Do Calcifications Seen on Mammography After Neoadjuvant Chemotherapy for Breast Cancer Always Need to Be Excised?

This study aimed to determine the relationship between mammographic calcifications and magnetic resonance imaging (MRI) tumoral enhancement before and after neoadjuvant chemotherapy (NAC) and to assess the impact of these findings on surgical management. This Institutional Review Board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study involved breast cancer patients who underwent NAC between 2009 and 2015. The study cohort comprised 90 patients with pre- and posttreatment MRI and mammograms demonstrating calcifications within the tumor bed either at presentation or after treatment. The data gathered included pre- and post-NAC imaging findings and post-NAC histopathology, particularly findings associated with calcifications. Comparisons were made using Fisher's exact test, with p values lower than 0.05 considered significant. Complete resolution of MRI enhancement occurred for 44% of the patients, and a pathologic complete response (pCR) was achieved for 32% of the patients. No statistically significant correlation between changes in mammographic calcifications and MRI enhancement was found (p = 0.12). Resolution of enhancement was strongly correlated with pCR (p < 0.0001). The majority of the patients with pCR demonstrated complete resolution of enhancement (79%, 23/29). No statistically significant relationship was found between changes in calcifications and rates of pCR (p = 0.06). A pCR was achieved most frequently for patients with resolution of enhancement and new, increasing, or unchanged calcifications (p < 0.0001). Although calcifications seen on post-NAC mammography may be associated with benign disease, loss of MRI enhancement does not predict the absence of residual tumor with sufficient accuracy to leave calcifications in place. Complete excision of tumor bed calcifications remains standard practice and a substantial limitation to NAC use for downstaging patients to be eligible for breast conservation treatment

A 10-year trend analysis of sentinel lymph node frozen section and completion axillary dissection for breast cancer: are these procedures becoming obsolete?

Recent results from the ACOSOG Z0011 trial question the use of intraoperative frozen section (FS) during sentinel lymph node (SLN) biopsy and the role of axillary dissection (ALND) for SLN-positive breast cancer patients. Here we present a 10-year trend analysis of SLN-FS and ALND in our practice

Wavy and Cycloidal Lineament Formation on Europa from Combined Diurnal and Nonsynchronous Stresses

In a companion abstract, we show that fractures propagated into combined diurnal and nonsynchronous rotation (NSR) stress fields can be cycloidal, "wavy," or arcuate in planform as the relative proportion of NSR stress in increased. These transitions occur as NSR stress accumulates over approx. 0 to 10 deg of ice shell rotation, for average fracture propagation speeds of approx. 1 to 3 m/s. Here we consider the NSR speed parameter space for these morphological transitions, and explore the effects on cycloids of adding NSR to diurnal stress. Fitting individual Europan lineaments can constrain the combined NSR plus diurnal stress field at the time of formation

Wavy Lineaments on Europa: Fracture Propagation into Combined Nonsynchronous and Diurnal Stress Fields

Understanding the processes that have operated on Europa and the manner in which they may have changed through time is fundamental to understanding the satellite's geology and present-day habitability. Previous studies have shown that lineament patterns on Europa can be explained by accumulation of tensile stress from slow nonsynchronous rotation (NSR), while the cycloidal planforms of other Europan lineaments can be explained if fractures propagate through a diurnally changing tensile stress field. We find that fractures propagated into combined diurnal and NSR stress fields can be "wavy" in planform for NSR stress accumulated over ~2 to 8 of ice shell rotation and average propagation speeds of approx. 1 to 3 m/s. The variety of Europa's observed lineament planforms from cycloidal, to wavy, to arcuate can be produced by accumulation of NSR stress relative to the diurnal stress field. Varying proportions of these stress mechanisms plausibly may be related to a time-variable (slowing) NSR rate