the degree of breast specialisation and GS on-call required by NHS employers. This was compared with current commitments and future aspirations of surgeons and tra...
Article
We present clinical outcomes after SSM in operable breast cancer especially in light of increased diagnoses of in situ disease after screening and increased usage of adjuvant aromatase inhibitors (AIs) in recent years. Case records of 81 patients who had SSM for cancer over 4 years (April 2006-July 2010) were reviewed. Eighty-one patients (median a...
Article
e11567 Background: Serum CA15.3 (assay for MUC1 mucin, a membrane glycoprotein of breast ductal epithelium) is elevated in 50-70% of patients with metastatic disease. Transient initial rise (i.e., spike) of CA15.3 due to partial agonistic or cytotoxic effects of tamoxifen and chemotherapy is known. We report differential expression of spike in ER+...
Article
Full-text available
Lobular carcinoma in accessory breast tissue is a rare occurrence. We present such a case in a 61-year-old woman. A skin nodule in the axillary skin on excision biopsy revealed invasive lobular carcinoma. Carcinoma in accessory breast tissue is uncommon especially invasive lobular type. A high index of suspicion may avoid late diagnosis.
Article
AIMS: Skin Sparing Mastectomy (SSM) is widely practised now in major centres which manage large numbers of breast cancer but anxiety still exists over the safety of SSM both from oncological and aesthetic points of view. We aim to review literature to date in SSM and summarise and discuss the current evidence. METHODS: Studies were identified by an...
Article
Full-text available
It has been shown in in-vitro experiments that "withdrawal" of tamoxifen inhibits growth of tumor cells. However, evidence is scarce when this is extrapolated into clinical context. We report our experience to verify the clinical relevance of "withdrawal therapy". Breast cancer patients since 1998 who fulfilled the following criteria were selected...
Article
Full-text available
We report the case of a 41-year-old man with a known right inguinal hernia presenting with groin pain following a fall while dog walking. Operative findings showed a small bowel perforation affecting the loop of bowel in the hernial sac. Bowel perforations caused by blunt abdominal injury in patients with an inguinal hernia is a rare and not well r...
Article
Trials have shown superiority of aromatase inhibitors (AIs) over tamoxifen for post-menopausal oestrogen receptor-positive advanced breast cancer (ER+ABC). We previously reported the use of goserelin plus anastrozole (G+A) as second-line endocrine therapy for pre-menopausal ER+ABC. We report clinical and endocrine data from G+A as first-line system...
Article
Full-text available
Adenosquamous carcinoma of the breast is a rare form of metaplastic breast carcinoma. We report such a case in a 19 years old female. Case notes and histopathology were reviewed. Adenosquamous carcinoma was diagnosed on wide local excision and patient underwent skin-sparing mastectomy with Latissimus dorsi flap reconstruction. Adenosquamous carcino...
Article
Estrogen receptor (ER)-positive acquired tamoxifen-resistant (TAM-R) MCF-7 breast cancer cell lines exhibit epidermal growth factor receptor (EGFR) expression/signaling and are growth-inhibited by gefitinib (IRESSA). We examined the effect of gefitinib on ER-positive TAM-R and ER-negative hormone-insensitive breast cancer in a Phase II study. Fifty...
Article
Full-text available
Estrogen receptor (ER)-positive acquired tamoxifen-resistant (TAM-R) MCF-7 breast cancer cell lines exhibit epidermal growth factor receptor (EGFR) expression/signaling and are growth-inhibited by gefitinib (IRESSA). We examined the effect of gefitinib on ER-positive TAM-R and ER-negative hormone-insensitive breast cancer in a Phase II study. Fifty...
Article
Full-text available
Tamoxifen has a protective effect on bone metabolism in breast cancer; aromatase inhibitors deleterious and that of fulvestrant is unknown. Fourteen locally advanced breast cancers with clinical benefit on fulvestrant (250 mg/month) as first-line primary endocrine therapy had sequential serum bone-specific alkaline phosphatase (BAP), N-terminal pro...
Article
e20622 Background: Aromatase inhibitors (AIs) have been shown to be superior to tamoxifen in several settings. However, it is unclear whether this superiority extends to its use as primary endocrine therapy in elderly patients with early operable primary breast cancer. Biological characteristics of the tumours may aid in selecting the most suitable...
Article
Aromatase inhibitors have been shown to be superior to Tamoxifen in several settings. It is unclear whether this superiority extends to their use as primary endocrine therapy in elderly patients with early operable primary breast cancer. Biological characteristics of the tumours may aid in selecting the most suitable agent. Primary endocrine therap...