Optimization of sentinel lymph node biopsy in breast cancer using an operative gamma camera

<p>Abstract</p> <p>Background</p> <p>Sentinel lymph node (SLN) procedure is now a widely accepted method of LN staging in selected invasive breast cancers (unifocal, size ≤ 2 cm, clinically N0, without previous treatment). Complete axillary clearance is no longer needed if the SLN is negative. However, the oncological safety of this procedure remains to be addressed in randomized clinical trials. One main pitfall is the failure to visualize SLN, resulting in incorrect tumor staging, leading to suboptimal treatment or axillary recurrence. Operative gamma cameras have therefore been developed to optimize the SLN visualization and the quality control of surgery.</p> <p>Case presentation</p> <p>A 44-year-old female patient with a 14-mm infiltrative ductal carcinoma underwent the SLN procedure. An operative gamma camera was used during and after the surgery. The conventional lymphoscintigraphy showed only one SLN, which was also detected by the operative gamma camera, then removed and measured (9.6 kBq). It was analyzed by frozen sections, showing no cancer cells. During this analysis, the exploration of the axillary area with the operative gamma camera enabled the identification of a second SLN with low activity (0.5 kBq) that conventional lymphoscintigraphy, surgical probe and blue staining had failed to visualize. Histological examination revealed a macrometastasis. Axillary clearance was then performed, followed by a postoperative image proving that no SLN remained. Therefore, the use of the operative gamma camera prevented an under-estimation of staging which would have resulted in a suboptimal treatment for this patient.</p> <p>Conclusion</p> <p>This case report illustrates that an efficient operative gamma camera may be able to decrease the risk of false negative rate of the SLN procedure, and could be an additional tool to control the quality of the surgery.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Identifier: NCT00357487</p

Disease-specific survival for limited-stage small-cell lung cancer affected by statistical method of assessment

BACKGROUND: In general, prognosis and impact of prognostic/predictive factors are assessed with Kaplan-Meier plots and/or the Cox proportional hazard model. There might be substantive differences from the results using these models for the same patients, if different statistical methods were used, for example, Boag log-normal (cure-rate model), or log-normal survival analysis. METHODS: Cohort of 244 limited-stage small-cell lung cancer patients, were accrued between 1981 and 1998, and followed to the end of 2005. The endpoint was death with or from lung cancer, for disease-specific survival (DSS). DSS at 1-, 3- and 5-years, with 95% confidence limits, are reported for all patients using the Boag, Kaplan-Meier, Cox, and log-normal survival analysis methods. Factors with significant effects on DSS were identified with step-wise forward multivariate Cox and log-normal survival analyses. Then, DSS was ascertained for patients with specific characteristics defined by these factors. RESULTS: The median follow-up of those alive was 9.5 years. The lack of events after 1966 days precluded comparison after 5 years. DSS assessed by the four methods in the full cohort differed by 0–2% at 1 year, 0–12% at 3 years, and 0–1% at 5 years. Log-normal survival analysis indicated DSS of 38% at 3 years, 10–12% higher than with other methods; univariate 95% confidence limits were non-overlapping. Surgical resection, hemoglobin level, lymph node involvement, and superior vena cava (SVC) obstruction significantly impacted DSS. DSS assessed by the Cox and log-normal survival analysis methods for four clinical risk groups differed by 1–6% at 1 year, 15–26% at 3 years, and 0–12% at 5 years; multivariate 95% confidence limits were overlapping in all instances. CONCLUSION: Surgical resection, hemoglobin level, lymph node involvement, and superior vena cava (SVC) obstruction all significantly impacted DSS. Apparent DSS for patients was influenced by the statistical methods of assessment. This would be clinically relevant in the development or improvement of clinical management strategies

Women's gambling behaviour, product preferences, and perceptions of product harm: Differences by age and gambling risk status

Background: Women's participation in, and harm from gambling, is steadily increasing. There has been very limited research to investigate how gambling behaviour, product preferences, and perceptions of gambling harm may vary across subgroups of women. Methods: This study surveyed a convenience sample of 509 women from Victoria and New South Wales, Australia. Women were asked a range of questions about their socio-demographic characteristics and gambling behaviour. Focusing on four gambling products in Australia-casino gambling, electronic gambling machines (EGMs), horse betting, and sports betting-women were asked about their frequency of participation, their product preferences, and perceptions of product harms. The sample was segmented a priori according to age and gambling risk status, and differences between groups were identified using Chi-square tests and ANOVAs. Thematic analysis was used to interpret qualitative data. Results: Almost two thirds (n=324, 63.7%) of women had engaged with one of the four products in the previous 12 months. Compared to other age groups, younger women aged 16-34 years exhibited a higher proportion of problem gambling, gambled more frequently, and across more products. While EGMs were the product gambled on most frequently by women overall, younger women were significantly more likely to bet on sports and gamble at casinos relative to older women. Qualitative data indicated that younger women engaged with gambling products as part of a 'night out', 'with friends', due to their 'ease of access' and perceived 'chance of winning big'. There were significant differences in the perceptions of the harms associated with horse and sports betting according to age and gambling risk status, with younger women and gamblers perceiving these products as less harmful. Conclusions: This study highlights that there are clear differences in the gambling behaviour, product preferences, and perceptions of product harms between subgroups of women. A gendered approach will enable public health researchers and policymakers to ensure that the unique factors associated with women's gambling are taken into consideration in a comprehensive public health approach to reducing and preventing gambling harm

Histopathologic Evidence of Tumor Regression in the Axillary Lymph Nodes of Patients Treated With Preoperative Chemotherapy Correlates With Breast Cancer Outcome

Background: The benefits of primary tumor downstaging and assessment of chemoresponsiveness have resulted in expanded applications for induction chemotherapy. However, the pathologic evaluation and prognostic significance of response in preoperatively treated lymph nodes have not been defined.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41400/1/10434_2003_Article_734.pd

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection ar

Abstract P4-02-15: Preoperative MRI of the breast and ipsilateral breast tumor recurrence: Long-term follow up

Abstract Introduction: Local recurrence after breast conserving surgery for invasive breast cancer is uncommon, reported in 5 to 10% of cases at 10 years after surgery. Prior studies with short term follow-up have shown that preoperative breast MRI does not reduce re-excision rates for positive margins or reduce local recurrence after lumpectomy and radiation therapy. This study aims to determine 1) if preoperative breast MRI is associated with reduced ipsilateral breast tumor recurrence (IBTR) rates in the longer term and 2) the IBTR rates of a high risk (triple negative (TN) and Her-2 positive) subgroup in those receiving or not receiving preoperative MRI. Methods: Between 1999 and 2005, a cohort of patients with invasive breast cancer undergoing breast conservative surgery and radiation therapy were identified from a prospectively collected database and followed. The primary endpoint was IBTR rate. Secondary outcomes included the determination of factors associated with the use of preoperative breast MRI and prognostic factors related to IBTR. IBTR rate was calculated by Kaplan-Meier method. Univariate analysis was calculated using log-rank test and chi-squared test. Results: The cohort consisted of 470 cases with invasive breast cancer undergoing lumpectomies with negative resection margins. All patients received adjuvant radiation therapy. 127 (27%) patients underwent preoperative breast MRI and 343 (73%) did not. Median follow-up was 97 months. The overall 10-year IBTR rate was 3.6%. Overall, there was no significant difference in IBTR rate at 10 years between those receiving preoperative MRI and those without (IBTR: 1.6% and 4.2%, respectively (p = 0.37). There were no differences in IBTR rate between MRI and no-MRI after adjusting for age, year of surgery, tumor size, and adjuvant treatments on univariate analysis. For patients who recurred, median time to recurrence was 26 months for MRI group vs. 25 months for no-MRI group. Factors associated with the receipt of preoperative MRI were age &amp;lt; 50 years, lesion &amp;gt; 2 cm and receipt of adjuvant chemotherapy. We also found that the TN and Her-2 positive combined subgroup had a higher IBTR rate than all others (9.8% vs. 3.1%, p= 0.03). In those that received preoperative MRI, there was no difference in IBTR between the high risk group (n= 33) and the remaining patients (3.3% vs 1.2%, p= 0.5), but in the group without an MRI, the IBTR rate of the high risk group (n= 75) was 11.8% compared to the remainder (vs. 4.0%, p= 0.0529). For the TN and Her-2 positive combined group, the difference in IBTR rate when this subgroup was subdivided if they had received preoperative MRI vs. no-MRI (3.3% vs. 11.8%, p= 0.3) was not significant. Conclusion: With long term 10-year follow up, there is no overall significant difference in IBTR rate whether preoperative breast MRI is performed versus not. However, the high risk triple negative breast cancers and Her-2 positive populations combined have shown an increased IBTR rate, and this was more marked in those who did not receive preoperative MRI. Citation Format: Gervais M-K, Maki E, Schiller DE, McCready DR. Preoperative MRI of the breast and ipsilateral breast tumor recurrence: Long-term follow up. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-02-15.</jats:p

Abstract P1-13-14: Discordance of ER and PR status between primary and recurrent breast cancer in association with endocrine therapy

Abstract Background: Discordance in tumor receptor status between primary and recurrent tumors has been previously reported. Discordant ER/PR status has been used to differentiate recurrences from new primaries. We evaluated discordance rates of ER and PR expression between the primary and locoregional/contralateral recurrences and examined the relationship with adjuvant endocrine therapy (ET). Methods: We conducted a retrospective chart review of breast cancer patients (pts) treated with lumpectomy and adjuvant locoregional radiation (RT) from 1999-2005 at the Princess Margaret Cancer Centre. Tumor recurrence was classified as locoregional recurrence (LRR) for ipsilateral breast or lymph node recurrence, contralateral disease (CD) or distant recurrence. ER and PR were assessed by immunohistochemistry; positive if &amp;gt;10% tumor cells staining, borderline if 10% staining, and negative if &amp;lt;10% staining. Univariate analyses were applied to determine the association of receptor discordance with age, menopausal status, tumor grade, endocrine therapy or adjuvant chemotherapy. Results: All 441 pts had a lumpectomy with negative margins and RT, and had a median follow-up of 8.3 years. The median age at primary surgery was 57, and 67% of pts were postmenopausal. ET (tamoxifen and/or aromatase inhibitors) was initiated in 294 (84%) eligible patients. There were 24 (5.4%) pts with LRR, 20 (4.5%) pts with CD, and 28 (6.3%) with distant metastases. Nine pts with LRR also had distant disease, and 3 pts with CD also had distant disease. Among pts with LRR, 17 had ER/PR status available for comparison. Discordance rates for ER and PR were (1/17) 5.9% and (3/17) 17.6%, respectively, and the most common change was ER becoming positive, and PR becoming negative (75%). For pts with CD, 18 had ER/PR status available for comparison. Discordance rates for ER and PR were (7/18) 38.9% and (9/18) 50%, respectively. The most common change was ER becoming positive (86%), and PR becoming positive (75%). Distant disease receptor status was only available for two patients, therefore not included. The patient with LRR and discordant ER did not receive ET, while pts with LRR and discordant PR all received ET. Among patients with CD, 15% of patients with discordant ER status received ET, and 33% with discordant PR received ET. There was no statistically significant association between discordance rates in either LRR or CD groups and use of ET. Similarly, discordance rates were not associated with the other patient or tumor variables studied, or the development of distant metastases or death. Conclusions: Discordance of ER and PR expression was low in LRR and higher in CD, where the majority of changes were from negative to positive receptor status. Receptor discordance was not associated with endocrine therapy. This study suggests that the biology of LRR and CD may be different, and re-evaluation of receptor status could lead to additional treatment options becoming available from an endocrine standpoint. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-13-14.</jats:p