Imperial College London

Mr Daniel Richard Leff

Faculty of MedicineDepartment of Surgery & Cancer

Reader in Breast Surgery
 
 
 
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Contact

 

d.leff Website

 
 
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Location

 

016Paterson WingSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

215 results found

Che Bakri NA, Kwasnicki RM, Dhillon K, Khan N, Ghandour O, Cairns A, Darzi A, Leff DRet al., 2021, ASO visual abstract: objective assessment of postoperative morbidity following breast cancer treatments with wearable activity monitors: The "BRACELET" study., Annals of Surgical Oncology, ISSN: 1068-9265

Journal article

Kedrzycki MS, Leiloglou M, Chalau V, Chiarini N, Thiruchelvam PTR, Hadjiminas DJ, Hogben KR, Rashid F, Ramakrishnan R, Darzi AW, Elson DS, Leff DRet al., 2021, ASO visual abstract: the impact of temporal variation in indocyanine green administration on tumor identification during fluorescence-guided breast surgery, Annals of Surgical Oncology, ISSN: 1068-9265

Journal article

Che Bakri NA, Kwasnicki RM, Dhillon K, Khan N, Ghandour O, Cairns A, Darzi A, Leff DRet al., 2021, ASO author reflections: Improving management of upper limb complications after breast cancer treatments, Annals of Surgical Oncology, ISSN: 1068-9265

Journal article

Vidya R, Leff DR, Green M, McIntosh SA, St John E, Kirwan CC, Romics L, Cutress RI, Potter S, Carmichael A, Subramanian A, O'Connell R, Fairbrother P, Fenlon D, Benson J, Holcombe Cet al., 2021, Innovations for the future of breast surgery., Br J Surg, Vol: 108, Pages: 908-916

BACKGROUND: Future innovations in science and technology with an impact on multimodal breast cancer management from a surgical perspective are discussed in this narrative review. The work was undertaken in response to the Commission on the Future of Surgery project initiated by the Royal College of Surgeons of England. METHODS: Expert opinion was sought around themes of surgical de-escalation, reduction in treatment morbidities, and improving the accuracy of breast-conserving surgery in terms of margin status. There was emphasis on how the primacy of surgical excision in an era of oncoplastic and reconstructive surgery is increasingly being challenged, with more effective systemic therapies that target residual disease burden, and permit response-adapted approaches to both breast and axillary surgery. RESULTS: Technologies for intraoperative margin assessment can potentially half re-excision rates after breast-conserving surgery, and sentinel lymph node biopsy will become a therapeutic procedure for many patients with node-positive disease treated either with surgery or chemotherapy as the primary modality. Genomic profiling of tumours can aid in the selection of patients for neoadjuvant and adjuvant therapies as well as prevention strategies. Molecular subtypes are predictive of response to induction therapies and reductive approaches to surgery in the breast or axilla. CONCLUSION: Treatments are increasingly being tailored and based on improved understanding of tumour biology and relevant biomarkers to determine absolute benefit and permit delivery of cost-effective healthcare. Patient involvement is crucial for breast cancer studies to ensure relevance and outcome measures that are objective, meaningful, and patient-centred.

Journal article

Leiloglou M, Kedrzycki MS, Elson DS, Leff DRet al., 2021, ASO author reflections: towards fluorescence guided tumor identification for precision breast conserving surgery., Annals of Surgical Oncology, ISSN: 1068-9265

Journal article

Kedrzycki MS, Leiloglou M, Chalau V, Chiarini N, Thiruchelvam PTR, Hadjiminas DJ, Hogben KR, Rashid F, Ramakrishnan R, Darzi AW, Elson DS, Leff DRet al., 2021, The impact of temporal variation in indocyanine green administration on tumor identification during fluorescence guided breast surgery., Annals of Surgical Oncology, ISSN: 1068-9265

BACKGROUND: On average, 21% of women in the USA treated with Breast Conserving Surgery (BCS) undergo a second operation because of close positive margins. Tumor identification with fluorescence imaging could improve positive margin rates through demarcating location, size, and invasiveness of tumors. We investigated the technique's diagnostic accuracy in detecting tumors during BCS using intravenous indocyanine green (ICG) and a custom-built fluorescence camera system. METHODS: In this single-center prospective clinical study, 40 recruited BCS patients were sub-categorized into two cohorts. In the first 'enhanced permeability and retention' (EPR) cohort, 0.25 mg/kg ICG was injected ~ 25 min prior to tumor excision, and in the second 'angiography' cohort, ~ 5 min prior to tumor excision. Subsequently, an in-house imaging system was used to image the tumor in situ prior to resection, ex vivo following resection, the resection bed, and during grossing in the histopathology laboratory to compare the technique's diagnostic accuracy between the cohorts. RESULTS: The two cohorts were matched in patient and tumor characteristics. The majority of patients had invasive ductal carcinoma with concomitant ductal carcinoma in situ. Tumor-to-background ratio (TBR) in the angiography cohort was superior to the EPR cohort (TBR = 3.18 ± 1.74 vs 2.10 ± 0.92 respectively, p = 0.023). Tumor detection reached sensitivity and specificity scores of 0.82 and 0.93 for the angiography cohort and 0.66 and 0.90 for the EPR cohort, respectively (p = 0.1051 and p = 0.9099). DISCUSSION: ICG administration timing during the angiography phase compared with the EPR phase improved TBR and diagnostic accuracy. Future work will focus on image pattern analysis and adaptation of the camera system to targeting fluorophores specific to breast cancer.

Journal article

Che Bakri NA, Kwasnicki R, Dhillon K, Ghandour O, Khan N, Cairns A, Darzi A, Leff Det al., 2021, Objective assessment of post-operative morbidity following breast cancer treatments with wearable activity monitors, Annals of Surgical Oncology, ISSN: 1068-9265

BackgroundCurrent validated tools to measure upper limb dysfunction after breast cancer treatment, such as questionnaires, are prone to recall bias and do not enable comparisons between patients. This study aimed to test the feasibility of wearable activity monitors (WAMs) for achieving a continuous, objective assessment of functional recovery by measuring peri-operative physical activity (PA).MethodsA prospective, single-center, non-randomized, observational study was conducted. Patients undergoing breast and axillary surgery were invited to wear WAMs on both wrists in the peri-operative period and then complete upper limb function (DASH) and quality-of-life (EQ-5D-5L) questionnaires. Statistical analyses were performed to determine the construct validity and concurrent validity of WAMs.ResultsThe analysis included 39 patients with a mean age of 55 ± 13.2 years. Regain of function on the surgically treated side was observed to be an increase of arm activity as a percentage of preoperative levels, with the greatest increase observed between the postoperative days 1 and 2. The PA was significantly greater on the side not treated by surgery than on the surgically treated side after week 1 (mean PA, 75.8% vs. 62.3%; p < 0.0005) and week 2 (mean PA, 91.6% vs. 77.4%; p < 0.005). Subgroup analyses showed differences in recovery trends between different surgical procedures. Concurrent validity was demonstrated by a significant negative moderate correlation between the PA and DASH questionnaires (R = −0.506; p < 0.05).ConclusionThis study demonstrated the feasibility and validity of WAMs to objectively measure postoperative recovery of upper limb function after breast surgery, providing a starting point for personalized rehabilitation through early detection of upper limb physical morbidity.

Journal article

Kedrzycki MS, Leiloglou M, Ashrafian H, Jiwa N, Thiruchelvam PTR, Elson DS, Leff DRet al., 2021, Meta-analysis comparing fluorescence imaging with radioisotope and blue dye-guided sentinel node identification for breast cancer surgery., Annals of Surgical Oncology, Vol: 28, Pages: 3738-3748, ISSN: 1068-9265

INTRODUCTION: Conventional methods for axillary sentinel lymph node biopsy (SLNB) are fraught with complications such as allergic reactions, skin tattooing, radiation, and limitations on infrastructure. A novel technique has been developed for lymphatic mapping utilizing fluorescence imaging. This meta-analysis aims to compare the gold standard blue dye and radioisotope (BD-RI) technique with fluorescence-guided SLNB using indocyanine green (ICG). METHODS: This study was registered with PROSPERO (CRD42019129224). The MEDLINE, EMBASE, Scopus, and Web of Science databases were searched using the Medical Subject Heading (MESH) terms 'Surgery' AND 'Lymph node' AND 'Near infrared fluorescence' AND 'Indocyanine green'. Studies containing raw data on the sentinel node identification rate in breast cancer surgery were included. A heterogeneity test (using Cochran's Q) determined the use of fixed- or random-effects models for pooled odds ratios (OR). RESULTS: Overall, 1748 studies were screened, of which 10 met the inclusion criteria for meta-analysis. ICG was equivalent to radioisotope (RI) at sentinel node identification (OR 2.58, 95% confidence interval [CI] 0.35-19.08, p < 0.05) but superior to blue dye (BD) (OR 9.07, 95% CI 6.73-12.23, p < 0.05). Furthermore, ICG was superior to the gold standard BD-RI technique (OR 4.22, 95% CI 2.17-8.20, p < 0.001). CONCLUSION: Fluorescence imaging for axillary sentinel node identification with ICG is equivalent to the single technique using RI, and superior to the dual technique (RI-BD) and single technique with BD. Hospitals using RI and/or BD could consider changing their practice to ICG given the comparable efficacy and improved safety profile, as well as the lesser burden on hospital infrastructure.

Journal article

Che Bakri NA, Kwasnicki R, Dhillon K, Ghandour O, Khan N, Cairns A, Darzi A, Leff Det al., 2021, Improving management of upper limb complications after breast cancer treatments, Annals of Surgical Oncology, ISSN: 1068-9265

Journal article

Dave RV, Kim B, Courtney A, O'Connell R, Rattay T, Taxiarchi VP, Kirkham JJ, Camacho EM, Fairbrother P, Sharma N, Cartlidge CWJ, Horgan K, McIntosh SA, Leff DR, Vidya R, Potter S, Holcombe C, Copson E, Coles CE, Cutress RI, Gandhi A, Kirwan CC, B-MaP-C study collaborativeet al., 2021, Publisher Correction: Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK 'Alert Level 4' phase of the B-MaP-C study., Br J Cancer

Journal article

Lee A, Kwasnicki R, Leff D, 2021, Outcomes and outcome measures reported in clinical studies of therapeutic mammaplasty: a systematic review protocol, BMJ Open, Vol: 11, ISSN: 2044-6055

ntroduction Therapeutic mammaplasty (TM) is an oncological procedure which combines tumour resection with breast reduction and mastopexy techniques. Previous systematic reviews have demonstrated oncological safety of TM, but poor and inconsistent reporting of quality-of-life, aesthetic and functional outcomes, often with non-validated measurement tools. Moreover, there is a paucity of patient-reported outcome measures. Standardisation of outcome reporting is required to enable study results to be compared and combined, for example, through core outcome set (COS) development. This systematic review aims to comprehensively describe the outcomes reported in clinical studies of TM, their respective outcome measures and the time points at which they were evaluated. The overall objective is to facilitate the development of a COS for TM.Methods and analysis A systematic review of clinical studies evaluating outcomes following TM will be completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following electronic databases have been searched from inception to 5 August 2020: Ovid MEDLINE, Embase, CINAHL and Web of Science. Primary outcomes will include the number of reported outcomes of various types (clinical, aesthetic, functional, quality-of-life and cost-effectiveness), whether these are patient-reported or clinician-reported, how outcomes are defined and the outcome measurement tool(s) used. The time point(s) at which outcomes were measured will be a secondary outcome. No studies will be excluded on the basis of methodological quality in order to generate a comprehensive list of reported outcomes and outcome measures; hence, risk of bias assessment is not required. The data will be described narratively. This protocol has been reported in line with PRISMA-Protocols.Ethics and dissemination This study does not involve human or animal participants, hence ethical approval is not required. The findings will be p

Journal article

Dave RV, Kim B, Courtney A, O'Connell R, Rattay T, Taxiarchi VP, Kirkham JJ, Camacho EM, Fairbrother P, Sharma N, Cartlidge CWJ, Horgan K, McIntosh SA, Leff DR, Vidya R, Potter S, Holcombe C, Copson E, Coles CE, Cutress RI, Gandhi A, Kirwan CC, B-MaP-C study collaborativeet al., 2021, Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK 'Alert Level 4' phase of the B-MaP-C study, British Journal of Cancer, Vol: 124, Pages: 1785-1794, ISSN: 0007-0920

BACKGROUND: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. METHODS: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated 'standard' or 'COVID-altered', in the preoperative, operative and post-operative setting. FINDINGS: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had 'COVID-altered' management. 'Bridging' endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2-9%) using 'NHS Predict'. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. CONCLUSIONS: The majority of 'COVID-altered' management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.

Journal article

Grant Y, Thiruchelvam P, Al-Mufti R, Hadjiminas D, Hogben K, Leff D, Grant Yet al., 2021, Staged unilateral versus immediate bilateral symmetrising mammoplasty: a sensitivity analysis of patient level costs, EJSO - European Journal of Surgical Oncology, ISSN: 0748-7983

Journal article

Leiloglou M, Chalau V, Kedrzycki MS, Thiruchelvam P, Darzi A, Leff DR, Elson DSet al., 2021, Tissue texture extraction in indocyanine green fluorescence imaging for breast-conserving surgery, Journal of Physics D: Applied Physics, Vol: 54, ISSN: 0022-3727

A two-camera fluorescence system for indocyanine green (ICG) signal detection has been developed and tested in a clinical feasibility trial of ten patients, with a resolution in the submillimetre scale. Immediately after systemic ICG injection, the two-camera system can detect ICG signals in vivo (~2.5 mg ${{\text{l}}^{ - 1}}$ or 3.2 × ${10^{ - 6}}{ }$ M). Qualitative assessment has shown that the fluorescence signal does not always correlate with the cancer location in the surgical scene. Conversely, fluorescence image texture metrics when used with the logistic regression model yields good accuracy scores in detecting cancer. We have demonstrated that intraoperative fluorescence imaging for resection guidance is a feasible solution to tackle the current challenge of positive resection margins in breast conserving surgery.

Journal article

Grant Y, Leff D, 2021, Staged unilateral versus immediate bilateral symmetrising mammoplasty: a sensitivity analysis of patient level costs, EJSO - European Journal of Surgical Oncology, Vol: 47, Pages: e286-e287, ISSN: 0748-7983

Introduction: The incidence of lactational mastitis ranges between 2 to 33% with an average incidence of 10%. It is highest in first few weeks and decreases gradually. Breast abscess occurs in 3-11% of cases of mastitis. The cause can be mainly attributed to maternal factors (nipple abnormalities, faulty feeding technique).Aims: Evaluation of nipple abnormality and counselling of pregnant women during pregnancy is likely to increase establishment of breastfeeding rate and reduction of lactational mastitis and abscess.Methodology: Intervention arm (group A,n=100 ): The pregnant ladies were counselled about correct technique of lactation. The nipple was examined to check if it can cause any hindrance to breastfeeding (Inverted, Flat, Very large, Very small). Control Arm (group B, n=92): The pregnant ladies (equally matched) with group A were included. The result was analysed using chi square test using SPSS software version24Result Analysis: In Gr A 90 out of 100 mothers could establish breast feeding. Out of 10, 2 developed mastitis. In Gr B 60 out of 92 established breastfeeding. Of the 32 remaining mothers, 18 developed mastitis. There was significant improvement in establishment of breast feeding amongst mothers who were counselled/examined during pregnancy (The chi-square statistic is 17.2204. The p-value is .000033). The incidence of lactational mastitis was significantly lower in GrA (The chi-square statistic is 4.0139. The p-value is .045128)Discussion: Predelivery counselling and evaluation of nipple abnormalities (and appropriate measures) improves establishment of lactation and reduction of lactational mastitis/ breast abscess.

Journal article

Jiwa N, Takats Z, Leff D, 2021, Breast health screening: a UK-wide questionnaire, BMJ Nutrition, Prevention & Health, Vol: 4, Pages: 1-7, ISSN: 2516-5542

Background Currently, there is an unmet clinical need in identifying and screening women at high risk of breast cancer, where tumours are often aggressive and treatment intervention is too late to prevent metastasis, recurrence and mortality. This has been brought into sharp focus by the SARS-CoV-2 global pandemic, constantly changing hospital policies and surgical guidelines in reducing access to established screening and treatment regimens. Nipple aspirate fluid (NAF), is thought to provide a unique window into the biological processes occurring within the breast, particularly in the context of a developing neoplasm. Evaluation of NAF in asymptomatic women, for novel chemical biomarkers of either early disease and/or cancer risk offers tremendous promise as a tool to facilitate early detection and to supplement screening. However, it is acceptability as a method of collection and screening by women is critical and yet unknown. A breast health questionnaire was disseminated to women through breast cancer charities, patient support groups and social media platforms, with the aim of collecting opinions on the acceptability of use of NAF as a potential screening tool.Method Following ethical approval a questionnaire was prepared using online surveys consisting of four parts: (a) introduction on breast health screening in the UK, (b) core demographic data, (c) questions regarding screening and the acceptability of using NAF and (d) opinions about the process of collecting and using nipple fluid for screening. The voluntary and anonymous questionnaire was disseminated through social media, professional networks, charity websites and by individuals between October 2019 and December 2020. Survey responses were collected electronically, and the data analysed using online surveys statistical tools.Results A total of 3178 women completed the questionnaire (65.9% Caucasian, 27.7% Asian/British Asian, 0.6% black and 5.0% other). Of these, 2650 women (83.4%) had no prior knowle

Journal article

Patel R, Rai A, Thornton-Wood F, Wilkinson A, Darzi A, Singh H, Leff DRet al., 2021, Neuroenhancement of future surgeons - Opinions from students, surgeons and patients, Brain Stimulation, Vol: 14, Pages: 616-618, ISSN: 1876-4754

Journal article

Jiwa N, Kedrzycki M, Kumar S, Gandhewar R, Chauhan H, Wright C, Takats Z, Ashrafian H, Leff DRet al., 2021, Diagnostic Accuracy of Nipple Discharge Fluid Cytology: A Meta-Analysis and Systematic Review of the Literature, Publisher: SPRINGER, Pages: S346-S347, ISSN: 1068-9265

Conference paper

Kedrzycki MS, Leiloglou M, Chalau V, Lin J, Thiruchelvam PTR, Elson DS, Leff DRet al., 2021, Guiding light to optimize wide local excisions: the "GLOW" study, Volume XXII 2021 Annual Meeting Scientific Session, Publisher: Springer, Pages: S199-S200, ISSN: 1068-9265

Conference paper

Berthet-Rayne P, Sadati S, Petrou G, Patel N, Giannarou S, Leff DR, Bergeles Cet al., 2021, MAMMOBOT: A Miniature Steerable Soft Growing Robot for Early Breast Cancer Detection, IEEE Robotics and Automation Letters, Pages: 1-1

Journal article

Dryden SD, Anastasova S, Satta G, Thompson AJ, Leff DR, Darzi Aet al., 2021, Rapid uropathogen identification using surface enhanced Raman spectroscopy active filters., Scientific Reports, Vol: 11, Pages: 1-10, ISSN: 2045-2322

Urinary tract infection is one of the most common bacterial infections leading to increased morbidity, mortality and societal costs. Current diagnostics exacerbate this problem due to an inability to provide timely pathogen identification. Surface enhanced Raman spectroscopy (SERS) has the potential to overcome these issues by providing immediate bacterial classification. To date, achieving accurate classification has required technically complicated processes to capture pathogens, which has precluded the integration of SERS into rapid diagnostics. This work demonstrates that gold-coated membrane filters capture and aggregate bacteria, separating them from urine, while also providing Raman signal enhancement. An optimal gold coating thickness of 50 nm was demonstrated, and the diagnostic performance of the SERS-active filters was assessed using phantom urine infection samples at clinically relevant concentrations (105 CFU/ml). Infected and uninfected (control) samples were identified with an accuracy of 91.1%. Amongst infected samples only, classification of three bacteria (Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae) was achieved at a rate of 91.6%.

Journal article

Kedrzycki M, Leiloglou M, Leff D, Elson D, Chalau V, Thiruchelvam P, Darzi Aet al., 2021, Versatility in Fluorescence Guided Surgery with the GLOW Camera System, Surgical Life: The Journal of the Association of Surgeons of Great Britain and Ireland

Journal article

Dave RV, Kim B, Courtney A, O'Connell R, Rattay T, Taxiarchi VP, Kirkham JJ, Camacho EM, Fairbrother P, Sharma N, Cartlidge CWJ, Horgan K, McIntosh SA, Leff DR, Vidya R, Potter S, Holcombe C, Copson E, Coles CE, Cutress RI, Gandhi A, Kirwan CCet al., 2021, Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK 'Alert Level 4' phase of the B-MaP-C study (Mar, 10.1038/s41416-020-01234-4, 2021), BRITISH JOURNAL OF CANCER, ISSN: 0007-0920

Journal article

St John ER, Bakri AC, Johanson E, Loughran D, Scott A, Chen ST, Joshi S, Darzi A, Leff DRet al., 2021, Assessment of the introduction of semi-digital consent into surgical practice, BRITISH JOURNAL OF SURGERY, Vol: 108, Pages: 342-345, ISSN: 0007-1323

Journal article

Patel R, Singh H, Ashcroft J, Woods A, Darzi A, Leff Det al., 2021, Dataset of prefrontal transcranial direct-current stimulation to improve early surgical knot-tying skills, Data in Brief, Vol: 35, ISSN: 2352-3409

Transcranial direct-current stimulation (tDCS) has previously demonstrated promising effects in improving surgical performance with motor region stimulation [1], [2], [3], [4]. However, extensive prior research has revealed an important role of the prefrontal cortex in surgical skill development [5,6]. This article presents the data of a double-blind randomized sham-controlled trial investigating the effect of prefrontal tDCS on knot-tying performance [7]. Data was collected from an active (n = 20) and sham (n = 20) group across three blocks: pre-, online- (during) and post-tDCS. Group and block differences of knot-tying performance were analyzed using a Generalized linear mixed model and supported with a Friedman's test. Further sub-analyses were conducted to compare high vs. low skilled individuals and initial vs. last knots. Subjective workload was assessed after each block using a SURG-TLX questionnaire and side-effects of the tDCS block were recorded using an additional survey.

Journal article

Tanaka MB, St John ER, Exarchos G, Hogben K, Ahmed HU, Hrouda D, Patrick J, Mundell A, Scrimgeour G, Abboudi H, Agarwal S, Al-Mufti R, Arya M, Dasgupta R, El-Husseiny T, Gibbons N, Hadjiminas D, Hellawell G, Karim O, Khoubehi B, Leff DR, Minhas S, Morley R, Rashid T, Thiruchelvam P, Urch CE, Vyas L, Winkler Met al., 2021, Safety and adverse events of urgent elective surgery during COVID-19 within three UK hospitals, BRITISH JOURNAL OF SURGERY, Vol: 108, Pages: E51-E52, ISSN: 0007-1323

Journal article

Koh A, Parks RM, Courtney A, Leff DRet al., 2021, The Mastitis and Mammary Abscess Management Audit (MAMMA), British Journal of Surgery, ISSN: 0007-1323

Journal article

Kedrzycki MS, Elson DS, Leff DR, 2020, ASO author reflections: fluorescence-guided sentinel node biopsy for breast cancer, Annals of Surgical Oncology, Vol: 28, Pages: 3749-3750, ISSN: 1068-9265

Journal article

Jiwa N, Gandhewar R, Chauhan H, Ashrafian H, Kumar S, Wright C, Takats Z, Leff DRet al., 2020, Diagnostic accuracy of nipple aspirate fluid cytology in asymptomatic patients: a meta-analysis and systematic review of the literature, Annals of Surgical Oncology, Vol: 28, Pages: 3751-3760, ISSN: 1068-9265

PURPOSE: To calculate the diagnostic accuracy of nipple aspirate fluid (NAF) cytology. BACKGROUND: Evaluation of NAF cytology in asymptomatic patients conceptually offers a non-invasive method for either screening for breast cancer or else predicting or stratifying future cancer risk. METHODS: Studies were identified by performing electronic searches up to August 2019. A meta-analysis was conducted to attain an overall pooled sensitivity and specificity of NAF for breast cancer detection. RESULTS: A search through 938 studies yielded a total of 19 studies. Overall, 9308 patients were examined, with cytology results from 10,147 breasts [age (years), mean ± SD = 49.73 ± 4.09 years]. Diagnostic accuracy meta-analysis of NAF revealed a pooled specificity of 0.97 (95% CI 0.97-0.98), and sensitivity of 0.64 (95% CI 0.62-0.66). CONCLUSIONS: The diagnostic accuracy of nipple smear cytology is limited by poor sensitivity. If nipple fluid assessment is to be used for diagnosis, then emerging technologies for fluid biomarker analysis must supersede the current diagnostic accuracy of NAF cytology.

Journal article

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