A Retrospective Audit of Axillary Lymph Node Assessment and Treatment at UHCW Breast Unit
Laura Wheeler | University of Warwick
In accordance with NICE, breast centres should follow a set pathway in the treatment and assessment of the axilla in early invasive breast cancer. Adherence acts to minimise overtreatment and adverse post-surgical outcomes such lymphoedema. This audit aims to assess adherence to this pathway at the UHCW breast unit. It will also evaluate accuracy of the pre-operative axillary ultrasound scan. Results will be compared on a national level using the nationwide audit carried out by Public Health England.
A retrospective audit approach was used to assess care received by a sample of 352 patients diagnosed with invasive breast cancer across 2015 and 2018 respectively. Exclusions were applied to those receiving palliative care, neo-adjuvant chemotherapy and those with a previous diagnosis of breast cancer.
Adherence to pre-operative axillary ultrasound (US) scanning equalled 99% and subsequent appropriate needle sampling, 92%. There was a 93.2% overall adherence to the recommended sentinel lymph node biopsy in those with US or needle sampling negative nodes. The positive predictive value of the axillary ultrasound sat above national average at 53.2%.
Overall, the results are in line or better than national performance measured in the NHSBPS audit. The NICE recommended assessment and treatment pathway appears to be fully cemented into the UHCW breast unit’s practice. However, in just over a third of patients, additional non-sentinel lymph nodes were taken at sentinel lymph node biopsy. This is an area that would benefit from further research into the risks/advantages of additional sampling.
Effective Oncology teaching to Medical Undergraduates: A Systematic Review
Natasha Bechman | University of Warwick
Cancer is still one of the most common causes of death worldwide and thus it is critical to analyse how it is being taught at undergraduate level. This research compares current methods of undergraduate oncology teaching to ascertain which methods are most effective in improving both student confidence and clinical competence.
A systematic review of the literature was conducted; searches were performed in MEDLINE, EMBASE, Web of Science, Education Research Complete and the Cochrane Library.
Very few comparative studies were elucidated by the search; only two studies directly compared teaching methods. 17 studies were included to demonstrate effective teaching principles that improved student confidence, and clinical ability. The use of new technologies such as virtual learning environments can enhance learning but cannot entirely replace clinical teaching and direct patient contact. Clinical clerkships appear to be more effective when taught with didactic components that enhance learning. Shorter learning programmes outside of the curriculum can improve student understanding and interest in oncology, and these do not need to be lengthy undertakings to show effects.
This study has found 17 articles on oncology teaching at undergraduate level further to Gaffan et al.’s original paper that fit the inclusion criteria. Oncology teaching needs to be less disparate in the curriculum, with multi-modal methods of teaching and should ideally include as much direct patient contact as is feasible. Further studies should be conducted to directly compare methods, and knowledge level to discern how best to improve oncology curricula.
Isolation of Cell-Free Tumour DNA from Peripheral Blood: A Method Development Study in Patients with Neuroendocrine Tumours
Rhiannon White | University of Warwick
The presence of cell-free genetic material (cfDNA) circulating freely in the blood has a range of potential clinical uses, particularly in the diagnosis and management of a range of cancers. However, there currently exists no standardised and validated method of extracting and analysing this cfDNA from peripheral blood samples, and it is unclear to what extent the various methods that are commercially available are appropriate for use in a non-specialist clinical laboratory setting. This study aimed to compare a range of commercially available DNA isolation kits (Maxwell, QIA and MagMAX), and evaluate their efficacy and appropriateness for use in a non-specialist lab.
Plasma samples from seven patients with Neuroendocrine tumours were used to extract cfDNA using each of three different isolation kits. The isolated products were then evaluated in terms of the quantity of cfDNA, as well as the presence of specific mutations known to be present in some Neuroendocrine tumours, as a proxy of the quality of extracted cfDNA.
Using cfDNA quantity as a measure of kit efficiency, it was found that the Maxwell was the most efficient in cfDNA isolation, followed by the QIA, with MagMAX found to be the least efficient kit. In terms of appropriateness, the Maxwell was the most straightforward method, with QIA and MagMAX having the advantage of being able to process a large volume of sample. The QIA had the added advantage of lowest cost per sample, and fastest total running time.
Effective cfDNA isolation is possible in a non-specialist setting, with the optimal kit dependent on the value a laboratory places on factors such as efficiency, time and cost.