Browsing by Author "Malherbe, Francois"

Now showing 1 - 9 of 9
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    A Clinical Approach to Common Surgical Scenarios: A Handbook for Students and Junior Doctors
    (The Authors, 2020-01) Panierie, Eugenio; Cairncross, Lydia; Boutall, Adam; Bernon, Marc; Malherbe, Francois; Panieri, Eugenio; Malherbe, Francois
    Aimed at students and junior doctors, the purpose of this book is to provide a guide to the evaluation of common surgical problems as well as test diagnostic and troubleshooting skills when there is nobody to help or ask for advice.
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    Correction to: Diagnostic accuracy of the Xpert MTB/Rif Ultra for tuberculosis adenitis
    (2020-03-02) Antel, Katherine; Oosthuizen, Jenna; Malherbe, Francois; Louw, Vernon J; Nicol, Mark P; Maartens, Gary; Verburgh, Estelle
    After publication of the original article [1], we were notified that there is a mistake in the article note.
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    Delay in provision of breast cancer care in patients seen at a district hospital diagnostic breast unit in South Africa
    (2018) Ng'ang'a, Mukuhi; Panieri, Eugenio; Malherbe, Francois
    Background: There is evidence to show that delays in breast cancer management are detrimental to patient outcome. The aim of this study was to determine time trends and causes of delay in a newly established diagnostic breast clinic based at a district hospital in South Africa. Method: All patients who presented to Mitchells Plain District Hospital Breast Clinic from January to December 2015 and had a diagnosis of breast cancer were included in this study. The intervals between the time she first noted her symptoms to initial contact with a health professional and delivery of definitive therapy was documented. Patient delay referred to the interval from when the patient first noted her symptoms to her initial contact with a health care provider. Provider delay referred to the interval between the first hospital visit and onset of therapy. Result: A total of 33 patients were enrolled in this study. The median overall total delay (time lapse between the moment the patient first noticed her symptoms to time definitive anti-cancer treatment was started) was 157days, (range 29 to 839 days). Median patient delay (time lapse between the moment the patient first noticed her symptoms and the visit to a health professional) was 56 days, (range 7 to 730 days). Median overall provider delay (time lapse between the patients' first encounter with a clinician to time definitive anti-cancer treatment was started) was 84 days, (range 22 to 338 days). Median Referral delay was 11 days (range 4 to 39 days). Median Diagnostic delay was 15 days (range 9 to 135 days) and median treatment delay was 45 days (range 5 to 246 days). Conclusion: The median overall total delay for patients diagnosed with breast cancer at Mitchells Plain District Hospital does not compares well with institutions in developed nations but it is similar to studies done in developing nations. The largest contributor to this delay was patient delay. The main contributors to provider delay was related to diagnosis (almost exclusively related to tissue diagnosis) and treatment (mainly patients who received surgery as their first definitive therapy).
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    Diagnostic accuracy of the Xpert MTB/Rif Ultra for tuberculosis adenitis
    (2020-01-13) Antel, Katherine; Oosthuizen, Jenna; Malherbe, Francois; Louw, Vernon J; Nicol, Mark P; Maartens, Gary; Verburgh, Estelle
    Abstract Background The WHO recently recommended the new Xpert MTB/RIF Ultra assay (Ultra) instead of the Xpert MTB/RIF assay because Ultra has improved sensitivity. We report the diagnostic accuracy of Ultra for tuberculous adenitis in a tuberculosis and HIV endemic setting. Methods We obtained fine-needle aspirates (FNA) and lymph node tissue by core-needle biopsy in adult patients with peripheral lymphadenopathy of >20 mm. Ultra and mycobacterial culture were performed on FNA and tissue specimens, with histological examination of tissue specimens. We assessed the diagnostic accuracy of Ultra against a composite reference standard of ‘definite tuberculosis’ (microbiological criteria) or ‘probable tuberculosis’ (histological and clinical criteria). Results We prospectively evaluated 99 participants of whom 50 were HIV positive: 21 had ‘definite tuberculosis’, 15 ‘probable tuberculosis’ and 63 did not have tuberculosis (of whom 38% had lymphoma and 19% disseminated malignancy). Using the composite reference standard the Ultra sensitivity on FNA was 70% (95% CI 51–85; 21 of 30), and on tissue was 67% (45–84; 16/24) these were far superior to the detection of acid-fast bacilli on an FNA (26%; 7/27); AFB on tissue (33%; 8/24); or tissue culture (39%; 9/23). The detection of granulomas on histology had high senstivity (83%) but the lowest specficity. When compared with culture the Ultra on FNA had a sensitvity of 78% (40-97; 7/9) and tissue 90% (55-100; 9/10). Conclusions Ultra performed on FNA or tissue of a lymph node had good sensitivity and high specificity. Ultra had a higher yield than culture and has the advantage of being a rapid test. Ultra on FNA would be an appropriate initial investigation for lymphadenopathy in tuberculosis endemic areas followed by a core biopsy for histopathology with a repeat Ultra on tissue if granulomas are present.
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    Localization Techniques for Non-Palpable Breast Lesions: Current Status, Knowledge Gaps, and Rationale for the MELODY Study (EUBREAST-4/iBRA-NET, NCT 05559411)
    (Multidisciplinary Digital Publishing Institute, 2023-02-12) Banys-Paluchowski, Maggie; Kühn, Thorsten; Masannat, Yazan; Rubio, Isabel; de Boniface, Jana; Ditsch, Nina; Karadeniz Cakmak, Güldeniz; Karakatsanis, Andreas; Dave, Rajiv; Hahn, Markus; Potter, Shelley; Kothari, Ashutosh; Gentilini, Oreste Davide; Gulluoglu, Bahadir M.; Lux, Michael Patrick; Smidt, Marjolein; Weber, Walter Paul; Aktas Sezen, Bilge; Krawczyk, Natalia; Hartmann, Steffi; Di Micco, Rosa; Nietz, Sarah; Malherbe, Francois; Cabioglu, Neslihan; Canturk, Nuh Zafer; Gasparri, Maria Luisa; Murawa, Dawid; Harvey, James
    Background: Surgical excision of a non-palpable breast lesion requires a localization step. Among available techniques, wire-guided localization (WGL) is most commonly used. Other techniques (radioactive, magnetic, radar or radiofrequency-based, and intraoperative ultrasound) have been developed in the last two decades with the aim of improving outcomes and logistics. Methods: We performed a systematic review on localization techniques for non-palpable breast cancer. Results: For most techniques, oncological outcomes such as lesion identification and clear margin rate seem either comparable with or better than for WGL, but evidence is limited to small cohort studies for some of the devices. Intraoperative ultrasound is associated with significantly higher negative margin rates in meta-analyses of randomized clinical trials (RCTs). Radioactive techniques were studied in several RCTs and are non-inferior to WGL. Smaller studies show higher patient preference towards wire-free localization, but little is known about surgeons’ and radiologists’ attitudes towards these techniques. Conclusions: Large studies with an additional focus on patient, surgeon, and radiologist preference are necessary. This review aims to present the rationale for the MELODY (NCT05559411) study and to enable standardization of outcome measures for future studies.
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    Neoadjuvant endocrine therapy for estrogen receptor positive breast cancer in an African setting
    (2022) Molabe, Hunadi; Malherbe, Francois
    Background Several studies have reported response rates for ER positive cancers on neoadjuvant endocrine therapy (NET), with lower toxicity compared to neoadjuvant chemotherapy (NCT). During the first wave of the COVID pandemic, clinician preference for NET increased significantly, buying time for hospital recovery before proceeding to surgery. To date, no studies have yet explicitly reported on the use of NET in an African context. Methods This study was a retrospective review, looking at breast cancer patients who received NET between 01 March 2019 to 31 December 2020 at Groote Schuur Hospital. Patients were included if they were female, older than 18 years, ER positive, and had a biopsy-proven breast cancer less than 50mm in size on clinical exam. Results There were 16 patients included in the study, of which all were female. The mean age was 59 years (range 41-75). When comparing the histological measurement to initial size on imaging, 7 patients had an excellent response to NET with tumours that decreased in size, whereas 9 patients had tumours that increased in size despite NET. There was no statistically significant difference between the two groups in terms of patient and pre-treatment tumour characteristics, pathological results, endocrine therapy, surgical therapy, or adjuvant oncological therapy. For the 9 patients who had progression on NET, the post resection median tumour size was more than double the pre-NET tumour size, as determined on imaging. Conclusion Until further studies can be performed in this setting, NET should be used with caution in situations where there will be a significant delay to surgery.
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    Pathological response of breast cancer to neo-adjuvant chemotherapy at a single tertiary centre with no access to Trastuzumab
    (2024) Khamajeet, Arvin; Malherbe, Francois
    Introduction: Neoadjuvant chemotherapy (NACT) has firmly solidified its status as the gold standard in the treatment of breast cancer for eligible patients. While prevailing guidelines advocate for a combined approach involving chemotherapy and Trastuzumab for individuals with HER2-positive breast cancer, Groote Schuur Hospital faces constraints in administering Trastuzumab due to cost-related considerations. This study delves into the impact of neoadjuvant chemotherapy on breast cancer patients, specifically focusing on the response of local patients who are HER2-positive and do not receive Trastuzumab. Methods A retrospective audit was conducted on all patients who underwent NACT followed by surgical intervention, to assess response, between 1 January 2017 and 31 December 2018 within the Cape Town, Metro West surgical platform. Comprehensive data were gathered about tumour dimensions, axillary staging, tumour subtype, and treatment response. Results Data from 160 tumours were included. Predominantly, the cohort comprised women (97.5%, n=156), with a smaller representation of men (2.5%, n=4). In terms of surgical approach, a majority of patients underwent mastectomy (88%,n=141 ), while a minority opted for breast-conserving surgery (12%, n=19). The most common histology was infiltrating ductal carcinoma (94%, n=151), followed by infiltrating lobular carcinoma (3.8%, n=6). The analysis of NACT responses revealed a spectrum of outcomes: overall, 21% of patients achieved a pathological complete response (pCR), 31% demonstrated a partial response, 31% exhibited stable disease, and 17% experienced disease progression. Notably, triple-negative breast cancer displayed the most favourable response, with a pCR rate of 32% (p<0.005). In contrast, patients with ER-positive/HER2-negative tumours exhibited the least favourable response, with 2.9% achieving pCR (p<0.05). ER-negative/HER2-positive patients demonstrated a pCR rate of only 6.7% (p=0.215). Conclusion: Neoadjuvant chemotherapy appears particularly beneficial for patients with triple-negative breast cancer. This study reveals a significantly lower pCR rate in ER-negative/HER2-positive patients, even when compared to studies where Trastuzumab was not administered. For HER2-positive patients, the addition of Trastuzumab is advocated to augment the likelihood of achieving pCR and thereby improve overall survival rates.
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    Sentinel Lymph Node Biopsy in a Resource Limited Setting: A Retrospective Comparison of Sentinel Lymph Node Biopsy before and after the introduction of SentiMag at an Academic Breast Unit
    (2022) Yousef, Mazen Mohamed S; Malherbe, Francois
    Background: Sentinel lymph node biopsy (SLNB) is performed for the staging and prognostication of breast cancer in cases with a clinically and radiologically negative axilla. Using blue dye and a radioactive colloid injection is considered the gold standard for SLNB. This study aims to evaluate the SLNB outcomes before and after the introduction of SentiMag at an academic breast unit Methods: A retrospective cohort study was performed comparing SLNBs done from (1 January 2017 to 31 December 2017) and (1 January 2018 to 31 December 2018). During 2017 all SLNBs were done with a nuclear medicine technique and in 2018 the Sentimag system was used. Results: There was no difference between the 2 groups comparing age, T-stage, size of tumour, grade of tumour and molecular status. The only statistically significant difference found was more higher-grade tumours in the group where a nuclear medicine technique was used (2017) p=0.04. There was no difference in the type of surgery performed comparing mastectomy and breast conserving surgery rates between the 2 groups. There was an 11% increase in the number of patients who had a SLNB done with the SentiMag technique (2018). In 2017 42% (58/139) had a SLNB and in 2018 53% (59/112) had a SLNB Conclusion: This result demonstrates the feasibility of the magnetic technique for SLNB in a resource constrained low- and middle-income country. This new method has none of the disadvantages of the standard technique and is promising as a safe and effective alternative in the absence of nuclear medicine facilities.
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    Systems delays in the management of malignant breast disease
    (2016) Dalwai, Ebrahim; Malherbe, Francois
    Centralised multidisciplinary management of breast cancer occurs in KwaZulu-Natal, South Africa and requires a diagnostic and staging pathway at the referring hospital. Delays in this pathway are unknown. This study, conducted at a referring hospital, R K Khan (RKK), quantifies and analyses these delays. A retrospective folder review included all patients with breast cancer diagnosed at RKK from January 2008 to January 2009. Data extraction included demographic data, time to diagnosis and initial staging using a standardised datasheet. Specific care steps were identified, namely delays to initial imaging with mammography, pathology confirmation, staging workup and eventual referral to a centralised breast clinic.