Background: Wire-guided localization (WGL) has been the mainstay for localizing non-palpable breast lesions before excision. Due to its limitations, various wireless alternatives have been developed. In this prospective study, we evaluate the role of radiation-free wireless localization using the SAVI SCOUT ® localization at a European centre. Patients and Methods: This technique was evaluated in a prospective cohort of 20 patients. The evaluation focused on clinical and pathological parameters in addition to patient and physician acceptance. Results: SAVI SCOUT reflectors (n=23) were deployed to localize 22 occult breast lesions and one axillary lymph node in 20 patients. The mean deployment duration was 5.6 min, with a mean distance from the lesion of 0.6 mm. The migration rate was 0% and the mean identification and retrieval time was 25.1 min. In patients undergoing therapeutic excision for malignancy (n=17), only one (5.9%) required reoperation for positive surgical margins. Radiologists and surgeons rated the technique as better than WGL and patient satisfaction was high. Conclusion: Our study demonstrates that wireless localization using SAVI SCOUT ® is an effective and time-efficient alternative to WGL with excellent physician and patient acceptance.The number of patients with non-palpable breast lesions has increased due to the widespread improvement and use of screening mammography (1). In addition, there has been an increase in the use of neoadjuvant chemotherapy (NACT) for breast cancer (2). Partial or complete response often renders breast tumours non-palpable and therefore accurate preoperative localization of these lesions is essential in order to guide precise surgical excision.Wire-guided localization (WGL) is currently the most widely used technique on a global scale, however, this technique has several disadvantages. It requires close coordination between the radiological and surgical departments, the insertion usually being performed on the day of surgery thus affecting radiology suite and operating theatre efficiency. The protruding wire can be bothersome for the patient, causing discomfort and anxiety. It also carries the risk of dislodgement, particularly if it is placed on the day before surgery for logistical reasons, where patient discomfort from the wire with difficulty in sleeping position, and wire dislodgement factors become of definite concern. During surgery, the wire can be transected or displaced, leading to fragment retention and possible migration. Furthermore, it can limit the surgical incision and dissection route, with a potential adverse impact on the aesthetic outcome, and can also rarely lead to potential injury to other organs such as the pleura, causing pneumothorax (3). Another potential limitation of WGL that is under-reported in the literature is the risk of needle stick injury to surgical staff caused by the sharp end of the wire. Therefore, other alternatives have been evolving to overcome these disadvantages. These include radioactive seed localization (RSL) (4), l...

Background: Routine follow up of patients' post treatment of breast cancer is standard practice in most countries. Follow up involves regularly scheduled clinical appointments with the aim of detecting early breast cancer recurrence and provision of psychological support to the patient. In the United Kingdom, financial constraint has led individual hospital trusts to revaluate the need for lengthy follow up schedules. Development of novel, less time intensive follow-up services, such as ‘open access follow up’ favour a more patient-led approach. Aim: To assess patients' views on breast cancer follow up, as well as the effect on patient satisfaction of transferring current clinical follow up to an 'open access follow up'. Method: We report the patients’ views on the basis of pooled data of a detailed survey performed in a large Breast Cancer Centre. All patients receiving regular clinical follow up care over a 6-month period were invited to participate in this prospective study. Patients were provided with a flow-chart, illustrating the current follow up, as well as a proposed ‘open access follow up’ process. Results: Between November 2013 and April 2014, 304 patients were recruited into the study. 39% of patients were within the first year of their diagnosis with 18% more than 3 years into their follow up. Caucasian women made up the majority of our population group (81%), with 7% Indo-Asian, and 7% Afro-Caribbean. The main expectation from follow up was surveillance for early detection of recurrence as expressed by 92% and anxiety of treatment side effects. 93% were satisfied with the current follow up they were receiving (satisfaction scores 7-10) and of those, 84% would choose to continue current follow up rather than move toward an ‘open access’ approach. 92% of patients favoured current clinical follow up over ‘open access follow up’, with 66% highlighting ‘open access follow up’ as an ineffective method of follow up. In stark contrast, 94% of patients reported current clinical led follow up to be effective. 91% of patients requested their follow up to be led by a breast surgeon and oncologist, rather than their primary care physician or community nurse. Interestingly, no significant correlation was established between age, ethnic background, distance from hospital and time from diagnosis with the type of follow up preferred. Conclusion: Following treatment for breast cancer, patients prefer a more regular clinician-led service to a patient-led ‘open access follow up’ process. This may be explained by the observation that patients seek the reassurance of regular clinical review to identify recurrence early, however the psychological support of a clinical consultation cannot be underestimated. It may be inferred that patients who are satisfied in the follow up they were currently receiving are more likely to appreciate the current follow up system rather than moving to an ‘open access' approach. Further study is warranted which investigates the impact of intensified surveillance on survival based on identification of recurrence and to repeat this study to seek consistency of opinion. Citation Format: Samantha T Muktar, Paul TR Thiruchelvam, Dimitri Hadjiminas. Patient's views of follow-up after treatment for breast cancer. A comparison of two approaches [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-19.

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A 48-year-old man presented as an emergency with a 3-week history of rectal bleeding. Examination of his rectum revealed a circumferential tumour, 2 cm from the anal verge. An MRI scan reported a locally infiltrative mid-lower rectal tumour staged as T3d/T4 N2 MX. A colonoscopy revealed appearances of severe proctitis and biopsies did not show any evidence of dysplasia or malignancy. The patient was discussed at the regional colorectal cancer multidisciplinary team meeting with a management plan for neoadjuvant chemoradiotherapy following repeat biopsies, which were again negative for malignancy. He tested positive for the HIV and was referred to genitourinary medicine. A positive nucleic acid test from a rectal swab was serovar L2 consistent with a diagnosis of lymphogranuloma venereum. He was treated with doxycycline and subsequent MRI scans showed reduction in tumour size with eventual resolution. This case report highlights the importance of HIV testing in patients with newly diagnosed colorectal tumours.

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