Staff Publication

How accurate is axillary ultrasound? Comparing pre-operative ultrasound assessments to post-operative axillary node status in breast cancer positive patients (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Chai A.; Walajahi F.

Citation:

Breast Cancer Research. Conference: British Society of Breast Radiology Annual Scientific Meeting 2024. Liverpool United Kingdom. 27(Supplement 1) (no pagination), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background: The cortical thickness of axillary lymph nodes has been linked to nodal metastasis, with smaller measurements associated with lower rates of metastasis. There is currently no international standard used to define a safe threshold for cortical thickness. In this analysis, we compare three proposed safe thresholds of 2.30 mm, 2.50 mm, and 3.00 mm, and observe how axillary node involvement changes between each group. Methods: Retrospective review of all known breast cancer patients who underwent node surgery in October 2023 at our center. Cortical thickness and final nodal status were collected. 91 Patients were divided into 4 groups from their cortical thickness measurements. These groups were < 2.30 mm (n = 65), 2.30-2.49 mm (n = 5), 2.50-3.00 (n = 4), and > 3.00 mm (n = 17). Results 91 patients (57.82} 11.13 years) underwent WLE or ANC. 26 (28.57%) patients were node positive at surgery. When split into their groups,12 (18.46%) patients in the < 2.30 mm group were node positive, 1 (20%) in the 2.30-2.49 mm group, 2 (50%) in the 2.50-3.00 group, and 11 (64.71%) in the > 3.00 mm group. OR = 1.97 (95%CI, 1.21-3.20) was found when using 2.30 mm as the safe threshold, OR = 2.01 (95%CI, 1.16-3.48) at 2.50 mm, and OR = 2.26 (95%CI, 1.18-4.34) at 3.00 mm. Preliminary multiple regressions were run, with thickness as both a continuous and categorical variable. As a continuous variable, cortical thickness produced OR = 2.67 (95%CI, 1.60-4.46) (p = < 0.01). The categorical model further concluded that OR = 10.05 (95%CI, 2.78-36.31) (p = < 0.01) when cortical thickness is > 3.00 mm. Discussion: Further research with more robust regressions and sample size is warranted to continue investigating the value of cortical thickness.

DOI: 10.1186/s13058-025-02023-8

Link to full-text [open access - no password required]

The significance of breast lesions identified incidentally on Lung Health Check CT (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Chai A.; Hutchison G.;

Citation:

Breast Cancer Research. Conference: British Society of Breast Radiology Annual Scientific Meeting 2024. Liverpool United Kingdom. 27(Supplement 1) (no pagination), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background The Targeted Lung Health Check Programme offers low-dose CT scans to populations at higher risk of lung cancer. Like other forms of crosssectional imaging, this can produce incidental findings, resulting in onward referral to specialist services and increased patient anxiety which may be unnecessary. We investigated the frequency of incidental breast lesions found through this programme. Method: A retrospective review of all patients with breast findings detected by LDCT from November 2019 and July 2024. Their referral method for breast assessment, findings on breast imaging, and biopsy results were recorded. Results 52 patients (64.19 5.84 years) had breast lesions reported. Of these, 50 (96%) were female. 39 cases were first discussed with a breast radiologist, 26 (66%) of which were referred for triple assessment. 13 cases did not have initial input from a breast specialist, 10 (77%) of which were referred for assessment. The average number of days between LDCT and breast assessment was 35.89 19.64 days, and the highest score on imaging was 2.79 1.40. 8 patients were biopsied, with 5 having malignant findings. All 5 malignant cases had been discussed with a breast radiologist prior to breast clinic referral. Discussion(s): Lower referral rates were seen when a breast specialist opinion was requested prior to referral. This allowed savings in clinic capacity and reduction in patient anxiety caused by unnecessary referral.

DOI: 10.1186/s13058-025-02023-8

Link to full-text [open access - no password required]

A Prospective Study of the Operative Treatment of Clavicular Fractures (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Bhakar, Ranj; Chakrapani, Arjun S; Shaik, Arfaz; Alexander, Aaron; Murugesan, Thivagar; Anbazhagan, Prasanna Kumar; Ghent, Dan.

Citation:

Cureus. 18(1):e102481, 2026 Jan.

Abstract:

Objective This study aimed to evaluate the functional and radiological outcomes associated with the operative management of displaced midshaft clavicular fractures using pre-contoured locking compression plates (LCPs), specifically in cases that met surgical indications such as fracture displacement, shortening, or comminution. Methodology In this prospective study, 30 adult patients with displaced midshaft or lateral clavicular fractures underwent open reduction and internal fixation (ORIF) with pre-contoured LCPs at a tertiary care center. Patients were followed clinically for six months postoperatively. Functional outcomes were assessed using the Constant-Murley Score (CMS), and radiological union was evaluated through serial radiographs. Data were analyzed using SPSS Statistics version 25.0 (IBM Corp., Armonk, NY), and results were reported as mean +/- standard deviation (SD). Results The mean age of the patients was 36.4 +/- 10.2 years, with 21 patients (70%) being male. The mean time to radiographic union was 12.8 +/- 2.3 weeks. At the final follow-up, the mean Constant-Murley Score (CMS) was 91.2 +/- 6.4, with 24 patients (80%) demonstrating excellent shoulder function. Complications were limited to two patients (6.7%), while three patients (10%) experienced superficial infections or implant-related irritation. There were no observed cases of nonunion or implant failure. Conclusions Operative fixation of displaced clavicular fractures using pre-contoured LCPs provides stable fixation, facilitates early mobilization, and results in excellent functional recovery with minimal complications. Surgical management may be considered in active adults with displaced fractures to help optimize outcomes.

DOI: 10.7759/cureus.102481

Link to full-text [open access - no password required]

Robotic hysterectomy: an umbrella review and regional access in the Midlands, UK - Is there inequity? (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Saoudi, Tareq Al; Kanani, Trisha; McGill, Shaun; Isherwood, John; Fan, Frankie; Brown, Luke; Williams, Philippa; Sahare, Pankhuri; Sisodia, Shilpa; McVicar, Kathryn; Lacey, Patricia; Elleray, Rebecca; *Cheetham, Mark; Habiba, Marwan; Orrock, Emma; Wilson, Robert; Dennison, Ashley.

Citation:

European Journal of Obstetrics, Gynecology, & Reproductive Biology. 321:115041, 2026 Feb 28.

Abstract:

STUDY OBJECTIVE: To review current evidence on robotic-assisted hysterectomy (RAH) and assess hysterectomy practices across the Midlands, UK, with a focus on the availability of robotic procedures, geographical variations in the incidence of uterine cancer, and service provision.

DESIGN: An umbrella review conducted in accordance with the PRISMA guidelines combined with a descriptive regional data analysis.

SETTING: Midlands, UK.

PATIENTS: Women undergoing hysterectomy for uterine cancer between 2019 and 2023, based on national and regional datasets.

INTERVENTION: Comparison of RAH with open and laparoscopic approaches, and assessment of access to robotic surgery across integrated care boards (ICBs) in the Midlands.

MEASUREMENTS AND MAIN RESULTS: The final analysis included 12 systematic reviews. Compared with open hysterectomy, RAH was associated with reduced blood loss, lower transfusion rate, shorter hospital stay, and lower complication rates, while benefits over laparoscopic hysterectomy were less consistent. Descriptive regional analysis demonstrated substantial variation in uterine cancer incidence and hysterectomy rates across ICBs in the Midlands. Visual comparison suggested that areas with a higher
incidence of uterine cancer did not align consistently with higher rates of RAH, and access to robotic surgery varied across the region, with some ICBs having no local provision.

CONCLUSION: The continued expansion of RAH in the UK highlights the need for coordinated governance and service planning. Observed regional variation supports the development of clear referral pathways, standardized patient selection criteria, and regional oversight to guide equitable and effective integration of robotic surgery, particularly in areas with limited local provision.

DOI: 10.1016/j.ejogrb.2026.115041

Arteriolar Collapse and Haemodynamic Incoherence in Shock: Rethinking Critical Closing Pressure (2026)

Posted on by

Type of publication:

Journal article

Author(s):

*Miller, Ashley; Rola, Philippe; Spiegel, Rory; Haycock, Korbin.

Citation:

Journal of Personalized Medicine. 16(2), 2026 Feb 01.

Abstract:

Critical closing pressure (CCP) and the vascular waterfall have long been used to explain perfusion failure in shock, yet their physiological meaning has been inconsistently interpreted. CCP is frequently treated as a continuous downstream pressure and inserted into formulas such as mean arterial pressure (MAP) – CCP, implying that a collapse threshold behaves like an opposing pressure even when vessels remain open. Drawing on classical vascular mechanics, whole-bed flow studies, microvascular models, and contemporary clinical physiology, we show that this interpretation is incorrect. Tone-dependent arteriolar collapse does not behave as a Starling resistor: CCP is a threshold at which smooth-muscle tension exceeds intraluminal pressure and vessels close, not a pressure governing flow in patent vessels. Perfusion becomes heterogeneous because different vascular beds reach their collapse thresholds at different pressures (via excessive tone, extrinsic compression, or profound hypotension), disconnecting macro-haemodynamics from microcirculatory flow. This explains why systemic variables such as MAP and systemic vascular resistance (SVR) may appear adequate even while tissues are under-perfused, a phenomenon now termed haemodynamic incoherence. Reframing CCP as a binary collapse threshold resolves longstanding contradictions in the literature, clarifies why MAP-centred targets often fail, and unifies the behaviour of shock states within a four-interface model of circulatory coupling. Therapeutically, the aim is not to "restore a waterfall" but to reopen closed vascular territories by lowering excessive tone, relieving external pressure, or raising truly low arterial inflow. This mechanistic reinterpretation provides a more coherent, physiologically grounded approach to personalised perfusion management in critical illness.

DOI: 10.3390/jpm16020078

Link to full-text [open access - no password required]

Day case and inpatient elective thyroid lobectomy across England: observational study of variation in practice and safety (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Monaghan, Michael; Gray, William K; *Cheetham, Mark; Dent, Paul; Briggs, Tim W R; Lansdown, Mark.

Citation:

British Journal of Surgery. 113(2), 2026 Feb 11.

Abstract:

BACKGROUND: Day case elective surgery is becoming increasingly common across a range of procedures. The aim of this study was to investigate the safety of day case thyroid lobectomy, a procedure with low uptake in the UK.

METHODS: This study analysed the Hospital Episode Statistics administrative data set for all first-time elective thyroid lobectomies performed on adults in England from 1 April 2017 to 31 March 2024. The primary outcome was 30-day emergency readmission and secondary outcomes were 30-day emergency readmission for complications and specifically for haemorrhage. The primary exposure variable was whether patients were day case patients or inpatients. Models were adjusted for the demographic and frailty characteristics of the patients.

RESULTS: Over the 7-year interval, 41 518 elective thyroid lobectomies were performed by 127 different hospital trusts. The day case rate was 9.9% (4125 patients) across all hospital trusts. Rates in the 118 hospital trusts conducting >20 procedures during the 7 years varied from 0% to 74.6%. Day case surgery was associated with a lower 30-day emergency readmission rate (OR 0.73 (95% c.i. 0.56 to 0.96); P < 0.021), with no evidence of association with poorer outcomes. There was no evidence that trusts with day case rates >30% had poorer outcomes than trusts with day case rates <1%.

CONCLUSION: In low-risk patients, day case thyroid lobectomy is safe.

DOI: 10.1093/bjs/znaf299

Literature review on Mammary Paget's Disease Mimicking Benign and Malignant Dermatological Conditions: Clinical Challenges and Diagnostic Considerations (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Ahmadi Y.

Citation:

Journal of Investigative Dermatology. Conference: 54th ESDR 2025 Meeting. Antwerp Belgium. 145(12 Supplement) (pp S341), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Mammary Paget's disease (MPD) or Paget's disease of the breast is a rare dermatological malignancy of the nipple-areolar complex that manifests with a spectrum of symptoms spanning from itching and redness to more severe indications such as breast lump, nipple-areolar complex destruction, or nipple discharge. It is predominantly associated with an underlying ductal carcinoma in situ or invasive ductal carcinoma. MPD often masquerades as other benign and malignant dermatological conditions, including eczema, atopic dermatitis, psoriasis, and squamous and basal cell carcinomas, leading to delayed diagnosis and inappropriate treatment. Only one-third of the patients present with a palpable lump; therefore, advanced age with chronic and unilateral lesions should raise concern for MPD. Our review article presents case reports of MPD imitating other skin conditions and underscores the key findings of clinical features and diagnostic workup to help differentiate the condition. A literature review revealed that studies emphasize caution regarding the sole use of mammography and ultrasound in diagnosing MPD, particularly in cases lacking a palpable lump. This highlights the MRI as a superior and more accurate imaging tool. However, any suspicious lesion must be biopsied to allow histopathological and immunohistochemical examination, since there are some cases where MRI findings were negative in the presence of a biopsy-proven MPD. This highlights the need for clinicians to investigate any suspicious lesion of the nipple or breast using the complete triple assessment approach to exclude an underlying malignancy. It is imperative to establish therapeutic guidelines to approach any nipple lesion to minimize the risk of misdiagnosing any underlying cancer, which can be potentially fatal if left alone.

DOI: 10.1016/j.jid.2025.10.439

Sparkles, anxiety and enhanced cataract consent": a patient-centred audit to address emotional wellbeing and improve informed consent prior to cataract surgery (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Nayak D.; *Yadav S.; *Owoniyi M.; *Sanjana E.; Makwana T.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 191-192), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: The current cataract surgery consent form primarily focuses on the surgeon's perspective of potential complications, often neglecting the patient's emotional and visual experiences during the procedure. This audit aimed to explore the importance of informing patients about the potential visual experiences they might encounter during cataract surgery. By incorporating this information into the consent process, the goal was to enhance patient understanding, alleviate anxiety, and reduce distress during the surgery. This study was discussed with a patient focus group to understand their concerns about cataract surgery, particularly regarding anxiety and the unknown aspects of the procedure. Patients emphasised the lack of information about potential visual phenomena, like flashes of light and shimmer, which contributed to their anxiety. Method(s): To evaluate the impact of preoperative information about potential intraoperative visual phenomena on patient anxiety during cataract surgery and to compare outcomes between patients who were informed about these visual disturbances and those who were not Study Design: A prospective audit was conducted involving two groups of patients undergoing cataract surgery at a single surgical centre over a defined period (6months). One group received preoperative information about the possibility of visual phenomena during surgery, while the other group was not informed. Group Classification: Group 1 (Informed group): This information was included in the preoperative counselling session and added to the consent forms. Group 2 (Non-informed group) Data Collection: Patient Survey: The survey included questions about their emotional state, whether they were surprised or distressed by any visual phenomena, and how well they felt prepared for the surgery. Apprehension Scoring: Likert scale (non continuous) along with open-ended questions to gather qualitative feedback on patient experiences and Visual Analogue Score (continuous) was also used. Result(s): Preliminary data suggests that a significant number of patients experience distress due to the visual phenomena during cataract surgery. Incorporating this information into the consent forms is expected to better prepare patients for the procedure, thereby improving their overall experience and reducing unnecessary anxiety. Informed Group: The group that was informed about potential visual disturbances prior to surgery reported significantly lower levels of anxiety during the procedure. The mean apprehension score for this group was 2.1 +/- 0.8, with 72% of patients rating their apprehension as mild or minimal (scores 1-2). Statistical analysis revealed a significant difference in apprehension scores between the informed and non-informed groups (p < 0.01). Non-informed Group: The non-informed group showed a higher level of distress, with a mean apprehension score of 3.8 +/- 1.2. A larger proportion of patients in this group (43%) reported moderate to high distress (scores 4-5). The difference in distress between the two groups was statistically significant (p < 0.001). Chi-Square Test Results: The chi-square test indicated a significant difference in the frequency of patients reporting surprise or discomfort related to visual phenomena, with 55% of the non-informed group expressing surprise, compared to just 20% in the informed group (chi2 =14.68, p < 0.01). Confidence Interval: The 95% confidence interval for the mean difference in apprehension scores between the informed and non-informed groups was (1.3, 2.4), suggesting a moderate -large effect size in the reduction of patient anxiety when preoperative information was provided. Conclusion(s): Statistical analysis substantiated that reduction in anxiety was clinically and statistically significant(p < 0.01). Cataract surgery remains a common procedure in ophthalmology in elderly patients, many with diverse co-morbidities. A proposal is advanced to revise the informed consent documents and preoperative counselling protocols to include comprehensive details about the potential visual phenomena that patients may encounter postoperatively. An enhanced cataract consent framework should be regarded as an integral aspect of evidence-based, patient-centred care, ensuring patients are thoroughly educated and psychologically prepared for surgery.

DOI: 10.1038/s41433-025-03831-0

Top 12 "wet macular conditions" that do not require intravitreal anti vascular endothelial growth factor (anti-VEGF) injections. (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Rao P.; *Perera L.; Garikapati N.; *Godbole K.; *Zaw S.-N.; *Mathew N.M.; Veeramani P.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 271), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: Intravitreal injections of anti-VEGF drugs have revolutionised the management of wet age related macular degeneration (ARMD), retinal vein occlusion (RVO) and diabetic maculopathy over the last 18 years in the UK. In the year 2022 over 677,000 intravitreal injections were performed in England alone (4796 per 100,000 population). In the UK over 75% of intravitreal injections are performed by allied health professionals such as nurses, optometrists and orthoptists. Although anti-VEGF injections are only NICE approved for 4 main conditions (wet ARMD, retinal vein occlusion, diabetic maculopathy and myopic choroidal neovascular membrane(CNV))often clinicians are faced with clinical presentations that mimic the 4 main indications thereby making the clinical decision to treat or not treat a particular patient with anti-VEGF injections difficult. Method(s): We have retrospectively reviewed the case records of patients attending rapid access clinics and intravitreal injection clinics over a 4 year period to identify macular and retinal conditions that mimic the four major NICE approved indications for intravitreal anti-VEGF injections. Result(s): We identified 12 such clinical conditions: 1) Adult vitelliform macular degeneration 2) Peripapillary pachychoroid syndromes 3) Central serous retinopathy 4) Intraretinal fluid overlying the old disciform macular scars 5) Retinal pigment epithelial rips involving the fovea 6) Old BRVO/ CRVO with extrafoveal macular oedema/ thickening 7) Macular oedema/ haemorrhage secondary to a macroaneurysm 8) Peripapillary CNV without involvement of the macula 9) Macular oedema secondary to epiretinal membrane 10) Inactive CNV: slow growing lesion with minimal fluid leakage and stable vision. 11) Transient foveal oedema due to microaneurysms close to foveola 12) Macular oedema mistaken for vein occlusions and Diabetic maculopathy a) Post operative cystoid macular oedema (CMO) b) CMO in hereditary dystrophies c) Drug (toxic) related macular oedema. Conclusion(s): We have identified the most common macular / retinal conditions for which anti-VEGF therapies are not necessarily of benefit. In a large cohort of injection patients it is not unusual to find some patients with other varied pathologies receiving anti-VEGF injections with limited or no benefit. We believe that it is important to highlight these varied pathologies to all clinicians to avoid inappropriate treatments. We demonstrate each category of patients with evidence on multimodal imaging to support the diagnosis and also of suboptimal outcomes.

DOI: 10.1038/s41433-025-03831-0

Adult vitelliform macular degeneration: a new United Kingdom perspective (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Rao P.; *Zaw S.-N.; Garikapati N.; *Godbole K.; Veeramani P.; *Perera L.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 244-245), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: With emergence of new imaging technology adult vitelliform macular degeneration (AVMD) is being diagnosed with increasing frequency over the last two decades. The condition is often mistaken for wet age-related macular degeneration (ARMD) when the vitelliform material starts scrambling showing pseudo fluid in optical coherence tomography (OCT) scans. In addition, in some AVMD patients the vitelliform lesions in fact do develop choroidal neovascularisation (CNV) requiring urgent intravitreal injections. We aim to highlight the prevalence, natural progression and treatment options for patients presenting with AVMD. Method(s): We have retrospectively analysed 123 eyes of 82 patients of AVMD presented to this department over the last 4 years. Result(s): We identified 44 females and 38 males, 41 patients with bilateral involvement at presentation. The clinical findings varied from a classical sub foveal yellow lesion to partial empty spaces within the lesion, to complete atrophic scar following resorption of all the colloid material. The presenting Visual acuity in the worse eye also varied from 6/9 to HM according to the stage of degeneration they presented with. Thirty-nine patients were asymptomatic and AVND was an incidental finding in one of their eyes. We have obtained serial optical coherence tomography (OCT) scan to monitor the progress whenever possible. All patients had OCT, optical coherence tomographic angiography (OCTA), and fundus autofluorescence (FAF). Some patients in addition underwent fundus fluorescein angiography (FFA) and indocyanine green angiography (ICG) when a choroidal neovascular membrane (CNVM) was suspected. Sixty nine of 82 patients did not need any active interventions. Fourteen patients were already taking antioxidant supplementations. Thirteen patients have developed significant subretinal fluid (SRF) and were treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. On further reviewing of the OCTA scans and FFA only 10 of 13 showed active CNVM. The other 3 patients only had passive subretinal fluid with no evidence of CNVM. Therefore only 12 % of AVMD patients seem to have developed wet ARMD in our series. Response to the anti-VEGF injections was suboptimal in AVMD patients with CNV compared to a case of conventional wet ARMD. This unfavourable response was most likely due to pre-existing long standing atrophic and degenerative changes. Contrary to earlier publications, based on family history alone we did not find any strong evidence of autosomal dominance inheritance therefore we prefer to call it a degenerative rather than dystrophic condition. Conclusion(s): With increasing use of OCT imaging by optometrists and primary care physicians more patients are being diagnosed with macular pathology, AVMD is one such condition. Most of these patients do not need any active interventions or long term follow ups in hospital clinics. Our study shows only 12% of AVMD patients go on to develop CNV requiring intravitreal anti-VEGF injections. As our cohort shows it may not be unusual to mistake passive fluid lakes within vitelliform lesions for active wet ARMD. It is important for clinicians to be aware of the possibility of AVMD with passive subretinal fluid and not to resort to unnecessary long term intravitreal anti-VEGF injections. As we have shown even in cases of AVMD with secondary CNV the prognosis is poor for long term retention of central vision.

DOI: 10.1038/s41433-025-03831-0