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

191 results found

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, Pages: 194005-194005, ISSN: 0022-3727

Journal article

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

Jiwa N, Takats Z, Leff D, 2021, Breast Health Screening: A UK-Wide Questionnaire, BMJ Nutrition, Prevention & Health, ISSN: 2516-5542

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, 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

St John ER, Bakri AC, Johanson E, Loughran D, Scott A, Chen S-T, Joshi S, Darzi A, Leff DRet al., 2021, Assessment of the introduction of semi-digital consent into surgical practice., Br J Surg

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 Stimul, Vol: 14, Pages: 616-618

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, 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

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, ISSN: 2352-3409

Journal article

Bertoncelli Tanaka M, St John ER, Exarchos G, Hogben K, Ahmed HU, Hrouda D, Imperial Breast and Urology Covid-19 Outcomes Groupet al., 2021, Safety and adverse events of urgent elective surgery during COVID-19 within three UK hospitals., Br J Surg, Vol: 108, Pages: e51-e52

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, 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, 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

Kedrzycki MS, Leiloglou M, Ashrafian H, Jiwa N, Thiruchelvam PTR, Elson DS, Leff DRet al., 2020, Meta-analysis comparing fluorescence imaging with radioisotope and blue dye-guided sentinel node identification for breast cancer surgery., Annals of Surgical Oncology, 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

Ashcroft J, Patel R, Woods A, Darzi A, Singh H, Leff Det al., 2020, Prefrontal transcranial direct-current stimulation improves early technical skills in surgery, Brain Stimulation, Vol: 13, Pages: 1834-1841, ISSN: 1876-4754

BackgroundStudies applying transcranial direct-current stimulation (tDCS) to motor regions to enhance surgical skills have observed modest benefits in performance. Early surgical skills acquisition is known to be dependent on the prefrontal cortex (PFC) which could be a suitable target for performance enhancement in fields with high cognitive demand.ObjectiveTo assess whether prefrontal tDCS could improve early phases of surgical skill development.MethodsIn a randomized sham-controlled double-blind parallel design, 40 surgical novices performed an open knot-tying task repeated in three blocks; pre-, online- and post-tDCS. During online stimulation, participants were randomized to either active tDCS (2 mA for 15 min) to the prefrontal cortex (anode over F3, cathode over F4) or sham tDCS. Performance score (PS) was computed using a validated algorithm and introspective workload domains were assessed using a SURG-TLX questionnaire.ResultsThere was no difference in demographics or PS between groups prior to receiving tDCS. PS significantly improved from pre-to online- (p < 0.001) and from pre-to post-tDCS (p < 0.001) in the active group only. Following active tDCS, PS was closer to the defined proficiency benchmark and significantly greater compared to sham (p = 0.002). Only the active group reported significantly improved temporal demand scores from pre-to online- (p = 0.004) to post-tDCS (p = 0.002).ConclusionsThis study demonstrates significantly improved early phase surgical-skill acquisition following prefrontal tDCS. Further work is required to determine the underlying neurophysiological mechanisms and whether the benefits observed are retained long-term.

Journal article

Jallali N, Hunter JE, Henry FP, Wood SH, Hogben K, Almufti R, Hadjiminas D, Dunne J, Thiruchelvam PTR, Leff DRet al., 2020, The feasibility and safety of immediate breast reconstruction in the COVID-19 era, Journal of Plastic, Reconstructive and Aesthetic Surgery, Vol: 73, Pages: 1917-1923, ISSN: 0007-1226

The coronavirus disease-2019 pandemic has had a significant impact on the delivery of surgical services, particularly reconstructive surgery. This article examines the current evidence to assess the feasibility of recommencing immediate breast reconstruction services during the pandemic and highlights considerations required to ensure patient safety.

Journal article

Scrimgeour GE, St John ER, Leff DR, 2020, Langer's arch: A rare but important consideration for axillary surgery with implications for training, BREAST JOURNAL, Vol: 26, Pages: 2226-2228, ISSN: 1075-122X

Journal article

Modi H, Singh H, Darzi A, Leff Det al., 2020, Multitasking and time pressure in the operating room: impact on surgeons’ brain function, Annals of Surgery, Vol: 272, Pages: 648-657, ISSN: 0003-4932

Objective:To assess the impact of multitasking and time pressure on surgeons’ brain function during laparoscopic suturing.Summary Background Data:Recent neuroimaging evidencesuggests that deterioration in surgical performance under time pressure is associated with deactivationof the prefrontal cortex (PFC),an area important for executive functions. However, the effect ofmultitasking on operator brain functionremains unknown.Methods:29surgical residentsperformed anintracorporealsuturing task under fourconditions: 1) self-pacedsuturing,2) time-pressured suturing, 3) self-paced suturingplus decision-making, and 4) time-pressured suturing plus decision-making. Subjectiveworkload was quantified using the Surgical Task Load Index. Technical skill was objectively assessed using task progression scores, error scores, leak volumes, and knot tensile strengths. PFC activation was measuredusing optical neuroimaging. Results:Compared with self-paced suturing, subjective workload(au)was significantly greater in time-pressuredsuturing (146.0 vs. 196.0), suturing with decision-making (146.0 vs.182.0), and time-pressuredsuturing with decision-making (146.0 vs.227.0). Technical performance duringcombined suturing and decision-making taskswas inferiortosuturing alone undertime pressure orself-paced conditions(p<0.001).Significant dorsolateral PFC (DLPFC) activations were observed during self-paced suturing, and ventrolateral PFC (VLPFC) deactivations were identified during time-pressuredsuturing. However, suturing in conjunction withdecision-making resulted in 2significantdeactivation across boththe VLPFC and DLPFC (p<0.05). Random effects regression analysis confirmed decision-making predicts VLPFC and DLPFC deactivation (z=-2.62, p<0.05).Conclusions:Performance degradation during high workload conditions is associated with deactivation of prefrontal regions important fo

Journal article

Dawidziuk A, Patel R, Darzi A, Leff D, Singh Het al., 2020, The Impact of tDCS on fNIRS Haemodynamic Responses During a Surgical Task: A Pilot Study, London Surgical Symposium 2020

Conference paper

Dawidziuk A, Patel R, Darzi A, Leff D, Singh Het al., 2020, Using Optical Neuroimaging to Reveal Mechanisms of Augmentation by Transcranial Electrical Stimulation (TES): A Systematic Review, Brainbox Initiative Virtual Conference 2020

Conference paper

Courtney A, O'Connell R, Rattay T, Kim B, Cutress RI, Kirwan CC, Gandhi A, Fairbrother P, Sharma N, Cartlidge CWJ, Horgan K, McIntosh SA, Leff DR, Vidya R, Potter S, Holcombe C, Copson E, Coles CE, Dave RVet al., 2020, The B-MaP-C study: Breast cancer management pathways during the COVID-19 pandemic. Study protocol, International Journal of Surgery Protocols, Vol: 24, Pages: 1-5, ISSN: 2468-3574

IntroductionApproximately 55,000 women in the United Kingdom are diagnosed with new breast cancer annually. Since emerging in December 2019, SARS-CoV-2 (coronavirus disease 2019, COVID-19) has become a global pandemic, affecting healthcare delivery worldwide. In response to the pandemic, multiple guidelines were issued to assist with rationalising breast cancer care. The primary aim of the B-MaP-C study is to audit and describe breast cancer management of patients newly diagnosed with breast cancer during the COVID-19 pandemic against pre-COVID-19 management practice in the UK. The implications of changes to management will be determined and the impact of a COVID-19 diagnosis on the patient’s breast cancer management will be determined.Methods and analysisThis is a multi-centre collaborative audit of consecutive breast cancer patients undergoing treatment decisions during the acute and recovery phases of the COVID-19 pandemic. All patients with newly diagnosed primary breast cancer, whose treatment was decided in a multidisciplinary meeting from the 16th March 2020, are eligible for inclusion.Ethics and disseminationAs this is an audit ethical approval is not required. Each participating centre is required to register the study locally and obtain local governance approvals prior to commencement of data collection. Local audit data will be available to individual participating units for governance purposes. The results of the data analysis will be submitted for publication, as well as disseminated via the ABS newsletter and a webinar. All data will be presented at national and international conferences, circumstances permitting.Registration detailsEach participating centre received local governance audit registration.

Journal article

Joshi M, Karat I, Leff DR, 2020, COVID19 and breast surgery - silver linings?, BRITISH JOURNAL OF SURGERY, Vol: 107, Pages: E359-E359, ISSN: 0007-1323

Journal article

Kassanos P, Berthelot M, Kim JA, Rosa BMG, Seichepine F, Anastasova S, Sodergren MH, Leff DR, Lo B, Darzi A, Yang G-Zet al., 2020, Smart sensing for surgery from tethered devices to wearables and implantables, IEEE Systems Man and Cybernetics Magazine, Vol: 6, Pages: 39-48, ISSN: 2333-942X

Recent developments in wearable electronics have fueled research into new materials, sensors, and microelectronic technologies for the realization of devices that have increased functionality and performance. This is further enhanced by advances in fabr ication methods and printing techniques, stimulating research on implantables and the advancement of existing medical devices. This article provides an overview of new designs, embodiments, fabrication methods, instrumentation, and informatics as well as the challenges in developing and deploying such devices and clinical applications that can benefit from them. The need for and use of these technologies across the perioperative surgical-care pathway are highlighted, along with a vision for the future and how these tools can be adopted by potential end users and health-care systems.

Journal article

Muthuswamy K, Fisher R, Mavroveli S, Petrou F, Khawar S, Amlani A, Hanna GB, Hadjiminas D, Thiruchelvam P, Leff Det al., 2020, Assessment of technical skills in axillary lymph node dissection, Annals of Surgery, ISSN: 0003-4932

Objective A simulator to enable safe practice and assessment of ALND has been designed, and face, content and construct validity has been investigated.Summary and Background Data The reduction in the number of ALNDs conducted has led to decreased resident exposure and confidence. MethodsA cross-sectional multi-center observational study was carried out between July 2017 to August 2018. Following model development, 30 surgeons ofvarying experience (n=9 ‘experts’, n=11 ‘senior residents’ and n=10 ‘junior residents’) were asked to perform a simulated ALND. Face and content validity questionnaires were administered immediately after ALND. All ALND procedures were retrospectively assessed by two attending breast surgeons, blinded to operator identity, using a video-based assessment tool and an end product assessment tool.ResultsStatistically significant differences between groups were observed across all operative sub-phases on theaxillary clearance assessment tool (p<0.001). Significant differences between groups were observed for overall procedure quality (p<0.05) and total number of lymph nodes harvested (p<0.001). However, operator grade could not be distinguished across other end product variables such as axillary vein damage (p=0.864) and long thoracic nerve injury R1 ALND Structured abstract(p=0.094). Overall, participants indicated that the simulator has good anatomical (median score >7) and procedural realism (median score >7).ConclusionsVideo based analysis demonstrates construct validity for ALND assessment. Given reduced ALND exposure, this simulation is a useful adjunct for both technical skills training and formative Deanery orFaculty administered assessments.

Journal article

Gandhewar R, Jiwa N, Leff D, 2020, How Are We Preparing Our Nipple Smears for Cytology?, International Surgical Conference of the Association-of-Surgeons-in-Training, Publisher: WILEY, Pages: 8-8, ISSN: 0007-1323

Conference paper

Grant Y, Thiruchelvam P, Al-Mufti R, Hogben K, Hadjiminas D, Leff Det al., 2020, Patient-level Costs of Staged Unilateral versus Immediate Bilateral Symmetrisation Mammaplasty, 21st Annual Meeting of the American-Society-of-Breast-Surgeons (ASBS), Publisher: SPRINGER, Pages: S449-S450, ISSN: 1068-9265

Conference paper

Denning M, Hayes P, Tsang F, Leff D, Thiruchelvam P, Hadjiminas Det al., 2020, The modified crescenteric anterior intercostal perforator (AICAP) flap, Plastic and Reconstructive Surgery Global Open, Vol: 8, ISSN: 2169-7574

Background Lower pole breast cancers are challenging to manage since conventional wide local excision may produce a “bird beak” deformity. In an era of oncoplastic surgery, techniques that balance oncological results with cosmetic outcomes such as local flaps have extended the role of breast conserving surgery. Local flaps are particularly useful for partial breast reconstruction due to the relative simplicity of the surgical procedure, and reduced morbidity. Intercostal artery perforator (ICAP) flaps have a shorter duration of surgery than free flaps and do not require microsurgical anastomoses. AICAP flaps provide excellent cosmesis, yet traditional crescenteric harvest yields limited volume for reconstruction.Idea/InnovationWe describe a modification to an established reconstructive technique for lower pole breast defects. The technique is based on 3 extensions of tissue, providing a larger volume of tissue replacement compared with traditional AICAP flaps. The technique is particularly suitable for small and medium sized non-ptotic breasts, with lower pole tumours. ConclusionThe modified crescenteric AICAP technique can be used to increase the available tissue when performing lower pole reconstructions.

Journal article

Tsang-Wright F, Lewis R, Nicola M, Beattie A, Leff D, Tasoulis M, Thiruchelvam Pet al., 2020, The Effect of Involved Anterior Margins on Loco-regional Recurrence Rates Following Breast Cancer Surgery, 21st Annual Meeting of the American-Society-of-Breast-Surgeons (ASBS), Publisher: SPRINGER, Pages: S417-S417, ISSN: 1068-9265

Conference paper

Benjamin A, Cleator S, Gujral D, Leff D, Thiruchelvam Pet al., 2020, Breast Cancer Screening in Hodgkin's Disease Survivors: Can We Reach a Consensus on the Guidelines?, 21st Annual Meeting of the American-Society-of-Breast-Surgeons (ASBS), Publisher: SPRINGER, Pages: S457-S458, ISSN: 1068-9265

Conference paper

Chauhan H, Ho H-Y, StJohn E, Takats Z, Leff Det al., 2020, Improving the Diagnostic Accuracy of the Intelligent Knife (iKnife) by Identifying DCIS, 21st Annual Meeting of the American-Society-of-Breast-Surgeons (ASBS), Publisher: SPRINGER, Pages: S614-S615, ISSN: 1068-9265

Conference paper

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