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Biomedical subjects

Alexandra M Easson

Publications and source records attributed to Alexandra M Easson.

11 recordsLinked to original sources
PubMed2006

Role of sentinel lymph node biopsy in ductal carcinoma-in-situ treated by mastectomy.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is a widely accepted alternative to axillary lymph node dissection in invasive breast cancer. Its role in ductal carcinoma-in-situ (DCIS) is unclear. The purpose of this study was to determine factors associated with the subsequent diagnosis of invasive disease and to determine the role of SLNB when performing a mastectomy for DCIS. METHODS: A retrospective study was conducted of all mastectomies performed on patients with a preoperative diagnosis of DCIS between 2000 and 2005 at a single tertiary-care institution. RESULTS: Ninety mastectomies for DCIS were included, 54 (60%) of which were performed with concurrent SLNB. Of 44 patients diagnosed preoperatively with DCIS by core biopsy only, 34 patients (63%) had a concurrent SLNB, while 10 patients (28%) were treated with mastectomy alone (P < .01). Overall, 30 patients (33%) had invasive disease, 22 of whom received concurrent SLNB. Seven SLNB patients (13%) had positive SLNs. On univariate analysis, multifocality (P = .03), multicentricity (P = .01), comedonecrosis (P = .01), and diagnosis by core biopsy (P < .001) were associated with invasive disease on pathology. On multivariate analysis, comedonecrosis (P = .04) and diagnosis by core biopsy (P < .01) were independent predictors for invasion. There was no statistically significant predictor for sentinel lymph node metastasis. CONCLUSIONS: Approximately one-third of patients with DCIS treated with mastectomy at our institution later had invasive disease, and factors associated with invasion have been identified. On the basis of our results, routine SLNB is recommended in this patient population.

Breast Neoplasms↗
PubMed2005

The investigation of primary rectal cancer by surgeons: current pattern of practice.

OBJECTIVE: Selection of the optimal treatment strategy for patients with rectal cancer requires appropriate investigation, but published guidelines provide no clear consensus. We examined the current practice pattern for the investigation of primary rectal cancer by general surgeons in the province of Ontario, Canada. METHODS: A telephone interview was completed by 124 surgeons in Ontario who manage patients with rectal cancer, who indicated the investigations they routinely perform in assessment before treatment. An exploratory cluster analysis was used to identify surgeon-related variables that predicted the pattern of investigation; these were tested in univariate and multivariate analyses. RESULTS: Cluster analysis identified 3 distinct groups of surgeons based on patterns of test usage. Univariate analysis showed that the use of chest radiography, computed tomography of the abdomen and pelvis, and ultrasound of the abdomen varied significantly with the surgeon's subspecialty training, practice location and years in practice. Regression analysis confirmed that each of these 3 variables independently predicted the pattern of preoperative investigation. There were no significant predictors of the use of colonoscopy, sigmoidoscopy or carcinoembryonic antigen level. Over half of surgeons reported that they would have ordered additional imaging tests but did not because of lack of availability. The perceived desirability of additional tests, endorectal ultrasound in particular, varied with training. CONCLUSIONS: The current practice pattern for the preoperative investigation of primary rectal cancer by general surgeons varies significantly with specific surgeon-related variables, with potential impact on the management and outcome of patients with rectal cancer.

Adult↗
PubMed2004

Should research be part of advance care planning?

Advance care planning is a process to help people to formulate and communicate their preferences regarding future care during critical illness. Reviews of the advance care planning process in its current form have been disappointing. Improvements in care at the end of life and palliative care are necessary for the provision of modern medical care. Medical research has led to many improvements at the physiological and technological levels. It is only by applying the same rigour of scientific study and research ethics that improvements in the advance care planning process can be made.

Advance Care Planning↗
PubMed2004

Management of local recurrence of breast cancer.

This article reviews the management of isolated recurrences after primary treatment of breast cancer. These recurrences may occur within the breast after breast-conserving surgery, on the chest wall after mastectomy, or in the axilla. While often a marker of concurrent or future metastatic disease, local management with curative intent is advocated if the recurrence is isolated at presentation. Systemic therapy at this time (readjuvant) may well have benefit and should be more thoroughly investigated. Changes in breast cancer management, including sentinel lymph node biopsy, neoadjuvant chemotherapy, hormonal therapy and partial breast irradiation, may change the implications and management of isolated local breast, chest wall and axillary recurrences.

Breast Neoplasms↗
PubMed2002

A population-based study of the extent of surgical resection of potentially curable colon cancer.

BACKGROUND: We attempted to determine factors contributing to the extent of initial curative resection for colon cancer in a population-based cohort. Total abdominal colectomy with ileorectal anastomosis (TAC-IR) may be considered for young patients or those with a colorectal cancer family history to prevent metachronous lesions and facilitate surveillance. METHODS: All Ontario patients newly diagnosed with colon cancer over 12 months beginning in July 1997 were staged at the time of surgery. The extent of resection was compared with variables, including familial risk obtained from the Ontario Familial Colon Cancer Registry. RESULTS: Complete staging was possible for 86% of patients. A total of 1223 patients had a potentially curative resection: 17%, 46%, and 36% were stage I, II, and III, respectively. Patients were more likely to receive a TAC-IR if they were < or = 50 years old (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.8-6.6), if they had a synchronous lesion (OR, 28.37; 95% CI, 12.2-61.2), or if they were at a teaching hospital (OR, 2.8; 95% CI, 1.6-4.7), but not if they had a family history (OR,.7; 95% CI,.3- 1.5). CONCLUSIONS: Young age, teaching hospital, and multiple cancers but not family history were important factors for performing a TAC-IR.

Adult↗