tbuckley/cabot-search huggingface dataset:
Intraoperative ultrasound guided wire (IOUS-wire) localization biopsy with frozen section versus preoperative fine needle aspiration cytology (FNAC) for the evaluation of clinically positive nodes in patients with early breast cancer in China real-world clinical practice.
Authors: Xue Song, Qianjun Chen, Jiafa He, Rui Xu, Shijun Tan, Yan Dai, Lingling Ye, Xiaojie Lin
Journal: Journal of Clinical Oncology (2024)

e12600 Background: Appropriate biopsy procedure for clinically positive (suspicious) lymph nodes (LN) plays a key role in accurate axillary staging of early breast cancer. Fine needle aspiration (FNA) is a recommended method for clinically suspicious nodes in the National Comprehensive Cancer Network (NCCN) guidelines. However, the false negative rate (FNR) of FNA remains too high. Therefore, it is valuable to explore an alternative and appropriate procedure in clinical practice. We conducted a retrospective review to compare the feasibility and diagnostic efficiency of using a novel procedure, the intraoperative ultrasound guided wire (IOUS-wire) localization biopsy with frozen section, to FNA for assessment of clinically positive nodes in patients with early breast cancer. Methods: Data on consecutive primary breast cancer patients with documented axillary ultrasound results who had clinically positive lymph nodes (cN1) between January 2015 and September 2023 either utilization of IOUS-wire localization or ultrasonography-guided fine-needle aspiration cytology (US-FNAC) for clinically positive lymph nodes were retrospectively analyzed. Sentinel lymph node biopsy (SLNB) was performed in patients with negative histopathological or cytological results. The false negative rate (FNR) of histopathology between two groups was calculated. Results: Eligible patients (n=198) referred to axillary biopsy by IOUS-wire localization biopsy(n=100) and US-FNAC(n=98) in this study. The FNR of clinically positive lymph nodes biopsy was 12.8 percent in the IOUS-wire localization group and 87.5 percent in the US-FNAC group.IOUS-wire failed in 5 patients. Among the remaining 32 successful identifications, 26 were IOUS-wire-node positive by intraoperative frozen section. 42 patients with additional lymph node metastases were found in FNAC-LN-negative patients by SLNB. The accuracy rate was respectively 95% and 57.1%. No significant difference was observed in complications and median number of SLNs harvested (5.3 versus 5.5; P=0.631) between the groups. Sufficient tissue samples can be obtained for intraoperative frozen pathology so the FNR is potentially reduced. In addition, the interval of waiting time for pathological results is reduced. Conclusions: Intraoperative US-guided wire localization biopsy is a feasible and alternative procedure compared to preoperative FNA for clinically node-positive patients with early breast cancer. This novel method is suitable for China's national conditions and should be further pursued as a potential biopsy method for evaluation of axillary node status in clinical practice.
Impact of breast-conserving surgery incisions on aesthetics, satisfaction, and complications: A prospective study.
Authors: Weijing Liu, Ruixian Chen, Ruoning Yang, Ya Huang, Yunhao Wu, Xin Zhao, Xiangyue Meng, Zhihao Zhang, Dengjie Ouyang, Qintong Li, Ting Luo, Xin Sun, Jie Chen
Journal: Journal of Clinical Oncology (2024)

e12603 Background: Breast-conserving (BCS) is favored for its aesthetics benefits and minimal invasiveness. Ensuring tumor safety is essential, but so are post-surgery appearance, satisfaction, and complications. Incision selection for BCS influences both operability of procedures and postoperative results. This study aims to investigate the impact of different incisions on the aesthetic outcome, patient satisfaction, and postoperative complications of BCS. Methods: A prospective single-center cohort study was conducted from July 2020 on breast cancer patients who underwent BCS. The Breast-Q questionnaire and the Aesthetic Items Scale (AIS) were used to assess breast aesthetics and satisfaction outcomes at different times before and after surgery. Complications evaluated include incision dehiscence, subcutaneous hydrops, and nipple-areolar complex (NAC) ischemia, which were recorded once postoperatively and classified according to the Clavien-Dindo classification. Results: A total of 429 patients were enrolled in this study: 247 with a periareolar incision, 30 with a crescentic periareolar incision, 41 with a curvilinear incision, and 111 with a radial incision. Compared to traditional radial incisions, the periareolar and crescent incisions showed significantly better results in psychological well-being, sexual well-being, satisfaction with breasts, and AIS scores at 1-, 3-, and 6-months post-operation. The crescentic incision demonstrated a notable advantage in physical well-being: chest at the 6-month. In contrast, no significant difference was observed between the curvilinear and radial incisions in terms of these outcomes. The overall complication rates for periareolar, crescentic periareolar, curvilinear, and radial incisions were 11.3%, 16.7%, 9.8%, and 7.2%, respectively, indicating no significant differences. Similarly, the rates of NAC ischemia for the periareolar (5.7%) and crescentic (3.3%) incisions did not significantly differ. All complications were graded in categories I to III, and the distribution showed no statistically significant differences among the four groups. Conclusions: Among various incisions, periareolar and crescentic incisions demonstrated superior outcomes in postoperative follow-up, with a comparable incidence of complications to other incisions. These findings may provide valuable surgical decision-making guidance for achieving optimal aesthetic and clinical outcomes in BCS.
Trends in the management of small HER2-positive breast cancers.
Authors: Carolin Mueller, Rangan Rahul, Megan Lynn Kruse, Zahraa Alhilli
Journal: Journal of Clinical Oncology (2024)

e12523 Background: Small HER2 positive breast cancers have not been well studied in randomized trials. The treatment landscape for this population aims to optimize efficacy while minimizing potential over-treatment and associated toxicities. Due to the potential for post-neoadjuvant therapy optimization, use of neoadjuvant systemic therapy (NAT) increased in recent years. However, this approach can often lead to overtreatment of patients with small tumors. This study aims to evaluate recent trends in treatment patterns of patients with T1 HER2 positive tumors. Methods: Patients diagnosed with HER2 positive, T1, any N, breast cancer treated at a single institution from January 2018 to December 2022 were included. Clinicopathological data, treatment data, and survival data were collected and analyzed. Results: 326 patients were included. Mean age was 62 (±12.2) years. T category included 3 (0.9%) cT0, 17 (5.2%) cTmi, 28 (8.6%) cT1a, 94 (28.8%) cT1b, 178 (54.6%) cT1c tumors, and 6 patients (1.8%) had clinical T1 stage without further specification. 41 patients (12.6%) had cN+ disease and 243 (74.5%) were hormone receptor positive. Systemic therapy data was available for 288 patients; 7 (2.4%) received Herceptin monotherapy, 105 (36.5%) Taxol + Herceptin, 41 (14.2%) Taxol + Carboplatin + Herceptin, and 74 (25.7%) Taxol + Carboplatin + Herceptin + Pertuzumab (TCHP), 12 (4.2%) other. 49 patients (17%) did not receive any systemic therapy. 58 patients (17.8%) were treated with NAT and a pathologic complete response rate was noted in 39 patients (67.2%) undergoing NAT. Overall, in patients who received systemic therapy, NAT increased from 2018 (17.6%) to 2021 (37.5%) and decreased in 2022 (23.5%). Similar patterns were observed in patients with T1a/b (2021: 17.4%; 2022: 0%), as well as T1c (2021: 51.4%; 2022: 36.4%). TCHP was the most commonly administered NAT regimen (86.2%). Discontinuation or dose reduction occurred in a total of 57 patients (18.8%). Conclusions: The primary treatment for T1 HER2 positive breast cancers is surgery with adjuvant HER2 targeted therapy in combination with chemotherapy. Although NAT witnessed an upward trend from 2018 to its peak in 2021, its utilization declined again in 2022. A balance between the most effective treatment and minimizing toxicities should be ensured.
Coronary Computed Tomography Angiography for the Diagnosis of Spontaneous Coronary Artery Dissection
Authors: Christos Pagonis, Mårten Sandstedt, Christian Dworeck, David Erlinge, Erika Fagman, David Adlam, Jonas Andersson, Mats Fredriksson, Natalie Glaser, Lilian Henriksson, Nina Johnston, Loghman Henareh, Lena Jonasson, Ellen Ostenfeld, Per Tornvall, Dimitrios Venetsanos, Kerstin Welén-Schef, Troels Yndigegn, Eva Swahn, Sofia Sederholm Lawesson
Journal: JACC. Cardiovascular imaging (2024)
De-escalation neoadjuvant chemotherapy in triple negative breast cancer.
Authors: Gara Rodriguez Gonzalez, Noemí Tuset Der-abrain, ANA Prieto Garcia, Ariadna Gasol Cudos, Serafin Morales Murillo
Journal: Journal of Clinical Oncology (2024)

e12520 Background: Neoadjuvant chemotherapy (NAT) represents the predominant therapeutic approach in the early triple negative breast cancer. NAT has demonstrated high overall survival rates in patients that achieve a pathological complete response (pCR). In patients with a tumor size less than 5 cm and no involvement of axillary lymph nodes, it may be advisable to consider a shorter chemotherapy regimen to evaluate the achievement of pCR percentages compared to longer regimens. Methods: We conducted an analysis of a cohort comprising 62 patients with triple-negative breast cancer in stages I and II that received 4 cycles of NAT with paclitaxel 80 mg/m2 weekly for 12 weeks plus carboplatin in AUC 5 doses every three weeks. Results: The median age within the cohort was 61 years (32-83) with an initial tumor size of 22 mm (10-82) and Ki67 expression of 54% (13-90). Ten patients (16%) presented histologically confirmed initial axillary involvement. The group attained a pCR rate of 56% while only 21% exhibited a minor response with a residual tumor exceeding 10 mm. Over a median follow-up period of 34 months, the recurrence rate was only 5%. The distribution of pathological response across the different clinical variables is delineated in the Table. Conclusions: The NAT regimen with carboplatin AUC 5 + weekly paclitaxel (80 mg/m2) for four cycles is safe for patients diagnosed with stage I and II, demonstrating a high pCR (56%) and a lower recurrence rate (5%). The pathological response observed across all clinical variable subgroups suggests that this regimen could be considered a potential standard for NAT in patients with stage I and II triple-negative breast cancer. [Table: see text]
Impact of comorbidity on surgical management of breast cancer in elderly patients.
Authors: Evgenii Shivilov, Kristina Anichkina, Khalil Arslanov, Gurami Kvetenadze, Lyudmila Zhukova
Journal: Journal of Clinical Oncology (2024)

e12596 Background: More than half of breast cancers are diagnosed above the age of 60 years, a quarter of which diagnosed with invasive breast cancer among those over 75 years of age. Treatment of breast cancer (BC) at this age remains a complex problem. Elderly patients often have various comorbidities that impose increased risks of complications with antitumor treatment. This leads to both excessive and insufficient treatment of BC. In patients over 75 years of age, an individual approach to treatment is recommended, taking into account their general health and life expectancy, the risk of death from breast cancer compared to other causes, as well as the advantages and disadvantages of treatment methods. Objective: To evaluate the influence of comorbidity on the risks of complications (early and delay) after surgical treatment in elderly and senile patients (pts). Methods: A retrospective analysis of the results of breast cancer treatment in 292 pts over 75 years of age, who underwent surgical treatment at the first stage in SBIH Moscow Clinical Scientific and Practical Center named after A.S. Loginov of DHM from 2016 to 2019. The initial stages of breast cancer (I and IIA) were diagnosed in 257 (88.0%) pts, 35 pts (12.0%) has IIB and IIIA clinical stages. Radical mastectomy was performed in 171 (58.6%) cases, breast-conserving surgery was performed in the remaining 121 (41.4%). Forty-six (15.8%) patients had diabetes mellitus, 121 (41.4%) had cardiovascular disease, 36 (12.3%) had heart rhythm disorders, 38 (13.0%) had chronic cerebral ischemia, and the risk of grade 3 and 4 cardiovascular complications was found in 251 (86.0%) cases. Results: In the early postoperative period severe complications occurred in 1 (1.7%) patient (acute coronary syndrome) leading to death. No local recurrences were detected. The overall 3-year survival rate was 86.3% and the recurrence-free survival rate was 89.7%. In 10 (3.4%) cases, death was due to progression of RRMS, 30 (10.3%) patients died from other causes (acute cardiovascular failure, stroke, COVID-19). Conclusions: Comorbid conditions in elderly patients after surgery did not affect the development of complications in the early postoperative period. Preliminary preoperative preparation of elderly patients (correction and selection of drug therapy for concomitant chronic diseases) reduces the risk of early postoperative complications.
Retrospective study on the profile of patients undergoing intraoperative radiotherapy with INTRABEAM for breast cancer treatment at a Brazilian cancer center.
Authors: Verônica Pereira Ferraz, Renato Cagnacci Neto, Solange Moraes Sanches, Guilherme Rocha Melo Gondim, Fabiana Baroni Alves Makdissi
Journal: Journal of Clinical Oncology (2024)

e12538 Background: Conservative breast therapy combined with adjuvant radiotherapy has been the preferred treatment for early-stage breast cancer for many decades. Considering that most breast cancer recurrences occur near the original tumor site, partial breast radiotherapy has become an alternative for patients in this scenario, allowing for a single-dose radiation application directly to the tumor site. This technique has advantages such as reducing local toxicity and improving the quality of life for treated patients, in addition to decreasing the waiting time for radiotherapy treatment in developing countries like ours. Our case series is the largest in Latin America to date, and we believe that reporting the results of our experience will be valuable for the scientific community and aid in treatment decision-making in low- and middle-income countries. Methods: This is a retrospective study based on data from the medical records of 209 patients with early-stage breast cancer undergoing conservative surgery and intraoperative radiotherapy at A.C. Camargo Cancer Center (São Paulo, Brazil) from 2016 to 2023. Results: In our cohort, 88.5% of tumors were invasive ductal carcinomas. The majority were T1b (41.8%), had histological grade 2 (45.4%), nuclear grade 2 (62.7%), and showed no axillary involvement (87.6%). All patients received intraoperative radiotherapy in a single dose of 20 Gy radiation at the tumor site with a voltage of 50 kV. In our study, 17.7% of patients required additional external radiotherapy due to postoperative histopathological findings inconsistent with treatment indication criteria, including 35.3% for micrometastasis and 32.4% for nodal macrometastasis, 10.8% for narrow or compromised margins, 10.8% for histological types not covered in the final report, 2.7% for multifocality, 2.7% for extensive ductal carcinoma in situ, 2.7% for negative progesterone receptor, and 2.7% for the presence of lymphatic vascular invasion. The average follow-up time for patients was 36 months. The local recurrence rate was 0.5%. Conclusions: The results of this study support established data indicating the efficacy of intraoperative radiotherapy in early-stage breast cancer treatment. Therefore, for carefully selected patients, this technique with should be considered as a treatment option. We will continue to follow this patient cohort to identify the occurrence of late recurrences and publish long-term follow-up data.
Cost-effectiveness of adjuvant abemaciclib and ribociclib in high-risk, hormone receptor–positive, early breast cancer in India.
Authors: Manraj Singh Sra, Archana Sasi, Atul Batra, Sameer Bakhshi, Shuvadeep Ganguly
Journal: Journal of Clinical Oncology (2024)

e12516 Background: Incorporating adjuvant cyclin-dependent kinase (CDK) 4/6 inhibitors abemaciclib and ribociclib along with endocrine therapy has been shown to improve invasive disease-free survival (iDFS) for hormone receptor-positive (HR+) human epidermal receptor 2 negative (HER2-) early breast cancer (EBC). This study assesses the cost-effectiveness of this strategy, along with adjuvant aromatase inhibitors (AI) from an Indian perspective. Methods: A Markov chain model evaluated the cost-effectiveness of abemaciclib and ribociclib with letrozole compared to letrozole alone for HR+/HER2- EBC from a payer perspective in India. Key measures included lifetime quality-adjusted life years (QALY), life-years (LY), and total costs. This study explores two scenarios for effectiveness: a best-case (BC) scenario, where the benefit of CDK4/6 inhibitors in improving iDFS lasts a lifetime, and a worst-case (WC) scenario, where benefits disappear after 5 years. Probabilistic sensitivity analyses (PSA) were used to account for simulation uncertainty. Results: In the BC scenario, abemaciclib added 2.17 QALY and 4.96 LY, costing $27,756.65 more. Ribociclib in the BC scenario added 0.98 QALY and 2.58 LY, with added costs of $20,494.6. The incremental cost-effectiveness ratio for abemaciclib and ribociclib surpassed the willingness to pay threshold for in India in both scenarios (Table). At current market prices there is 0% probability of cost-effectiveness of abemaciclib and ribociclib. The cost of abemaciclib and ribociclib needs to be reduce by 78.61% and 87.19%, respectively to achieve cost-effectiveness. Conclusions: The combination of adjuvant abemaciclib or ribociclib with letrozole is not cost-effective for HR+/HER2- EBC in India in either the best or worst-case scenario.[Table: see text]
Examining a genomic test in predicting extended endocrine benefit and recurrence risk in a diverse breast cancer population.
Authors: Ho Hyun Lee, Nicholas Siu-Li, Ian Pagano, Jami Aya Fukui
Journal: Journal of Clinical Oncology (2024)

e12526 Background: Extending adjuvant endocrine therapy (EET) beyond five years for early-stage hormone receptor-positive (HR+) breast cancer reduces late distant recurrence risk. The genomic test, Breast Cancer Index (BCI), has prognostic value and predicts the benefits of prolonged therapy, yet no studies have explored this testing in a diverse population. This study assesses late distant recurrence risk and predictive benefits of EET to better understand its relevance in a diverse early-stage HR+ breast cancer population. Methods: We analyzed patient demographics, clinical and pathologic characteristics, and BCI scores of 150 women in Hawaii with early-stage HR+ breast cancer, self-identifying as White, Filipino, Japanese, Native Hawaiian, or other. Tumor characteristics examined include size, grade, histology, lymph node, and ER/PR/HER2 receptor status. Logistic regression analyses used race, distant recurrence risk, and tumor features as predictor variables. BCI prediction of benefit and distant recurrence risk served as outcome variables. Results: Japanese patients had significantly lower odds of having a high risk for distant recurrence (OR = 0.02, p &lt; 0.0001) compared to White. Other Asian PIs also showed reduced odds of high distant recurrence risk (OR = 0.07, p = 0.02), albeit to a lesser extent than Japanese. Patients with high distant recurrence risk had significantly greater odds of a score predicting benefit than those with low risk (OR = 5.03, p = 0.009). Racial or ethnic differences in predicting benefit with EET were not statistically significant. Conclusions: Results show no racial or ethnic differences in predicting the benefit of EET, strengthening BCI’s universal applicability in diverse women with early-stage HR+ breast cancer. Patients with higher distant recurrence risk were predicted to benefit from EET. This suggests potential variations in tumor features or other factors affecting distant recurrence risk among racial groups. Limitations include a relatively small sample size and lack of data from patients representing other racial groups. Future studies should expand the sample size and adjust for known breast cancer risk factors to better understand the racial and ethnic implications of BCI.
HR+/HER2- early breast cancer with a high risk of recurrence: The impact of online education on clinician knowledge, competence, and confidence in utilization of clinical practice guidelines to enhance patient care.
Authors: Urvi Patel, Nabil Dorkhom, Victoria Phoenix, Cong Zhang, Sukhbir Bahra
Journal: Journal of Clinical Oncology (2024)

e12515 Background: Clinical practice guidelines drive treatment decision making in HR-positive, HER2-negative early breast cancer with a high risk of recurrence. Understanding is necessary to incorporate the guidelines into practice and improve patient care. To address this gap, two global educational activities were developed that consisted of a 1-hour live streaming virtual meeting with a 45-minute online enduring activity and a 30-minute panel discussion. The objective of this study was to assess the educational impact of the online educational activities. Methods: To assess educational impact a repeated-pairs pre-/post-assessment study design using 6 knowledge/competence questions, in which everyone served as their own control. A paired samples t-test assessed mean differences in the average number of correct responses to the matched pre-/post-assessment questions, and a McNemar’s test assessed significance of improvement across core learning topics from pre- to post-assessment. P values &lt;.05 are statistically significant. Confidence was also assessed using a pre/post confidence question. The activities launched in March 2023 and data was collected till January 2024. Results: 385 oncologists from the US and outside of the US who answered all the pre-/post-assessment questions were included in the analysis. Each assessment question was mapped to an activity learning objective. The learning objectives were grouped into three core topics. All core topics showed a significant improvement in education. Conclusions: These online activities resulted in a significant improvement of oncologists’ knowledge and competence related to the utilization of clinical practice guidelines. Confidence in understanding the implications of the latest guidelines also showed a statistically significant improvement. However, there is still a need for education in a significant percentage of oncologists on this topic. [Table: see text]