A man in his 30s with alpha thalassaemia (four-alpha globin gene deletion) presented with 1 week of shortness of breath and 1 month of general malaise. Pulse oximetry monitoring revealed low peripheral oxygen saturation of approximately 80% despite maximal high-flow nasal cannula oxygen (fractional inspired oxygen 1.0–60 L/min flow). Arterial blood gas samples were chocolate brown in colour, with a low arterial partial pressure of oxygen of 197 mm Hg. This large oxygen saturation gap raised suspicion for methaemoglobinaemia. However, the patient’s co-oximetry results were suppressed by the blood gas analyser and delayed a definitive diagnosis. A methaemalbumin screen was sent instead, which was positive at 65 mg/L (reference interval: <3 mg/L). Treatment with methylene blue was initiated but did not result in complete resolution of cyanosis. This patient had been red cell exchange dependent since childhood for thalassaemia. Therefore, an urgent red cell exchange was initiated overnight, leading to an improvement in symptoms and interpretability of co-oximetry results. This resulted in rapid improvement without residual sequelae or complications. We conclude that a methaemalbumin screen can be used as a surrogate test for prompt confirmation of diagnosis in lieu of co-oximetry in cases of severe methaemoglobinaemia or in cases with underlying haemoglobinopathy. Red cell exchange can allow prompt methaemoglobinaemia reversal, especially if methylene blue is only partially effective.

Introduction: Oncoplastic breast surgery combines oncologic partial mastectomy with ipsilateral defect repair using volume displacement and volume replacement techniques with contralateral symmetrising surgery as appropriate. Oncoplastic surgery aims to maintain quality of life by pre-empting and mitigating against breast asymmetry whilst not compromising oncological effectiveness. Although growing in popularity in North America, many patients still do not have access to these techniques which usually involve longer operation times and require a surgeon with specialized oncoplastic training. This study demonstrates the implementation of an effective oncoplastic surgical practice in a community hospital within Canada and shows low rates of peri-operative complications as well as high levels of patient-reported outcome measures. Methods:A retrospective chart review of consecutive patients diagnosed with Stage 0-3 breast cancer treated with level I and level II oncoplastic techniques by a single breast surgeon was undertaken. Patient demographics, tumor characteristics, procedure types, and clinical outcomes were collected. Patient satisfaction was assessed with the Breast-Q questionnaire administered pre-operatively as well as 3 months and 9 months post-operatively. Results:Oncoplastic breast conservation surgery was performed in 340 patients over a 31 month period from 2017-2019. The average size of breast lesion was 1.8 cm with 96 patients having lesions 2-5 cm in size, and 10 patients having tumours &gt;5cm. Thirty (8.8%) patients experienced a complication requiring intervention. Margin revisions were required in 21.8% of patients which reduced to 18% after the implementation of the new margin consensus guidelines. The completion mastectomy rate was 4.7%. Contralateral symmetrizing procedures were performed in 31 (9.1%) of patients by the surgeon performing the patient's breast conservation surgery. Breast Q scores increased across breast satisfaction, process of care, psychosocial, physical, and sexual satisfaction domains post-operatively. Conclusion:This study demonstrates the feasibility of an oncoplastic breast surgery practice in a busy community hospital in Canada. This adds to the growing body of North American data on the clinical and oncological safety of these techniques and introduces the idea of collecting patient-reported outcome measures within a Canadian population. We hope that this will serve to aid in the recruitment of oncoplastic-trained surgeons to both teaching and community hospitals and enable these techniques to become the standard of care in North America. Citation Format: Ashley DiPasquale, Zofia Prus-Czarnecka, Lindsay Delmar, Lashan Peiris. Clinical and patient reported outcomes in oncoplastic breast conservation surgery from a single surgeon's practice in a busy community hospital in Canada [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-61.

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