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.

The concept of SLN has been well validated and is the standard of care in early breast cancer. A multidisciplinary approach and structured training is the key to the successful introduction of the technique.

Background Temporal artery biopsy (TAB) is considered the gold standard for diagnosing Giant Cell Arteritis (GCA). The aim of this study was to compare the functional utility of the 2016 revised ACR (rACR) criteria against the original ACR criteria with a view to avoiding TABs in select groups. We also aimed to investigate the temporal relationship of positive biopsies. Methods A retrospective study was conducted of patients undergoing TAB from August 2014 to August 2016, at a DGH. Data collected included patient demographics, history, biochemistry, time to TAB from commencement of steroids and histology. The ACR and the rACR scores and the relative TAB results were analysed using ROC to determine statistical measures of performance. Different score thresholds were applied to propose a clinical tool to be used as an adjunct in the management of suspected GCA. Results and Discussion Forty two TABs were performed during this period of which 10 were males and 32 females. ROC analysis showed significant relationships between both ACR and rACR to TAB result. The AUC for rACR was 0.880 (p < 0.001) and for ACR was 0.737 (p = 0.023). The median time to TAB from referral was 10 days (IQR 6–13). The diagnostic yield was highest within 8 days (41%) of all positive biopsies. Conclusion This study demonstrates the potential value of the rACR criteria and a simple clinical tool is proposed to stratify relevant patients with a view to avoiding unnecessary TAB. Prolonged wait between referral to TAB is also likely to reduce its validity. Highlights

In this proof-of-principle study, the ESS results were comparable with current intraoperative diagnostic techniques of lymph node assessment.