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Mr Iain Macleod Miss Amanda Taylor Mr Kian Chin

Pre-operative Assessment in Day Case Breast Cancer Surgery: Can We Safely avoid Cancer Staging with CXR?. Mr Iain Macleod Miss Amanda Taylor Mr Kian Chin. Plan. Background Problems Methods Results Discussion Recommendations. Background.

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Mr Iain Macleod Miss Amanda Taylor Mr Kian Chin

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  1. Pre-operative Assessment in Day Case Breast Cancer Surgery: Can We Safely avoid Cancer Staging with CXR? Mr Iain Macleod Miss Amanda Taylor Mr Kian Chin

  2. Plan • Background • Problems • Methods • Results • Discussion • Recommendations

  3. Background • Breast cancer is the most common cancer in the United Kingdom • Increasingly treated with day case procedures1 • Traditionally patients staged with CXR prior to operation, usually requiring o/p appt at radiology • Successful day-case surgery depends upon efficient pre-operative assessment2 • Implementation of a short-stay programme after breast cancer surgery. Br J Surg. 2010 Feb;97(2):189-94. • NHS Institute for Innovation and Improvement 2008

  4. Problems • No current national guidance – BASO guidelines recommened develop local protocol1 • CXR low yield • Metastases not always in lungs • Logistically taxing • Surgical guidelines for the management of breast cancer, Association of Breast Surgery at BASO 2009, Eur J Surg Oncol (2009)

  5. Methods • Retrospective analysis of all cases March ‘07 – June ’09 at Milton Keynes General Hospital • Inclusion • Histological evidence of breast cancer available • Surgery in MKGH • Exclusion • Unavailable radiographic history • Radiography not done for staging purposes, including high-risk disease

  6. Methods cont’d • Almost 200 cases identified • 48 excluded for above reasons • 149 patients included • Radiography scrutinised for evidence of metastases at pre-op stage and now • Selected case histories reviewed

  7. Results 149 pts Yes No CXR ? 140 pts (94%) 9 pts (6%) Normal? No Yes 136 pts (97%) 4 pts (3%) Yes Evidence of mets? Yes Yes 4 pts (3%) 1 pts (25%) 0 pts (0%) Did not manifest until >1yr post-op

  8. Results

  9. Discussion • Our results suggest little is gained from staging CXR • Eliminating this step will: • Streamline day-case surgery process • Save time, money (greater than £1.2m nationally each year) • Free up resources • Reduce anxiety for patients • Reduce iatrogenic harm to patients (up to 0.6% de novo cancers from imaging)1 • Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 2004; 363: 345–51

  10. Recommendation • Local protocols for the management of breast cancer should not include staging chest radiography pre-operatively unless there are compelling clinical indications.

  11. Questions?

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