Objective: To compare the incidence of catheter-related infection in the bloodstream and non-infectious complication rate of Hickman catheter and peripherally inserted central venous catheter (PICC) in oncology patients. Methods: A retrospective study was performed of oncology patients who underwent Hickman catheter or PICC placement at the radiology department of a regional hospital in Hong Kong from January 2008 to December 2013. The catheter-related bloodstream infection rate, time to infection onset, and non-infectious complication rate of the Hickman group and PICC group were evaluated and compared. Results: During the study period, 161 Hickman catheters and 29 PICCs were inserted in oncology patients (n = 190). There were 38 cases of catheter-related bloodstream infection in the Hickman group and four cases in the PICC group. The catheter-related bloodstream infection rate for all catheters, Hickman group, and PICC group was 1.364, 1.340 and 1.654 per 1000-catheter-days, respectively. For non-infectious complications, 15 of 161 Hickman cases had complications (6 catheter blockage, 5 leakage, 4 migration and dislodgement). In the PICC group, 6 of 29 had complications (3 blockage, and 3 migration and dislodgement). There was, however, no statistically significant difference between the Hickman and PICC groups in terms of number of infections (p = 0.241), time to infection onset (p = 0.187), non-infectious complication rate (p = 0.101), and overall complication rate (p = 0.766). Conclusion: With the less invasive nature of PICC insertion, it provides a viable means of vascular access for oncology patients.

Objectives: To determine the effect of transarterial chemoembolisation (TACE) on liver function and procedurerelated mortality in patients with unresectable hepatocellular carcinoma (HCC) and portal vein tumour thrombosis (PVTT). Methods: This was a retrospective study of patients with HCC and PVTT who underwent TACE from January 2012 to December 2013 at a single tertiary medical centre in Hong Kong. Patient demographics, aetiology of cirrhosis, alpha fetoprotein (AFP) level, tumour size, number of tumours, liver function (total bilirubin, albumin, international normalised ratio [INR]), and Child-Pugh score were evaluated before and 4 weeks after TACE. The 30-day mortality was also recorded. Results: TACE was performed in 26 patients with unresectable HCC and PVTT (mean age, 61 years). The mean total bilirubin level before and after TACE was 18.2 μmol/l and 26.8 μmol/l (p = 0.140), respectively, and mean albumin level fell from 36.8 g/l to 33.9 g/l (p = 0.009). The respective mean INR before and after TACE was 1.1 and 1.2 (p = 0.120), the AFP level was 35,364.0 ng/ml and 37,424.5 ng/ml (p = 0.563), and the mean Child-Pugh score was 6.0 and 6.6. The mean and median survival of patients was 5.1 months (range, 1.5-8.8 months) and there was no 30-day mortality. Conclusion: TACE has a deteriorating effect on liver function in patients with unresectable HCC and PVTT. Nonetheless since there were no procedure-related deaths and TACE has potential survival benefits, it should be a treatment option along with superselective catheterisation of tumour feeding vessels for patients with HCC and PVTT.

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Objective: To evaluate the characteristics and clinical outcome of non-palpable breast lesions screened by ultrasound. Methods: From January 2011 to June 2011, all new cases referred to the breast clinic at Tuen Mun Hospital, Hong Kong, were identified. All patients underwent ultrasound with or without mammography. Patients with a palpable or mammographically detected breast mass were included in the control group. Patients with nonpalpable breast lesions detected incidentally on ultrasound only were included in the investigation group. Any patients who underwent targeted ultrasound were excluded. Baseline patient demographics, including age and family history of breast cancer, were documented. Lesion characteristics on ultrasound, including maximum dimension and Breast Imaging Reporting and Data System (BI-RADS) classification, were analysed. The nature of the lesions was confirmed histologically or by follow-up imaging for at least 2 years to indicate benignity. Results: A total of 196 patients with 422 lesions were identified. Among the 422 lesions, 130 were palpable or mammographically detected lesions (control group) and 292 were non-palpable ultrasound-detected lesions (investigation group). The baseline characteristics in both groups were comparable. The mean age was 44 years in the control group and 42 years in the investigation group. There were 10 and 8 patients with a family history of breast cancer in the control group and investigation group, respectively. Compared with the control group, the maximum dimension of the lesion was significantly smaller in the investigation group (p < 0.05). The BI-RADS classification was significantly lower in the investigation group (p < 0.05). A total of 156 lesions had tissue diagnosis and 270 lesions were followed up for at least 2 years with no change or a decrease in size, indicating benignity. In the control group, 18 (13.8%) lesions were malignant while in the investigation group, no lesions were malignant (p < 0.05). Conclusion: Ultrasound can detect small lesions that are mammographically occult and non-palpable. However, these lesions are likely more benign-looking (BI-RADS 2/3) and pathologically benign.