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0-100. Preliminary in vitro studies of electrical impedance mammography (EIM): a future technique for non-invasive breast tissue imaging?
Abstracts of the 5th Nottingham International Breast Cancer Conference
253
O-100. Preliminary in vitro studies of electrical impedance mammography (EIM): a future technique for non-invasive breast tissue imaging?
O-102. The psychological impact of a rapid diagnosis service for women with symptoms suggestiveof breast cancer
Tunstall B, Wang W, McCormick M, Walker R, Rew DA University Breast Unit and Leicester School of Engineering, de Montfort University, Leicester
Hopwood P, Dey P, Baildam A, Bundred N, Asbury D, Leidecker V Christie Hospital, Manchester and University Hospital of South Manchester
Electrical impedance signals can be used to construct cross sectional soft tissue images without the invasive properties of X-rays. Theory indicates that resolutions of 1 m m should be achievable. The phenomenon may be the basis of a new detection system for breast and other soft tissue lesions. 100 breast samples comprising 50 normal fatty tissue samples paired with 20 tumour and 30 glandular/stromal samples were studied. Tissue blocks were obtained from fresh theatre resection specimens and cut into 1.0 cm’ blocks. Samples were analysed between electrodes in a purpose built impedance chamber in saline at body temperature. Signal collection and analysis was performed with a standard PC and proprietary software. Complex impedance signals were measured for phase and conductivity over a range of stimulating frequencies from 1 kHz to 4 MHz. Signals distinguished consistently between fatty and other tissue, such that conductivity was a mean 8 mV/mm in fat and 1.5 mV/mm in other tissue. Stroma could be discriminated from tumour at high frequencies. Signals appeared to be sensitive to changes in cell structure and function, such as due to altered molecular structure and membrane physiology. We conclude that pilot studies in vitro have encouraged further development of this 2D and 3D imaging modality, initially to build a more sensitive system incorporating 32 electrodes, with a view to the construction of an in vivo evaluation system in due course.
O-101. A randomised controlled trial investigating the psychological impact of same-day diagnosis at a ‘one stop’breast clinic versus conventional clinic arrangements Harcourt DM, Cawthorn SJ, Ambler N, Rumsey N The Breast Care Centre, Frenchay Healthcare Trust, Bristol NHS (1996) guidelines for the provision of care for breast cancer patients recommend that investigative procedures and diagnosis be available at a single ‘one stop’ appointment. Such recommendations are based on the belief that a reduction in delay will decrease anxiety. However, very little is known regarding both the short-term and longer-term psychological implications of speedier diagnosis either for those confirmed as having breast cancer or for the much larger proportion with an ‘all clear’ result. A randomised controlled trial compared two styles of clinic investigating symptomatic breast disease: a ‘one stop’ clinic (307 patients) and a conventional ‘two stop’ clinic (276 patients) in which assessment and diagnosis are made in separate clinic attendance, one week apart. A semistructured interview and standardised scales (HADS. EORTC-QLQ C30) were completed at initial clinic attendance (prior to diagnosis), 6 days and 8 weeks later During the first 6 days an ‘all clear’ finding led to a rapid improvement in reported levels of anxiety, depression, cognitive functioning and quality of life in the one-stop group compared to the two-stop group who were still awaiting their results (P < 0.05). However, diagnosis of breast cancer (one stop n = 44; two stop n = 34) increased anxiety and depression levels in the one-stop group during those six days as compared to the two-stop control.
‘One stop’ breast clinics offer same day reporting of investigations and a definitive diagnosis at the first appointment and it is anticipated that this will result in a reduction of anxiety for clinic attenders. However, the impact of an expedited diagnosis of malignancy is unknown. This study assessed immediate, short and medium term psychological morbidity in 476 women aged > 35 years randomised to attend a rapid diagnosis clinic (RDC) (n = 266) or a designated OP service (OP) (n = 210). Anxiety was assessed pre consultation and 24 h later using the Spielberger State Trait Anxiety Inventory (STAl) and at baseline, 3 weeks post diagnosis and 3 months later using the Hospital Anxiety and Depression Scale (HADS). Compliance with all 3 assessmentswas 71% (RPC) and 63% (OP). There were no differences between groups in psychological distress pre consultation on either measure. Immediate anxiety reduction as measured by the STAl was significantly greater for the RDC group than the OP group (P > 0.001). At baseline, 33% RDC and 35% OP women were deemed to be clinically anxious using the HADS (X’ 0.18, P = 0.67). This decreased to 23% and 26% respectively 3 weeks after diagnosis (x? 0.18, P = 0.67) and to 19% and 24% respectively 3 months later (X’1.09, P = 0.3) with no significant difference between groups, However, there was a strong suggestion of greater improvement within the RDC group. (Significance of change: P = 0.002). In conclusion the RDC service was associated with a significant reduction in immediate anxiety and a greater reduction in short and medium term anxiety compared with the OP service, although the level of benefit was not maintained. Further analyses are underway to explore the impact for different diagnostic subgroups.
O-103. One year psychosocial outcomes for women attending a breast cancer Family History Clinic Hopwood P, Keeling F, Thompson J, Pool C, Howell A, Evans G Christie Hospital, Manchester and St Mary’s Hospital, Manchester Information is needed about the psychological costs and benefits of offering risk counselling to women with a family history of breast cancer. 158 women first time attenders at the Manchester Family History Clinic, with a > 2 fold risk of breast cancer, were followed to assessthe short and long term impact of genetic risk counselling. Outcomes included risk knowledge, psychological distress, health care behaviour and lifestyle changes. Women completed self report questionnaires at 0. 3, 6, 9 and 12 months and were interviewed at 3 and 12 months. Whilst less than 1:lO women had an accurate perception of either population or their personal risk level at baseline, this improved significantly post counsel to 65% accurate and was well maintained at 1 year (59%). Results were independent of the doctor providing risk counselling. No association was found between perceived risk level and psychological morbidity at baseline (P = 0.678) or follow up (P = 0.79). Psychological distress as measured by the General Health Questionnaire was stable over time (24-30%) and showed no increase with risk counselling. Initially only I:4 women breast checked monthly, and 18% not at all. This increased to 53% checking monthly 3 months later, but reduced to
253
O-100. Preliminary in vitro studies of electrical impedance mammography (EIM): a future technique for non-invasive breast tissue imaging?
O-102. The psychological impact of a rapid diagnosis service for women with symptoms suggestiveof breast cancer
Tunstall B, Wang W, McCormick M, Walker R, Rew DA University Breast Unit and Leicester School of Engineering, de Montfort University, Leicester
Hopwood P, Dey P, Baildam A, Bundred N, Asbury D, Leidecker V Christie Hospital, Manchester and University Hospital of South Manchester
Electrical impedance signals can be used to construct cross sectional soft tissue images without the invasive properties of X-rays. Theory indicates that resolutions of 1 m m should be achievable. The phenomenon may be the basis of a new detection system for breast and other soft tissue lesions. 100 breast samples comprising 50 normal fatty tissue samples paired with 20 tumour and 30 glandular/stromal samples were studied. Tissue blocks were obtained from fresh theatre resection specimens and cut into 1.0 cm’ blocks. Samples were analysed between electrodes in a purpose built impedance chamber in saline at body temperature. Signal collection and analysis was performed with a standard PC and proprietary software. Complex impedance signals were measured for phase and conductivity over a range of stimulating frequencies from 1 kHz to 4 MHz. Signals distinguished consistently between fatty and other tissue, such that conductivity was a mean 8 mV/mm in fat and 1.5 mV/mm in other tissue. Stroma could be discriminated from tumour at high frequencies. Signals appeared to be sensitive to changes in cell structure and function, such as due to altered molecular structure and membrane physiology. We conclude that pilot studies in vitro have encouraged further development of this 2D and 3D imaging modality, initially to build a more sensitive system incorporating 32 electrodes, with a view to the construction of an in vivo evaluation system in due course.
O-101. A randomised controlled trial investigating the psychological impact of same-day diagnosis at a ‘one stop’breast clinic versus conventional clinic arrangements Harcourt DM, Cawthorn SJ, Ambler N, Rumsey N The Breast Care Centre, Frenchay Healthcare Trust, Bristol NHS (1996) guidelines for the provision of care for breast cancer patients recommend that investigative procedures and diagnosis be available at a single ‘one stop’ appointment. Such recommendations are based on the belief that a reduction in delay will decrease anxiety. However, very little is known regarding both the short-term and longer-term psychological implications of speedier diagnosis either for those confirmed as having breast cancer or for the much larger proportion with an ‘all clear’ result. A randomised controlled trial compared two styles of clinic investigating symptomatic breast disease: a ‘one stop’ clinic (307 patients) and a conventional ‘two stop’ clinic (276 patients) in which assessment and diagnosis are made in separate clinic attendance, one week apart. A semistructured interview and standardised scales (HADS. EORTC-QLQ C30) were completed at initial clinic attendance (prior to diagnosis), 6 days and 8 weeks later During the first 6 days an ‘all clear’ finding led to a rapid improvement in reported levels of anxiety, depression, cognitive functioning and quality of life in the one-stop group compared to the two-stop group who were still awaiting their results (P < 0.05). However, diagnosis of breast cancer (one stop n = 44; two stop n = 34) increased anxiety and depression levels in the one-stop group during those six days as compared to the two-stop control.
‘One stop’ breast clinics offer same day reporting of investigations and a definitive diagnosis at the first appointment and it is anticipated that this will result in a reduction of anxiety for clinic attenders. However, the impact of an expedited diagnosis of malignancy is unknown. This study assessed immediate, short and medium term psychological morbidity in 476 women aged > 35 years randomised to attend a rapid diagnosis clinic (RDC) (n = 266) or a designated OP service (OP) (n = 210). Anxiety was assessed pre consultation and 24 h later using the Spielberger State Trait Anxiety Inventory (STAl) and at baseline, 3 weeks post diagnosis and 3 months later using the Hospital Anxiety and Depression Scale (HADS). Compliance with all 3 assessmentswas 71% (RPC) and 63% (OP). There were no differences between groups in psychological distress pre consultation on either measure. Immediate anxiety reduction as measured by the STAl was significantly greater for the RDC group than the OP group (P > 0.001). At baseline, 33% RDC and 35% OP women were deemed to be clinically anxious using the HADS (X’ 0.18, P = 0.67). This decreased to 23% and 26% respectively 3 weeks after diagnosis (x? 0.18, P = 0.67) and to 19% and 24% respectively 3 months later (X’1.09, P = 0.3) with no significant difference between groups, However, there was a strong suggestion of greater improvement within the RDC group. (Significance of change: P = 0.002). In conclusion the RDC service was associated with a significant reduction in immediate anxiety and a greater reduction in short and medium term anxiety compared with the OP service, although the level of benefit was not maintained. Further analyses are underway to explore the impact for different diagnostic subgroups.
O-103. One year psychosocial outcomes for women attending a breast cancer Family History Clinic Hopwood P, Keeling F, Thompson J, Pool C, Howell A, Evans G Christie Hospital, Manchester and St Mary’s Hospital, Manchester Information is needed about the psychological costs and benefits of offering risk counselling to women with a family history of breast cancer. 158 women first time attenders at the Manchester Family History Clinic, with a > 2 fold risk of breast cancer, were followed to assessthe short and long term impact of genetic risk counselling. Outcomes included risk knowledge, psychological distress, health care behaviour and lifestyle changes. Women completed self report questionnaires at 0. 3, 6, 9 and 12 months and were interviewed at 3 and 12 months. Whilst less than 1:lO women had an accurate perception of either population or their personal risk level at baseline, this improved significantly post counsel to 65% accurate and was well maintained at 1 year (59%). Results were independent of the doctor providing risk counselling. No association was found between perceived risk level and psychological morbidity at baseline (P = 0.678) or follow up (P = 0.79). Psychological distress as measured by the General Health Questionnaire was stable over time (24-30%) and showed no increase with risk counselling. Initially only I:4 women breast checked monthly, and 18% not at all. This increased to 53% checking monthly 3 months later, but reduced to