Utilization of Circulating Tumor DNA in the Surveillance Setting.

Introduction: National guidelines give recommendations regarding cancer surveillance follow-up. In many early staged cancers radiographic imaging and labs are not routinely recommended unless patients are symptomatic. This can cause a gap in care because commonly when patients present symptomatically, they have progressed and transitioned to later-stage cancer.

Mucocele-like Lesions of the Breast.

Mucocele-like lesions of the breast (MLL) are believed to be due to mucinous ducts extruding their contents into the surrounding stroma. MLLs are a rare entity usually identified by calcifications noted on routine screening mammography. Surgical excision has been recommended due to the propensity for these lesions to harbor atypical ductal hyperplasia (ADH) or malignancy.

Integration of a 31-Gene Expression Profile Into Clinical Decision-Making in the Treatment of Cutaneous Melanoma.

Background: The practice of utilizing gene expression profile (GEP) for the evaluation and treatment of cutaneous melanomas has been found to predict the risk of sentinel-node metastasis and recurrence. Information obtained from this assay has been used to determine clinical decision-making, including serving as an indication for sentinel lymph node biopsy and also for the intensity of screening measures.

Methods: Herein we present our early experience in utilizing 31-GEP in intermediate melanomas and its effect on clinical management.

Comparison of Call-Back Rates between Digital Mammography and Digital Breast Tomosynthesis.

The effect of mammographic screening on the natural history and evolution of breast cancer treatment cannot be overstated; however, despite intensive and resource consuming screening, advanced breast cancer is still diagnosed frequently. The development of three-dimensional mammography or digital breast tomosynthesis (DBT) has already demonstrated greater sensitivity in the diagnosis of breast pathology and effectiveness in identifying early breast cancers. In addition to being a more sensitive screening tool, other studies indicate DBT has a lower call-back rate when compared with traditional DM.

Nuclear Factor-κB is Activated in Filter-Implanted Vena Cava.

Background: Implantation of a retrievable vena cava filter (VCF) is an effective method for preventing pulmonary embolism. Retrieval of filters, however, may be difficult due to intimal hyperplasia and inflammation in the cava wall. The transcription factor nuclear factor-kappaB (NF-κB) plays an important role in regulation of numerous genes participating in the inflammatory and proliferative responses of cells.

A 12-Year Single-Institution Experience with Accelerated Partial Breast Irradiation.

Accelerated partial breast irradiation (APBI) using the implanted brachytherapy device MammoSite® was approved for routine use by the Food and Drug Administration in 2002. The American Society of Breast Surgeons MammoSite® Breast Brachytherapy Registry served as a guideline for our institution to begin offering this treatment in 2005. This report reviews our available data to provide an analysis of patient outcomes over 12 years of use at a single institution.

In support of the Choosing Wisely campaign: Perceived higher risk leads to unnecessary imaging in accelerated partial breast irradiation?

Accelerated partial breast irradiation (APBI) is an increasingly utilized modality for early stage breast cancer as part of breast conservation therapy (BCT). There remains concern regarding local recurrence, requiring more frequent post-radiation surveillance imaging. The purpose of this study is to determine clinical significance of frequent surveillance in this perceived higher risk population.

Foaming Betadine Spray as a potential agent for non-labor-intensive preoperative surgical site preparation.

Background: The Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) report published in 2009 shows that there were about 16,000 cases of surgical site infection (SSI) following ~ 850,000 operative procedures making SSI one of the most predominant infection amongst nosocomial infections. Preoperative skin preparation is a standard procedure utilized to prevent SSIs thereby improving patient outcomes and controlling associated healthcare costs. Multiple techniques/ products have been used for pre-operative skin preparation, like 2 step scrubbing and painting, 2 step scrubbing and drying, and 1 step painting with a drying time.

Surveillance recommendations in reducing risk of and optimally managing breast cancer-related lymphedema.

Breast cancer survivors are at increased risk for the development of breast cancer-related lymphedema (BCRL), a chronic, debilitating, and disfiguring condition that is progressive and requires lifelong self-management of symptoms. It has been reported that over 40% of the 2.5 million breast cancer survivors in the United States may meet the criteria for BCRL during their lifetimes.

Gold nanoparticle mediated detection of prostate cancer cells using photoacoustic flowmetry with optical reflectance.

The presence of circulating tumor cells in the bloodstream has been correlated with disease state in cancer patients. While we have successfully exploited melanin, the natural light absorber in melanoma cells, to induce photoacoustic waves for tumor cell detection, non-pigmented tumor cells do not have sufficient optical contrast for such a method. For example, breast, prostate and lung cancers lack intrinsic pigmentation and thus do not generate photoacoustic waves.

Detection of melanoma cells in vitro using an optical detector of photoacoustic waves.

Background And Objective: Circulating tumor cells have been shown to correlate positively with metastatic disease state in patients with advanced cancer. We have demonstrated the ability to detect melanoma cells in a flow system by generating and detecting photoacoustic waves in melanoma cells. This method is similar to flow cytometry, although using photoacoustics rather than fluorescence.

Detection of circulating melanoma cells in human blood using photoacoustic flowmetry.

Detection of circulating tumor cells (CTC's) in human blood and lymph systems has the potential to aid clinical decision making in the treatment of cancer. The presence of CTC's may signify the onset of metastasis, indicate relapse, or may be used to monitor disease progression. A photoacoustic flowmetry system was designed and tested for detecting circulating melanoma cells (CMC's) by exploiting the broadband absorption spectrum of melanin within CMC's.

Rapid and label-free detection of breast cancer biomarker CA15-3 in clinical human serum samples with optofluidic ring resonator sensors.

Sensitive and specific detection of breast cancer biomarker CA15-3 in human serum is an important step toward successful evaluation of clinical treatment and prediction of breast cancer recurrence. In this work, we developed an optofluidic ring resonator (OFRR) sensor and the corresponding sensing protocols for label-free CA15-3 detection without any additional signal amplification steps. Nonspecific serum protein adsorption was minimized with effective surface blocking methods.

Photoacoustic detection of melanoma micrometastasis in sentinel lymph nodes.

Melanoma is the deadliest form of skin cancer and has the fastest growth rate of all cancer types. Proper staging of melanoma is required for clinical management. One method of staging melanoma is performed by taking a sentinel node biopsy, in which the first node in the lymphatic drainage path of the primary lesion is removed and tested for the presence of melanoma cells.

Plantar fibromatosis masquerading as metastatic melanoma.

We present the evaluation and treatment of a 59-year-old male with a medical history significant for multiple recurrences of malignant melanoma. The patient was found to have increased focal uptake of his right foot on fluorodeoxyglucose positron emission tomography. Given the patient's clinical history, the increased uptake was suspected to be recurrence of his disease.

Mammography as a screening tool for diabetes.

Background: This large retrospective study investigates the relationship between breast arterial calcifications (BAC) identified on screening mammography and the presence of DM, thereby evaluating the utility of screening mammography as an additional screening tool for diabetes.

Materials And Methods: The screening mammograms of 1000 women were prospectively evaluated for BAC; women with a prior history of DM or CAD were excluded. This screening group was compared with all diabetic women who had undergone routine mammographic screening at our institution.

Vascular calcifications on screening mammography identify women with increased risk of coronary artery disease and diabetes.

Background: Mammographic breast arterial calcifications (BAC) have been reported in women with diabetes and coronary artery disease (CAD). This prospective study further investigates the clinical significance of BAC, CAD, and diabetes.

Methods: Women undergoing screening mammography were prospectively evaluated for mammographic BAC.

Mammography as a screening tool for coronary artery disease.

Background: The leading cause of death in women over 40 y old is coronary artery disease (CAD) followed by cancer. This large retrospective study investigates the relationship between mammographic benign arterial calcifications (BAC) and a history of CAD to determine if mammography is a suitable screening tool for CAD.

Methods: To determine the incidence of BAC in our general screening population, we prospectively studied 1000 consecutive women undergoing screening mammography.

Mammography as screening for coronary artery disease.

Coronary artery disease (CAD) is the leading cause of death in American women. Screening mammograms are recommended for women starting at age 40 for the early detection of breast cancer. An additional benefit of this routine screening tool may be to detect breast arterial calcifications (BAC) as a possible sign of CAD.

Analysis of biomolecule detection with optofluidic ring resonator sensors.

We theoretically and experimentally analyze the biomolecule detection capability of the liquid core optical ring resonator (LCORR) as a label-free bio/chemical sensor. We first establish a simple and general linear relationship between the LCORR's bulk refractive index sensitivity (BRIS) and its response to molecule deposition onto the surface, which enables us to easily characterize the LCORR sensing performance. Then, biosensing experiments are performed with bovine serum albumin (BSA) and LCORRs of various BRISs.

Photoacoustic detection of metastatic melanoma cells in the human circulatory system.

Detection of disseminating tumor cells among patients suffering from various types and stages of cancer can function as an early warning system, alerting the physician of the metastatic spread or recurrence of the disease. Early detection of such cells can result in preventative treatment of the disease, while late stage detection can serve as an indicator of the effectiveness of chemotherapeutics. The prognostic value of exposing disseminating tumor cells poses an urgent need for an efficient, accurate screening method for metastatic cells.

Mammography as a screening tool for peripheral vascular disease.

Background: Peripheral vascular disease (PVD) is a progressive and debilitating disease often diagnosed only when patients become symptomatic. Currently there are no widespread screening tests available for the early detection of PVD. Patients with diabetes and coronary artery disease are known to have a higher incidence of PVD.

Nipple aspirate fluid color is associated with breast cancer.

Background: Fluid can be non-invasively aspirated from the breast nipple (nipple aspirate fluid, NAF). NAF may have many colors, including clear, white, yellow, green, and red/brown. While bloody spontaneous nipple discharge has been linked with breast cancer, the association of NAF color with cancer is not established.

Radio-frequency ablation of large, nonresectable hepatic tumors.

Patients with nonresectable hepatic metastases who are not treated survive an average of 6 months. We report our experience with radio-frequency ablation (RFA) of nonresectable hepatic tumors 4 cm or greater in size. A retrospective chart review of all patients undergoing RFA of hepatic tumors 4 cm or greater from October 1, 1999, through August 31, 2002, was performed.