Maidstone and Tunbridge Wells NHS Trust

Abstract Background Idiopathic granulomatous mastitis (IGM) is a rare, benign breast disease characterised by granulomatous inflammation. Current literature mainly comprises of small-sized retrospective studies with no well-designed clinical trials and limited representation of UK population. With no consensus to guide clinical practice there is a significant risk of delayed diagnosis and variation in management strategies that may adversely affect patient outcomes Methods ENIGMA is a multi-stage programme of work aiming to develop guidelines for the diagnosis and management of IGM in the UK. A scoping review will assess the range and quality of existing evidence, focusing on its relevance to UK practice. Findings from this review will inform a national practice questionnaire (NPQ) to capture current approaches to IGM care across the UK. These data, combined with a modified Delphi process involving experts and stakeholders, will support guideline development and help define priority research questions to advance best practice. Progress The scoping review identified 225 papers, involving 13 062 patients, mostly from Turkey, the USA, and China. Only three studies, covering 25 patients, originated from the UK. Commonly reported ethnic groups were Hispanic and Turkish. Risk factors include smoking and hormonal influences such as oestrogen and prolactin. Reported treatment strategies range from conservative approaches to medical therapies (antibiotics, steroids, immunosuppressants) and surgical interventions (drainage or excision). Preliminary results of the NPQ highlight substantial heterogeneity in UK diagnostic and management practices. Once the NPQ analysis is complete, the working group will initiate the Delphi process to establish consensus and inform guideline development.

Abstract Background: Detection of circulating tumour DNA (ctDNA) in plasma predicts future recurrence in early breast cancer (EBC). Previous studies have relied on tumour-informed approaches with personalised assays. In this study, we performed orthogonal testing on plasma samples collected prospectively in the c-TRAK-TN study to compare a tissue-free assay with digital droplet PCR (ddPCR) for ctDNA analysis. Methods: c-TRAK-TN recruited 161 patients with early triple negative breast cancer (TNBC) deemed clinically high risk of relapse. Patients underwent ctDNA analysis by ddPCR starting within 4 weeks of completion of treatment and continuing every 3 months for up to 2 years. ddPCR tracked 1 or 2 patient specific variants as previously described. We further analysed 1062 timepoints from a total of 159 patients (median 7 per patient, range 1-11) using Guardant Reveal assay, a tissue-free approach that exploits differential methylation patterns in breast cancer compared with normal tissue. Results: Samples were successfully analysed from 95.3% (1012/1062) timepoints from 159 patients with the tissue-free Reveal assay. CtDNA was detected in 34.0% (54/159) of patients in at least 1 timepoint, with a median methylation tumour fraction of 0.266% (range 0.002 to 51.0%). Detection of ctDNA with the tumour agnostic assay strongly associated with future risk of relapse (HR 20.62, p<0.0001; logrank). Of patients who relapsed by 24 months follow up, 89.5% (34/38) of relapses were detected by prior ctDNA analysis. There were 159 patients available for comparison between ddPCR and the tissue-free assay (Reveal), in 1005 timepoints (median 7 per patient, range 1-11). Concordant test results were observed in 950/1005 timepoints with an overall agreement rate of 94.5%. In this cohort, 63.5% (101/159) of patients did not have ctDNA detected by either assay; 26.4% (42/159) had ctDNA detected by both assays and 10.1% (16/159) had discordant results. Of those detected, 44.8% (26/58) were detected by the tissue-free assay first and 6.9% (4/58) by ddPCR (p<0.0001, Fisher exact test). The median time from first detection of ctDNA to relapse for the tissue-free assay was 7.9 months (95% confidence interval (CI): 5.7-10.5 months) compared to ddPCR assay with 5.7 months (95% CI: 2.9-9.7 months) (HR = 0.6, p=0.0574; mixed effects cox model). Conclusion: Detection of ctDNA with a tissue-free assay anticipated relapse with high accuracy, in patients with early TNBC. The tissue-free assay frequently detected ctDNA at an earlier timepoint than ddPCR, trending towards a longer lead time from detection of ctDNA to relapse. Tissue-free approaches might offer simpler workflows for ctDNA analysis than tumour-informed approaches, and further assessment in clinical trials is warranted. Citation Format: N. Cunningham, R. J. Cutts, C. Swift, K. Dunne, M. Dewan, L. Kilburn, K. Goddard, P. Hall, C. Harper-Wynne, T. Hickish, I. Macpherson, A. Okines, A. Wardley, S. Waters, C. Palmieri, M. Winter, J. Bliss, D. Dustin, M. Ellis, I. Garcia- Murillas, N. C. Turner. Tissue-free circulating tumour DNA detection in patients with early triple negative breast cancer from the c-TRAK-TN trial [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr RF3-05.

Primary mucinous adenocarcinoma (PMAC) of the urethra is an exceptionally rare subtype of primary urethral carcinoma, with limited published data to guide diagnosis or treatment. Most literature consists of isolated case reports, and the non-specific presentation often delays diagnosis. This report presents two further cases and a review of the literature with a view to expand current understanding. We report two cases of PMAC. The first involves a 67-year-old male with progressive lower urinary tract symptoms initially treated as benign prostatic hyperplasia. Histology following a transurethral resection of the prostate revealed invasive mucinous adenocarcinoma with enteric features. He underwent radical prostatectomy, chemotherapy and radiotherapy for metastatic disease. The second case is a 52-year-old female with chronic urinary symptoms and a urethral mass initially misattributed to being from gynaecological origin. However, a biopsy later confirmed mucinous adenocarcinoma of the urethra. She underwent chemotherapy and radiotherapy, with partial response, but later developed further metastatic spread and is now undergoing palliative chemotherapy. PMAC is aggressive, often presents with non-specific urinary symptoms and lacks standardised diagnostic or treatment protocols. These cases highlight the importance of early detection through biopsies, immunohistochemical analysis and a multidisciplinary approach. Broader awareness and further reporting of cases are essential to develop evidence-based diagnostic and treatment guidelines for this rare malignancy.

Intraoperative neurophysiological monitoring (IONM), including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs), aims to reduce ischemic complications during unruptured intracranial aneurysm clipping. This systematic review focuses on the clinical value of IONM. We systematically searched PubMed, Medline, and Embase up to January 2025 for studies reporting neurological outcomes after microsurgical clipping of unruptured intracranial aneurysms with IONM. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, outcomes included new neurological deficits at discharge and at first follow-up. In addition to summarizing complication rates across IONM modalities, we conducted an individual patient data analysis to evaluate the predictive value of IONM signal changes. Receiver operating characteristic curve analysis was used to define optimal duration thresholds for reversible IONM changes associated with neurological outcomes. Seventeen studies (3222 patients) were included, with consistent anesthetic protocols, typical demographic characteristics, and modality use aligned with aneurysm location. The individual patient data analysis of 129 cases demonstrated that timely intraoperative intervention in response to IONM signal changes significantly reduces the risk of postoperative neurological deficits. Patients without any IONM signal loss had a 6% deficit rate at discharge. When signal changes occurred, reversal within <18 minutes for MEP or <16 minutes for SSEP was associated with a 15% deficit rate, compared with 95% when signals were not reversed. Isolated changes in either SSEP or MEP also led to deficits, underscoring the added value of multimodal monitoring. IONM signal duration and reversibility are critical predictors of neurological outcome in aneurysm surgery. Multimodal IONM not only improves ischemia detection but also offers actionable thresholds for intraoperative decision-making. Its routine use should be considered to reduce neurological morbidity in microsurgical clipping of unruptured aneurysms.

Cardio-oncology remains a speciality dominated by cardiologists despite the importance of doctors from other specialties, such as oncology and haematology, for managing the cardiovascular health of patients living with cancer. A major reason for this is a distinct lack of cardio-oncology training opportunities for the noncardiology trainee. This is because of several factors, including a lack of awareness of cardio-oncology as a specialty. We propose a cardio-oncology training programme that involves early exposure to cardio-oncology as a specialty and provides the noncardiologist with a good understanding of cardiological investigations and treatment in the context of cancer treatment. Future work should elucidate additional barriers to cardio-oncology training as well as identifying programmes that have integrated cross-disciplinary cardio-oncology content to inform future curriculum development. Future work should also focus on establishing pilot cardio-oncology training programmes for the noncardiologist.

Theranostics, the integration of diagnostic imaging with targeted radiopharmaceutical therapy, is reshaping the practice of nuclear medicine worldwide. This article provides a global perspective on how multidisciplinary teams deliver theranostics care in diverse health care systems. Contributions from experts across Asia, Europe, South Africa, Australia, Latin America, and the United States highlight the shared and region-specific roles of nuclear medicine physicians, technologists, radiopharmacists, physicists, and nurses in patient selection, radiopharmaceutical preparation, treatment delivery, and posttherapy care. A consistent theme across regions is the central role of the nuclear medicine physician in treatment oversight and the expanding responsibilities of nuclear medicine technologists in imaging protocols, radiopharmaceutical administration, patient care, and dosimetry. The roles of radiopharmaceutical scientists, medical physicists, nurses, and trial coordinators are variable but overall beneficial in delivering a successful theranostics service. Workforce shortages, financial barriers, and regulatory challenges continue to be significant obstacles to equitable patient access. Despite these challenges, multidisciplinary collaboration, tumor board integration, and shared care models are improving patient outcomes and advancing the field.