Breast cancer treatment delay and the Hispanic paradox: A SEER database analysis.

Background: Breast cancer (BC) is the most common cancer in US women. Knowledge gaps exist regarding healthcare inequities in Hispanic BC patients. This study assessed BC characteristics and treatment patterns among Hispanics.

Axillary de-escalation after neoadjuvant chemotherapy for advanced lymph node involvement in breast cancer.

Introduction: Sentinel lymph node biopsy reduces morbidity in patients with clinically node-positive breast cancer who achieve axillary pathologic complete response following neoadjuvant therapy (NACT). De-escalation trials primarily addressed cN1 disease, with underrepresentation of cN2 disease. This study evaluates the role of de-escalation in patients with cN2 breast cancer.

Axillary Management Following Neoadjuvant Chemotherapy in Clinically Node-Positive Breast Cancer.

Introduction: Clinical trial data indicate that omitting axillary lymph node dissection (ALND) is feasible and may reduce morbidity for carefully selected patients with clinically node-positive breast cancer who achieve a pathological complete response (pCR) after neoadjuvant chemotherapy (NCT). However, there remains a need to understand how these findings translate to broader clinical practice and to identify which patients benefit most. This study utilizes a national dataset to assess outcomes in axillary management, aiming to inform best practice in axillary de-escalation.

Reliability of artificial intelligence chatbot responses to frequently asked questions in breast surgical oncology.

Introduction: Artificial intelligence (AI)-driven chatbots, capable of simulating human-like conversations, are becoming more prevalent in healthcare. While this technology offers potential benefits in patient engagement and information accessibility, it raises concerns about potential misuse, misinformation, inaccuracies, and ethical challenges.

Methods: This study evaluated a publicly available AI chatbot, ChatGPT, in its responses to nine questions related to breast cancer surgery selected from the American Society of Breast Surgeons' frequently asked questions (FAQ) patient education website.

Immediate lymphatic reconstruction: Lessons learned over eight years.

Immediate lymphatic reconstruction (ILR) is recognized as a surgical approach used to reduce the risk of developing secondary lymphedema, and evidence demonstrating the efficacy of ILR is favorable. Our Lymphatic Center has become a centralized location offering ILR for the risk-reduction in breast cancer-related lymphedema (BCRL) in New England. Over the course of our experience, we made several modifications and adapted our approach to enhance the operative success of this procedure.

Expanding Access to Immediate Lymphatic Reconstruction Through an Axillary Surgery Referral Program: A 6-Year Single-Center Experience.

Background: Recent advances in breast cancer have progressed toward less aggressive axillary surgery. However, axillary lymph node dissection (ALND) remains necessary in specific cases and can increase the risk of lymphedema. Performing ALND with immediate lymphatic reconstruction (ILR) can help lower this risk.

Discordant Breast and Axillary Pathologic Response to Neoadjuvant Chemotherapy.

Introduction: Neoadjuvant chemotherapy (NAC) for breast cancer has the advantage of determining in vivo response to treatment, enabling more conservative surgery, and facilitating the understanding of tumor biology. Pathologic complete response (pCR) after NAC is a predictor of improved overall survival. However, some patients demonstrate a discordant response to NAC between the breast and axillary nodes.

A 4-Year Institutional Experience of Immediate Lymphatic Reconstruction.

Background: Up to one in three patients may go on to develop breast cancer-related lymphedema (BCRL) after treatment. Immediate lymphatic reconstruction (ILR) has been shown in early studies to reduce the risk of BCRL, but long-term outcomes are limited because of its recent introduction and institutions' differing eligibility requirements. This study evaluated the incidence of BCRL in a cohort that underwent ILR over the long term.

Variable Anatomy of the Lateral Upper Arm Lymphatic Channel: An Anatomical Risk Factor for Breast Cancer-Related Lymphedema.

Background: The lateral upper arm channel is an accessory lymphatic pathway that drains the upper extremity by means of the deltopectoral groove and supraclavicular nodes, thereby bypassing the axilla. Its variable connectivity to the forearm has not been studied in vivo.

Methods: Indocyanine green (ICG) lymphography was performed preoperatively to map the superficial and functional arm lymphatics in breast cancer patients without clinical or objective evidence of lymphedema.

Evaluating Axillary Lymph Node Yield After Neoadjuvant Chemotherapy.

Introduction: The benefits that neoadjuvant chemotherapy (NAC) provides in treating patients with breast cancer are well known. However, its effects on axillary lymph nodes and lymph node yield (LNY) following axillary lymph node dissection (ALND) remain unclear. Given the importance of LNY for accurate axillary staging in patients with breast cancer, we retrospectively reviewed a large national cancer database to determine if NAC has an effect on LNY following axillary surgery.

Utilizing a lower extremity vein graft for immediate lymphatic reconstruction.

Immediate lymphatic reconstruction (ILR) is targeted at preventing breast cancer related lymphedema (BCRL) by anastomosing disrupted arm lymphatic channels to axillary vein tributaries. Inadequate vein length and venous back-bleeding are two technical reasons that lead to ILR procedures being aborted intraoperatively. Recently, our team began routinely harvesting a lower extremity vein graft (LEVG) for all ILR procedures to reduce our abort rate.

Home Recovery After Mastectomy: Review of Literature and Strategies for Implementation American Society of Breast Surgeons Working Group.

Background: Practices regarding recovery after mastectomy vary significantly, including overnight stay versus discharge same day. Expanded use of Enhanced Recovery After Surgery (ERAS) algorithms and the recent COVID pandemic have led to increased number of patients who undergo home recovery after mastectomy (HRAM).

Methods: The Patient Safety Quality Committee of the American Society of Breast Surgeons created a multispecialty working group to review the literature evaluating HRAM after mastectomy with and without implant-based reconstruction.

Identifying Strategies for Robust Survivorship Program Implementation: A Qualitative Analysis of Cancer Programs.

Purpose: The Commission on Cancer seeks to promote robust survivorship programs among accredited cancer programs. In practice, cancer programs' survivorship programs range from cursory (eg, developing care plans without robust services) to robust (eg, facilitating follow-up care). To inform cancer programs' future efforts, in this study, we identified the implementation strategies that cancer programs used to achieve robust survivorship programs, distinguishing them from cursory programs.

Malpractice Cases in Breast Surgery: An Assessment of Litigation Involving Surgeons.

Introduction: Improving patient safety and quality are priorities in health care. The study of malpractice cases provides an opportunity to identify areas for quality improvement. While the issues surrounding malpractice cases in breast cancer are often multifactorial, there are few studies providing insight into malpractice cases specifically related to common breast cancer surgical procedures.

Burnout and Professional Fulfillment in Early and Early-Mid-Career Breast Surgeons.

Background: Prior work has shown that burnout among breast surgeons is prevalent and highest in those earlier in their clinical practice career. Therefore, we sought to better understand and identify specific contributors to early-career breast surgeon burnout.

Methods: We analyzed data from our 2017 survey of members of the American Society of Breast Surgeons.

Implementing radar reflector-guided localization of nonpalpable breast lesions: Feasibility, challenges, outcomes, and lessons learned.

Reflector-guided localization uses a nonradioactive radar implant for wire-free presurgical breast lesion localization. A single-institution retrospective evaluation found lower rates of positive margins and of close margins for reflector-guided localizations compared with wire localizations, resulting in a statistically significant decrease in the re-excision rates (p = 0.015).