bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nipple-sparing subcutaneous mastectomy (NSSM) as dual-plane prosthetic reconstruction using the modified Wise pattern mastectomy, fasciocutaneous flap, and titan-polypropylen-mesh-interponation in women with macromastia.
Authors: Paepke Stefan , Klein Evelyn , Ettl Johannes , Niemeyer Markus , Bronger Holger , Paepke Daniela , Kiechle Marion 
Published: February 2017

156 Background: Ablative surgery of voluminous, ptotic breasts poses the problem of implant cover of the lower and lateral two thirds that are not coverd by the liftet pectoral muscle. Based on reduction mammaplasty techniques we applied a method that utilizes the excess mammary skin in terms of vertical, lateral, and medial de-epithelialized fascio-cutaneous tissue columns that serve together with a mesh (TiLoop bra) as cover for the subpectoral implant. Methods: Between 06/2009 and 01/2012 we performed 16 nipple and skin sparing mastectomies with marked tissue reduction (defined as difference in weight between implant and resected tissue of more than 300 g) in 7 patients. Indications comprise primary and secondary prophylactic as well as 4 nipple sparing mastectomies after neoadjuvant chemotherapy. Results: Mastectomy weights ranged between 325 and 1100 g; implant volumes ranged between 295 and 800 cm3. There occured five partial necrosis of the nipple-areolar complex (NAC) and three partial skin necrosis at the margin of the vertical incision. Two patients had to be operated on a second time for cosmetic reasons. The overall complication rate was low. Conclusions: The method described herein using the de-epithelialized excess mammary skin and the advantages of the titanized polypropylene mesh archieves stable reconstructions and a safe vascularization of the NAC.
Skin dose effects of postmastectomy chest wall radiation therapy using brass mesh as an alternative to a bolus.
Authors: Healy Erin , Anderson Shawnee , Cui Jing , Beckett Laurel , Chen Allen M. , Perks Julian , Stern Robin , Mayadev Jyoti 
Published: February 2017

157 Background: The use of brass mesh as an alternative to a bolus is relatively uncommon in post-mastectomy chest wall radiation therapy (PMRT). This study aimed to characterize the skin dose effects of using 2mm fine brass mesh as an alternative to the traditional tissue-equivalent bolus during chest wall PMRT. Methods: Data was collected from patients who received PMRT using brass mesh at UC Davis Medical Center’s Department of Radiation Oncology between January 2008 and June 2011. Several patient characteristics including age, body habitus, and ethnicity were analyzed along with several disease and treatment characteristics to determine whether or not they had an impact on the skin reaction observed during radiation treatment. In addition to assessing skin toxicity visually using standardized National Cancer Institute scores (NCIS), surface doses were measured for 16 of the 48 patients (33%) to quantify radiation exposure to the chest wall. Results: 48 female patients aged 28-83 received PMRT using brass mesh. As expected, the severity of skin toxicity increased with subsequent doses of radiation with all patients beginning treatment with no skin reaction (NCIS = 0) and the majority of patients completing treatment with either faint to moderate erythema (N = 19, 40%, NCIS = 1) or moderate to brisk erythema (N = 23, 48%, NCIS = 2). In vivo dosimetry analysis revealed surface doses between 81% and 110% of the prescribed dose, with an average of 99% of the prescribed radiation dose being delivered and a standard deviation of 10%. Conclusions: For post-mastectomy chest wall radiation therapy, brass mesh is an effective alternative to the tissue-equivalent bolus. The brass mesh achieved moderate erythema in the majority of patients at the end of treatment and the surface dose was validated using in vivo dosimetry.
Incidence of local recurrence in patients after breast-conserving surgery and postoperative radiotherapy with or without a supplementary radiation.
Authors: Scepanovic Danijela D. , Hurakova Andrea , Lukacovicova Martina , Dolinska Zuzana , Masarykova Andrea , Lukacko Pavol , Pobijakova Margita 
Published: February 2017

159 Background: We evaluated the incidence of local recurrence (LR) among patients (pts) who received radiotherapy with/without a supplementary dose of radiation (boost) to the tumor bed after breast-conserving surgery (BCS) for early breast cancer (BC). Methods: In our retrospective analysis (from 2000-2004) 449 pts with stage I/II BC received 50Gy of radiation to the whole breast in 2Gy fractions over a five-week period after BCS. There were 328 pts (73%) with microscopically complete excision (>5mm margins) and 121 pts (27%) with a microscopically incomplete excision (≤5mm margins). Patients with a microscopically complete or incomplete excision were randomly assigned to receive either no further local treatment (190) or an additional localized dose (309) of 10-16Gy, usually given in 5-8 fractions (fr) by electrons/15Gy in 3 fr by HDR interstitial brachytherapy. Results: During a median follow-up period of 79 months (min 20, max 120), the cumulative incidence of LR was 3% for all group of pts (449). The LR was observed in 1 of 190 pts in group without boost and 13 of 309 pts in group with boost. There was statistically significant difference between two groups of pts regarding local recurrence rate (LRR) (p= 0.0218).The 5 year actuarial rates of LR were 1% in group of pts with negative surgical margins versus 8% in group of pts with positive margins [95% CI, 6% (1%-26%)] (p<0.001). Multivariate analysis showed that pts with negative surgical margins had strongly statistically significant influence (p<0.001) and pts with negative lymph/angioinvasion had statistically significant influence on low risk of LR (p = 0.007). The 5 year DFS was 90% and OS was 98% in all group of pts (449). There was no statistical significant difference between two groups of pts regarding DFS and OS. Conclusions: In our analysis, the incidence of LR is low. However, there was better result in no boost group of pts regarding LRR. The cause was in more frequent selection among worse group of pts with positive surgical margins for application of boost (73% vs 52%, p<0.0001). The strong criteria for identifying low risk group of pts for LR were: negative surgical margins and absence of lymph/angioinvasion.
Immunohistochemical analysis of pathway HER2 4B5 performance in breast carcinoma expressing HER4.
Authors: Jay Julie I , Brunhoeber Patrick S , Smith Margie H , Williams Ryan R , Sugarman Michael , Free Heather L , Tast David E 
Published: February 2017

16 Background: The ability of pharmacodiagnostic antibodies to specifically detect their target antigen is essential to their performance. Non-clinical protein based models for specificity of two human epidermal growth factor 2 (HER2) pharmacodiagnostic antibodies, Oracle CB11 and PATHWAY HER2 4B5 (4B5) (Ventana Medical Systems Inc., Tucson, AZ, USA), have been reported to demonstrate affinity to both HER2 and HER4. To date there has been no evidence showing that affinity of 4B5 for HER4 impacts the IHC clinical HER2 assay. We therefore sought to investigate whether there exists any risk of the 4B5 antibody detecting HER4-positive but HER2-negative cases as falsely positive due to a hypothetical cross reactivity to HER4. Methods: A HER4 IHC assay was developed by screening ten HER4 antibodies for specificity by staining FFPE blocks of recombinant HEK-293 cells expressing HER1, HER2, HER3 and HER4. Specific HER4 antibodies were then evaluated in breast carcinoma to identify a clone that provided distinct membrane staining in tumour cells. This pattern was used as a reference in order to detect any potential interference of HER4 detection in determining the HER2 score. The HER4 antibody E200 (Epitomics) was selected and used to evaluate a cohort of breast carcinoma cases. The HER2 expression in these cases was then assessed using anti-HER2 clone PATHWAY HER2 4B5 and a HER2 reference antibody, clone SP3 (Spring Bioscience). Results: 117 out of 241 (48%) breast tissue cases evaluated were HER4 positive for membrane staining by IHC using E200. The scoring criteria for determining the HER4 score was based on the system used to score HER2, however a positive score indicated any membrane staining and therefore a 1+, 2+ or 3+ score was considered HER4-positive. 4B5 exhibited similar staining patterns as SP3 in co-expressing HER4 and HER2 tissues indicating that 4B5 was detecting only the HER2 antigen. Eighteen cases were HER4-positive by E200 and level 0 by 4B5 including a HER4 level 3+ case. Conclusions: PATHWAY HER2 4B5, a clinically relevant pharmacodiagnostic antibody for detecting HER2 expression in breast carcinoma, does not demonstrate cross reactivity to HER4 in IHC of FFPE clinical tissues.
Will neoadjuvant chemotherapy affect the lymphatic routes to the sentinel lymph node? Investigation using indocyanine green fluorescence method.
Authors: Tsuyuki Shigeru , Kawata Yukiko , Yamaguchi Ayane , Kawaguchi Kosuke , Okamura Miru , Kawaguchi Nobuko , Kono Yukihiro ,   Osaka Red Cross Hospital Research
Published: February 2017

164 Background: Neoadjuvant chemotherapy (NAC) is a standard therapy for breast cancer. However, the changes in the lymphatic route to the sentinel lymph node (SLN) before and after NAC are unclear. Indocyanine green (ICG) fluorescence method of SLN biopsy (ICG-SLNB) is useful because of its high identification rate of the SLN and ability to visualize lymphatic routes. Using ICG-SLNB, we compared the lymphatic routes to the SLN (sentinel lymphatic routes) before and after NAC and investigated whether chemotherapy affects the sentinel lymphatic routes. Methods: From October 2010 to April 2012 20 patients received NAC. In 13 cases of clinical node-negative cancer, we performed SLNB before NAC. We recorded the sentinel lymphatic routes before NAC and confirmed the routes at surgery after NAC by using the same method. In 7 cases of clinical node-positive cancer, we recorded the localization of SLN and lymphatic routes by using the ICG fluorescence method before NAC. After NAC, we performed SLNB with axillary dissection and recorded the sentinel lymphatic routes by photography and drawing. Results: Regardless of the presence or absence of lymph node metastasis, the SLN and sentinel lymphatic routes could be detected before and after NAC in all cases. All sentinel lymphatic routes reached the same location of the SLN before and after NAC. In 3 cases, the number of sentinel lymphatic routes had increased after NAC, but the location of the SLN was the same before and after NAC. Other cases showed no changes in the sentinel lymphatic routes. In clinical node-positive cases of pathological complete response, there was no metastasis to the SLN, but there were 2 metastases in the lymph nodes after back-up dissection. Conclusions: ICG fluorescence method provided visual confirmation that the sentinel lymphatic routes were not affected by NAC. This result suggests that SLNB after NAC can be used to safely and positively identify the SLN in clinical node-negative patients. Further investigation would be required to safely perform SLNB after NAC in clinical node-positive patients.
Circulating CD68 positive (+) leukocytes in blood samples from patients (pts) with breast cancer (BC).
Authors: Lustberg Maryam B. , Miller Brandon L. , Wu Yongqi , Xue Wei , Deighan Clayton , Carothers Sarah , Berger Michael J. , Shapiro Charles L. , Chalmers Jeffrey J. 
Published: February 2017

172 Background: Several different CD45 + leukocyte populations are present in primary breast tumors and stroma (Coussens et al, 2011). These include CD4+/CD8+ T cells and myeloid derived cells such tumor associated macrophages/monocytes (TAMs). TAMs are under investigation as prognostic and predictive markers during chemotherapy (CX). The detection of TAMs has been restricted thus far to tumor tissue. We hypothesized that we can detect changes in CD45+ leukocyte populations in blood samples obtained before and during CX from pts with early and advanced BC. Methods: Venous blood samples from BC patients were collected, and were either directly analyzed or further processed using previously described immunomagnetic negative depletion. Multistep, sequential labeling was performed to first label and fix cell surface markers followed by permeablization for cytokeratins, before and after negative depletion, followed by multiparameter flow cytometry analysis for the following basic markers: CD45, cytokeratins, and EpCAM, and for a subset of patients additional markers including: CD13, CD14, CD68, and CD133. Results: Forty blood samples were analyzed and study is ongoing. Different CD45+ subpopulations were observed in peripheral blood including: a) CD45+, CK+, CD68 negative (-), b) CD45+, CK+, CD68+, c) CD45+, CK+, CD68+, CD14+, and CD16+. In addition, there was a trend in increasing CD 68+ leukocytes after 1 cycle of CX in pts with poor response to therapy or progression of disease. No abnormal cell subpopulations were present blood samples from healthy volunteers. Conclusions: This is the first study to report various peripheral blood leukocyte populations in BC that are similar to those observed in primary breast tumor stroma. The precise origin of these CD45 + cells is under investigation, including additional phenotypic characterization for TAMs. Results will be correlated to patient stage, tumor subtype and response to therapy.
Atypical vascular lesion after radiation therapy for breast cancer.
Authors: Refinetti Ana Paula , Shapiro Richard , Cangiarella Joan , Guth Amber Azniv 
Published: February 2017

184 Background: Atypical vascular lesions (AVLs) are known to occur in the setting of radiation therapy after breast conserving surgery for treatment of breast cancer. Their relationship with potential secondary angiosarcoma has yet not been fully characterized. AVLs typically present as single or multiple pink papules in the skin of the breast. Histologic examination reveals proliferation of dilated vascular channels in the dermis with IHC reactive for CD31, CD34 and D2-40. Management consists of local excision to rule out angiosarcoma. Methods: The pathology records of the NYU Langone Medical Center were queried for patients who were diagnosed with atypical vascular lesions. Results: A total of 3 patients with previous history of breast cancer treated with breast conserving therapy (BCT) and radiation therapy were included in this case series. Two patients were diagnosed with DCIS and one was diagnosed with Invasive ductal carcinoma. The median time between the cancer diagnosis and the development of AVL was 5 years (3-9 years). Presentation was an erythematous skin nodule in two patients and progressive telangectasia in one. Diagnosis was made initially by punch biopsy and it was followed by excisional biopsy in all three cases. Only one patient had residual atypical vascular lesion in the excisional biopsy especimen. Conclusions: AVL is a pathological entity with growing importance over the years due to its questionable progression to angiosarcoma. The improvement in survival of patients diagnosed with breast cancer as well as the widespread use of lumpectomy with breast irradiation for the treatment of the disease have caused an exponential increase in the number of patients seen in daily practice after BCT. Clinicians must implement high surveillance of these patients and have a low threshold for further work up of skin changes in the radiated breast in order to early diagnose these lesions since it is yet unknown which ones will progress to angiosarcoma. There are ongoing studies in the development of immunophenotypical markers such as MYC that will be a useful diagnostic tool to differentiate AVL from its malignant counterpart.
Predictors of microinvasion and its prognostic role in ductal carcinoma in situ.
Authors: Sue Gloria , Lannin Donald R. , Killelea Brigid K. , Horowitz Nina Ruth , Chagpar Anees B. 
Published: February 2017

188 Background: Predictors of microinvasion in ductal carcinoma in situ (DCIS) are not well understood. We sought to determine factors predicting microinvasion and the prognostic role this plays in patients with DCIS. Methods: A retrospective cohort study of 205 consecutive patients presenting to the Yale Breast Center with DCIS from 2000 through 2003 was performed. A chart review was conducted and bivariate and multivariate analyses comparing patients with and without possible microinvasion were performed. Statistical analyses were done using SPSS software version 19. Results: Of the 205 patients who presented with DCIS and were treated with surgical excision, 51 (24.9%) had evidence of possible microinvasion on final pathology. The median age of all patients was 53.0 years (range 35.8 to 88.9). On bivariate analysis, patients with microinvasion had larger areas of DCIS, and were more likely to have high grade DCIS, of solid type, associated with necrosis and microcalcifications (see table). There was a trend towards white women having a higher rate of microinvasion than black women (26.9% vs. 8.7%, p=0.061). On multivariate analysis, none of these factors were independent predictors of microinvasion. With a median follow-up of 8.5 years, there was no difference in the likelihood of recurrence in the microinvasion vs. no microinvasion groups (6.0% vs. 7.2%, p=1.000). 5-year actuarial overall survival was also not different between the two groups (96% vs. 94%, p=0.202, respectively). Conclusions: Patients with larger DCIS size, higher grade, solid histology, necrosis, and microcalcifications have a higher likelihood of microinvasion. However, the presence of possible microinvasion does not significantly increase risk of recurrence or decrease survival. [Table: see text]
Higher tamoxifen use as chemoprophylaxis in patients with ductal carcinoma in situ (DCIS) in the last decade.
Authors: Roesch Erin E. , Wei Lai , Ramaswamy Bhuvaneswari 
Published: February 2017

191 Background: The incidence of DCIS over the last two decades has increased, with over 62,000 new cases diagnosed annually in the United States. Tailored management of DCIS is still a work in progress and currently treatment options are varied. We sought to identify changes in patterns of care in individual and physician choices for surgery and chemoprophylaxis over the last two decades at our institution. Methods: We performed a retrospective chart review and identified 773 eligible patients using the James Cancer Registry and the NCCN database at The Ohio State University between 1990 and 2010. We compared the proportion of patients undergoing mastectomy vs breast conserving surgery (BCT), use of radiation and hormone therapy, and recurrence rates between the years 1990-2000 and 2001-2010 using Chi-square test. Results: There was no significant difference in race (p=0.21) or age (p=0.09) among patients diagnosed with DCIS between 1990-2000 (Group A, N=462) and 2001-2010 (Group B, N=311). There was no significant difference in mastectomy rates between the two groups (31% vs. 27%, p= 0.26). Patients less than 50 years old were more likely to undergo mastectomy in both groups (p=0.02). Use of radiation therapy following BCT was similar between the two groups (52% vs. 53%, p=0.76). Interestingly more patients received hormone therapy during 2001-2010 than 1990-2000 (48% vs. 26%, p < 0.0001). Patients undergoing mastectomy were less likely to receive radiation (2% vs. 74%, p<0.0001) and hormone therapy (25% vs. 39%, p<0.0001). There was no significant correlation between race and type of surgery. We are in the process of comparing recurrence rates between the two groups which will be reported. Conclusions: Previously published studies have reported higher rates of mastectomy among patients with early stage breast cancer in the recent years. Data from our institution over the last two decades did not corroborate this finding, although interestingly we have found increasing use of tamoxifen therapy for DCIS in the second decade. Understanding current practices is helpful in designing future studies for management of DCIS using novel prognostic assays such as Oncotype Dx assay.
Novel surgical technique to selectively remove metastatic axillary lymph nodes in breast cancer patients after neoadjuvant chemotherapy: The MARI procedure—Marking of the axilla with radioactive iodine seeds.
Authors: Vrancken Peeters Marie-Jeanne TFD , Straver Marieke Evelien , Donker Mila , Loo Claudette , Sonke Gabe S. , Wesseling Jelle , Rutgers Emiel J. 
Published: February 2017

196 Background: An important benefit of neoadjuvant chemotherapy (NAC) is the increase in breast-conserving surgery. At present the response of axillary lymph node metastases to chemotherapy cannot be accurately assessed. Therefore axilla-conserving therapy is not yet a benefit. We aimed to assess a new surgical method to evaluate the axillary response: the MARI procedure, which stands for Marking of the Axillary lymph node with Radioactive Iodine seeds. Methods: Prior to NAC, proven tumor-positive axillary lymph nodes were marked with a Iodine-125 seed. After NAC, the marked lymph node was selectively removed with the use of a gamma-detection probe. A complementary axillary lymph node dissection was performed to assess whether pathological response in the marked node was indicative for the pathological response in the additional lymph nodes. Results: Tumor-positive axillary lymph nodes were successfully marked with Iodine-125 seeds in 68 patients. The marked lymph node (MARI-node) was surgically detected and selectively removed after NAC in all patients. The pathological response to chemotherapy in the MARI-node was indicative for the overall response in the additionally removed lymph nodes. In 47 patients the MARI-node contained residual disease (n=45 macrometastasis, n= 2 ITC). Thirty-five of them had macro- or micro metastases in the complementary axillary lymph node dissection specimen. In 21 patients the MARI-node was tumor negative. In 2 patients a macro metastasis was found in the additionally removed nodes, in 2 patients ITC were found and in the remaining 17 patients no residual tumor was found in the additionaly removed lymphnodes. (false negative rate of the MARI procedure: 9.5%). Conclusions: This study shows that marking and selectively removing metastatic lymph nodes after NAC is feasible. The tumor-response in the marked lymph node may be used to tailor further axillary treatment, and herewith enabling axilla-conserving surgery after neoadjuvant chemotherapy.