A retrospective study of the impact of 21-gene recurrence score assay on treatment choice in node positive micrometastatic breast cancer.

To assess clinical utility of the 21-gene assay (Oncotype DX® Recurrence Score®), we determined whether women with HER2(−)/ER+ pN1mi breast cancer with low ( vs. 57.9% in the intermediate-risk group and 100% in the high-risk group (p \u3c 0.001). A total of 80.2% of the low-risk group were recommended endocrine therapy alone, while 77.8% of the high-risk group were recommended both endocrine and chemotherapy (p \u3c 0.001). The Oncotype DX Recurrence Score result provides actionable information that can be incorporated into treatment planning for women with HER2(−)/ER+ pN1mi breast cancer. The Recurrence Score result has clinical utility in treatment planning for HER2(−)/ER+ pN1mi breast cancer patients

An Updated Institutional Review of Mastectomy and Contralateral Prophylactic Mastectomy Rates

An Updated Institutional Review of Mastectomy and Contralateral Prophylactic Mastectomy Rates_x000D_ Anita Sambamurty, M.P.H., Cecilia Rossi, Christine Teal, M.D., Anita McSwain, M.D., M.P.H., Claire Edwards M.D. Breast conservation (BCT) followed by radiation therapy has been shown to be as effective for long term survival of breast cancer as mastectomies, and is considered standard of care for patients who are candidates. However, patients are increasingly electing to have mastectomies with contralateral prophylactic mastectomies (CPM). A previous study from our institution observed factors that influenced patients to choose mastectomies over BCT between 2002 and 2009. The purpose of the current study was to observe mastectomy rates in our institution over the past 2 years and to evaluate factors for BCT-eligible patients who elected to have mastectomies with and without CPM. A retrospective analysis was performed for 201 mastectomy surgeries among females between September 2013 and August 2015 at The George Washington University Breast Care Center. Patients who were eligible for BCT were compared to patients not eligible for BCT. Rates of CPM were also compared among those who were and were not eligible for BCT. Chi-squared test of independence was used to evaluate statistical significance. Of 201 mastectomies performed, 34 were prophylactic and 167 were for cancer. Of the 167 for cancer, 97 (58.1%) were not eligible for BCT and 70 (41.9%) were eligible for BCT. Of mastectomy patients who were BCT-eligible, 49 (70.0%) also elected to have CPM (p Mastectomy and CPM rates have been increasing at our institution, which has been observed by other authors. Preoperative diagnosis of invasive carcinoma, family and personal history of disease, age and race were found to be associated with mastectomy and CPM in this study. However, more studies observing BCT-eligible patients who elected mastectomy versus BCT are required to further evaluate the factors that impact patients’ choices for surgical management

Pre-incisional SPY angiography use in nipple and skin sparing mastectomy surgery: An institutional review

Pre-incisional SPY angiography use in nipple and skin sparing mastectomy surgery: An institutional review Lawren Wooten B.S., Cecilia Rossi, Sarah Sirajuddin M.D., Anita McSwain M.D., Joanne Lenert, M.D., Christine Teal M.D. INTRODUCTION: SPY angiography has been widely used to evaluate tissue perfusion in skin and tissue flaps during breast reconstruction. While limited studies have investigated SPY imaging in mastectomy surgery, only one has evaluated the use of SPY to identify the dominant blood supply to the mastectomy flaps and nipple areolar complex (NAC) prior to incision. OBJECTIVE: To study the intraoperative use of pre-incisional SPY angiography and the ability to identify mastectomy flap and nipple-areolar complex perfusion prior to nipple and skin sparing mastectomies. METHODS: A retrospective chart review of patients who underwent nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) with intraoperative pre-incisional SPY angiography was performed from August 2016 to October 2016. Study variables included age, reason for surgery, change in incision location, post-operative ischemia, hyperbaric oxygen therapy (HBO), and excision of necrotic tissue. For the purposes of this review, cases were labeled prophylactic when neither breast was cancerous. A case was delineated as therapeutic if mastectomy was only performed on the breast containing cancer or if the patient underwent bilateral mastectomies when one or both breasts were cancerous. RESULTS: This study included 27 mastectomies in 14 patients with average age of 44.3 ± 11.4 years. Ten cases were defined as prophylactic (71.4%) and 4 cases were defined therapeutic (28.6%). Most cases enabled breast surgeons to identify major perforators during surgery. The location of the planned incision was changed after SPY imaging in one mastectomy (3.7%) due to the location of vasculature. Of the 27 mastectomies, three (11.1%) experienced mastectomy flap or nipple-areolar complex necrosis. One underwent HBO, and all three required subsequent excision of necrotic skin. CONCLUSIONS: This study describes the possible utility of SPY angiography to identify the dominant perforators supplying the mastectomy flap and nipple areolar complex (NAC). The major limitation is the small number of patients. We recommend larger studies to determine if there is any benefit of having breast surgeons perform SPY angiography prior to performing skin and nipple sparing mastectomies

Factors associated with re-excision in patients with early-stage breast cancer treated with breast conservation therapy

One of the risks of breast conservation surgery is local recurrence, which predominantly occurs as a result of inadequate surgical margins. The purpose of this study was to identify factors associated with close or positive surgical margins leading to reexcision (RE). The charts of 532 consecutive breast cancer patients treated at our center between September 2001 and June 2007 were reviewed to evaluate patients who opted for breast conservation surgery and needed reexcision. A total of 351 patients were treated with breast conservation, of which 118 (34%) had positive or close surgical margins and went on to RE. On univariate analysis, factors that significantly correlated with RE (P \u3c 0.05) were preoperative diagnosis, final pathology, size of tumor, and presentation with nipple discharge. RE was necessary in 53 per cent of patients with a preoperative diagnosis of ductal carcinoma in situ (DCIS), 57 per cent of patients diagnosed by surgical excision, 86 per cent of patients presenting with nipple discharge, and 87 per cent of patients with DCIS or invasive carcinoma with extensive intraductal component in the final pathology. Additionally, 53 per cent of patients with T3 tumors required RE. Age, race, and grade of tumor had no effect on RE rates. Most (75%) patients were able to ultimately have breast conservation

Factors associated with re-excision in patients with early-stage breast cancer treated with breast conservation therapy

One of the risks of breast conservation surgery is local recurrence, which predominantly occurs as a result of inadequate surgical margins. The purpose of this study was to identify factors associated with close or positive surgical margins leading to reexcision (RE). The charts of 532 consecutive breast cancer patients treated at our center between September 2001 and June 2007 were reviewed to evaluate patients who opted for breast conservation surgery and needed reexcision. A total of 351 patients were treated with breast conservation, of which 118 (34%) had positive or close surgical margins and went on to RE. On univariate analysis, factors that significantly correlated with RE (P \u3c 0.05) were preoperative diagnosis, final pathology, size of tumor, and presentation with nipple discharge. RE was necessary in 53 per cent of patients with a preoperative diagnosis of ductal carcinoma in situ (DCIS), 57 per cent of patients diagnosed by surgical excision, 86 per cent of patients presenting with nipple discharge, and 87 per cent of patients with DCIS or invasive carcinoma with extensive intraductal component in the final pathology. Additionally, 53 per cent of patients with T3 tumors required RE. Age, race, and grade of tumor had no effect on RE rates. Most (75%) patients were able to ultimately have breast conservation

Mastectomy and Contralateral Prophylactic Mastectomy Rates: An Institutional Review

Background. Breast conservation surgery (BCS) followed by radiation is as effective as mastectomy for long-term survival and is considered standard of care for early-stage breast cancer. An increasing number of patients are opting for cancer-side mastectomies (CM) and often contralateral prophylactic mastectomies (CPM). Our study investigates if there are increasing trends in our patient population toward CM and CPM and identifies common factors associated with those electing to have more extensive surgery. Methods. A retrospective analysis was performed on 812 breast cancer surgeries between January 2001 and December 2009 at The George Washington University Breast Care Center. BCS-eligible patients who elected to have BCS were compared with those who chose CM. Patients who underwent CM were compared with patients undergoing CM and CPM. Results. A personal or family history of breast cancer and larger tumor size were positively associated with choosing CM in BCS-eligible patients. A nonstatistically significant trend toward CM was seen in younger patients. Age, family history, fewer children, Caucasian race, and reconstructive surgery were positively associated with choosing CPM. Conclusion. Mastectomy rates at this institution have not shown the recent sharp increase observed by some authors. The association of age, race, family history, and parity with CPM has been corroborated in multiple studies. However, there is disagreement between statistically significant findings among investigators evaluating factors associated with CPM, and there is limited data in the literature characterizing BCS-eligible patients who chose CM. Larger prospective studies are necessary to further evaluate CM and CPM rates

Breast-specific gamma imaging influences surgical management in patients with breast cancer

Breast-specific gamma imaging (BSGI) is a physiologic breast imaging modality that provides more sensitive detection of breast lesions than mammography or ultrasound, and appears to have greater specificity than breast MRI. The purpose of this study was to evaluate how often BSGI changed surgical management in patients with breast cancer. Charts were reviewed from 218 consecutive eligible patients who had preoperative evaluation with BSGI or MRI before surgery for breast cancer from January 2008 to May 2010. Patients who were initially considered eligible for breast-conserving therapy (BCT) were evaluated to determine how many ultimately had mastectomies. Patients who underwent mastectomy because of personal choice or ineligibility for BCT were excluded. Management was changed to mastectomy in 11.9% of those who had BSGI and 28.9% of those who had MRI. Review of pathology demonstrated that all patients who underwent mastectomies were not candidates for breast conservation. 15.4% of patients who underwent BCT based on BSGI findings required a single re-excision due to positive surgical margins. 14.4% required mastectomy. In the MRI group, 18.8% required a single re-excision, and 6.3% required mastectomy. Evaluation with BSGI changed management to mastectomy in a substantial proportion of patients believed to be eligible for BCT following standard imaging. BSGI is effective in evaluation of extent of disease in patients with breast cancer, and is comparable to MRI in terms of its influence on surgical management. © 2013 Wiley Periodicals, Inc

Breast-specific gamma imaging influences surgical management in patients with breast cancer

Breast-specific gamma imaging (BSGI) is a physiologic breast imaging modality that provides more sensitive detection of breast lesions than mammography or ultrasound, and appears to have greater specificity than breast MRI. The purpose of this study was to evaluate how often BSGI changed surgical management in patients with breast cancer. Charts were reviewed from 218 consecutive eligible patients who had preoperative evaluation with BSGI or MRI before surgery for breast cancer from January 2008 to May 2010. Patients who were initially considered eligible for breast-conserving therapy (BCT) were evaluated to determine how many ultimately had mastectomies. Patients who underwent mastectomy because of personal choice or ineligibility for BCT were excluded. Management was changed to mastectomy in 11.9% of those who had BSGI and 28.9% of those who had MRI. Review of pathology demonstrated that all patients who underwent mastectomies were not candidates for breast conservation. 15.4% of patients who underwent BCT based on BSGI findings required a single re-excision due to positive surgical margins. 14.4% required mastectomy. In the MRI group, 18.8% required a single re-excision, and 6.3% required mastectomy. Evaluation with BSGI changed management to mastectomy in a substantial proportion of patients believed to be eligible for BCT following standard imaging. BSGI is effective in evaluation of extent of disease in patients with breast cancer, and is comparable to MRI in terms of its influence on surgical management. © 2013 Wiley Periodicals, Inc

Breast-specific gamma imaging influences surgical management in patients with breast cancer.

Breast-specific gamma imaging (BSGI) is a physiologic breast imaging modality that provides more sensitive detection of breast lesions than mammography or ultrasound, and appears to have greater specificity than breast MRI. The purpose of this study was to evaluate how often BSGI changed surgical management in patients with breast cancer. Charts were reviewed from 218 consecutive eligible patients who had preoperative evaluation with BSGI or MRI before surgery for breast cancer from January 2008 to May 2010. Patients who were initially considered eligible for breast-conserving therapy (BCT) were evaluated to determine how many ultimately had mastectomies. Patients who underwent mastectomy because of personal choice or ineligibility for BCT were excluded. Management was changed to mastectomy in 11.9% of those who had BSGI and 28.9% of those who had MRI. Review of pathology demonstrated that all patients who underwent mastectomies were not candidates for breast conservation. 15.4% of patients who underwent BCT based on BSGI findings required a single re-excision due to positive surgical margins. 14.4% required mastectomy. In the MRI group, 18.8% required a single re-excision, and 6.3% required mastectomy. Evaluation with BSGI changed management to mastectomy in a substantial proportion of patients believed to be eligible for BCT following standard imaging. BSGI is effective in evaluation of extent of disease in patients with breast cancer, and is comparable to MRI in terms of its influence on surgical management. © 2013 Wiley Periodicals, Inc

Breast-specific gamma imaging in the detection of atypical ductal hyperplasia and lobular Neoplasia

Rationale and Objectives: Atypical lesions such as atypical ductal hyperplasia (ADH) and lobular neoplasia are nonmalignant lesions that are associated with significant increased risk of developing breast cancer. Atypical lesions have been reported to present with focal increased radiotracer uptake on breast-specific gamma imaging (BSGI) examination, a novel physiologic tool for the detection of breast cancer. To date the sensitivity of BSGI in the detection of atypical lesions has not been reported. The purpose of this study is to determine the sensitivity of BSGI in detecting ADH and lobular neoplasia. Materials and Methods: A total of 1316 patients who received a BSGI exam between January 2006 and July 2009 were retrospectively reviewed. All patients who underwent minimally invasive biopsy and subsequent surgical excision where the highest pathology was solely ADH or lobular neoplasia (reported as ALH, lobular carcinoma in situ or lobular neoplasia), according to the pathology database were included (n = 15). The sensitivity was determined as the percentage of positive BSGI exams out of all patients diagnosed with ADH or lobular neoplasia who received a BSGI. Results: Patient ages ranged from 39 to 67 (mean, 52). Eight of 15 patients had ADH, 6/15 lobular neoplasia, and 1/15 ADH and lobular neoplasia in one lesion. Fifteen of the 15 (100%) patients with surgically confirmed ADH or lobular neoplasia had a positive BSGI, with focally increased radiotracer uptake at the site of the verified high-risk lesion. Conclusion: BSGI has a high sensitivity for the detection of atypical, high-risk breast lesions. A diagnosis of an atypical lesion is concordant with focal increased radiotracer uptake with BSGI and can identify women at increased risk for breast cancer. © 2012