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Abstract: The provision of breast cancer care tends to vary substantially from one breast unit to another. To provide state-of-the-art patient-centered care to women diagnosed with breast cancer, adoption and adherence to structured treatment algorithms, protocols, and international guidelines are essential. In this review, we endeavor to audit breast cancer care at our tertiary cancer center against published EUSOMA guidelines. This was a retrospective study with an observational design. All patients who completed recommended treatment for breast diseases at our institute from January 1, 2018 to December 31, 2018 were included and evaluated. Data were retrieved from patient e-prescriptions and medical records. Analysis was performed using Microsoft Office 2010 to measure how our practices compared to EUSOMA quality indicators (QIs). Clinical assessments, imaging, and preoperative work-up of breast cancer patients met EUSOMA standards. Prognostic and predictive characterization of tumors was performed in all cases. Surgical management of invasive cancer and ductal carcinoma in situ (DCIS) was in accordance with the guidelines. Adherence to postoperative radiation and adjuvant endocrine therapy was adequate. More mastectomies were performed in patients with invasive cancers measuring <3 cm. Overtreatment was avoided in every other subgroup. Adjuvant and neoadjuvant chemotherapy and targeted adjuvant therapy were adequately utilized unlike neoadjuvant targeted therapy. Minimal attrition was noted in patient follow-up. This extensive audit has set a benchmark for future annual audits and helped highlight areas where improvement of service delivery is needed., (Copyright © 2024 Copyright: © 2024 Indian Journal of Cancer.)

Competing Interests: Conflict of InterestThe authors declare no competing interests.

Telemedicine has revolutionized areas of medical practice and care. It has a potential in field of continuum of cancer care in India. SARS-CoV-2 has highlighted the potential use of this tool effectively. Scope of newer applications of telemedicine in field of cancer is reviewed in current paper enlisting benefits to patient, healthcare providers and centers in a developing country like India. Each of them is supported by appropriate evidence and examples. An analysis of strengths and opportunities when compared with weakness and threats brings out how telemedicine can redistribute oncology work force in a rational way and minimize disruption caused by the pandemic. Telemedicine can be utilized in cancer management starting from prevention, screening, diagnosis, treatment and rehabilitation to palliative care., (© 2023 Indian Council of Medical Research.)

Sentinel lymph node biopsy is an established practice to avoid axillary clearance, in clinically negative axilla, in breast cancer patients. Sentinel nodes harvested by dual technique, if found negative on intraoperative frozen section, can prevent breast cancer patient from a potentially debilitating complete axillary clearance. Hence, analyzing the institutional accuracy of this technique and comparing it with international standards, becomes important in providing optimal treatment to these patients. A retrospective analysis of all patients who had undergone sentinel lymph node biopsy at our institute from December 2014 to December 2018 was carried out. At our institute, sentinel lymph nodes are identified using dual technique of methylene blue and radiocolloid dye. Intraoperative frozen section of these hot or blue or any enlarged nodes is performed. Patients with positive frozen section undergo complete axillary clearance. All frozen and unfrozen biopsy material is subjected to further paraffin sectioning and immunohistochemistry. False negative rate and factors associated with were analyzed. A total number of 424 patients had undergone intraoperative frozen section for the sentinel node in breast cancer at our institute during the study period. Among these, 307 patients had negative sentinel nodes and 117 had positive sentinel nodes of frozen section. Seventeen patients out of 307 had lymph node metastases in final paraffin report (false negative rate = 12.6%). Two of these were found to have macrometastasis, 13 had micrometastasis and 2 had isolated tumor cells on final immunohistochemistry report. Size of metastases to sentinel lymph node was found to be a statistically significant contributor to higher false negative rate. Sentinel lymph node biopsy using intraoperative frozen section, is a sensitive and specific technique of staging axilla in breast cancer patients. Detection of micrometastasis and isolated tumor cells present a technical challenge and are associated with higher false negative rates., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© Indian Association of Surgical Oncology 2021.)

Hereditary breast cancer (HBC) accounts for 5-10% of all breast cancer patients. Mutations in BRCA 1 and 2 are the most common culprits of HBC. These patients have a much higher lifetime risk of developing breast cancer than the non-carriers. Thus these high-risk patients qualify to receive risk-reducing measures in form of close surveillance, chemoprophylaxis, or sometimes even risk-reducing surgeries in high penetrance mutation carriers. We report a case of bilateral risk-reducing prophylactic mastectomies (B/L RRM) and bilateral risk-reducing salpingo-oophorectomy (B/L RRSO) performed in a 37-year-old healthy BRCA 1 carrier. Although, this is an age-old practice, its acceptance in India has been low for reasons such as cost of surgery, social stigma, lack of awareness, fear of visiting an oncology clinic, surgery and reconstruction, or loss of a healthy organ; and more acceptance towards other risk reduction methods., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© Indian Association of Surgical Oncology 2021.)

In the last two decades, surgical methods for axillary staging in breast cancer patients have become less extensive, and full axillary lymph node dissection (ALND) is confined to selected patients. In initially node-positive patients undergoing neoadjuvant chemotherapy, however, the optimal management remains unclear. Current guidelines vary widely, endorsing different strategies. We performed a literature review on axillary staging strategies and their place in international recommendations. This overview defines knowledge gaps associated with specific procedures, summarizes currently ongoing clinical trials that address these unsolved issues, and provides the rationale for further research. While some guidelines have already implemented surgical de-escalation, replacing ALND with, e.g., sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) in cN+ patients converting to clinical node negativity, others recommend ALND. Numerous techniques are in use for tagging lymph node metastasis, but many questions regarding the marking technique, i.e., the optimal time for marker placement and the number of marked nodes, remain unanswered. The optimal number of SLNs to be excised also remains a matter of debate. Data on oncological safety and quality of life following different staging procedures are lacking. These results provide the rationale for the multinational prospective cohort study AXSANA initiated by EUBREAST, which started enrollment in June 2020 and aims at recruiting 3000 patients in 20 countries (NCT04373655; Funded by AGO-B, Claudia von Schilling Foundation for Breast Cancer Research, AWOgyn, EndoMag, Mammotome, and MeritMedical).

Newer advances in breast cancer management have led to increased disease free survival and overall survival. It is important to prevent debilitating complications after axillary lymph node dissection (ALND) to be able to successfully translate this survival benefit to quality of life benefit. By reducing disruption of lymphatic channels, sentinel lymph node biopsy (SLNB) decreases incidence of lymphedema (LE). Initiating early physiotherapy regimens, too, improves arm symptoms. In this review, we analyze the incidence of LE at our center and compare it with western literature. Retrospective analysis of all post-surgery breast cancer 18 patients, who followed up routinely with our oncophysiotherapist, was carried out. Incidence of LE in patients undergoing SLNB or ALND was followed up for a mean period of 17.5 months. Only 3.6%, i.e., 6 patients out of 166 developed LE. Amongst 166, 80 had only SLNB; the rest had ALND (either upfront or post-positive SLNB). None of the SLNB only cohort patients developed LE. SLNB in clinically node negative axilla, followed by initiation of arm physiotherapy early in post-operative period, may reduce LE incidence in breast cancer patients., (© Indian Association of Surgical Oncology 2020.)

Background and Aims: Dexmedetomidine has been demonstrated to be safe and efficacious in prolonging the duration of peripheral nerve blocks. This study was designed to compare the duration, quality of postoperative analgesia, hemodynamic stability, and patient's satisfaction with addition of dexmedetomidine to bupivacaine versus plain bupivacaine in pectoral nerve block (Pecs) type I and II in breast surgeries., Material and Methods: This prospective randomized double-blind study was carried out in 60 American Society of Anesthesiologists grade I-III female patients, aged 18-70 years randomly allocated into two equal groups. Group A received 10 ml 0.25% bupivacaine for pecs I block and 20 ml 0.25% bupivacaine for pecs II block. Group B received 10 ml 0.25% bupivacaine with dexmedetomidine for pecs I block and 20 ml 0.25% bupivacaine with dexmedetomidine in pecs II block, keeping a total dose of dexmedetomidine of 1 μg/kg body weight and the volume constant in both the groups., Results: Numerical rating scores at rest and on abduction of arm were significantly lower in Group B. There was a 40% increase in duration of complete analgesia in dexmedetomidine group (1024.0 ± 124.9 min) compared to plain bupivacaine (726.4 ± 155.3 min; P < 0.001). Total consumption of injection diclofenac sodium in 24 h was 23% less in Group B (77.5 ± 13.6 mg) compared to Group A (100.0 ± 35.9 mg, P = 0.003). Patient satisfaction score was significantly better in dexmedetomidine group. No adverse effects were noted in either group., Conclusion: Dexmedetomidine as an adjunct to bupivacaine helps prolong the duration and improves the quality of postoperative analgesia in pecs I and II block without serious side effects., Competing Interests: There are no conflicts of interest.