Publications by authors named "Mara A Piltin"
Background: Racial differences in invasive breast cancer exist, but less is known about ductal carcinoma in situ. Our aim was to assess racial/ethnic differences in ductal carcinoma in situ tumor biology and treatment.
Methods: Adults with ductal carcinoma in situ were identified from the National Cancer Database, 2012-2021.
Background: Efforts to define the key technical elements of breast cancer surgery, the foundation of curative treatment, have been recognized recently by the Commission on Cancer (CoC). Effective 1 January 2023, surgeon documentation in synoptic format of specific technical elements of axillary surgery for breast cancer became a CoC accreditation requirement (standards 5.3 and 5.
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- The study investigates the impact of internal mammary lymphadenopathy (IML) on breast cancer treatment and outcomes, focusing on patients from the I-SPY-2 clinical trial between 2010 and 2022.
- Out of 2095 patients, 198 were found to have IML, with most detected via MRI; younger age, larger tumors, and higher tumor grade were linked to IML presence.
- Although IML patients were more likely to receive radiation therapy, there were no significant differences in recurrence rates or event-free survival compared to patients without IML, suggesting that IML is not a negative prognostic factor when treated with modern approaches.
Internal mammary lymphadenopathy in breast cancer: a narrative review and update.
Transl Breast Cancer Res
April 2024
Article Synopsis
- The internal mammary (IM) lymph node chain is important in breast cancer management, as it can be involved in around 13-37% of cases, but current data on diagnosis and treatment is limited.
- Improved imaging techniques have enhanced the detection of IM nodal involvement, making traditional surgical staging less relevant, although IM nodal metastases do not independently increase locoregional recurrence risk.
- Variations in radiation treatment practices for IM lymphadenopathy exist globally, pointing to the need for clearer guidelines and more data to inform clinical decision-making.
Article Synopsis
- - The study evaluates the safety and detectability of polymethyl methacrylate (PMMA) as a breast biopsy marker, using ultrasound Doppler twinkling to track its presence over a 6-month period in pigs.
- - Different markers were tested, with PMMA showing a gradual decrease in detectability but remaining clinically useful for localization of lymph nodes even after 6 months.
- - No adverse events were reported, suggesting that PMMA is a safe option for long-term use in biopsy marking, though the effectiveness may decrease over time.
Both targeted therapies and immunotherapies provide benefit in resected Stage III melanoma. We hypothesized that the combination of targeted and immunotherapy given prior to therapeutic lymph node dissection (TLND) would be tolerable and drive robust pathologic responses. In NeoACTIVATE (NCT03554083), a Phase II trial, patients with clinically evident resectable Stage III melanoma received either 12 weeks of neoadjuvant vemurafenib, cobimetinib, and atezolizumab (BRAF-mutated, Cohort A, n = 15), or cobimetinib and atezolizumab (BRAF-wild-type, Cohort B, n = 15) followed by TLND and 24 weeks of adjuvant atezolizumab.
View Article and Find Full Text PDFBackground: In July 2016, the American Society of Breast Surgeons published guidelines discouraging contralateral prophylactic mastectomy for average-risk women with unilateral breast cancer. We incorporated these into practice with structured patient counseling and aimed to assess the effect of this initiative on contralateral prophylactic mastectomy rates.
Methods: We evaluated female patients with unilateral breast cancer undergoing mastectomy at our institution from January 2011 to November 2022.
Article Synopsis
- - Variability in compliance with melanoma lymph node surgery guidelines is linked to disputes over patient selection, with many patients receiving suboptimal care, especially before recent studies.
- - An analysis of data from 2004 to 2018 showed that a significant portion (28.8%) of T2/T3 melanoma patients did not undergo any lymph node surgery, although compliance improved for node-negative patients over time.
- - Factors such as younger age, male sex, and tumor characteristics influenced adherence to guidelines, and proper lymph node surgery led to better survival rates, highlighting the need for consistent practice.
Article Synopsis
- Researchers studied how axillary surgery practices have changed over time following neoadjuvant chemotherapy (NAC) in breast cancer patients enrolled in the I-SPY2 trial from 2011 to 2021.
- The findings showed a significant decrease in axillary lymph node dissection (ALND) procedures, particularly in patients who were clinically node-positive (cN+) at diagnosis, with a corresponding increase in the use of sentinel lymph node (SLN) surgery.
- These trends indicate a shift in surgical practices, with less extensive surgery being performed after NAC, particularly for patients showing node positivity before treatment, reflecting evolving clinical approaches prior to further research outcomes.
Article Synopsis
- - Breast biopsy markers are critical for surgical management in patients with node-positive breast cancer, helping to ensure accurate imaging and reducing false negatives in sentinel lymph node biopsies.
- - There's a need for better visibility of these markers, especially in the axilla (armpit area), to assist with preoperative localization.
- - A study of eight women showed that while traditional B-mode ultrasound couldn't locate the biopsy markers, the use of color Doppler ultrasound twinkling successfully identified these markers in all patients.
Background And Purpose: To evaluate the long-term outcome of accelerated partial breast irradiation utilizing intraoperatively placed applicator-based brachytherapy (ABB) in early-stage breast cancer.
Materials And Methods: From our prospective registry, 223 patients with pTis-T2, pN0/pN1mic breast cancer were treated with ABB. The median treatment duration including surgery and ABB was 7 days.
Article Synopsis
- The study investigates the effectiveness of different biopsy markers in demonstrating actionable twinkling during ultrasound scans of cadaveric breast tissue after neoadjuvant systemic therapy for breast cancer.
- It evaluates how the presence of embedding material and the type of ultrasound transducer affects twinkling scores, which indicate the markers' ability to be visualized for targeted lymph node dissection.
- Results show that markers with embedding material and certain transducers produced higher twinkling scores, suggesting they are more reliable for identifying metastatic lymph nodes.
Background: Ductal carcinoma in situ (DCIS) is noninvasive breast cancer and therefore nodal staging is not routinely recommended. We evaluated the use of and factors associated with axillary surgery in DCIS in the National Cancer Database (NCDB).
Methods: DCIS cases were identified from the NCDB 2012-2018.
Article Synopsis
- The study investigates how neoadjuvant systemic therapies (NST) affect the complexity of surgical procedures for patients with resectable stage III melanoma compared to traditional surgery.
- Researchers used surveys to gather surgeons’ assessments of the difficulty of lymphadenectomy before and after NST in a clinical trial with stage III melanoma patients.
- Results showed that while many surgeries were viewed as initially more challenging, a significant number turned out to be easier post-NST than expected, indicating potential benefits of NST in surgery outcomes.
Article Synopsis
- The study focuses on the management of the axilla in clinically node-negative breast cancer patients who have one or two positive sentinel lymph nodes (SLNs), analyzing the effects of frozen-section pathology on patient outcomes.
- Among 338 patients, those with positive SLNs detected during surgery (FS+SLN) were more likely to undergo completion axillary lymph node dissection (cALND) and had larger metastatic sizes compared to those with positive SLNs found after surgery (FS-SLN).
- The findings suggest that FS+SLN patients generally have a higher risk of cancer spread, leading most to undergo further surgery, while many FS-SLN patients effectively avoided additional procedures, indicating frozen-section analysis can help tailor treatment plans.
Article Synopsis
- The study examined how tumor genomic prognostic assays, specifically the DCIS score, influenced treatment decisions for patients with ductal carcinoma in situ (DCIS) who underwent breast-conserving surgery between 2010 and 2016.
- Out of 141,047 DCIS patients, only 3% had a DCIS score assessed, with the percentage increasing over the years, particularly among those with more favorable tumor characteristics.
- Results revealed that patients with low-risk DCIS scores received significantly less radiation compared to those with higher-risk scores, demonstrating the DCIS score's potential to guide treatment de-escalation.
Background: Sentinel lymph node (SLN) surgery after neoadjuvant chemotherapy (NAC) has been well studied. However, outcomes data addressing the oncologic safety of this technique are sparse. This study aimed to evaluate use of SLN surgery versus axillary lymph node dissection (ALND) for clinically node-positive patients treated with NAC and to report outcomes.
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- The study compared three nomograms that predict how well patients with clinically node-positive breast cancer respond to neoadjuvant chemotherapy (NAC) based on their axillary lymph nodes.
- The analysis involved 581 patients, revealing that 43.5% achieved a pathologic node-negative (ypN0) status, with significant variation by cancer subtype.
- While all three models (Mayo and MD Anderson Cancer Center models) had comparable overall discrimination, the Mayo model had better sensitivity for identifying ypN+ patients, but the MDACC models showed higher specificity for ypN0 status in certain subtypes, particularly not performing well for the ER+/HER2- group.