30 research outputs found
Improved false negative rate of axillary status using sentinel lymph node biopsy and ultrasound-suspicious lymph node sampling in patients with early breast cancer
Sentinel Node Identification Rate and Nodal Involvement in the EORTC 10981-22023 AMAROS Trial
Background
The randomized EORTC 10981-22023 AMAROS trial investigates whether breast cancer patients with a tumor-positive sentinel node biopsy (SNB) are best treated with an axillary lymph node dissection (ALND) or axillary radiotherapy (ART). The aim of the current substudy was to evaluate the identification rate and the nodal involvement.
Methods
The first 2,000 patients participating in the AMAROS trial were evaluated. Associations between the identification rate and technical, patient-, and tumor-related factors were evaluated. The outcome of the SNB procedure and potential further nodal involvement was assessed.
Results
In 65 patients, the sentinel node could not be identified. As a result, the sentinel node identification rate was 97% (1,888 of 1,953). Variables affecting the success rate were age, pathological tumor size, histology, year of accrual, and method of detection. The SNB results of 65% of the patients (n = 1,220) were negative and the patients underwent no further axillary treatment. The SNB results were positive in 34% of the patients (n = 647), including macrometastases (n = 409, 63%), micrometastases (n = 161, 25%), and isolated tumor cells (n = 77, 12%). Further nodal involvement in patients with macrometastases, micrometastases, and isolated tumor cells undergoing an ALND was 41, 18, and 18%, respectively.
Conclusions
With a 97% detection rate in this prospective international multicenter study, the SNB procedure is highly effective, especially when the combined method is used. Further nodal involvement in patients with micrometastases and isolated tumor cells in the sentinel node was similar—both were 18%
Training in crisis communication and volcanic eruption forecasting:Design and evaluation of an authentic role-play simulation
We present an interactive, immersive, authentic role-play simulation designed to teach tertiary geoscience students
in New Zealand to forecast and mitigate a volcanic crisis. Half of the participating group (i.e., the Geoscience Team)
focuses on interpreting real volcano monitoring data (e.g., seismographs, gas output etc.) while the other half of the
group (i.e., the Emergency Management Team) forecasts and manages likely impacts, and communicates emergency
response decisions and advice to local communities. These authentic learning experiences were aimed at enhancing
upper-year undergraduate students’ transferable and geologic reasoning skills. An important goal of the simulation was
specifically to improve students’ science communication through interdisciplinary team discussions, jointly prepared,
and delivered media releases, and real-time, high-pressure, press conferences.
By playing roles, students experienced the specific responsibilities of a professional within authentic organisational
structures. A qualitative, design-based educational research study was carried out to assess the overall student experience
and self-reported learning of skills. A pilot and four subsequent iterations were investigated.
Results from this study indicate that students found these role-plays to be a highly challenging and engaging learning
experience and reported improved skills. Data from classroom observations and interviews indicate that the students
valued the authenticity and challenging nature of the role-play although personal experiences and team dynamics
(within, and between the teams) varied depending on the students’ background, preparedness, and personality.
During early iterations, observation and interviews from students and instructors indicate that some of the goals of the
simulation were not fully achieved due to: A) lack of preparedness, B) insufficient time to respond appropriately, C)
appropriateness of roles and team structure, and D) poor communication skills. Small modifications to the design of
Iterations 3 and 4 showed an overall improvement in the students’ skills and goals being reached.
A communication skills instrument (SPCC) was used to measure self-reported pre- and post- communication competence
in the last two iterations. Results showed that this instrument recorded positive shifts in all categories of self-perceived
abilities, the largest shifts seen in students who participated in press conferences. Future research will be aimed
at adapting this curricula to new volcanic and earthquake scenarios
A comprehensive overview of radioguided surgery using gamma detection probe technology
The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology