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The effect of postoperative sensation on quality-of-life (QoL) following nipple-sparing mastectomy (NSM) with implant-based reconstruction is not well described. We evaluated the impact of breast and nipple sensation on patient QoL by using BREAST-Q. Patients undergoing NSM with implant reconstruction from 2008 to 2020 were mailed a survey to characterize their postoperative breast and nipple sensation. BREAST-Q metrics were compared between totally numb patients and those with sensation. A total of 349 patients were included. Overall, 131 (38%) responded; response rates regarding breast and nipple sensation were 36% (N = 124/349) and 34% (N = 117/349). Median time from surgery to survey completion was 6 years. The majority had bilateral procedures (101, 77%), including direct-to-implant (99, 76%) and tissue expander (32, 24%) reconstruction. Regarding breast sensation, the majority of patients reported their reconstructed breasts as totally numb (47, 38%) or much less sensation than before surgery (59, 48%). Regarding nipple sensation, the majority of patients reported their nipples were totally numb (67, 57%) or had much less sensation than before surgery (37, 32%). Total numbness of reconstructed breasts resulted in a significantly lower chest physical well-being (mean score: 73.5 vs. 81.2, respectively, P = 0.048). Total numbness of postoperative nipple(s) resulted in significantly lower chest physical (mean score: 74.8 vs. 85.2, respectively, P = 0.007), psychosocial (mean score 77.4 vs. 84.4, respectively, P = 0.041), and sexual well-being (mean score: 55.7 vs. 68.3, respectively, P = 0.002). Long-term breast and nipple sensation are significantly diminished after NSM with implant reconstruction. Patients with preserved sensation experience better physical, psychosocial, and sexual well-being. [Display omitted] [ABSTRACT FROM AUTHOR]

The prognostic significance of regression in melanoma is debated. We present a large multicenter study correlating regression with sentinel lymph node metastasis and melanoma-specific survival. The Sentinel Lymph Node Working Group database was reviewed from 1993 to 2018. Patients with known regression and sentinel lymph node status were included. Clinicopathologic factors were correlated with regression, sentinel lymph node status, and melanoma-specific survival. There were 4,790 patients; median follow-up was 39.6 months. Regression was present in 1,081 (22.6%) cases, and 798 (16.7%) patients had sentinel lymph node metastases. On multivariable analysis, male sex, truncal tumors, and decreasing thickness were significantly associated with regression (P <.05), whereas head/neck or leg tumors had lower rates of regression (P <.05). Regression was significantly correlated with a decreased risk of sentinel lymph node disease on multivariable analysis (odds ratio 0.68, 95% confidence interval 0.54–0.85; P =.0008). Multivariable analysis also showed that increasing age, male sex, increasing thickness, ulceration, lymphovascular invasion, microsatellitosis, and sentinel lymph node metastasis were significantly (P <.05) associated with worse melanoma-specific survival, while regression was significantly associated with better melanoma-specific survival (hazard ratio 0.75, 95% confidence interval 0.57–0.99; P =.043). This large study shows that regression is significantly associated with better outcomes in patients with melanoma and is correlated with a lower risk of sentinel lymph node metastasis and a better melanoma-specific survival. [ABSTRACT FROM AUTHOR]

Thyroid nodules discovered incidentally during transplant may prolong time to transplantation. Although data suggest that incidence of thyroid cancer increases after solid organ transplantation, the impact on prognosis in differentiated thyroid cancer is not well characterized. We performed a retrospective review of patients with history of thyroid cancer and solid organ transplantation at our institution. A total of 13,037 patients underwent solid organ transplantation of which there were 94 patients with differentiated thyroid cancer (0.7%). Of these, 50 patients (53%) had cancer pre–solid organ transplantation, whereas 44 patients (47%) developed cancer post–solid organ transplantation. Papillary histology was most common (88%), followed by follicular (3%), Hurthle cell (3%), and medullary (2%) carcinomas. One patient in the post-transplant cohort died from metastatic thyroid cancer 11.8 years after transplantation. There were 5 patients in the pre-transplant group and 4 patients in the post-transplant group who had recurrent thyroid disease. There were no patients treated for differentiated thyroid cancer pre–solid organ transplantation that experienced disease recurrence after transplantation. Disease-free survival at 5 and 10 years was 95.8% and 92.1% (confidence interval 84.9–99.2%, 80.0–97.4%) in the pre–solid organ transplantation group vs 89.7% and 84.4% in the post (confidence interval: 80.0–96.3% and 79.0–93.1%, P =.363), respectively. Survival outcomes and recurrence rates in patients with thyroid cancer are not significantly affected by solid organ transplantation. A history of thyroid cancer or discovery of thyroid nodules during transplant screening should not be a contraindication for transplant listing. [ABSTRACT FROM AUTHOR]

It is unknown whether all thick melanomas share the same prognostic features. We present a large, multi-institutional study on thick melanoma, evaluating for factors prognostic of survival. We queried the database of the Sentinel Lymph Node Working Group for patients with thick melanoma (>4 mm) who had a sentinel lymph node biopsy from 1993 to 2018. Clinicopathologic characteristics were correlated with overall survival. There were 1,235 patients with a median follow-up of 28 months. Median thickness was 5.9 mm, with 713, 356, and 166 cases having a thickness of >4 to 6, >6 to 10, and >10 mm, respectively. Ulceration was seen in 51.2% of cases, while sentinel lymph node metastases were seen in 439 of 1,235 (35.5%) cases. For melanomas >4 to 6 mm, age, thickness, ulceration, lymphovascular invasion, and sentinel lymph node metastasis were correlated with overall survival (all P <.05), but for melanomas >6 to 10 mm, only sex and sentinel lymph node metastasis were prognostic of overall survival (both P <.05). For melanomas >10 mm, only sentinel lymph node metastasis predicted overall survival on multivariable analyses (P <.05). Prognostic markers of overall survival for thick melanoma include thickness, ulceration, and sentinel lymph node metastasis, but also include other unique factors such as lymphovascular invasion. Moreover, certain prognostic markers for survival are associated with different subgroups of thick melanoma, which vary based on thickness group. [ABSTRACT FROM AUTHOR]

Background: There is large variability in the risk of sentinel lymph node (SLN) positivity among patients with intermediate thickness melanoma (ITM), with a subgroup of patients exhibiting a low risk of nodal disease.Objective: To identify a group of patients with ITM for whom the risk of nodal disease is low.Methods: A retrospective cohort of patients with ITM who underwent wide excision and nodal evaluation from 2010 to 2013 was identified by using the National Cancer Database and analyzed for the presence of nodal disease. Classification and regression tree analysis identified the most important factors used in a model to identify groups at low risk of SLN positivity.Results: Of 23,440 patients, 14.7% were found to have nodal metastasis. On classification and regression tree analysis, patients older than 55 years without lymphovascular invasion and with a lesion thickness less than 1.7 mm had an SLN positivity rate of 4.9%. A model using age and thickness in nonulcerated patients identified a low-risk subgroup with a corresponding SLN positivity rate of 4.7%.Limitations: This was a retrospective study, and the model developed requires prospective validation.Conclusions: Patient age is an important factor in estimating risk of SLN in patients with ITM and may help identify patients without ulceration who may be safely spared an SLN biopsy. [ABSTRACT FROM AUTHOR]

Objectives A recent multidisciplinary consensus defined an adequate breast cancer margin as no ink on tumor. The purpose of this study was to analyze rates of residual disease at re-excision by margin width. Materials and methods A prospective database at a single institution was reviewed from 2000 to 2012. Institutional protocol had been to perform re-excision surgery when margins were <2 millimeters (mm). Results There were 2520 procedures. Re-excision surgery was performed for 12% of breast conserving therapy (BCT) procedures and 2% of mastectomies; residual disease was present in 38% and 26%, respectively. The rates of residual disease for all patients with positive, 0.1–0.9 mm, and 1.0–1.9 mm margins were 40%, 38%, and 33%, respectively. Age, race, menopause status, width of closest final margin, tumor histology, hormone receptor status, triple-negative disease and presence of lymphovascular invasion (LVI) were not significantly associated with the presence of residual disease. The presence of multiple margins <2 mm trended toward significance (p = 0.06). Median follow-up was 43 months. The five-year local recurrence rates (5-year LR) were 1.1% for mastectomy patients and 1.9% for BCT patients. Conclusions Breast cancer patients with margins of excision <2 mm have a substantial risk of residual disease but the rates far exceed LR rates. These findings suggest that using residual disease rates to determine the appropriate margin width is not reliable, but also serve as a note of caution to track LR rates as institutions conform to new national guidelines for margin management. [ABSTRACT FROM AUTHOR]

Background: Conflicting data exist on predictors of nodal metastases and their impact on survival in patients with pancreatic neuroendocrine tumors (PNETs). We aim to identify factors associated with lymph node involvement and evaluate the effect of nodal metastases on survival. Methods: All patients undergoing surgery for PNETs in the Surveillance, Epidemiology, and End Results (SEER) tumor registry from 1988 to 2010 were included. Predictors of lymph node involvement and disease-specific survival (DSS) were evaluated using logistic regression and Cox regression, respectively. Results: Patients (1,915) underwent surgery for a PNET (62 % nonfunctional). Nodal positivity was associated with increasing tumor size ( p < 0.001) and grade ( p < 0.001). Unadjusted DSS at 5 years was 81 % for N0, 74 % for Nx, and 69 % for N1, respectively, ( p < 0.001). After adjustment for tumor size and grade, DSS was significantly decreased in N1 patients (HR 1.57; 95 % CI 1.23-1.95). For patients who had at least one node examined and had low-grade PNETs <1 cm, no nodal metastases were found. Conclusions: High tumor grade and increasing size predict nodal metastases in patients with PNETs. N1 status is independently associated with decreased DSS. Low-grade tumors <1 cm may be observed or enucleated. [ABSTRACT FROM AUTHOR]

Background: Decreased survival after colon cancer surgery has been reported in patients with deficient preoperative quality of life. We hypothesized that deficits in preoperative quality of life are associated with postoperative complications. Patient and Methods: A secondary analysis of the Clinical Outcomes Surgical Therapy trial NCCTG 93-46-53 (INT 0146, Alliance) was performed. Quality of life deficit was defined as overall quality of life score <50 on a 100-point scale and used for univariate and multivariate analysis. Results: Of 431 patients enrolled in the quality of life portion of the trial, 81 patients (19 %) experienced complications including two deaths (0.5 %). Fifty-five patients (13 %) had a preoperative quality of life score <50. Patients with a preoperative deficit were more likely to have a serious early complication (16 vs 6 %, p = 0.023). Using stepwise logistic model, the variables significantly associated with having any early complications (yes/no) were age, ASA III and change in 'activity' from baseline to day 14. Patients with an early complication experienced a 3.5-day longer hospital stay ( p = 0.0001). Gender, race, tumor stage, and laparoscopic or open approach were not associated with an increased frequency of complications. After adjusting for demographics, tumor stage, ASA, and operative approach, significant predictors for readmission were preoperative pain (odds ratio (OR) 1.61, confidence interval (CI) 1.11-2.34, p = 0.0125), and changes from baseline to day 2 in fatigue (OR 1.34, CI 1.03-1.74, p = 0.032). Conclusions: This study suggests that quality of life can provide an early indicator for patients at risk of complications. Further studies should evaluate how perioperative quality of life assessment may assist to improve outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: The American College of Surgeons Oncology Group Z0011 trial results have the potential to bias the number of sentinel lymph nodes (SLNs) surgeons remove and axillary lymph node dissections (ALNDs) performed. METHODS: A single-institution prospectively collected database was queried for T1 to T2 clinically node-negative breast cancer patients. RESULTS: A total of 923 patients underwent breast conserving therapy with SLN biopsy. The mean number of SLNs retrieved before the trial's presentation (June 2010) was 2.7 compared with 2.6 after (P = .19). The mean number of SLNs retrieved before the trial's publication (February 2011) was 2.7 compared with 2.5 after (P = .10). Overall, the rate of completion ALND in patients with SLN macrometastases decreased from after presentation (84% to 63%; P < .01) and publication (83% to 62%; P < .01). CONCLUSIONS: There was no difference in the number of SLNs harvested after either the Z0011 trial presentation or publication; however, surgeons should be aware of the potential for bias. The trial appears to influence practice management with fewer completion ALNDs performed after its release. [ABSTRACT FROM AUTHOR]

Background: The number of lymph nodes required for accurate staging after distal pancreatectomy for pancreatic adenocarcinoma is unknown. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 1,473 patients who underwent distal pancreatectomy for pancreatic adenocarcinoma from 1998 to 2010. We evaluated the influence of the total number of lymph nodes examined (NNE) and the lymph node ratio (LNR-positive nodes/total nodes examined) on survival. Results: The median NNE was 8. No nodes were examined in 232 (16 %) of the patients, and 843 (57 %) had <10 NNE. Of the patients who had at least one node examined, 612 (49 %) were node positive. In the node-negative subset, the median and 5-year overall survival for patients with ≤10 NNE was significantly worse than patients with >10 NNE (16 vs. 20 months and 13 vs. 19 %, respectively, p < 0.011). For node-positive patients, those with LNR ≤0.1 had better 5-year overall survival compared with LNR >0.1 (17 vs. 6 %, p = 0.002). Discussion: Patients with pancreatic cancer undergoing distal pancreatectomy should ideally have at least 11 lymph nodes examined to avoid understaging. For node-positive patients, LNR may be a better prognostic indicator than the total number of positive nodes. [ABSTRACT FROM AUTHOR]

Background: Locoregional recurrence occurs in approximately 20% of patients with melanoma and is associated with a significantly worse prognosis. Standards are well established for peripheral margins; however, there is insufficient evidence regarding depth of resection. Methods: Retrospective review of 964 patients undergoing excision of trunk or extremity melanoma ≥1 mm thick during a 29-year period at a tertiary academic center. Multivariate analysis and hazard ratios were used to determine the effect of excision of the deep muscular fascia on locoregional recurrence. Results: A total of 278 (29%) patients underwent resection of the muscular fascia. Of these patients, 18 (6%) developed local, 33 (12%) developed in-transit, and 68 (24%) developed nodal recurrence within 5 years. A total of 686 (71%) patients underwent excision of their primary melanoma with preservation of the muscular fascia. Of these patients, 40 (6%) developed local, 30 (4%) developed in-transit, and 84 (12%) developed nodal recurrence at 5 years. In multivariate analysis excision of the deep muscular fascia was an independent predictor of locoregional recurrence in patients treated with sentinel lymph node biopsy. Specifically, fascia resection was associated with a 2.5-fold increased risk of nodal recurrence but not associated with local recurrence or overall survival. Conclusion: On the basis of no demonstrated advantage for resection of the deep muscular fascia, but potential for increased risk of intralymphatic recurrences, we recommend preservation of the deep muscular fascia during resection of primary cutaneous melanoma. [ABSTRACT FROM AUTHOR]

Introduction: The recently published 7th edition of the American Joint Committee on Cancer (AJCC) TNM staging criteria for gastric adenocarcinoma contains important revisions to T and N classifications, as well as overall stage grouping. Our goal was to validate the new staging system using a cancer registry. Methods: Retrospective review of gastric cancer patients from Surveillance, Epidemiology, and End Results (SEER) registry data (2004-2007). Patients were staged according to both 6th and 7th edition criteria, and 3-year disease-specific survival was compared. Results: Thirteen thousand five hundred forty-seven patients with gastric adenocarcinoma were identified with complete staging information. When using 7th edition criteria, there was an increase in the number of patients classified as stage III (23% vs. 13%), and a decrease in patients classified as stage IV (47% vs. 53%). Statistically significant differences in 3-year disease-specific survival were observed for all T and N categories and re-staging the same population according to the 7th edition criteria improved survival discrimination. Multivariate analysis revealed statistically significant differences in survival and linear progression of hazard ratios for each stage grouping. Conclusions: The 7th edition AJCC staging criteria for gastric adenocarcinoma demonstrate better survival discrimination and risk stratification than previous criteria. [ABSTRACT FROM AUTHOR]

Abstract: Background: The relative contributions of patient and tumor factors versus radiologic localization technique to the rates of inadequate margins of excision in breast-conserving therapy have not been defined. Methods: Patients undergoing breast-conserving therapy were studied. Margins less than 2 mm from tumor were considered inadequate. Results: Of 539 patients, 31% were guided by palpation and 69% were guided by preoperative radiologic localization. The palpation-guidance patients had larger tumors (P < .0001) and more nodal metastases (P = .0005). The rates of inadequate margins were 10% for palpation-guided patients and 11% for radiologic-localization patients (P = .53). The 3-year rates of local recurrence were .7% for palpation-guided patients and 1.8% for radiologic-guided patients (P = .5). Conclusions: Patient, tumor, and intraoperative pathologic factors, not just localization device shortcomings, produce inadequate margins of excision in breast-conserving therapy. A reasonable expected rate of inadequate margins owing to patient and tumor factors is 10%. Quality improvement for margin management must focus on intraoperative assessment of margins, especially for patients with identified risk factors, in addition to improving localization technique. [Copyright &y& Elsevier]

Background: Many women with nipple discharge undergo operative duct excision with few actually having carcinoma. Methods: We reviewed all patients with nipple discharge at our institution from 2001 to 2005. Clinical findings were analyzed to determine an appropriate treatment algorithm. Results: Nipple discharge was present in 204 patients. Carcinoma was identified in 7 patients (3% of all, 9% of those undergoing biopsy). Age > or = 50 years, abnormal mammography, and abnormal sonography were the only significant predictors of carcinoma. Among patients with unilateral, spontaneous, bloody, or serous discharge with a negative mammogram, the carcinoma risk was 3%. Among patients with unilateral, spontaneous, bloody, or serous discharge with a negative mammogram and subareolar ultrasound, the carcinoma risk was 0%. Conclusions: Patients with nipple discharge can be divided into risk groups by combining clinical and radiologic findings. Low-risk patients can be offered close clinical follow-up rather than operation. A recommended management algorithm is presented. [ABSTRACT FROM AUTHOR]

Background: The current study sought to validate radioactive seed localization (RSL) as an alternative to wire localization (WL) to facilitate the operative excision of nonpalpable breast lesions. Methods: One hundred consecutive patients underwent preoperative WL and the next 100 RSL. Margins were considered negative if > or =2 mm from in situ and invasive disease. Results: RSL resulted in 100% retrieval of the seeds and lesions. Sixty-eight percent of patients underwent RSL at least 1 day before surgery. RSL resulted in a 35% relative improvement in the rate of negative margins in the first specimen (P = 0.01) and a 62% relative improvement in the rate of reoperation for positive margins (P = 0.01). The sentinel lymph node (SLN) identification rate was 100% in both groups. Conclusions: RSL is effective and safe, and this procedure significantly improved the rate of negative margins in the first specimen and the rate of reoperation for positive margins compared to WL. We highly favor RSL over WL. [ABSTRACT FROM AUTHOR]

Background Determining sentinel lymph nodes (SLNs) in breast cancer staging involves subjective interpretation by the surgeon. We hypothesized patient and tumor characteristics influence number of SLNs harvested. Methods A single-institution, prospectively collected database was queried for breast cancer patients undergoing SLN surgery (2002–2013) and mean SLN counts were compared. Results There were 2394 SLN biopsies. Mean number of SLNs per patient for the entire cohort was 2.6. Mean number of SLNs removed was greater for patients ≤50 years (2.9 versus 2.6; p < 0.0001). Fewer SLNs were removed with tumors ≤1 cm (2.5 versus 2.6; p = 0.002). Patients with grades 2 or 3 tumors had more SLNs removed than grade 1 (2.6 versus 2.5; p = 0.03). Receipt of neoadjuvant therapy was associated with more SLNs removed (3.0 versus 2.6; p = 0.005). Conclusion Number of SLNs removed varies based on risk factors for SLN metastasis or false-negative SLN biopsy. [ABSTRACT FROM AUTHOR]

There is disagreement regarding the preferred injection site for breast sentinel lymph node mapping.The concordance of blue staining and radioactivity in the sentinel nodes of 730 consecutive patients was analyzed based on injection of mapping agents into the same or separate intradermal and subareolar sites.There were no significant differences in identification rates or the mean number of sentinel nodes whether agents were injected into the same or separate sites. In each group, a concordant sentinel node (both blue and “hot”) was identified in >90% of patients (P = not significant). There were no significant differences in the percentage of sentinel nodes identified as both blue and hot.Separate subdermal and subareolar injections of mapping agents drain to the same sentinel node as often as injections into the same location. These two injection techniques appear to result in the identification of the same sentinel nodes. [Copyright &y& Elsevier]

Our aim was to report physician- and patient-reported outcomes of patients with localized breast cancer treated with moderate versus ultrahypofractionated whole breast irradiation (WBI) after breast-conserving surgery (BCS). Between February 2018 and February 2020, patients with localized breast cancer (pT0-3 pN0-1 M0) were offered participation in a phase 3 randomized clinical trial assessing adjuvant moderate hypofractionation (MHF) to 40 Gy in 15 fractions versus ultrahypofractionation (UHF) to 25 Gy in 5 fractions after BCS, with an optional simultaneously integrated boost. Toxicities, cosmesis, and quality of life were assessed at baseline, end of treatment (EOT), and 3 months, 1 year, 2 years, and 3 years from irradiation using validated metric tools. One hundred seven patients were randomized to MHF (n = 54) or UHF (n = 53) adjuvant WBI. The median follow-up was 42.8 months. Grade 2 radiation dermatitis was experienced by 4 patients (7.4%) in the MHF arm and 2 patients (3.7%) in the UHF arm at EOT (P =.726). No grade 3 or higher toxicities were observed. Deterioration of cosmesis by physician assessment was observed in 2 (6.7%) patients treated in the UHF arm and 1 (1.9%) patient treated in the MHF arm at EOT (P =.534), whereas at 3 months, only 1 (1.8%) patient treated in the MHF arm demonstrated deterioration of cosmesis (P =.315). At EOT, 91% and 94% of patients reported excellent/good cosmesis among those treated with MHF and UHF regimens, respectively (P =.550). At 3 months, more patients within the MHF arm reported excellent/good cosmesis compared with those in the UHF arm (100% vs 91%; P =.030). However, the difference in patient-reported cosmesis disappeared at the 1-, 2-, and 3-year time points. UHF WBI showed similar treatment-related late toxicities and similar provider-scored cosmesis compared with MHF radiation in patients treated adjuvantly after BCS. [ABSTRACT FROM AUTHOR]

Background Merkel cell carcinoma (MCC) is a rare cutaneous malignancy of neuroendocrine origin with a high propensity for lymph node metastasis. Sentinel lymph node (SLN) status is important for accurate staging; however, the optimal treatment following SLN biopsy, regardless of nodal status, remains unclear. Methods 150 patients with MCC who underwent SLN biopsy from 1995 to 2011 at 3 Mayo Clinic sites were reviewed. Results Of 150 patients with MCC who underwent SLN biopsy, 39 (26%) were positive and 111 (74%) were negative. There was no significant difference between the sex, age, tumor location, or size of primary in the positive and negative SLN groups. While there was no difference in the cumulative incidence of any regional recurrence between SLN groups, the rate of in-transit recurrences was significantly higher in patients with a positive SLN (p = 0.022). The disease-specific survival for MCC was 97.0%, 82.4%, and 82.4% at 1, 3, and 5 years with a positive SLN and 99.0%, 94.9%, and 86.8% with a negative SLN (p = 0.31). Among those alive at last follow up, the median follow up was 3.8 years (IQR, 2.1-8.4) and 2.9 years (IQR, 1.8-6.1) for positive and negative SLN cohorts respectively. Conclusions Occult nodal metastasis is common in MCC(26%). No tumor or patient characteristics were identified to predict SLN positivity. Patients with a positive SLN have a higher risk of in-transit recurrence and may benefit from adjuvant radiation with inclusion of the in-transit field in amenable cases. When patients with a positive SLN receive additional treatment to the at-risk nodal basin, both OS and DSS are similar to patients with a negative SLN. [ABSTRACT FROM AUTHOR]

BACKGROUND: Nipple discharge occurs in 2% to 5% of women. We evaluated the effectiveness of a previously proposed treatment algorithm for these patients. METHODS: Patients with pathologic nipple discharge and a negative mammogram and subareolar ultrasound were offered follow-up from 2005 to 2011 according to the algorithm. RESULTS: A total of 192 patients, mean age 56 years, were studied. Risk of carcinoma among the entire cohort was 5%. Breast surgeon was consulted for 142 (74%) patients: 48 (34%) underwent initial subareolar excision and 94 (66%) were clinically followed. The rate of carcinoma was 17% (8/48) after initial subareolar excision, 0% (0/13) for those without imaging abnormalities, 23% (8/35) with imaging abnormalities, and 1% (1/94) with clinical follow-up. Of patients who underwent follow-up, 21% (n = 20) underwent subareolar excision because of imaging abnormality (n = 1, 1%) or persistent discharge (n = 19, 20%). Most patients had ductal carcinoma in situ (n = 5, 56%). CONCLUSIONS: Patients with nipple discharge can be prospectively identified based on radiographic findings and clinical examination for safe clinical follow-up. Most will have resolution avoiding a surgical procedure. [ABSTRACT FROM AUTHOR]

Abstract: Background: Patients are often concerned about the participation of junior trainees in their operative treatment. Breast-conserving therapy (BCT) for nonpalpable breast lesions requires the use of localization devices and carries a significant risk for positive margins of excision. It was therefore hypothesized that the participation of junior residents in BCT operations for nonpalpable breast lesions could result in an increased rate of positive margins of excision. Methods: Retrospective analysis of a prospective database of all patients with nonpalpable tumors who underwent BCT from August 1999 to August 2009 was performed. Patient and tumor characteristics and factors involved in resection were analyzed. A ≥2-mm margin of normal breast tissue beyond tumor was considered an adequate margin. Chi-square analysis and Student''s t test were performed to determine relationships between independent variables and margin status. Results: Of 308 BCT procedures for nonpalpable tumors, 241 (78%) were performed by attending surgeons and junior residents (group 1) and 67 (22%) by attending surgeons without resident assistance (group 2). The operations for group 1 took significantly longer than the operations for group 2 (mean, 130 vs 116 min, P = .006). Intraoperative reexcision of margins was performed for 37% of group 1 patients and 31% of group 2 patients (P = .249), and reoperation for inadequate margins was performed in 11% of group 1 patients and 13% of group 2 patients (P = .361). Conclusions: Junior resident participation in BCT procedures was not associated with higher rates of inadequate margins of excision. Patients can be reassured that junior resident involvement in their BCT operations is safe and effective. [Copyright &y& Elsevier]

Abstract: Background: For patients with microinvasive breast cancer, the value of intraoperative analysis of sentinel lymph nodes (SLNs) and complete axillary lymph node dissection (CALND) is not well known. Methods: All patients staged T1mic from 2001 to 2005 were analyzed. Results: Among all 81 patients, 4 (5%) had SLN metastases detected with hematoxylin and eosin staining and 2 (2%) had metastases identified by immunohistochemistry staining only. Seventy-seven patients (95%) underwent SLN biopsy; 3 (4%) had hematoxylin and eosin SLN metastases and 2 (3%) had immunohistochemistry-detected metastases. One SLN metastasis was identified on frozen section analysis. No patient with a SLN metastasis had additional metastases on CALND. The patient charges for frozen section analyses were $39,578 for 77 patients. This prevented 1 reoperative CALND at a charge of $20,274. Conclusions: Frozen section analysis should be used only in select patients with microinvasive breast cancer and CALND is of limited value for these patients. [Copyright &y& Elsevier]

Cancer thrives in a complex environment where interactions between cellular and acellular components, surrounding the tumor, play a crucial role in disease development and progression. Despite significant progress in cancer research, the mechanism driving tumor growth and therapeutic outcomes remains elusive. Two-dimensional (2D) cell culture assays and in vivo animal models are commonly used in cancer research and therapeutic testing. However, these models suffer from numerous shortcomings including lack of key features of the tumor microenvironment (TME) & cellular composition, cost, and ethical clearance. To that end, there is an increased interest in incorporating and elucidating the influence of TME on cancer progression. Advancements in 3D-engineered ex vivo models, leveraging biomaterials and microengineering technologies, have provided an unprecedented ability to reconstruct native-like bioengineered cancer models to study the heterotypic interactions of TME with a spatiotemporal organization. These bioengineered cancer models have shown excellent capabilities to bridge the gap between oversimplified 2D systems and animal models. In this review article, we primarily provide an overview of the immune and stromal cellular components of the TME and then discuss the latest state-of-the-art 3D-engineered ex vivo platforms aiming to recapitulate the complex TME features. The engineered TME model, discussed herein, are categorized into three main sections according to the cellular interactions within TME: (i) Tumor-Stromal interactions, (ii) Tumor-Immune interactions, and (iii) Complex TME interactions. Finally, we will conclude the article with a perspective on how these models can be instrumental for cancer translational studies and therapeutic testing. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether the use of a computer-aided diagnosis-contrast-enhanced spectral mammography (CAD-CESM) tool can further increase the diagnostic performance of CESM compared with that of experienced radiologists.Materials and Methods: This IRB-approved retrospective study analyzed 50 lesions described on CESM from August 2014 to December 2015. Histopathologic analyses, used as the criterion standard, revealed 24 benign and 26 malignant lesions. An expert breast radiologist manually outlined lesion boundaries on the different views. A set of morphologic and textural features were then extracted from the low-energy and recombined images. Machine-learning algorithms with feature selection were used along with statistical analysis to reduce, select, and combine features. Selected features were then used to construct a predictive model using a support vector machine (SVM) classification method in a leave-one-out-cross-validation approach. The classification performance was compared against the diagnostic predictions of 2 breast radiologists with access to the same CESM cases.Results: Based on the SVM classification, CAD-CESM correctly identified 45 of 50 lesions in the cohort, resulting in an overall accuracy of 90%. The detection rate for the malignant group was 88% (3 false-negative cases) and 92% for the benign group (2 false-positive cases). Compared with the model, radiologist 1 had an overall accuracy of 78% and a detection rate of 92% (2 false-negative cases) for the malignant group and 62% (10 false-positive cases) for the benign group. Radiologist 2 had an overall accuracy of 86% and a detection rate of 100% for the malignant group and 71% (8 false-positive cases) for the benign group.Conclusions: The results of our feasibility study suggest that a CAD-CESM tool can provide complementary information to radiologists, mainly by reducing the number of false-positive findings. [ABSTRACT FROM AUTHOR]

Objective Supplement tomosynthesis-detected architectural distortions (AD) with CESM to better characterize malignant vs benign lesions. Methods Retrospective review CESM prior to biopsied AD. Pathology: benign, radial scar, or malignant. Results 49 lesions (45 patients). 29 invasive cancers, 1 DCIS (range, 0.4–4.7 cm); 9 radial scars; 10 benign. 37 (75.5%) ADs had associated enhancement. PPV 78.4% (29/37), sensitivity 96.7% (29/30); specificity, 57.9% (11/19); NPV, 91.7% (11/12). False-positive rate 21.6% (8/37); false-negative rate, 8.3% (1/12). Accuracy 81.6% (40/49). Conclusions High sensitivity and NPV of CESM in patients with AD is promising as an adjunct tool in diagnosing malignancy and avoiding unnecessary biopsy, respectively. [ABSTRACT FROM AUTHOR]

Objectives To compare breast cancer size measurements on full-field digital mammography (FFDM), contrast-enhanced spectral mammography (CEDM), and ultrasound (US), with histologic tumor size used as the reference standard. Material and methods The HIPAA complaint, IRB approved study comprised 88 women with newly diagnosed breast cancer who underwent FFDM and CEDM;74 also had US. Breast density, histologic subtype, and maximum tumor measurements were recorded. Results Pearson correlation coefficients for FFDM, US, and CEDM vs histopathology were 0.598, 0.639, and 0.859, respectively ( P < 0.001). The following correlation coefficients were calculated for dense breasts (n = 48): histopathology vs FFDM (0.555), US (0.633), and CEDM (0.843) ( P < 0.001); for nondense breasts (n = 40), they were FFDM (0.618), US (0.512), and CEDM (0.885) ( P < 0.001). For size difference, the mean (SD) for histopathology vs FFDM, US, and CEDM was − 1.3 (11.9) mm, − 2.8 (11.1) mm, and 2.9 (9.5) mm, respectively. Limits of agreement were − 24.8 to 22.0 mm, − 24.5 to 18.8 mm, and − 15.6 to 21.4 mm, respectively. Conclusions In patients with biopsy-proven malignancy, size measurements correlated well with histopathologic size, and were higher on CEDM than those for FFDM and US in patients with dense or nondense breasts. The added value of CEDM as a supplement to FFDM in determining tumor size, however, was greater in patients with dense breasts. CEDM may be a promising alternative preoperative measurement tool for breast cancer patients with dense breasts and/or limited access or contraindications to MRI. [ABSTRACT FROM AUTHOR]