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Meyer-Schwickerath C, Weber C, Hornuss D, Rieg S, Hitzenbichler F, Hagel S, Ankert J, Hennigs A, Glossmann J, Jung N. Complexity of patients with or without infectious disease consultation in tertiary-care hospitals in Germany. Infection 2024; 52:577-582. [PMID: 38277092 PMCID: PMC10955003 DOI: 10.1007/s15010-023-02166-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024]
Abstract
PURPOSE Patients seen by infectious disease (ID) specialists are more complex compared to patients treated by other subspecialities according to Tonelli et al. (2018). However, larger studies on the complexity of patients related to the involvement of ID consultation services are missing. METHODS Data of patients being treated in 2015 and 2019 in four different German university hospitals was retrospectively collected. Data were collected from the hospitals' software system and included whether the patients received an ID consultation as well as patient clinical complexity level (PCCL), case mix index (CMI) and length of stay (LOS) as a measurement for the patients' complexity. Furthermore, a comparison of patients with distinct infectious diseases treated with or without an ID consultation was initiated. RESULTS In total, 215.915 patients were included in the study, 3% (n = 6311) of those were seen by an ID consultant. Patients receiving ID consultations had a significantly (p < 0.05) higher PCCL (median 4 vs. 0), CMI (median 3,8 vs. 1,1) and deviation of the expected mean LOS (median 7 days vs. 0 days) than patients in the control group. No differences among hospitals or between years were observed. Comparing patients with distinct infectious diseases treated with or without an ID consultation, the differences were confirmed throughout the groups. CONCLUSION Patients receiving ID consultations are highly complex, frequently need further treatment after discharge and have a high economic impact. Thus, ID specialists should be clinically trained in a broad spectrum of diseases and treating these complex patients should be sufficiently remunerated.
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Affiliation(s)
- C Meyer-Schwickerath
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
| | - C Weber
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - D Hornuss
- Faculty of Medicine, Department of Medicine II, Division of Infectious Diseases, Medical Center - University of Freiburg, Freiburg, Germany
| | - S Rieg
- Faculty of Medicine, Department of Medicine II, Division of Infectious Diseases, Medical Center - University of Freiburg, Freiburg, Germany
| | - F Hitzenbichler
- Department of Infection Prevention and Infectious Diseases, University Hospital of Regensburg, Regensburg, Germany
| | - S Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - J Ankert
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - A Hennigs
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Glossmann
- Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf, University of Cologne, Cologne, Germany
| | - N Jung
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany.
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Fathi A, Hennigs A, Addo MM. [Less is more… in infectious diseases]. Internist (Berl) 2021; 62:373-378. [PMID: 33580310 DOI: 10.1007/s00108-021-00967-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The increasing development of antimicrobial resistance has been identified as one of the greatest threats to public health and is caused to a relevant extent by falsely indicated antibiotic treatment. OBJECTIVE The main aim of this article is to identify areas in infectious disease diagnostics and treatment where overuse occurs and to provide recommendations on how to avoid it. MATERIAL AND METHODS The authors identified current and relevant studies on the topic of medical overuse in infectious diseases via a literature search. In particular, contributions from international "less is more" initiatives were included. The focus was on areas in which a reduction of diagnostic and therapeutic measures leads to an optimization of patient outcomes. RESULTS In many cases overuse in the context of diagnostics and treatment of infectious diseases not only leads to an unnecessary financial burden on the healthcare system and is not beneficial but can also increase the risk of development of antimicrobial resistance and have adverse consequences for patients. CONCLUSION Correct indications as well as focused selection and adequate application of antimicrobial agents is crucial to provide the best possible medical care. Diagnostic and antibiotic stewardship measures, which should be implemented in collaboration with infectious disease specialists, can help to identify and reduce areas of overuse and misuse.
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Affiliation(s)
- A Fathi
- Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - A Hennigs
- Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - M M Addo
- Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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Riedel F, Heil J, Feißt M, Moderow M, von Au A, Domschke C, Michel L, Schäfgen B, Golatta M, Hennigs A. Can the eligibility criteria of the ACOSOG Z0011 trial be extended to patients undergoing mastectomy and presenting T3-T4 tumors? An analysis of non-sentinel axillary metastases. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- F Riedel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - J Heil
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Feißt
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie und Informatik
| | | | - A von Au
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - C Domschke
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - L Michel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - B Schäfgen
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Golatta
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A Hennigs
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
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Platzer L, Orthmann N, Grozinger P, Hennigs A, Rippinger N, Wallwiener M, Rom J, Riedel F. Does music genre affect medical students’ performance in standardized laparoscopic exercises? Comparing exposure to rock, hip-hop, classic and mixed radio music at 70 decibels. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- L.K. Platzer
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - N. Orthmann
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - P. Grozinger
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A. Hennigs
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - N. Rippinger
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M. Wallwiener
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - J. Rom
- Klinikum Frankfurt-Höchst, Frauenklinik
| | - F. Riedel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
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Riedel M, Hennigs A, Dobberkau AM, Deutsch T, Rippinger N, Wallwiener M, Finkenzeller C, Golatta M, Heil J, Riedel F. Evaluation genderspezifischer Faktoren und Assoziationen für die Wahl zur Facharztweiterbildung in der Gynäkologie und Geburtshilfe – Ergebnisse einer Befragung unter Medizinstudierenden im klinischen Studienabschnitt. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- M Riedel
- Klinikum rechts der Isar der Technischen Universität München, Frauenklinik
| | - A Hennigs
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A.-M Dobberkau
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - T Deutsch
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - N Rippinger
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Wallwiener
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - C Finkenzeller
- Universitätsklinikum Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik
| | - M Golatta
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - J Heil
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - F Riedel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
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6
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Riedel F, Hoffmann AS, Moderow M, Heublein S, Deutsch T, Golatta M, Wallwiener M, Schneeweiss A, Heil J, Hennigs A. Wie hat sich die Anwendung von adjuvanter zu neoadjuvanter Chemotherapie beim frühen Mammakarzinom verändert? – Daten von 104 deutschen Brustzentren 2008-2017. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- F Riedel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - AS Hoffmann
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | | | - S Heublein
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - T Deutsch
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Golatta
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Wallwiener
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A Schneeweiss
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
- Nationales Centrum für Tumorerkrankungen
- Deutsches Krebsforschungszentrum
| | - J Heil
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A Hennigs
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
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Schäfgen B, Riedel F, Sinn P, Feisst M, Hennigs A, Hug S, Binning A, Sohn C, Golatta M, Gläser A, Heil J. Diagnostic accuracy and clinical utility of axillary ultrasound in the evaluation of axillary lymph node status in early breast cancer patients. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | | | | | - M Feisst
- Institute of Medical Biometry and Informatics
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8
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Stefanovic S, TM D, Riethdorf S, Fischer C, Hartkopf A, Sinn P, Feisst M, Pantel K, Hennigs A, Golatta M, Sütterlin M, Schneeweiss A, Wallwiener M. Receptor discordance between primary tumor and metastasis influences CTC-status. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- S Stefanovic
- Universitätsfrauenklinik, Universitätsklinikum Mannheim, Universität Heidelberg
| | - Deutsch TM
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - S Riethdorf
- Institut für Tumorbiologie, Universitätsklinikum Hamburg-Eppendorf
| | - C Fischer
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - A Hartkopf
- Universitätsfrauenklinik, Universitätsklinikum Tübingen
| | - P Sinn
- Institut für Pathologie, Universitätsklinikum Heidelberg
| | - M Feisst
- Institut für Medizinische Biometrie und Informatik, Universitätsklinikum Heidelberg
| | - K Pantel
- Institut für Tumorbiologie, Universitätsklinikum Hamburg-Eppendorf
| | - A Hennigs
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - M Golatta
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - M Sütterlin
- Universitätsfrauenklinik, Universitätsklinikum Mannheim, Universität Heidelberg
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen (NCT)
- Deutsches Krebsforschungszentrum (DKFZ)
| | - M Wallwiener
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
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9
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Riedel F, Heil J, Golatta M, Schaefgen B, Hug S, Schott S, Rom J, Schuetz F, Sohn C, Hennigs A. Changes of breast and axillary surgery patterns in patients with primary breast cancer during the past decade. Arch Gynecol Obstet 2018; 299:1043-1053. [PMID: 30478667 DOI: 10.1007/s00404-018-4982-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/16/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Breast-conserving therapy (BCT) is the standard procedure for most patients with primary breast cancer (BC). By contrast, axillary management is still under transition to find the right balance between avoiding of morbidity, maintaining oncological safety, and performing a staging procedure. The rising rate of primary systemic therapy creates further challenges for surgical management. METHODS Patients with primary, non-metastatic BC treated between 01.01.2003 and 31.12.2016 under guideline-adherent conditions were included in this study. For this prospectively followed cohort, breast and axillary surgery patterns are presented in a time-trend analysis as annual rate data (%) for several subgroups. RESULTS Overall, 6700 patients were included in the analysis. While BCT rates remained high (mean 2003-2016: 70.4%), the proportion of axillary lymph node dissection has declined considerably from 80.1% in 2003 to 16.0% in 2016, while the proportion for sentinel lymph node biopsy (SLND) has increased correspondingly from 10.3 to 76.4%. Among patients with cT1-2, cN0 breast cancer receiving BCT with positive SLND, the rate of axillary completion has decreased from 100% in 2008 to 24.4% in 2016. CONCLUSIONS In the past decade, SLNB has been established as the standard procedure for axillary staging of clinically node-negative patients. Surgical morbidity has been further reduced by the rapid implementation of new evidence from the ACOSOG Z0011 trial into clinical routine. The results reflect the transition towards more individually tailored, less invasive treatment for selected patient subgroups, especially in regards to axillary lymph node management.
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Affiliation(s)
- F Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - J Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - M Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - B Schaefgen
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - S Hug
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - S Schott
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - J Rom
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - F Schuetz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - C Sohn
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - A Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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10
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Riedel F, Heil J, Mahdi R, Nitz U, Moderow M, Golatta M, Schäfgen B, Sohn C, Schütz F, Schneeweiss A, Hennigs A. Chemotherapie-Anwendung beim frühen Mammakarzinom in Deutschland – aktuelle Daten aus 179 Brustkrebszentren (2008 – 2015). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- F Riedel
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - J Heil
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - R Mahdi
- Europäisches Brustzentrum Dr. Mahdi Rezai, Luisenkrankenhaus, Düsseldorf, Deutschland
| | - U Nitz
- Evangelisches Krankenhaus Bethesda, Brustzentrum Niederrhein, Mönchengladbach, Deutschland
| | - M Moderow
- Westdeutsches Brust-Centrum GmbH, Düsseldorf, Deutschland
| | - M Golatta
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - B Schäfgen
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - C Sohn
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - F Schütz
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - A Schneeweiss
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
| | - A Hennigs
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
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11
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Köpke M, Feißt M, Rezai M, Nitz U, Moderow M, Riedel F, Golatta M, Sohn C, Schneeweiss A, Heil J, Hennigs A. Veränderung des axillären Managements bei Brustkrebspatientinnen mit 1 – 2 tumorbefallenen Sentinel-Lymphknoten. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Köpke
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - M Feißt
- Medizinische Biometrie und Informatik, Heidelberg, Deutschland
| | - M Rezai
- Europäisches Brustzentrum Dr. Mahdi Rezai, Luisenkrankenhaus, Düsseldorf, Deutschland
| | - U Nitz
- Evangelisches Krankenhaus Bethesda, Brustzentrum Niederrhein, Mönchengladbach, Deutschland
| | - M Moderow
- Westdeutsches Brust-Centrum GmbH, Düsseldorf, Deutschland
| | - F Riedel
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - M Golatta
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - C Sohn
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
| | - J Heil
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Hennigs
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
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12
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Funk A, Schäfgen B, Heil J, Harcos A, Gomez C, Stieber A, Junkermann H, Hennigs A, Rauch G, Sinn HP, Riedel F, Hug S, Meier A, Schott S, Rom J, Schütz F, Sohn C, Golatta M. Evaluation des Nutzens von intraoperativer Präparateradiografie zur Randbeurteilung bei brusterhaltender Therapie maligner Brusttumore. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Funk
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - B Schäfgen
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - J Heil
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Harcos
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - C Gomez
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Stieber
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - H Junkermann
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Hennigs
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - G Rauch
- Institut für Medizinische Biometrie und Informatik, Heidelberg, Deutschland
| | - HP Sinn
- Institut für Pathologie und Neuropathologie, Heidelberg, Deutschland
| | - F Riedel
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - S Hug
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Meier
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - S Schott
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - J Rom
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - F Schütz
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - C Sohn
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - M Golatta
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
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Riedel F, Schneeweiss A, Sinn HP, Marmé F, Golatta M, Wallwiener M, Schütz F, Sohn C, Heil J, Hennigs A. Veränderungen in der Anwendung und beim Outcome von Chemotherapie beim frühen Mammakarzinom in der letzten Dekade. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1606152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- F Riedel
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
| | - A Schneeweiss
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
- Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg
| | - HP Sinn
- Universitätsklinikum Heidelberg, Pathologisches Institut, Heidelberg
| | - F Marmé
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
| | - M Golatta
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
| | - M Wallwiener
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
| | - F Schütz
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
| | - C Sohn
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
| | - J Heil
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
| | - A Hennigs
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg
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Hennigs A, Riedel F, Marmé F, Sinn P, Lindel K, Gondos A, Smetanay K, Golatta M, Sohn C, Schuetz F, Heil J, Schneeweiss A. Changes in chemotherapy usage and outcome of early breast cancer patients in the last decade. Breast Cancer Res Treat 2016; 160:491-499. [PMID: 27744486 PMCID: PMC5090013 DOI: 10.1007/s10549-016-4016-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/08/2016] [Indexed: 11/23/2022]
Abstract
Background During the last decade, neoadjuvant chemotherapy (NACT) of early breast cancer (EBC) evolved from a therapy intended to enable operability to a standard treatment option aiming for increasing cure rates equivalent to adjuvant chemotherapy (ACT). In parallel, improvements in the quality control of breast cancer care have been established in specialized breast care units. Patients and methods This study analyzed chemotherapy usage in patients with EBC treated at the Heidelberg University Breast Unit between January 2003 and December 2014. Results Overall, 5703 patients were included in the analysis of whom 2222 (39 %) received chemotherapy, 817 (37 %) as NACT, and 1405 (63 %) as ACT. The chemotherapy usage declined from 48 % in 2003 to 34 % in 2014 of the cohort. Further, the proportion of NACT raised from 42 to 65 % irrespective of tumor subtype. In addition, frequency of pathologic complete response (pCR) defined as no tumor residues in breast and axilla (ypT0 ypN0) at surgery following NACT increased from 12 % in 2003 to 35 % in 2014. The greatest effect was observed in HER2+ breast cancer with an increase in patients achieving pCR from 24 to 68 %. Conclusions The results mirror the refined indication for chemotherapy in EBC and its preferred usage as NACT in Germany. The increase in pCR rate over time suggests improvement in outcome accomplished by a multidisciplinary decision-making process and stringent measures for quality control. Electronic supplementary material The online version of this article (doi:10.1007/s10549-016-4016-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - F Riedel
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - F Marmé
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University of Heidelberg, Heidelberg, Germany
| | - P Sinn
- Department of Pathology, University of Heidelberg, Heidelberg, Germany
| | - K Lindel
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - A Gondos
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - K Smetanay
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - M Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - C Sohn
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - F Schuetz
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - J Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - A Schneeweiss
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany. .,National Center for Tumor Diseases (NCT), University of Heidelberg, Heidelberg, Germany.
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Heil J, Schaefgen B, Sinn P, Richter H, Harcos A, Gomez C, Stieber A, Hennigs A, Rauch G, Schneeweiss A, Schuetz F, Sohn C, Golatta M. Kann eine pathologische Komplettremission nach neoadjuvanter Chemotherapie bei Brustkrebspatientinnen mithilfe einer minimal invasiven Biopsie diagnostiziert werden? Ergebnisse einer prospektiven Pilotstudie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Hennigs A, Riedel F, Gondos A, Sinn HP, Marmé F, Golatta M, Rom J, Schütz F, Sohn C, Heil J, Schneeweiss A. Ergebnisqualität von Brustkrebs-Subtypen in der klinischen Routine – eine große, prospektive Kohortenstudie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Riedel F, Fremd C, Tabatabai P, Smetanay K, Doster A, Golatta M, Heil J, Schütz F, Sohn C, Hennigs A. Examensvorbereitungskurs für die Zweite Ärztliche Prüfung im Fach Gynäkologie und Geburtshilfe – Ein Proof-of-Concept an der Universitätsfrauenklinik Heidelberg. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Michel L, Sommer L, González Silos R, Lorenzo Bermejo J, Hennigs A, Golatta M, Heil J, Schneeweiss A, Sohn C, Marmé F. Evaluation des MD Anderson Prognostic Index (MDAPI) zur lokoregionären Risikostratifikation in der neoadjuvanten Therapiesituation. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Hennigs A, Heil J, Gondos A, Riedel F, Marme F, Sinn HP, Schirmacher P, Kauczor HU, Debus J, Golatta M, Schtz F, Sohn C, Schneeweiss A. Abstract P1-07-12: Prognosis of clinico-pathological breast cancer subtypes in routine clinical care. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-07-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background / Aim: To analyze oncological outcome of breast cancer (BC) subtypes in routine clinical care in specialized breast care units (BCU).
Patients and methods: A prospectively followed cohort of 4110 female cases with primary, non-bilateral, non-metastatic BC treated between 01.01.2003 and 31.12.2012 has been analyzed for the whole cohort and separately for the five routinely used clinico-pathological subtypes (i.e. Luminal A, Luminal B (=Her2 neg.), Luminal B (=Her2 pos.), HER-2, triple negative). The median follow-up of the cohort was 51 month. We calculated estimates for local control rate (LCR), disease-free survival (DFS), distant disease-free survival (DDFS), overall survival (OS) and relative overall survival (ROS).
5 year outcome results referred to 5 different endpoints (using Kaplan-Meier method) of all patients with primary, non-metastatic, non-bilateral breast cancer treated at Heidelberg Breast Care Unit between 01.01.2003 and 31.12.2012 All patients (including in-situ)Patients with invasive cancer (excluding in-situ) n=4102 (including 499 in-situ cases)n = 3603LCR [%] (95% CI)96.1 (95.6 ; 96.6)96.1 (95.7 ; 96.5)DFS [%] (95% CI)85.0 (84.2 ; 85.8)83.7 (82.8 ; 84.6)DDFS [%] (95% CI)86.9 (86.1 ; 87.7)85.7 (84.8 ; (86.6)OS [%] (95% CI)91.3 (90.5 ; 92.2)90.5 (89.6 ; 91.4)ROS [%] (95% CI)95.5 (94.3 ; 96.7)94.7 (93.4 ; 96.0)CI, confidence interval; LCR, local recurrence rate; DFS, disease-free survival; DDFS, distant disease-free survival; OS, observed overall survival; ROS, relative (age adjusted) overall survival
Outcome results referred to 5 different endpoints (using Kaplan-Meier method) according to clinico-pathological tumor subtype or in-situ tumor. Results in percent at 5 years (95% CI).invasive cancer (n = 34541) Lum A-likeLum B1-likeLum B2-likeHER2+Triple negativeCIS (n = 499)LCR [%] (95% CI)99.1 (98.7 ; 99.5)95.2 (-)**95.0 (86.3 ; 100)90.5 (-)89.6 (87.1 ; 92.1)96.2 (94.3 ; 98.1)DFS [%] (95% CI)92.2 (90.9 ; 93.5)80.1 (78.6 ; 81.6)79.0 (71.0 ; 86.0)77.0 (-)69.1 (66.4 ; 71.8)93.0 (91.3 ; 94.7)DDFS [%] (95% CI)92.9 (91.6 ; 94.2)82.2 (80.5 ; 83.9)82.8 (76.5 ; 89.1)83.3 (-)72.2 (70.7 ; 73.7)95.6 (94.4 ; 96.8)OS [%] (95% CI)95.1 (94.1 ; 96.1)88.7 (86.6 ; 90.8)92.5 (87.5 ; 97.5)85.6 (79.9 ; 91.3)78.5 (76.4 ; 80.6)96.9 (95.2 ; 98.6)ROS [%] (95% CI)100.0 (98.5 ; 100)93.4 (90.7 ; 96.1)96.0 (91.2 ; 100)88.8 (81.4 ; 96.2)80.1 (75.1 ; 85.1)100.0 (97.8 ; 100)
Results: LCR, DFS, DDFS, OS and ROS over 5 years for the whole cohort of invasive cases were 96.1%, 83.7%, 85.7%, 90.5% and 94.7%, respectively. Luminal A tumors were the most frequent (44.7%) and showed the best outcome with LCR, OS and ROS over 5 years at 99.1%, 95.1% and 100.0%, respectively; while triple negative tumors presented the poorest outcome with LCR, OS and ROS over 5 years at 89.6%, 78.5% and 80.1%, respectively.
Conclusions: This outcome analysis of a large cohort of patients with primary BC diagnosed, treated and prospectively followed on a routine basis at a specialized BCU in Germany confirmed general and detailed clinico-pathological subtype outcome data of clinical trials.
Citation Format: Hennigs A, Heil J, Gondos A, Riedel F, Marme F, Sinn H-P, Schirmacher P, Kauczor H-U, Debus J, Golatta M, Schtz F, Sohn C, Schneeweiss A. Prognosis of clinico-pathological breast cancer subtypes in routine clinical care. [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 P1-07-12.
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Affiliation(s)
- A Hennigs
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - J Heil
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - A Gondos
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - F Riedel
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - F Marme
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - H-P Sinn
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - P Schirmacher
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - H-U Kauczor
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - J Debus
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - M Golatta
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - F Schtz
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - C Sohn
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - A Schneeweiss
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Department of Pathology, University of Heidelberg, Heidelberg; Department of Radiology, University of Heidelberg, Heidelberg, Germany; Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
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Hennigs A, Heil J. Abstract P5-02-01: Diagnosis of pathological complete response by vacuum-assisted minimal invasive biopsy after neoadjuvant chemotherapy in breast cancer - Results from a prospective pilot study. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-02-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose:
To explore the ability of vacuum-assisted-biopsy (VAB) to diagnose pathological complete response (pCR) or residual tumor in breast cancer patients after neoadjuvant chemotherapy (NACT).
Patients and methods: 50 patients (22 with clinical / imaging complete response 28 with clinical / imaging residual tumor) were included in this review-board approved prospective pilot study between 08/14 and 02/15. Vacuum-assisted-biopsy (VAB) was performed after NACT and before surgery. Negative predictive values (NPV) and false-negative-rates (FNR) to predict a pCR in surgical specimen (=diagnose pCR through VAB) were the main outcome measures.
Results:
The cohort (n=50) consisted of 15 (30%) triple negative (TNBC), 13 (26%) HER2 positive (HER2+) and 22 (44%) hormone receptor positive / HER2 negative (HR+/HER2-) cancers. pCR in surgical specimen was diagnosed in 23 (46%) cases of the whole cohort. The NPV of the VAB diagnosis of pCR was 94.4% (95% CI: [0.84; 1.00]). The FNR was 3.7% (95% CI: [0; 0.12]) and specificity 73.9% (95% CI: [0.54; 0.94]). Taking only those biopsies into account that pathology confirmed to be representative of the (former) tumor region, improved the outcome of VAB to a specificity of 100% while the NPV (94.4% (95% CI: [0.84; 1.00]) and the FNR (4.8% (95% CI: [0.00; 0.15]) stayed the same.
Conclusion:
Overall accuracy of VAB diagnosis of pCR questions the necessity of surgical intervention to diagnose a pCR. A confirmative, multi-center, intra-individually-controlled clinical trial including patients with clinical complete, near complete or partial response to NACT to validate the above mentioned results is warranted.
Citation Format: Hennigs A, Heil J. Diagnosis of pathological complete response by vacuum-assisted minimal invasive biopsy after neoadjuvant chemotherapy in breast cancer - Results from a prospective pilot study. [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 P5-02-01.
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Affiliation(s)
- A Hennigs
- Universitäts-Frauenklinik, Heidelberg, Baden-Württemberg, Germany
| | - J Heil
- Universitäts-Frauenklinik, Heidelberg, Baden-Württemberg, Germany
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Schaefgen B, Mati M, Sinn HP, Golatta M, Stieber A, Rauch G, Hennigs A, Richter H, Domschke C, Schuetz F, Sohn C, Schneeweiss A, Heil J. Can Routine Imaging After Neoadjuvant Chemotherapy in Breast Cancer Predict Pathologic Complete Response? Ann Surg Oncol 2015; 23:789-95. [PMID: 26467456 DOI: 10.1245/s10434-015-4918-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study evaluated breast imaging procedures for predicting pathologic complete response (pCR = ypT0) after neoadjuvant chemotherapy (NACT) for breast cancer to challenge surgery as a diagnostic procedure after NACT. METHODS This retrospective, exploratory, monocenter study included 150 invasive breast cancers treated by NACT. The patients received magnetic resonance imaging (MRI), mammography (MGR), and ultrasound (US). The results were classified in three response subgroups according to response evaluation criteria in solid tumors. To incorporate specific features of MRI and MGR, an additional category [clinical near complete response (near-cCR)] was defined. Residual cancer in imaging and pathology was defined as a positive result. Negative predictive values (NPVs), false-negative rates (FNRs), and false-positive rates (FPRs) of all imaging procedures were analyzed for the whole cohort and for triple-negative (TN), HER2-positive (HER2+), and HER2-negative/hormone-receptor-positive (HER2-/HR+) cancers, respectively. RESULTS In 46 cases (31%), pCR (ypT0) was achieved. Clinical complete response (cCR) and near-cCR showed nearly the same NPVs and FNRs. The NPV was highest with 61% for near-cCR in MRI and lowest with 44% for near-cCR in MGR for the whole cohort. The FNRs ranged from 4 to 25% according to different imaging methods. The MRI performance seemed to be superior, especially in TN cancers (NPV 94%; FNR 5%). The lowest FPR was 10 % in MRI, and the highest FPR was 44% in US. CONCLUSION Neither MRI nor MGR or US can diagnose a pCR (ypT0) with sufficient accuracy to replace pathologic diagnosis of the surgical excision specimen.
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Affiliation(s)
- B Schaefgen
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - M Mati
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - H P Sinn
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - M Golatta
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - A Stieber
- Department of Diagnostic and Interventional Radiology, University Breast Unit, Heidelberg, Germany
| | - G Rauch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - A Hennigs
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - H Richter
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - C Domschke
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - F Schuetz
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - C Sohn
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - A Schneeweiss
- Department of Gynecology, University Breast Unit, Heidelberg, Germany.,National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology, University Breast Unit, Heidelberg, Germany.
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Hennigs A, Fuchs V, Rauch G, Golatta M, Smetanay K, Schneeweiss A, Sinn HP, Sohn C, Heil J. Einfluss von Nachresektion auf das Lokalrezidivrisiko bei Patientinnen mit Mammakarzinom nach brusterhaltender Therapie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Hennigs A, Biehl H, Golatta M, Rauch G, Domschke C, Schott S, Schütz F, Sohn C, Heil J. Vorhersage des ungünstigen ästhetischen Ergebnisses nach brusterhaltender Operation – Langzeitergebnisse einer prospektiven Kohortenstudie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Hennigs JK, Harlandt O, Hennigs A, Braune SA, Klose H, Kluge S. 43-jähriger Patient mit perakuter schwerer respiratorischer Insuffizienz und Volumenmangelschock durch ein massives Re-Expansionsödem. Pneumologie 2012. [DOI: 10.1055/s-0032-1302575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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