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Rufina Soomro

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Papers by Rufina Soomro

Breast Cancer Management Consensus By The Society of Surgeons and Surgical Oncology Society of Pakistan

PubMed, Nov 30, 2023

The Society of Surgeons of Pakistan and The Society of Surgical Oncology of Pakistan with faction... more The Society of Surgeons of Pakistan and The Society of Surgical Oncology of Pakistan with factions from various major centres comprising of surgical oncology, medical and radiation oncology collaborated to reach consensus on breast cancer management guidelines and a framework of "good practice" minimum standards of care. The aim of the task force was to enhance treatment standards, which have a direct correlation with improving patient mortality and morbidity and long-term survival whilst taking into consideration economic limitations of access to leading centers of excellence as well as minimum expertise required in health care. These multidisciplinary guidelines, whilst not exhaustive, aim to provide an algorithm of care for breast cancer patients at tertiary care centres and district level hospitals to provide most appropriate treatment.

Implementation of Targeted Axillary Node Assessment Following Neoadjuvant Therapy for Node-positive Breast Cancer Patients Improves Axillary Disease Detection

Journal of advances in medicine and medical research, Mar 8, 2024

Background: Assessing the targeted node, a biopsy-proven metastatic node marked with a metallic c... more Background: Assessing the targeted node, a biopsy-proven metastatic node marked with a metallic clip before neoadjuvant chemotherapy along with sentinel node dissection improves the evaluation of pathological response in the axillary nodal basin after systemic treatment as compared to sentinel node dissection with dual tracer alone. Objectives: The objective was to investigate the rate of the clipped node being a sentinel node and the sensitivity of targeted node dissection in detecting residual disease.

Clinicopathologic Predictors of Pathologic Complete Response after Neoadjuvant Systemic Therapy and Impact on Surgical Management

Journal of advances in medicine and medical research, Mar 1, 2022

Neoadjuvant systemic therapy previously given for inoperable breast cancer is increasingly being ... more Neoadjuvant systemic therapy previously given for inoperable breast cancer is increasingly being administered in early breast cancer especially in triple negative and HER2 positive molecular subtypes. It is associated with an increased rate of complete pathologic response (PCR) which is a surrogate marker for good survival outcomes and has role in de escalation of surgical management. We conduct this study to identify clinical and pathologic factors and systemic treatment regimens that predict PCR among Pakistan's breast cancer patients and its impact on surgical management. Materials and Methods: Patients with clinical stage I-III who received Neoadjuvant systemic therapy (NST) and underwent surgical intervention at Liaquat national hospital were included. The clinicopathologic factors included age, menopausal status, clinical tumor size, nodal status, stage, pathologic type, grade, molecular subtype, PR status, pathologic response, and treatment in terms of systemic therapy. The surgery underwent and pathologic stage(ypTN) were recorded. The association between these factors and PCR was analyzed with the chi-square test. Univariate analysis was performed to evaluate the influence of clinicopathologic factors on PCR. Results: PCR was achieved in 174(19.6%) out of the 889 patients. There was a significant association (P-value <0.001) with molecular subtype as follows PCR percentage for HER 2 enriched-39% and luminal B HER 2 positive-31%, triple negative-25% ,Luminal A-6.5% and Luminal

Breast Surgery Fellowship: Need of Contemporary Times

JCPSP. Journal of the College of Physicians & Surgeons Pakistan, Nov 1, 2019

Breast cancer is the most common cancer in women worldwide. Age standardised incidence of breast ... more Breast cancer is the most common cancer in women worldwide. Age standardised incidence of breast cancer is 43.9/100,000 worldwide with over 2 million new cases diagnosed in 2018. It has a mortality of 23.2/100,000. In Pakistan, a country with a population of over 200 million, the total new cancer cases diagnosed in 2018 were 173,937; and breast cancer accounts for 34,066 (19.6%). Among this, 92,693 were females and breast cancer is the most common cancer diagnosed in females (36.08%). The 5-year prevalence of breast cancer is 73,046. In 2018 alone, overall cancer-related deaths reported in Pakistan are 118,442. Breast cancer share is 17,158 (14.5%), which is the number one cause of cancer-related mortality (2018). 1

Discordance of biomarker status in recurrent breast cancer

PubMed, Feb 1, 2014

Objective: To study the pattern of percentage change of biomarker status in recurrent breast canc... more Objective: To study the pattern of percentage change of biomarker status in recurrent breast cancer and to compare it with its primary biomarker. Methods: Patients with recurrent breast disease presenting to the Breast Unit of Liaquat National Hospital and Medical College, Karachi, between January 2004 and January 2011 were included in this study. Outcome of interest was any change in the biomarker status of oestrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (HER2/neu) with respect to their respective primary status. SPSS 18 was used for statistical analysis. Results: The study had a total of 58 female patients with biopsy-proven recurrent breast carcinoma with a mean age of 46 +/- 11.3 years. Time to recurrence varied between 2 to 3 years with a mean of 2.3 +/- 1.9 years. Invasive ductal carcinoma was the most prevalent recurrent tumour (50/58 patients: 86%). There was a change of 25.9% in oestrogen receptor status (p < 0.01); change of 36.2% in progesterone receptor status (p = 0.036); and 22.4% change in Her2/neu status (p = < 0.01). Of the 42 (72.27%) patients who were triple negative at presentation, 30 (71.4%) remained triple negative (p = 0.02). Six of the 16 (37.5%) patients became triple negative upon recurrence (p < 0.01). Conclusions: The study demonstrated that there was indeed a change in biomarker status in patients presenting with recurrent breast carcinoma. There is need for clinicians to check biomarker status in recurrent breast cancer patients as it may assist a shift in the management plan.

Is our choice of empirical antibiotics appropriate for patients with methicillin resistant Staphylococcus aureus in breast abscess?

PubMed, Dec 1, 2018

Background and objectives: Breast abscesses remain as one of the most common reasons for females ... more Background and objectives: Breast abscesses remain as one of the most common reasons for females to come for a surgical consult. This retrospective cohort study includes both lactating and non-lactating females with breast abscesses. Due to changing trends in bacteriology of organisms, we need to reconsider our empirical choices of antibiotics. In our study, the main causative organism in breast abscess was Staphylococcus aureus with predominant species being MRSA. Materials and methods: This is an analytical review of all breast abscesses treated in a single center from 2012 to 2015. This study included bacterial cultures, antibiotic sensitivities and resistance pattern in breast abscesses. Results: 268 patients were included in the study. 143 (53.4%) were Lactational abscesses and 125 (46.6%) were non-Lactational abscesses. 169 (63.0%) harbored S. aureus in which 86 (50.8%) were MRSA. MRSA was the predominant organism in the Lactational group while non-Lactational group had no growth or other organisms in culture in this study. Other growing organisms were Klebsiella pneumoniae, Bacteroides, Pseudomonas, Streptococcus species and Mycobacterium tuberculosis. On comparative analysis, MRSA showed statistically a significant difference with p<0.0001, when it comes to predominant growth in lactating mothers. First line prescribed empirical antibiotics received by the patient, which is amoxicillin clavulanate, is mostly resistant. It is recommended that the institutional antibiogram targeted treatment be offered to patients with breast abscess. We also recommend ciprofloxacin with clindamycin as initial empirical therapy. Conclusion: MRSA was the most common organism seen in breast abscesses. Our first line treatment of antibiotics was resistant. Clindamycin and ciprofloxacin should be the preferred 1st choice for treatment.

Is breast cancer awareness campaign effective in Pakistan?

PubMed, Jul 1, 2017

Objective: To assess the effectiveness of existing breast cancer awareness strategies in terms of... more Objective: To assess the effectiveness of existing breast cancer awareness strategies in terms of early breast cancer detection.. Methods: This descriptive, retrospective study was conducted at the Breast Surgery department of the Liaquat National Hospital, Karachi, and comprised records of all biopsy-proven stage 1 breast cancer patients from 1994 to 2014.All relevant records were retrieved year-wise from computerised database and age and stage of each case at presentation were noted. Data of stage 1 breast cancer patients was calculated in all age groups in absolute numbers and in percentage. The total number of women aged below 40 years and stage 1 patients in each year were counted and percentages were calculated and year-wise plotted and compared with whole group. Results: A total of 8,291 patients were registered during the study period. Their number increased from 53(0.64%) in 1994 to 847(10.21%) in 2014. Over the study period, there was a slow trend towards improvement in early diagnosis of breast cancer. Conclusions: With existing breast cancer awareness strategies, the rate of change for early diagnosis of this deadly disease was very slow.

Impact of Training on Nurses Performance and Productivity at Neonatal Intensive Care Unit (NICU)

JOJ nursing & health care, Aug 15, 2018

Introduction: Neonatal Nursing is Sub-Specialty of Nursing that works with Newborns born with var... more Introduction: Neonatal Nursing is Sub-Specialty of Nursing that works with Newborns born with variety of problems. It generally encompasses care for those neonates who experiences problems shortly after the first initial hours of birth till 28 days of life. So, it is essentially important for caregivers to undergo training that not only enhance knowledge but bring change in behavior by holding accountability to care neonates and to meet general to specific needs. Objective and Purpose: Objective of the study was to assess the impact of training on Nurses Knowledge and Skills working at Neonatal Intensive Care Unit. Methodology: An Experimental Study was made and Basic Neonatology Course in collaboration with Department of Pediatrics, Nursing Education Services and Research Development and Skill Center of Liaquat National Hospital. The Program was initiated to train nurses and doctors dealing with neonates. Course evaluation was based on Pre and Post Test on ICU infection module, Mid-Quiz and Final Quiz based on different Sections. For skills development clinical Simulators were used at Skills Development Centre (RSDC) and rotations were done Neonatal Intensive care (NICU), Pleads OPD and Well Baby Centre were selected. Paired T-Test and ANOVAs was applied. Results: Total 25 participants were enrolled. We found significant differences in mean scores 26.82±6.16 and 31.9±10.45 of mid quiz and final quiz respectively (p=0.005). Conclusions: Study showed the impact of training on all participation and validated the significance of continuous nursing education and contributed to make nurses valuable and safe by enduring high quality care to neonates and helped nurses to have sound proficiency at NICU.

Prevalence of breast cancer intrinsic subtypes and its association with clinico-pathological feature

Journal of Molecular and Genetic Medicine, May 7, 2018

Background & Aim: Breast cancer is the commonest cancer in women worldwide and represents a highl... more Background & Aim: Breast cancer is the commonest cancer in women worldwide and represents a highly heterogeneous group of tumors particularly in terms of molecular features, prognosis and response to therapy. Molecular subtypes of breast cancer help in treatment planning, can predict the risk of recurrence and help in decision making about the need of systemic therapy. Breast carcinomas may be stratified into subtypes similar to those defined by expression profiling using a panel of immunehistochemical (IHC) markers. Routine IHC evaluations of breast cancers may therefore provide a reasonable alternative to costly genetic assays especially in under resourced health care systems .The purpose of this study is to investigate the prevalence of molecular subtypes and correlate it to clinic-pathological features. Methods: From 2005 to 2017 total of 4847 breast cancer patients, in whom complete information was available to classify them into luminal subtypes were retrieved and classified into intrinsic subtypes and patients information in each type was collected about age, tumor size, stage and grade. Results: In luminal classification, there was highly significant difference was found in mean age (p<0.001) and tumor size (p<0.001). The statistical significance of Her 2 positive and triple negative was found with metastasis, grade and Ki67. IHC assignment into Luminal subtypes is clinically informative in our patients and routinely using this in our practice could identify patients with luminal B breast cancer that may need a more aggressive treatment to reduce the likelihood of recurrences.

Coeliac artery aneurysm

PubMed, 2009

Aneurysms of coeliac artery are extremely rare and account for less than 4% of all splanchnic ane... more Aneurysms of coeliac artery are extremely rare and account for less than 4% of all splanchnic aneurysms. The detection of such aneurysms, which are often asymptomatic, is mostly occasional. Approximately 15% to 20% of the cases may get complicated by rupture with a mortality rate of around 80%. A reported case of a 55 year old male, who presented with pain and palpable mass in left upper abdomen was diagnosed to have coeliac artery aneurysm. Diagnosis was made on CT scan with selective visceral angiography. Simple ligation with partial excision of the coeliac artery aneurysm was performed.

256 Change of Biomarker Status in Recurrent Breast Cancer

European Journal of Cancer, Mar 1, 2012

Pathologic Predictors of Chemotherapy Response in Post Neo-Adjuvant Breast Cancer

Journal of advances in medicine and medical research, Feb 4, 2023

Introduction: Pathological complete response (pCR) is the most important prognostic factor in det... more Introduction: Pathological complete response (pCR) is the most important prognostic factor in determining survival in post-neoadjuvant breast cancer. In this study, we evaluated the pathologic predictors that are associated with pCR in post-neoadjuvant breast cancer. Methods: It was a retrospective observational study conducted in Liaquat National Hospital and Medical College, Pakistan, from January 2019 to December 2020 over a period of two years. All patients with primary breast cancer that received neo-adjuvant chemotherapy at Liaquat National Hospital were included in the study. Pathological parameters from pre-chemotherapy specimens like tumor type, grade, estrogen receptor (ER), progesterone receptor (PR), human epidermal Original Research Article

Performance of TyrerCuzick Model for Breast Cancer Risk Assessment among Pakistan’s Females

Journal of advances in medicine and medical research, Dec 10, 2021

Background: Breast cancer incidence is highest in Pakistan among Asian countries. The known risk ... more Background: Breast cancer incidence is highest in Pakistan among Asian countries. The known risk factors are family history, hormonal exposure, benign proliferative diseases, and high mammographic density which are included in the TyrerCuzick model. The model needs validation studies to implement in prediction, screening, and prevention strategies among different populations. This study aims to validate the TyrerCuzick model for Pakistan's females. Methods and Materials: A total of 317 biopsy-proven breast cancer patients from the breast surgery clinic at Liaquat National Hospital were included. The 10 years risk score is calculated by applying the TyrerCuzick model software. Subcategories of low risk <2%, moderate risk 2-7%, and high risk >8% were identified. Further risk group stratification is done to find the association with individual factors i.e., age group, menopausal status, family history, and mammographic density. Results: The mean TyrerCuzick score was low to moderate i.e. 2.23±1.66. The score was distributed as low risk 174(54.9%), moderate risk 137(43.2%), and high risk 6(1.9%). Low risk was observed among 116(81.7%) of less than 50 years old, 105(78.9%) premenopausal, 113(59.8%) with no family history, and 120 patients (59.7%) with low mammographic density. Most of the moderate risk was found in 113(64.6%) of more than 50 years old, 109(60.2%) with

Impact of Surgery in De Novo Metastatic Breast Cancer after Systemic Disease Control

Journal of advances in medicine and medical research, Nov 8, 2021

Background: Systemic chemotherapy is the standard of care for patients with metastatic breast can... more Background: Systemic chemotherapy is the standard of care for patients with metastatic breast cancer, with an undecided role in surgery. Limited data is available for the role of surgery on the overall survival of stage 4 breast cancer regarding luminal subtypes of patients. This is a retrospective data analysis comparing overall survival benefit and disease-free survival in stage IV breast cancer after systemic treatment and systemic disease control concerning luminal classification in the last five years. Method: Patients who had surgery and no surgery after systemic treatment and disease control were compared for 5 years overall survival as the primary endpoint and disease-free survival as the secondary endpoint. The survival benefit was also compared regarding tumor biology (ER/PR, HER2 status). Results: Data included 421 patients, 237 in surgery and 184 in no surgery group. At one year survival for surgery performed and not performed was not significant. Five-year overall survival for surgery performed and not performed was 84.4% and 74.5%. A statistically significant difference in survival rates was observed (p<0.0001). The mortality rate was 15.6% in surgery performed and Original Research Article

Do Neural Information Extraction Algorithms Generalize Across Institutions?

JCO clinical cancer informatics, Dec 1, 2019

PURPOSE Natural language processing (NLP) techniques have been adopted to reduce the curation cos... more PURPOSE Natural language processing (NLP) techniques have been adopted to reduce the curation costs of electronic health records. However, studies have questioned whether such techniques can be applied to data from previously unseen institutions. We investigated the performance of a common neural NLP algorithm on data from both known and heldout (ie, institutions whose data were withheld from the training set and only used for testing) hospitals. We also explored how diversity in the training data affects the system's generalization ability. METHODS We collected 24,881 breast pathology reports from seven hospitals and manually annotated them with nine key attributes that describe types of atypia and cancer. We trained a convolutional neural network (CNN) on annotations from either only one (CNN1), only two (CNN2), or only four (CNN4) hospitals. The trained systems were tested on data from five organizations, including both known and heldout ones. For every setting, we provide the accuracy scores as well as the learning curves that show how much data are necessary to achieve good performance and generalizability. RESULTS The system achieved a cross-institutional accuracy of 93.87% when trained on reports from only one hospital (CNN1). Performance improved to 95.7% and 96%, respectively, when the system was trained on reports from two (CNN2) and four (CNN4) hospitals. The introduction of diversity during training did not lead to improvements on the known institutions, but it boosted performance on the heldout institutions. When tested on reports from heldout hospitals, CNN4 outperformed CNN1 and CNN2 by 2.13% and 0.3%, respectively. CONCLUSION Real-world scenarios require that neural NLP approaches scale to data from previously unseen institutions. We show that a common neural NLP algorithm for information extraction can achieve this goal, especially when diverse data are used during training.

Clinicopathological Features and Survival Outcomes of Metaplastic Breast Carcinoma – An Observational Multi-Centric Study

Breast cancer, Mar 1, 2023

To describe the clinicopathological features, and subtypes of metaplastic breast cancer (MpBC) in... more To describe the clinicopathological features, and subtypes of metaplastic breast cancer (MpBC) in Pakistan and further to understand its response to treatment, including region-specific survival outcomes. Patients and Methods: This retrospective cohort study was conducted at two private tertiary care hospitals in Karachi, Pakistan. Our selection criteria included a total of 215 patients who were diagnosed with MpBC at an age older than 18 years from 1994 to 2021. Data regarding clinicopathological features, staging, receptor status, treatment modalities, recurrence, and survival was obtained. Death was scored as an event, and patients who were alive were censored at the time of the last follow-up. Results: The incidence of MpBC at our study centers is 3.21%. The median age of diagnosis was 50 years (range 22 to 80 years) and most patients presented at Stages II (45.1%) and III (44.2%). Among patients who received neoadjuvant chemotherapy, 31.7% achieved complete pathological response. The 3-year survival of those who received neoadjuvant chemotherapy was 96%. During our study, 19.1% of patients died and the median survival duration was 9 years 7 months 9 days. Survival of patients was significantly lower in patients who had metastasis (p-value = 0.042) and those who had tumor recurrence (p-value = 0.001). Conclusion: Metaplastic breast cancer is an extremely rare variant of breast cancer with features that exist as a spectrum. Our study demonstrated considerable success with the use of neoadjuvant chemotherapy. The pathological complete response achieved in our study is one of the highest ever reported. Our success, though limited, warrants further research in the use of neoadjuvant chemotherapy in MpBC.

Post Mastectomy Radiotherapy among Patients with T1-T2 1-3 node Positive Disease: Does it Make a Difference?

Research Square (Research Square), Dec 8, 2020

Background: Pakistan has the highest incidence of breast cancer among Asian Countries but there i... more Background: Pakistan has the highest incidence of breast cancer among Asian Countries but there is insu cient representation of local data addressing breast cancer treatment and outcome. We sought to determine the role of post-mastectomy radiotherapy (PMRT) in T1-T2 breast cancer with 1-3 positive axillary lymph nodes. Methods: Data was reviewed retrospectively of total 755 patients out of which 291 received PMRT and 464 did not from two large breast cancer centres. Results: With a median follow up of 78 months, 4 (4.5%) patients developed loco regional recurrence (LRR) in the PMRT group while a substantial number 74 (24.4%) recurred in the non PMRT group (p=0.000). Loco regional free survival rate (LRFS) and overall survival rate (OS) was signi cantly better for PMRT patients than non-PMRT patients (P = <0.000). Multivariate analysis identi ed young age, lymphovascular invasion, extra capsular extension, triple negative and ER/PR negative were independent prognostic factors affecting loco regional free survival (LRFS). Conclusion: Disease recurrence is a substantial issue in 1-3 node group despite early stage, PMRT has an instrumental effect in improving LRFS and OS.

ASO Visual Abstract: Impact of Postoperative, Antibiotic Prophylaxis on Surgical Site Infection Rates After Mastectomy with Drains but Without Immediate Reconstruction—A Multicenter, Double-Blinded, Randomized, Control Superiority Trial

Annals of Surgical Oncology

Frequency of recurrence in early breast cancer and association of known prognostic factors with relapse and time to relapse in a tertiary care hospital in Pakistan

Journal of Clinical Oncology, 2011

e21175 Background: Breast cancer is the most prevalent cancer in women and a leading cause of can... more e21175 Background: Breast cancer is the most prevalent cancer in women and a leading cause of cancer-related death. Following surgery and initial treatment, recurrence remains a risk for all patients with breast cancer. METHODS This is a cross sectional study. Complete data of 300 patients treated for early breast cancer during 2004-2008 at Oncology Dept, LNH was analysed. Out of these 300 patients, 76 patients had relapsed. Data were collected on SPSS version 17, and analyzed. Variables were age, tumor size, nodal status, tumor grade, hormonal status and her 2 neu status, taxanes versus non taxanes treatment, use of trastuzumab and hormonal treatment. Early relapse was defined as in less than 2 years and relapse after 2 or more years was taken as late relapse. RESULTS 300 patients were analyzed. Mean age of our patients were 47.6 ± 11.2 years. Out of these 300, 73 patients relapsed (24.7%). 44 patients (58%) relapsed in less than 2 years, and 33 patients (42%) relapsed after 2 years. Risk factors associated with relapse included tumor size, nodal status, grade and hormone receptor status. There was significant association between hormonal status and time to relapse ((P 0.001). We did not find any significant association in over all relapse rate, and different immunohistochemical subtypes but on analyses of time to relapse, early relapse was higher in triple negatives and her 2 neu positive group (P 0.001). There was a trend towards increased incidence of visceral and brain metastases in early relapse and of bone metastases in late relapse. Patients who relapsed early (< 2 years) had median survival of 1 year while those who relapsed after 2 years had median survival of 4 years. CONCLUSIONS We found strong association of ER/PR status only with time to relapse in carcinoma breast. Early relapse was higher in triple negatives and her 2 neu positive group with shorter median survival in early relapse.

Efficacy of Single Pre Operative Dose of Glucocorticoid (125 mg of Solumedrol Intravenous) in terms of Seroma Formation in Patients Undergoing Mastectomy with Axillary Clearance for Breast Cancer: A Randomized Controlled Trial

International journal of surgery research and practice, Feb 28, 2020

Objective: The study aimed to determine the efficacy of single dose of glucocorticoid (125 mg of ... more