ORCID Profile
0000-0002-1401-6674
Current Organisation
Sir Charles Gairdner Hospital
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Publisher: Wiley
Date: 07-2020
Publisher: Oxford University Press (OUP)
Date: 23-12-2021
DOI: 10.1093/BJS/ZNAA008
Abstract: Previous studies have suggested improved efficiency and patient outcomes with 125I seed compared with hookwire localization (HWL) in breast-conserving surgery, but high-level evidence of superior surgical outcomes is lacking. The aim of this multicentre pragmatic RCT was to compare re-excision and positive margin rates after localization using 125I seed or hookwire in women with non-palpable breast cancer. Between September 2013 and March 2018, women with non-palpable breast cancer eligible for breast-conserving surgery were assigned randomly to preoperative localization using 125I seeds or hookwires. Randomization was stratified by lesion type (pure ductal carcinoma in situ (DCIS) or other) and study site. Primary endpoints were rates of re-excision and margin positivity. Secondary endpoints were resection volumes and weights. A total of 690 women were randomized at eight sites 659 women remained after withdrawal (125I seed, 327 HWL, 332). Mean age was 60.3 years in the 125I seed group and 60.7 years in the HWL group, with no difference between the groups in preoperative lesion size (mean 13.2 mm). Lesions were pure DCIS in 25.9 per cent. The most common radiological lesion types were masses (46.9 per cent) and calcifications (28.2 per cent). The localization modality was ultrasonography in 65.5 per cent and mammography in 33.7 per cent. The re-excision rate after 125I seed localization was significantly lower than for HWL (13.9 versus 18.9 per cent respectively P = 0.019). There were no significant differences in positive margin rates, or in specimen weights and volumes. Re-excision rates after breast-conserving surgery were significantly lower after 125I seed localization compared with HWL. Registration number: ACTRN12613000655741 (www.ANZCTR.org.au/).
Publisher: Wiley
Date: 17-05-2023
DOI: 10.1002/JMRS.687
Abstract: Impalpable breast lesions generally require image‐guided localisation for breast‐conserving surgery. A standard technique is to place a hook wire (HW) within the lesion. Radioguided occult lesion localisation using iodine seeds (ROLLIS) involves inserting a 4.5 mm iodine‐125 seed (seed) into the lesion. We hypothesised that a seed could be more precisely positioned in relation to the lesion than a HW and that this may be associated with a lower re‐excision rate. Retrospective review of consecutive participant data from three ROLLIS RCT (ACTRN12613000655741) sites. Participants underwent preoperative lesion localisation (PLL) with seed or HW between September 2013 and December 2017. Lesion and procedural characteristics were recorded. Distances between (1) any part of the seed or thickened segment of the HW (‘TSHW’) and the lesion/clip (‘distance to device’ DTD) and (2) centre of the TSHW/seed and centre of the lesion/clip (device centre to target centre ‘DCTC’) were measured on immediate postinsertion mammograms. Pathological margin involvement and re‐excision rates were compared. A total of 390 lesions (190 ROLLIS and 200 HWL) were analysed. Lesion characteristics and guidance modality used were similar between groups. Ultrasound‐guided DTD and DCTC for seed were smaller than for HW (77.1% and 60.6%, respectively, P ‐value 0.001). Stereotactic‐guided DCTC for seeds was 41.6% smaller than for HW ( P ‐value = 0.001). No statistically significant difference in the re‐excision rates was found. Iodine‐125 seeds can be more precisely positioned for preoperative lesion localisation than HW, however, no statistically significant difference in re‐excision rates was detected.
Publisher: Wiley
Date: 08-05-2022
Abstract: Breast cancer surgery aims to excise lesions with clear margins and provide optimal cosmesis with a low re‐excision rates. These aims are aided by accurate lesion localisation and a surgical choice of incision site with minimal removal of healthy tissue. Problems associated with hookwires have led to adoption of non‐wire methods including radioguided occult lesion localisation using iodine‐125 (ROLLIS). This paper outlines the problems encountered and lessons learnt during the largest RCT involving 659 participants, conducted at eight sites (seven Australian, one New Zealand centres) between September 2013 and April 2018.* Data, along with substantive comments, regarding each ROLLIS procedure, documenting each step from the seed insertion, ease of operative retrieval, to return of the seed to medical physics, from a shared on‐line secure database and a separate site email survey, were synthesised and categorised. The Australian and New Zealand ROLLIS RCT experience highlights several important issues. Lessons learned were related to licencing the seed and tracking protocols. A Designated Team Lead, who is a good communicator, ensuring the Tracking Protocols were accurately followed and updated, subspecialty leads and a Co‐ordinator, responsible for training, logbook maintenance and seed ordering, enhanced the success and acceptance of the programme. Addressing radiation issues, fears, education of staff and seed loss was imperative. The Australian and New Zealand ROLLIS RCT experience highlights the need for adherence to local licencing laws and protocols, appointing a dedicated ROLLIS Designated Team Lead with good communication and a ROLLIS Co‐ordinator. These facilitate the adoption of a successful ROLLIS programme.
Publisher: Wiley
Date: 05-12-2022
Abstract: The aim of the study was to determine the rate of malignancy in breast incidentalomas found on 18‐Fluorodeoxyglucose Positron Emission Tomography‐Computed tomography (18 FDG PET‐CT) performed for non‐mammary causes and evaluate outcomes. A single‐centre, retrospective review of 5728 18‐FDG PET‐CT scans performed between January 1, 2017 and April 30, 2019 was undertaken. Cases with known primary breast cancer or metastases to the breast in the previous ten years were excluded. Diagnosis was confirmed with breast imaging, histology and 2‐year follow‐up. Data analysed included age, the pattern of uptake on 18‐FDG PET‐CT, lesion size and BIRADS score. Thirty‐two Breast incidentalomas were identified in 27/5728 scans (0.47%). 18 lesions (56.3%) were malignant. Five underwent curative surgery. Nine lesions (28.1%) were benign and five (15.6%) were false positive. Breast incidentalomas are uncommon on 18‐FDG PET‐CT but require work‐up for malignancy. BIRADS score has a high sensitivity and specificity for malignancy in18‐FDG PET‐CT incidentalomas but age, size of the lesion and the pattern of uptake on 18‐FDG PET‐CT were not useful in differentiating benign from malignant incidentalomas.
Location: Australia
No related grants have been discovered for Anita Bourke.