Extracorporeal Support: Improves Donor Renal Graft Function After Cardiac Death

Donors after cardiac death (DCD) could increase the organ pool. Data supports good long-term renal graft survival. However, DCDs are 50 mL/h in all DCDs, except in DCD-30 (6.8 mL/h ± 1.7). DCD-30 had lower CrCl (0.9 mL/min ± 0.2) and higher UrPr >200 mg/dL, compared to other DCDs >10 mL/min and <160 mg/dL, respectively. Normothermic ECS can resuscitate kidneys to transplantable status after 30 min of cardiac arrest/WI.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79164/1/j.1600-6143.2010.03063.x.pd

Parasitic infections of Piaractus mesopotamicus and hybrid (P. mesopotamicus xPiaractus brachypomus) cultured in Brazil

Este estudo avaliou a ocorrência de infecções parasitárias em pacus Piaractus mesopotamicus e do híbrido patinga (P. mesopotamicus x P. brachypomus) procedentes da região Noroeste do Estado de São Paulo, Brasil. Peixes de três pisciculturas foram avaliados bimestralmente: A - Reprodução e Larvicultura (n = 16 pacus / n = 19 patingas), B-Engorda n = 35 patingas), e C- Pesque-pague (n = 28 pacus / n = 7 patingas). Trinta e cinco peixes de cada propriedade foram coletados de fevereiro de 2010 a fevereiro de 2011, para análises parasitológicas. Os parasitas encontrados foram: Mymarothecium viatorum, Anacanthorus penilabiatus, Notozothecium janauachensis (Dactylogyridae, Monogenea), Trichodina spp., Ichthyophthirius multifiliis, Chilodonella sp. (Protozoa), Myxobolus spp., Henneguya spp. (Myxozoa), Rondonia rondoni, Contracaecum sp. (Nematoda), and Dolops carvalhoi (Crustacea). Dentre os peixes analisados, 62,9% de “A” e 100% de “B” e “C” estavam infectados/infestados por pelo menos uma espécie de parasita. Pacus (n = 44) apresentaram maior suscetibilidade a infestações por Anacanthorus penilabiatus, e patingas (n = 61), por Mymarothecium viatorum (p < 0.05). A profilaxia e cuidados durante o manejo (alimentação, transporte e estocagem), associados ao monitoramento da qualidade de água reduzem o estresse o qual os peixes cultivados estão submetidos, sendo medidas imprescindíveis para o controle de patógenos.This study evaluated the occurrence of parasitic infections in the “pacu” fish Piaractus mesopotamicus and the “patinga” hybrid (P. mesopotamicus x Piaractus brachypomus) in the northwest of São Paulo State, Brazil. Fish from the following three fish farms were evaluated every two months: A, a hatchery and larviculture farm (n = 16 pacu / n = 19 patinga), B, a growout farm (n = 35 patinga) and C, a fee-fishing property (n = 28 pacu / n = 7 patinga). Thirty-five fish from each property were collected from February 2010 to February 2011 and subjected to parasitological analysis. The parasites found were the following: Mymarothecium viatorum, Anacanthorus penilabiatus, Notozothecium janauachensis (Dactylogyridae, Monogenea), Trichodina spp., Ichthyophthirius multifiliis, Chilodonella sp. (Protozoa), Myxobolus spp., Henneguya spp. (Myxozoa), Rondonia rondoni, Contracaecum sp. (Nematoda), and Dolops carvalhoi (Crustacea). Of the fish examined, 62.9% from “A” and 100% from “B” and “C” were infested with at least one parasite species. Pacu fish (n = 44) showed a higher susceptibility to Anacanthorus penilabiatus infestations, whereas patinga (n = 61) were more susceptible to Mymarothecium viatorum (p < 0.05). Appropriate fish handling (nutrition, transport and storage), in conjunction with monitoring of water quality, can reduce the stress to which the farmed fish are exposed and is essential for pathogen control.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Estadual Paulista Instituto de Biociencias Programa de Pos-graduacao em Ciencias BiologicasAgencia Paulista de Tecnologia dos AgronegociosUniversidade Estadual Paulista Instituto de Biociencias Departamento de ParasitologiaUniversidade Estadual Paulista Instituto de Biociencias Programa de Pos-graduacao em Ciencias BiologicasUniversidade Estadual Paulista Instituto de Biociencias Departamento de ParasitologiaFAPESP: 10/01417-4CNPq: 577649/2008-

Taking the pulse of Earth's tropical forests using networks of highly distributed plots

Tropical forests are the most diverse and productive ecosystems on Earth. While better understanding of these forests is critical for our collective future, until quite recently efforts to measure and monitor them have been largely disconnected. Networking is essential to discover the answers to questions that transcend borders and the horizons of funding agencies. Here we show how a global community is responding to the challenges of tropical ecosystem research with diverse teams measuring forests tree-by-tree in thousands of long-term plots. We review the major scientific discoveries of this work and show how this process is changing tropical forest science. Our core approach involves linking long-term grassroots initiatives with standardized protocols and data management to generate robust scaled-up results. By connecting tropical researchers and elevating their status, our Social Research Network model recognises the key role of the data originator in scientific discovery. Conceived in 1999 with RAINFOR (South America), our permanent plot networks have been adapted to Africa (AfriTRON) and Southeast Asia (T-FORCES) and widely emulated worldwide. Now these multiple initiatives are integrated via ForestPlots.net cyber-infrastructure, linking colleagues from 54 countries across 24 plot networks. Collectively these are transforming understanding of tropical forests and their biospheric role. Together we have discovered how, where and why forest carbon and biodiversity are responding to climate change, and how they feedback on it. This long-term pan-tropical collaboration has revealed a large long-term carbon sink and its trends, as well as making clear which drivers are most important, which forest processes are affected, where they are changing, what the lags are, and the likely future responses of tropical forests as the climate continues to change. By leveraging a remarkably old technology, plot networks are sparking a very modern revolution in tropical forest science. In the future, humanity can benefit greatly by nurturing the grassroots communities now collectively capable of generating unique, long-term understanding of Earth's most precious forests. Resumen Los bosques tropicales son los ecosistemas más diversos y productivos del mundo y entender su funcionamiento es crítico para nuestro futuro colectivo. Sin embargo, hasta hace muy poco, los esfuerzos para medirlos y monitorearlos han estado muy desconectados. El trabajo en redes es esencial para descubrir las respuestas a preguntas que trascienden las fronteras y los plazos de las agencias de financiamiento. Aquí mostramos cómo una comunidad global está respondiendo a los desafíos de la investigación en ecosistemas tropicales a través de diversos equipos realizando mediciones árbol por árbol en miles de parcelas permanentes de largo plazo. Revisamos los descubrimientos más importantes de este trabajo y discutimos cómo este proceso está cambiando la ciencia relacionada a los bosques tropicales. El enfoque central de nuestro esfuerzo implica la conexión de iniciativas locales de largo plazo con protocolos estandarizados y manejo de datos para producir resultados que se puedan trasladar a múltiples escalas. Conectando investigadores tropicales, elevando su posición y estatus, nuestro modelo de Red Social de Investigación reconoce el rol fundamental que tienen, para el descubrimiento científico, quienes generan o producen los datos. Concebida en 1999 con RAINFOR (Suramérica), nuestras redes de parcelas permanentes han sido adaptadas en África (AfriTRON) y el sureste asiático (T-FORCES) y ampliamente replicadas en el mundo. Actualmente todas estas iniciativas están integradas a través de la ciber-infraestructura de ForestPlots.net, conectando colegas de 54 países en 24 redes diferentes de parcelas. Colectivamente, estas redes están transformando nuestro conocimiento sobre los bosques tropicales y el rol de éstos en la biósfera. Juntos hemos descubierto cómo, dónde y porqué el carbono y la biodiversidad de los bosques tropicales está respondiendo al cambio climático y cómo se retroalimentan. Esta colaboración pan-tropical de largo plazo ha expuesto un gran sumidero de carbono y sus tendencias, mostrando claramente cuáles son los factores más importantes, qué procesos se ven afectados, dónde ocurren los cambios, los tiempos de reacción y las probables respuestas futuras mientras el clima continúa cambiando. Apalancando lo que realmente es una tecnología antigua, las redes de parcelas están generando una verdadera y moderna revolución en la ciencia tropical. En el futuro, la humanidad puede beneficiarse enormemente si se nutren y cultivan comunidades de investigadores de base, actualmente con la capacidad de generar información única y de largo plazo para entender los que probablemente son los bosques más preciados de la tierra. Resumo Florestas tropicais são os ecossistemas mais diversos e produtivos da Terra. Embora uma boa compreensão destas florestas seja crucial para o nosso futuro coletivo, até muito recentemente os esforços de medições e monitoramento foram amplamente desconexos. É essencial formarmos redes para obtermos respostas que transcendem fronteiras e horizontes de agências financiadoras. Neste estudo nós mostramos como uma comunidade global está respondendo aos desafios da pesquisa de ecossistemas tropicais, com equipes diversas medindo florestas, árvore por árvore, em milhares de parcelas monitoradas à longo prazo. Nós revisamos as maiores descobertas científicas deste trabalho, e mostramos também como este processo está mudando a ciência de florestas tropicais. Nossa abordagem principal envolve unir iniciativas de base a protocolos padronizados e gerenciamento de dados a fim de gerar resultados robustos em escalas ampliadas. Ao conectar pesquisadores tropicais e elevar seus status, nosso modelo de Rede de Pesquisa Social reconhece o papel-chave do produtor dos dados na descoberta científica. Concebida em 1999 com o RAINFOR (América do Sul), nossa rede de parcelas permanentes foi adaptada para África (AfriTRON) e Sudeste asiático (T-FORCES), e tem sido extensamente reproduzida em todo o mundo. Agora estas múltiplas iniciativas estão integradas através de uma infraestrutura cibernética do ForestPlots.net, conectando colegas de 54 países de 24 redes de parcelas. Estas iniciativas estão transformando coletivamente o entendimento das florestas tropicais e seus papéis na biosfera. Juntos nós descobrimos como, onde e por que o carbono e a biodiversidade da floresta estão respondendo às mudanças climáticas, e seus efeitos de retroalimentação. Esta duradoura colaboração pantropical revelou um grande sumidouro de carbono persistente e suas tendências, assim como tem evidenciado quais direcionadores são mais importantes, quais processos florestais são mais afetados, onde eles estão mudando, seus atrasos no tempo de resposta, e as prováveis respostas das florestas tropicais conforme o clima continua a mudar. Dessa forma, aproveitando uma notável tecnologia antiga, redes de parcelas acendem faíscas de uma moderna revolução na ciência das florestas tropicais. No futuro a humanidade pode se beneficiar incentivando estas comunidades basais que agora são coletivamente capazes de gerar conhecimentos únicos e duradouros sobre as florestas mais preciosas da Terra. Résume Les forêts tropicales sont les écosystèmes les plus diversifiés et les plus productifs de la planète. Si une meilleure compréhension de ces forêts est essentielle pour notre avenir collectif, jusqu'à tout récemment, les efforts déployés pour les mesurer et les surveiller ont été largement déconnectés. La mise en réseau est essentielle pour découvrir les réponses à des questions qui dépassent les frontières et les horizons des organismes de financement. Nous montrons ici comment une communauté mondiale relève les défis de la recherche sur les écosystèmes tropicaux avec diverses équipes qui mesurent les forêts arbre après arbre dans de milliers de parcelles permanentes. Nous passons en revue les principales découvertes scientifiques de ces travaux et montrons comment ce processus modifie la science des forêts tropicales. Notre approche principale consiste à relier les initiatives de base à long terme à des protocoles standardisés et une gestion de données afin de générer des résultats solides à grande échelle. En reliant les chercheurs tropicaux et en élevant leur statut, notre modèle de réseau de recherche sociale reconnaît le rôle clé de l'auteur des données dans la découverte scientifique. Conçus en 1999 avec RAINFOR (Amérique du Sud), nos réseaux de parcelles permanentes ont été adaptés à l'Afrique (AfriTRON) et à l'Asie du Sud-Est (T-FORCES) et largement imités dans le monde entier. Ces multiples initiatives sont désormais intégrées via l'infrastructure ForestPlots.net, qui relie des collègues de 54 pays à travers 24 réseaux de parcelles. Ensemble, elles transforment la compréhension des forêts tropicales et de leur rôle biosphérique. Ensemble, nous avons découvert comment, où et pourquoi le carbone forestier et la biodiversité réagissent au changement climatique, et comment ils y réagissent. Cette collaboration pan-tropicale à long terme a révélé un important puits de carbone à long terme et ses tendances, tout en mettant en évidence les facteurs les plus importants, les processus forestiers qui sont affectés, les endroits où ils changent, les décalages et les réactions futures probables des forêts tropicales à mesure que le climat continue de changer. En tirant parti d'une technologie remarquablement ancienne, les réseaux de parcelles déclenchent une révolution très moderne dans la science des forêts tropicales. À l'avenir, l'humanité pourra grandement bénéficier du soutien des communautés de base qui sont maintenant collectivement capables de générer une compréhension unique et à long terme des forêts les plus précieuses de la Terre. Abstrak Hutan tropika adalah di antara ekosistem yang paling produktif dan mempunyai kepelbagaian biodiversiti yang tinggi di seluruh dunia. Walaupun pemahaman mengenai hutan tropika amat penting untuk masa depan kita, usaha-usaha untuk mengkaji dan mengawas hutah-hutan tersebut baru sekarang menjadi lebih diperhubungkan. Perangkaian adalah sangat penting untuk mencari jawapan kepada soalan-soalan yang menjangkaui sempadan dan batasan agensi pendanaan. Di sini kami menunjukkan bagaimana sebuah komuniti global bertindak balas terhadap cabaran penyelidikan ekosistem tropika melalui penglibatan pelbagai kumpulan yang mengukur hutan secara pokok demi pokok dalam beribu-ribu plot jangka panjang. Kami meninjau semula penemuan saintifik utama daripada kerja ini dan menunjukkan bagaimana proses ini sedang mengubah bidang sains hutan tropika. Teras pendekatan kami memberi tumpuan terhadap penghubungan inisiatif akar umbi jangka panjang dengan protokol standar serta pengurusan data untuk mendapatkan hasil skala besar yang kukuh. Dengan menghubungkan penyelidik-penyelidik tropika dan meningkatkan status mereka, model Rangkaian Penyelidikan Sosial kami mengiktiraf kepentingan peranan pengasas data dalam penemuan saintifik. Bermula dengan pengasasan RAINFOR (Amerika Selatan) pada tahun 1999, rangkaian-rangkaian plot kekal kami kemudian disesuaikan untuk Afrika (AfriTRON) dan Asia Tenggara (T-FORCES) dan selanjutnya telah banyak dicontohi di seluruh dunia. Kini, inisiatif-inisiatif tersebut disepadukan melalui infrastruktur siber ForestPlots.net yang menghubungkan rakan sekerja dari 54 negara di 24 buah rangkaian plot. Secara kolektif, rangkaian ini sedang mengubah pemahaman tentang hutan tropika dan peranannya dalam biosfera. Kami telah bekerjasama untuk menemukan bagaimana, di mana dan mengapa karbon serta biodiversiti hutan bertindak balas terhadap perubahan iklim dan juga bagaimana mereka saling bermaklum balas. Kolaborasi pan-tropika jangka panjang ini telah mendedahkan sebuah sinki karbon jangka panjang serta arah alirannya dan juga menjelaskan pemandu-pemandu perubahan yang terpenting, di mana dan bagaimana proses hutan terjejas, masa susul yang ada dan kemungkinan tindakbalas hutan tropika pada perubahan iklim secara berterusan di masa depan. Dengan memanfaatkan pendekatan lama, rangkaian plot sedang menyalakan revolusi yang amat moden dalam sains hutan tropika. Pada masa akan datang, manusia sejagat akan banyak mendapat manfaat jika memupuk komuniti-komuniti akar umbi yang kini berkemampuan secara kolektif menghasilkan pemahaman unik dan jangka panjang mengenai hutan-hutan yang paling berharga di dunia

Abdominal Normothermic Regional Perfusion in Donation After Circulatory Death:A Systematic Review and Critical Appraisal

Background: Abdominal normothermic regional perfusion (aNRP) for donation after circulatory death is an emerging organ preservation technique that might lead to increased organ utilization per donor by facilitating viability testing, improving transplant outcome by early reversal of ischemia, and decreasing the risk of unintentional surgical damage. The aim of the current review is to evaluate the recent literature on the added value of aNRP when compared to local standard perfusion technique.Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline for systematic reviews was used, and relevant literature databases were searched. Primary outcomes were organ utilization rate and patient and graft survival after 1 year. Secondary outcomes included delayed graft function, primary nonfunction, serum creatinine, and biliary complications.Results: A total of 24 articles were included in this review. The technique is unanimously reported to be feasible and safe, but the available studies are characterized by considerable heterogeneity and bias.Conclusions: Uniform reported outcome measures are needed to draw more definitive conclusions on transplant outcomes and organ utilization. A randomized controlled trial comparing aNRP with standard procurement technique in donation after circulatory death donors would be needed to show the added value of the procedure and determine its place among modern preservation techniques.Transplant surger

The Association of Preoperative Magnetic Resonance Imaging (MRI) With Surgical Management in Patients With Early-Stage Breast Cancer

The rate of mastectomy in lumpectomy-eligible patients with unilateral breast cancer is increasing. We sought to investigate the association between magnetic resonance imaging (MRI) and surgical management of patients with early-stage breast cancer by comparing the rate of mastectomy as first surgery in patients with and without preoperative MRI.A bi-institutional retrospective study included patients diagnosed between 2016 and 2020. Lumpectomy-eligible patients with in situ and invasive cancer were included. Those receiving preoperative therapy, MRI before diagnosis, or with known bilateral cancer were excluded. The risk factors for bilateral and multicentric disease were accounted for. Fisher's exact and chi-square tests compared categorical variables, Wilcoxon two-sample test analyzed continuous variables, and multivariate analyses were performed with Poisson regression.Four hundred twenty-eight participants met inclusion criteria. Patients who received MRI were younger (58 versus 67 y; P < 0.001) and had denser breasts (group 3 or 4; 61% versus 25%; P < 0.001). Mastectomy rate was twice as high in patients undergoing MRI (32% versus 15%, rate ratio 2.16; P < 0.001), which remained significant in multivariate analysis (rate ratio 2.0; P < 0.001). Contralateral mastectomy (12% versus 4%; P = 0.466) and reexcision (13% versus 12%; P = 0.519) rates were similar. Time to surgery was greater in those receiving MRI alone and MRI biopsy (34 [no MRI] versus 45 [MRI] versus 62 [MRI biopsy]; P < 0.001 for both).MRI receipt is associated with a doubled rate of mastectomy in lumpectomy-eligible patients. Future work is needed to standardize patient selection for MRI to those with the highest likelihood of having additional undiagnosed disease

Abstract P3-03-20: The association of preoperative MRI with surgical decision-making in patients with early-stage breast cancer: A multi-institutional analysis

Abstract Background: Lumpectomy with radiation (breast conservation) and mastectomy have equivalent overall survival. However, recent studies suggest that patients undergoing breast conservation have lower rates of recurrence compared to those undergoing mastectomy. A 2013 meta-analysis by Houssami, et al. found that the rate of mastectomy in patients who had preoperative MRI was 16%, twice as high as that in patients who did not have preoperative MRI. A multi-institutional analysis was performed to investigate the possible impact of modern MRI on the surgical management of early-stage breast cancer (ESBC). Methods: A retrospective comparative cohort study included patients with in-situ and invasive breast cancer eligible for breast conservation surgery from two institutions (NY and FL). Patients who received preoperative systemic therapy were excluded. Eligibility for breast conservation was defined as clinical stage Tis-2. Risk factors for the bilateral or multicentric disease were compared between the two groups including breast density, menopausal status, and concerning family history. The rate of ipsilateral mastectomy in lumpectomy-eligible women was compared between patients who did and did not receive preoperative MRI. Chi-square analysis was used to compare rates between groups. P values <0.05 were considered statistically significant. Results: 505 patients diagnosed between 1/2016-4/2019 (NY) and 2/2020-12/2020 (FL) underwent primary surgery for ESBC. 434 did not receive neoadjuvant therapy and were included in the analysis. 292 (67.3%) had preoperative MRI. There was no difference in the proportion of patients who were premenopausal or who met the criteria for genetic testing by family history. The largest dimension on preoperative imaging was similar between the two groups. Patients who had MRI were younger (median age 58 vs. 68, p<0.001) and more likely to have group 3 or 4 breast density (64.5% vs. 27.1%, p<0.001). Patients who underwent preoperative MRI were twice as likely to undergo mastectomy as their first surgery (32.6% vs. 15.3%, p<0.001). The rate of re-excision was similar between the two groups (MRI 13.0% vs. no MRI 10.8% p=0.511). Of note, the final pathologic size of the invasive or in-situ component was similar between the two groups (Table 1). Conclusion: Younger age and greater breast density are associated with preoperative MRI receipt and all three factors likely play a role in choosing mastectomy. Young women with dense breasts represent a unique cohort of patients that may be particularly susceptible to cancer-related worry and anxiety related to additional biopsies, and therefore may be more likely to opt against continued breast imaging. Since approximately 70% of patients with ESBC undergo preoperative MRI, future work should focus on mitigating these challenges to improve shared decision-making. Table 1.Comparison of ESBC Patients Who Did and Did Not Receive MRIMRI (n=292) %, median (IQR)No MRI (n=142)%, median (IQR)p-valueAge58 years (50-65)68 years (60-76)<0.001bPremenopausal27%21%0.108Dense Breasts65%27%<0.001bMeet Criteria for Genetic Testing40%38%0.207Imaging Size13 mm (9-21)12 mm (8-20)0.315Mastectomy as First Surgery33%15%<0.001bPlan for Repeat Surgerya20%24%0.402Re-excision13%11%0.511Pathologic Size (Invasive)13 mm (8-20)13 mm (9-22)0.482Pathologic Size (DCIS)10 mm (5-20)8 mm (3-15)0.093aRepeat surgery includes re-excision, completion mastectomy, and axillary dissectionbDenotes significant p-values. Citation Format: Peter A Borowsky, Seraphina Choi, Orly Morgan, Amy K White, Claudya Morin, Jose Net, Susan Kesmodel, Neha Goel, Yamini Patel, Alexa Griffiths, Joshua A Feinberg, Aaron Kangas-Dick, Charusheela Andaz, Christina Giuliano, Natalie Zelenko, Donna-Marie Manasseh, Patrick Borgen, Kristin E Rojas. The association of preoperative MRI with surgical decision-making in patients with early-stage breast cancer: A multi-institutional analysis [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-03-20

Abstract P3-03-20: The association of preoperative MRI with surgical decision-making in patients with early-stage breast cancer: A multi-institutional analysis

Abstract Background: Lumpectomy with radiation (breast conservation) and mastectomy have equivalent overall survival. However, recent studies suggest that patients undergoing breast conservation have lower rates of recurrence compared to those undergoing mastectomy. A 2013 meta-analysis by Houssami, et al. found that the rate of mastectomy in patients who had preoperative MRI was 16%, twice as high as that in patients who did not have preoperative MRI. A multi-institutional analysis was performed to investigate the possible impact of modern MRI on the surgical management of early-stage breast cancer (ESBC). Methods: A retrospective comparative cohort study included patients with in-situ and invasive breast cancer eligible for breast conservation surgery from two institutions (NY and FL). Patients who received preoperative systemic therapy were excluded. Eligibility for breast conservation was defined as clinical stage Tis-2. Risk factors for the bilateral or multicentric disease were compared between the two groups including breast density, menopausal status, and concerning family history. The rate of ipsilateral mastectomy in lumpectomy-eligible women was compared between patients who did and did not receive preoperative MRI. Chi-square analysis was used to compare rates between groups. P values &amp;lt;0.05 were considered statistically significant. Results: 505 patients diagnosed between 1/2016-4/2019 (NY) and 2/2020-12/2020 (FL) underwent primary surgery for ESBC. 434 did not receive neoadjuvant therapy and were included in the analysis. 292 (67.3%) had preoperative MRI. There was no difference in the proportion of patients who were premenopausal or who met the criteria for genetic testing by family history. The largest dimension on preoperative imaging was similar between the two groups. Patients who had MRI were younger (median age 58 vs. 68, p&amp;lt;0.001) and more likely to have group 3 or 4 breast density (64.5% vs. 27.1%, p&amp;lt;0.001). Patients who underwent preoperative MRI were twice as likely to undergo mastectomy as their first surgery (32.6% vs. 15.3%, p&amp;lt;0.001). The rate of re-excision was similar between the two groups (MRI 13.0% vs. no MRI 10.8% p=0.511). Of note, the final pathologic size of the invasive or in-situ component was similar between the two groups (Table 1). Conclusion: Younger age and greater breast density are associated with preoperative MRI receipt and all three factors likely play a role in choosing mastectomy. Young women with dense breasts represent a unique cohort of patients that may be particularly susceptible to cancer-related worry and anxiety related to additional biopsies, and therefore may be more likely to opt against continued breast imaging. Since approximately 70% of patients with ESBC undergo preoperative MRI, future work should focus on mitigating these challenges to improve shared decision-making. Table 1.Comparison of ESBC Patients Who Did and Did Not Receive MRIMRI (n=292) %, median (IQR)No MRI (n=142)%, median (IQR)p-valueAge58 years (50-65)68 years (60-76)&amp;lt;0.001bPremenopausal27%21%0.108Dense Breasts65%27%&amp;lt;0.001bMeet Criteria for Genetic Testing40%38%0.207Imaging Size13 mm (9-21)12 mm (8-20)0.315Mastectomy as First Surgery33%15%&amp;lt;0.001bPlan for Repeat Surgerya20%24%0.402Re-excision13%11%0.511Pathologic Size (Invasive)13 mm (8-20)13 mm (9-22)0.482Pathologic Size (DCIS)10 mm (5-20)8 mm (3-15)0.093aRepeat surgery includes re-excision, completion mastectomy, and axillary dissectionbDenotes significant p-values. Citation Format: Peter A Borowsky, Seraphina Choi, Orly Morgan, Amy K White, Claudya Morin, Jose Net, Susan Kesmodel, Neha Goel, Yamini Patel, Alexa Griffiths, Joshua A Feinberg, Aaron Kangas-Dick, Charusheela Andaz, Christina Giuliano, Natalie Zelenko, Donna-Marie Manasseh, Patrick Borgen, Kristin E Rojas. The association of preoperative MRI with surgical decision-making in patients with early-stage breast cancer: A multi-institutional analysis [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-03-20.</jats:p

A Multi-institutional Analysis of Factors Influencing the Rate of Positive MRI Biopsy Among Women with Early-Stage Breast Cancer

The use of preoperative magnetic resonance imaging (MRI) for early-stage breast cancer (ESBC) is increasing, but its utility in detecting additional malignancy is unclear and delays surgical management (Jatoi and Benson in Future Oncol 9:347-353, 2013. https://doi.org/10.2217/fon.12.186 , Bleicher et al. J Am Coll Surg 209:180-187, 2009. https://doi.org/10.1016/j.jamcollsurg.2009.04.010 , Borowsky et al. J Surg Res 280:114-122, 2022. https://doi.org/10.1016/j.jss.2022.06.066 ). The present study sought to identify ESBC patients most likely to benefit from preoperative MRI by assessing the positive predictive values (PPVs) of ipsilateral and contralateral biopsies. A retrospective cohort study included patients with cTis-T2N0-N1 breast cancer from two institutions during 2016-2021. A "positive" biopsy result was defined as additional cancer (Positive ) or cancer with histology often excised (Positive ). The PPV of MRI biopsies was calculated with respect to age, family history, breast density, and histology. Uni- and multivariate logistic regression determined whether combinations of age younger than 50 years, dense breasts, family history, and pure ductal carcinoma in situ (DCIS) histology led to higher biopsy yield. Of the included patients, 447 received preoperative MRI and 131 underwent 149 MRI-guided biopsies (96 ipsilateral, 53 contralateral [18 bilateral]). Positive for ipsilateral biopsy was 54.2%, and Positive for contralateral biopsy was 17.0%. Positive for ipsilateral biopsy was 62.5%, and Positive for contralateral biopsy was 24.5%. Among the contralateral MRI biopsies, patients younger than 50 years were less likely to have Positive (odds ratio, 0.02; 95% confidence interval, 0.00-0.84; p = 0.041). The combinations of age, density, family history, and histology did not lead to a higher biopsy yield. Historically accepted factors for recommending preoperative MRI did not appear to confer a higher MRI biopsy yield. To prevent delays to surgical management, MRI should be carefully selected for individual patients most likely to benefit from additional imaging