Serial expression analysis of breast tumors during neoadjuvant chemotherapy reveals changes in cell cycle and immune pathways associated with recurrence and response.

Introduction: The molecular biology involving neoadjuvant chemotherapy (NAC) response is poorly understood. To elucidate the impact of NAC on the breast cancer transcriptome and its association with clinical outcome, we analyzed gene expression data derived from serial tumor samples of patients with breast cancer who received NAC in the I-SPY 1 TRIAL.

Methods: Expression data were collected before treatment (T1), 24-96 hours after initiation of chemotherapy (T2) and at surgery (TS).

Recommendations for standardized pathological characterization of residual disease for neoadjuvant clinical trials of breast cancer by the BIG-NABCG collaboration.

Neoadjuvant systemic therapy (NAST) provides the unique opportunity to assess response to treatment after months rather than years of follow-up. However, significant variability exists in methods of pathologic assessment of response to NAST, and thus its interpretation for subsequent clinical decisions. Our international multidisciplinary working group was convened by the Breast International Group-North American Breast Cancer Group (BIG-NABCG) collaboration and tasked to recommend practical methods for standardized evaluation of the post-NAST surgical breast cancer specimen for clinical trials that promote accurate and reliable designation of pathologic complete response (pCR) and meaningful characterization of residual disease.

Coaching patients in the use of decision and communication aids: RE-AIM evaluation of a patient support program.

Background: Decision aids educate patients about treatment options and outcomes. Communication aids include question lists, consultation summaries, and audio-recordings. In efficacy studies, decision aids increased patient knowledge, while communication aids increased patient question-asking and information recall.

Comparison of Mammographic Findings Following Oncoplastic Mammoplasty and Lumpectomy Without Reconstruction.

Background: Reconstruction of lumpectomy defects with reduction mammoplasty techniques can improve aesthetic outcomes and patient satisfaction. However, one concern with the substantial tissue rearrangement required is the possible difficulty with mammographic follow up and/or increased recommendations for future biopsies.

Methods: We performed a retrospective review of 49 patients who underwent oncoplastic reduction mammoplasty between 2001 and 2009 who were age-matched to patients who underwent lumpectomy without reconstruction.

Rates of Reconstruction Failure in Patients Undergoing Immediate Reconstruction With Tissue Expanders and/or Implants and Postmastectomy Radiation Therapy.

Objectives: Mastectomy rates for breast cancer have increased, with a parallel increase in immediate reconstruction. For some women, tissue expander and implant (TE/I) reconstruction is the preferred or sole option. This retrospective study examined the rate of TE/I reconstruction failure (ie, removal of the TE or I with the inability to replace it resulting in no final reconstruction or autologous tissue reconstruction) in patients receiving postmastectomy radiation therapy (PMRT).

Approaches to microvascular breast reconstruction after total skin-sparing mastectomy: a comparison of techniques.

Introduction: Preserving the entire breast skin envelope through total skin-sparing mastectomy (TSSM) techniques, in conjunction with immediate autologous reconstruction, can provide excellent aesthetic outcomes for patients. However, postoperative ischemic complications, including nipple-areolar complex (NAC) and skin flap necrosis, can negatively impact reconstructive outcomes. As a strategy for minimizing ischemic complications, we have recently begun performing 2-stage autologous reconstruction after TSSM with immediate tissue expander placement, followed by second-stage microvascular reconstruction, as an alternative to immediate autologous reconstruction.

Phyllodes tumor: review of key imaging characteristics.

Phyllodes tumor of the breast is rare and often resembles the more commonly seen fibroadenoma at imaging and histologically. As core biopsy cannot always distinguish the two, assessing radiologic-pathologic concordance is essential to guide appropriate clinical management. We review the imaging characteristics of phyllodes tumor at mammography, ultrasound, and MRI to help the interpreting radiologist be aware of key imaging features that should alert him to the possibility of a phyllodes tumor even if not verified by initial core biopsy.

The impact of breast mass on outcomes of total skin-sparing mastectomy and immediate tissue expander-based breast reconstruction.

Background: Larger breast size has been viewed as a relative contraindication for nipple/areola preservation with mastectomy. Few studies have directly evaluated the effect of quantified breast size on postoperative outcomes.

Methods: The authors reviewed and assessed 325 total skin-sparing mastectomy cases performed in 224 patients with immediate tissue expander placement that had documented mastectomy specimen mass.

The Neoadjuvant Model Is Still the Future for Drug Development in Breast Cancer.

The many improvements in breast cancer therapy in recent years have so lowered rates of recurrence that it is now difficult or impossible to conduct adequately powered adjuvant clinical trials. Given the many new drugs and potential synergistic combinations, the neoadjuvant approach has been used to test benefit of drug combinations in clinical trials of primary breast cancer. A recent FDA-led meta-analysis showed that pathologic complete response (pCR) predicts disease-free survival (DFS) within patients who have specific breast cancer subtypes.

Development, implementation, and initial evaluation of a foundational open interoperability standard for oncology treatment planning and summarization.

Objective: Develop and evaluate a foundational oncology-specific standard for the communication and coordination of care throughout the cancer journey, with early-stage breast cancer as the use case.

Materials And Methods: Owing to broad uptake of the Health Level Seven (HL7) Consolidated Clinical Document Architecture (C-CDA) by health information exchanges and large provider organizations, we developed an implementation guide in congruence with C-CDA. The resultant product was balloted through the HL7 process and subsequently implemented by two groups: the Health Story Project (Health Story) and the Athena Breast Health Network (Athena).

Preoperative Breast Pain Predicts Persistent Breast Pain and Disability After Breast Cancer Surgery.

Context: Approximately 30% of the women report pain in the affected breast before breast cancer surgery.

Objectives: The purpose of this secondary analysis of our prospective study was to determine how women who experienced both preoperative and persistent postsurgical breast pain (n=107) differed from women who did not report preoperative breast pain and did (n=158) or did not (n=122) experience persistent postsurgical breast pain.

Methods: Differences in demographic and clinical characteristics were evaluated.

Construction and analysis of the NCI-EDRN breast cancer reference set for circulating markers of disease.

Background: Many circulating biomarkers have been reported for the diagnosis of breast cancer, but few, if any, have undergone rigorous credentialing using prospective cohorts and blinded evaluation.

Methods: The NCI Early Detection Research Network (EDRN) has created a prospective, multicenter collection of plasma and serum samples from 832 subjects designed to evaluate circulating biomarkers for the detection and diagnosis of breast cancer. These samples are available to investigators who wish to evaluate their biomarkers using a set of blinded samples.

SIS.NET: a randomized controlled trial evaluating a web-based system for symptom management after treatment of breast cancer.

Background: As cancer survivorship increases, health care systems will be challenged to meet patient needs. With the limited availability of clinician time and resources, novel methods of using patient-reported outcomes may improve the quality and efficiency of follow-up care in patients with breast cancer.

Methods: The authors conducted a randomized trial in patients with TNM stage I to III breast cancer comparing standard care with SIS.

Expression profiling of circulating tumor cells in metastatic breast cancer.

Circulating tumor cells (CTCs) are prognostic in all stages of breast cancer. However, since they are extremely rare, little is known about the molecular nature of these cells. We report a novel strategy for the isolation and expression profiling of pure populations of CTCs derived from peripheral blood.

Immediate implant-based breast reconstruction following total skin-sparing mastectomy: defining the risk of preoperative and postoperative radiation therapy for surgical outcomes.

Background: Radiation therapy is increasingly used in breast cancer therapy. With total skin-sparing mastectomy and nipple/areola complex preservation, defining the risks of various treatment regimens for morbidity is important, in the setting of immediate prosthetic reconstruction. The authors assessed the effects of premastectomy and postmastectomy radiation therapy on outcomes in total skin-sparing mastectomy and immediate prosthetic reconstruction.

Randomized trial of drain antisepsis after mastectomy and immediate prosthetic breast reconstruction.

Background: In this 2-site randomized trial, we investigated the effect of antiseptic drain care on bacterial colonization of surgical drains and infection after immediate prosthetic breast reconstruction.

Methods: With IRB approval, we randomized patients undergoing bilateral mastectomy and reconstruction to drain antisepsis (treatment) for one side, with standard drain care (control) for the other. Antisepsis care included both: chlorhexidine disc dressing at drain exit site(s) and irrigation of drain bulbs twice daily with dilute sodium hypochlorite solution.

Tissue Expander Reconstruction After Total Skin-Sparing Mastectomy: Defining the Effects of Coverage Technique on Nipple/Areola Preservation.

Background: Total skin-sparing mastectomy (TSSM) has become increasingly frequent in recent years, as inclusion criteria continue to expand. Options for tissue expander coverage in these patients include complete submuscular tissue expander coverage and acellular dermal matrix (ADM)-assisted coverage. This study compares both techniques with regard to relevant outcomes, during a recent 1-year period at our institution.

Total skin-sparing mastectomy and immediate breast reconstruction: an evolution of technique and assessment of outcomes.

Background: Total skin-sparing mastectomy (TSSM) with preservation of the breast and nipple-areolar complex (NAC) skin was developed to improve aesthetic outcomes for mastectomy. Over time, indications for TSSM broadened and our technique has evolved with a series of systematic improvements.

Methods: We reviewed all cases of TSSM with immediate breast reconstruction performed from 2005 to 2012.

Addressing overdiagnosis and overtreatment in cancer: a prescription for change.

A vast range of disorders--from indolent to fast-growing lesions--are labelled as cancer. Therefore, we believe that several changes should be made to the approach to cancer screening and care, such as use of new terminology for indolent and precancerous disorders. We propose the term indolent lesion of epithelial origin, or IDLE, for those lesions (currently labelled as cancers) and their precursors that are unlikely to cause harm if they are left untreated.

Imaging features of HER2 overexpression in breast cancer: a systematic review and meta-analysis.

Breast cancer imaging phenotype is diverse and may relate to molecular alterations driving cancer behavior. We systematically reviewed and meta-analyzed relations between breast cancer imaging features and human epidermal growth factor receptor type 2 (HER2) overexpression as a marker of breast cancer aggressiveness. MEDLINE and EMBASE were searched for mammography, breast ultrasound, magnetic resonance imaging (MRI), and/or [(18)F]fluorodeoxyglucose positron emission tomography studies through February 2013.

Local recurrence rates are low in high-risk neoadjuvant breast cancer in the I-SPY 1 Trial (CALGB 150007/150012; ACRIN 6657).

Background: Increasingly, women with stage 2 and 3 breast cancers receive neoadjuvant therapy, after which many are eligible for breast-conserving surgery (BCS). The question often arises as to whether BCS, if achievable, provides adequate local control. We report the results of local recurrence (LR) from the I-SPY 1 Trial in the setting of maximal multidisciplinary treatment where approximately 50 % of patients were treated with BCS.