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Jakub JW. Localization Devices and the Surgeon Innovator. Ann Surg Oncol 2024:10.1245/s10434-024-15230-y. [PMID: 38594576 DOI: 10.1245/s10434-024-15230-y] [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] [Received: 08/07/2023] [Accepted: 03/12/2024] [Indexed: 04/11/2024]
Affiliation(s)
- James W Jakub
- Division of Surgical Oncology, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
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Lee CU, Urban MW, Hesley GK, Wood BG, Meier TR, Chen B, Kassmeyer BA, Larson NB, Lee Miller A, Herrick JL, Jakub JW, Piltin MA. Long-Term Ultrasound Twinkling Detectability and Safety of a Polymethyl Methacrylate Soft Tissue Marker Compared to Conventional Breast Biopsy Markers-A Preclinical Study in a Porcine Model. Ultrasound Med Biol 2024:S0301-5629(24)00137-6. [PMID: 38575416 DOI: 10.1016/j.ultrasmedbio.2024.03.008] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/21/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE We have studied the use of polymethyl methacrylate (PMMA) as an alternative biopsy marker that is readily detectable with ultrasound Doppler twinkling in cases of in vitro, ex vivo, or limited duration in vivo settings. This study investigates the long-term safety and ultrasound Doppler twinkling detectability of a PMMA breast biopsy marker following local perturbations and different dwell times in a 6-mo animal experiment. METHODS This study, which was approved by our Institutional Animal Care and Use Committee, involved three pigs and utilized various markers, including PMMA (Zimmer Biomet), 3D-printed, and Tumark Q markers. Markers were implanted at different times for each pig. Mesh material or ethanol was used to induce a local inflammatory reaction near certain markers. A semiquantitative twinkling score assessed twinkling for actionable localization during monthly ultrasounds. At the primary endpoint, ultrasound-guided localization of lymph nodes with detectable markers was performed. Following surgical resection of the localized nodes, histomorphometric analysis was conducted to evaluate for tissue ingrowth and the formation of a tissue rind around the markers. RESULTS No adverse events occurred. Twinkling scores of all markers for all three pigs decreased gradually over time. The Q marker exhibited the highest mean twinkling score followed by the PMMA marker, PMMA with mesh, and Q with ethanol. The 3D-printed marker with mesh and PMMA with ethanol had the lowest scores. All wire-localized lymph nodes were successfully resected. Despite varying percentages of tissue rind around the markers and a significant reduction in overall twinkling (p < 0.001) over time, mean PMMA twinkling scores remained clinically actionable at 6 and 5 mo using a General Electric C1-6 probe and 9L-probe, respectively. CONCLUSIONS In this porcine model, the PMMA marker demonstrates an acceptable safety profile. Clinically actionable twinkling aids PMMA marker detection even after 6 mo of dwell time in porcine lymph nodes. The Q marker maintained the greatest twinkling over time compared to all the other markers studied.
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Affiliation(s)
- Christine U Lee
- Department of Radiology, Division of Breast Imaging and Intervention, Mayo Clinic, Rochester, MD, USA.
| | - Matthew W Urban
- Department of Radiology, Division of Radiology Research, Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MD, USA
| | - Gina K Hesley
- Department of Radiology, Division of Breast Imaging and Intervention, Mayo Clinic, Rochester, MD, USA
| | | | - Thomas R Meier
- Department of Comparative Medicine, Mayo Clinic, Rochester, MD, USA
| | - Beiyun Chen
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, MD, USA
| | - Blake A Kassmeyer
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MD, USA
| | - Nicholas B Larson
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MD, USA
| | - A Lee Miller
- Biomaterials and Histomorphometry Core, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MD, USA
| | - James L Herrick
- Biomaterials and Histomorphometry Core, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MD, USA
| | - James W Jakub
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic, Jacksonville, FL USA
| | - Mara A Piltin
- Department of Surgery, Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MD, USA
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Sonam F, Komforti MK, Jakub JW, Cornell LF, Robinson KA. Rare Presentation of Papillary Carcinoma Within a Sentinel Lymph Node in a Patient With Ductal Carcinoma in Situ of the Breast: A Challenging but Useful Case Report Discussion Regarding Displacement or True Metastasis? Int J Surg Pathol 2024:10668969241235316. [PMID: 38500348 DOI: 10.1177/10668969241235316] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Papillary carcinoma of the breast is a rare histologic subtype of invasive breast cancer. In contrast, ductal carcinoma in situ (DCIS) is a noninvasive, nonobligate precursor to invasive mammary carcinoma, confined within the terminal duct lobular unit of the breast and surrounded by an intact myoepithelial cell layer at the stromal/epithelial interface. We present an unusual case in which a patient with only DCIS of the breast exhibited papillary carcinoma within a sentinel lymph node, leading to questions about the origin of the lymph node lesion-whether it represents a true metastasis or iatrogenic displacement during diagnostic procedures. This case underscores the diagnostic challenges and clinical implications associated with such rare presentations.
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Affiliation(s)
- Fnu Sonam
- Department of Laboratory Medicine and Pathology, Mayo Clinic Research in Florida, Jacksonville, FL, USA
| | - Miglena K Komforti
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - James W Jakub
- Department of Oncology, Mayo Clinic in Florida Radiation, Jacksonville, FL, USA
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Jakub JW, Advani P, Maxwell R, Vallow L, Maimone S, McLaughlin S. SOUND (Sentinel Node Versus Observation After Axillary Ultrasound) Trial: Are We Ready to Change the Tune of Our Breast Cancer Practice? Ann Surg Oncol 2024:10.1245/s10434-024-15111-4. [PMID: 38418656 DOI: 10.1245/s10434-024-15111-4] [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] [Received: 01/25/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Affiliation(s)
- James W Jakub
- Division of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA.
| | - Pooja Advani
- Division of Hematology & Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Robert Maxwell
- Division of Breast Imaging, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Laura Vallow
- Department of Radiation Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Santo Maimone
- Division of Breast Imaging, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Sarah McLaughlin
- Division of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
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Huang K, Jakub JW, McLaughlin SA. ASO Author Reflections: Sequence of Treatment in Clinically Node-Negative T1 Triple-Negative Breast Cancer. Ann Surg Oncol 2023; 30:8455-8456. [PMID: 37566286 DOI: 10.1245/s10434-023-14122-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Kai Huang
- Breast Surgery, St. Mary Hospital, Prevea Health, Green Bay, WI, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
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Sarcon AK, Zhang W, Degnim AC, Johnson RL, Harmsen WS, Glasgow AE, Jakub JW. The Benefits of Local Anesthesia Used in Mastectomy Without Reconstruction. Am Surg 2023; 89:4271-4280. [PMID: 35656869 DOI: 10.1177/00031348221091959] [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] [Indexed: 12/06/2023]
Abstract
BACKGROUND The opioid epidemic has driven renewed interest in local anesthesia to reduce postoperative opioid use. Our objective was to determine if local anesthesia decreased hospital pain scores, oral morphine equivalents (OME), length of stay (LOS), and nausea/vomiting. METHODS Single institution retrospective study of females who underwent mastectomy without reconstruction. RESULTS Overall, 712 patients were included; 63 (8.8%) received bupivacaine (B), 512 (72%) liposomal bupivacaine (LB), and 137 (19%) no local. 95% were discharged on POD1. Liposomal bupivacaine use increased from 2014 to 2019. Additional factors associated with use of local regimen were surgeon and extent of axillary surgery. Fewer patients used postop opioids during their hospital stay if any local was used compared to none (76 vs 88%; 0.003). Compared to none, local had shorter mean PACU LOS (95 vs 87 min; P = .02), lower mean intraoperative-OME (96 vs 106; P < .001), and lower mean postoperative OME/hr (1.4 vs 1.8 P = .001). Multivariable analysis (MVA) showed lower OME/hr with LB compared to B and none (P = .002); this translates to 22 mg and 30 mg of oxycodone in a 24-hr period, respectively. MVA showed lower POD1 pain scores with LB relative to none (P = .049). Local did not impact nausea/emesis. CONCLUSION Local anesthesia was superior to no local in several measures. However, a consistent benefit of a specific local anesthetic agent was not demonstrated (LB vs B). A prospective study is warranted to determine the optimal local regimen for this cohort and further inform clinical relevance.
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Affiliation(s)
- Aida K Sarcon
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Wenxia Zhang
- Department of Breast Surgery, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China
- Department of Breast Surgery, Southern Medical University, Guangzhou, China
| | - Amy C Degnim
- Division of Breast & Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Rebecca L Johnson
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - William S Harmsen
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Amy E Glasgow
- Department of Health Care Policy & Research, Mayo Clinic, Rochester, MN, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, Fl, USA
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Benolken MM, McLaughlin S, Piltin M, Mrdutt M, Li Z, Jakub JW. Lymph Node Positivity of Axillary Reverse Mapping Lymph Nodes at the Time of Axillary Lymph Node Dissection: Two-Site Prospective Trial. Ann Surg Oncol 2023; 30:6042-6049. [PMID: 37466868 DOI: 10.1245/s10434-023-13883-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Axillary reverse mapping (ARM) was introduced in 2007 to identify and selectively preserve upper-extremity lymphatics during axillary lymph node surgery to decrease the risk of lymphedema. The patient population in which an ARM lymph node (LN) can be preserved during an axillary lymph node dissection (ALND) has not been established to date. This study aimed to determine the frequency of metastatic involvement of an ARM LN among patients undergoing ALND. METHODS Patients undergoing ALND with or without immediate lymphatic reconstruction (ILR) were enrolled in a prospective trial at two institutional sites between April 2018 and Decemeber 2022. This report analyzes the ARM node positivity and total LN positivity rates during ALND for the cohort of patients enrolled in the ILR intervention arm of the study. RESULTS The inclusion criteria were met by 139 patients, who made up the study population (133 with breast cancer and 6 with other disease). Of the breast cancer patients, 99.2% were female, 35.3% (47/133) were cT3 or greater, and 96.2% (128/133) had cN1 or greater disease. For 55 of the 133 patients (41.4%), the ARM nodes were marked and specified in the pathology report. Of the 55 patients, 39 (70.9%) had a positive LN at ALND. Of these 55 patients, 11 (20%) had positive ARM nodes. The ARM LN was the only positive node in 3 of the 11 patients. CONCLUSION In the contemporary patient population undergoing ALND, the positivity rate of the ARM LN was relatively high, suggesting that leaving ARM LNs in patients undergoing ALND may not be oncologically safe.
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Affiliation(s)
- Molly M Benolken
- Division of Surgical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Sarah McLaughlin
- Division of Surgical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Mara Piltin
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Mary Mrdutt
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Zhuo Li
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - James W Jakub
- Division of Surgical Oncology, Mayo Clinic, Jacksonville, FL, USA.
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Benolken MM, Jakub JW. ASO Author Reflections: Axillary Reverse Mapping: Where Do We Go from Here? Ann Surg Oncol 2023; 30:6051-6052. [PMID: 37477746 DOI: 10.1245/s10434-023-13959-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Affiliation(s)
| | - James W Jakub
- Surgical Oncology, Mayo Clinic, Jacksonville, FL, USA
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Benolken MM, McLaughlin S, Piltin M, Mrdutt M, Li Z, Jakub JW. ASO Visual Abstract: Lymph Node Positivity of Axillary Reverse Mapping Lymph Nodes at Time of Axillary Lymph Node Dissection, 2 Site Prospective Trial. Ann Surg Oncol 2023; 30:6050. [PMID: 37525003 DOI: 10.1245/s10434-023-14001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Affiliation(s)
- Molly M Benolken
- Division of Surgical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Sarah McLaughlin
- Division of Surgical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Mara Piltin
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Mary Mrdutt
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Zhuo Li
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - James W Jakub
- Division of Surgical Oncology, Mayo Clinic, Jacksonville, FL, USA.
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Degnim AC, Siontis BL, Ahmed SK, Hoskin TL, Hieken TJ, Jakub JW, Baum CL, Day C, Schrup SE, Smith L, Carter JM, Sae Kho TM, Glazebrook KN, Vijayasekaran A, Okuno SH, Petersen IA. Trimodality Therapy Improves Disease Control in Radiation-Associated Angiosarcoma of the Breast. Clin Cancer Res 2023; 29:2885-2893. [PMID: 37223927 DOI: 10.1158/1078-0432.ccr-23-0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/07/2023] [Accepted: 05/16/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE To evaluate the impact of trimodality treatment versus monotherapy or dual therapy for radiation-associated angiosarcoma of the breast (RAASB) after prior breast cancer treatment. EXPERIMENTAL DESIGN With Institutional Review Board approval, we identified patients diagnosed with RAASB and abstracted data on disease presentation, treatment, and oncologic outcomes. Trimodality therapy included (i) taxane induction, (ii) concurrent taxane/radiation, and then (iii) surgical resection with wide margins. RESULTS A total of 38 patients (median age 69 years) met inclusion criteria. Sixteen received trimodality therapy and 22 monotherapy/dual therapy. Skin involvement and disease extent were similar in both groups. All trimodality patients required reconstructive procedures for wound closure/coverage, compared with 48% of monotherapy/dual therapy patients (P < 0.001). Twelve of 16 (75%) patients receiving trimodality therapy had a pathologic complete response (pCR). With median follow-up of 5.6 years, none had local recurrence, 1 patient (6%) had distant recurrence, and no patients died. Among 22 patients in the monotherapy/dual therapy group, 10 (45%) had local recurrence, 8 (36%) had distant recurrence, and 7 (32%) died of disease. Trimodality therapy demonstrated significantly better 5-year recurrence-free survival [RFS; 93.8% vs. 42.9%; P = 0.004; HR, 7.6 (95% confidence interval, CI: 1.3-44.2)]. Combining all patients with RAASB regardless of treatment, local recurrence was associated with subsequent distant recurrence (HR, 9.0; P = 0.002); distant recurrence developed in 3 of 28 (11%) patients without local recurrence compared with 6 of 10 (60%) with local recurrence. The trimodality group had more surgical complications that required reoperation or prolonged healing. CONCLUSIONS Trimodality therapy for RAASB was more toxic but is promising, with a high rate of pCR, durable local control, and improved RFS.
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Affiliation(s)
- Amy C Degnim
- Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Safia K Ahmed
- Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Tanya L Hoskin
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Tina J Hieken
- Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota
| | - James W Jakub
- Division of Surgical Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Courtney Day
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Sarah E Schrup
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Lauren Smith
- Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jodi M Carter
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Kim H, Hieken TJ, Abraha F, Jakub JW, Corbin KS, Furutani KM, Boughey JC, Stish BJ, Deufel CL, Degnim AC, Shumway DA, Ahmed SK, Piltin MA, Sandhu NP, Conners AL, Ruddy KJ, Mutter RW, Park SS. Long-term outcomes of intraoperatively-placed applicator brachytherapy for rapid completion of breast conserving treatment: An analysis of a prospective registry data. Clin Transl Radiat Oncol 2023; 41:100639. [PMID: 37251618 PMCID: PMC10212787 DOI: 10.1016/j.ctro.2023.100639] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/09/2023] [Accepted: 05/07/2023] [Indexed: 05/31/2023] Open
Abstract
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. The prescribed doses were 32 Gy/8 fx BID (n = 25), 34 Gy/10 fx BID (n = 99), and 21 Gy/3 fx QD (n = 99). Endocrine therapy (ET) adherence was defined as completion of planned ET or ≥ 80% of the follow-up (FU) period. Cumulative incidence of ipsilateral breast tumor recurrence (IBTR) was estimated and influencing factors for IBTR-free survival rate (IBTRFS) were analyzed. Results 218/223 patients had hormone receptor-positive tumors, including 38 (17.0%) with Tis and 185 (83.0%) with invasive cancer. After a median FU of 63 months, 19 (8.5%) patients had recurrence [17 (7.6%) with an IBTR]. Rates of 5-year IBTRFS and DFS were 92.2% and 91.1%, respectively. The 5-year IBTRFS rates were significantly higher for post-menopausal women (93.6% vs. 66.4%, p = 0.04), BMI < 30 kg/m2 (97.4% vs. 88.1%, p = 0.02), and ET-adherence (97.5% vs. 88.6%, p = 0.02). IBTRFS did not differ with dose regimens. Conclusions Postmenopausal status, BMI < 30 kg/m2, and ET- adherence predicted favorable IBTRFS. Our results highlight the importance of careful patient selection for ABB and encouragement of ET compliance.
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Affiliation(s)
- Haeyoung Kim
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | | | - Feven Abraha
- Department of Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James W. Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | - Bradley J. Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Amy C. Degnim
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dean A. Shumway
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Safia K. Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Mara A. Piltin
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nicole P. Sandhu
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amy L. Conners
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Robert W. Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Sean S. Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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Mohan AT, MacArthur TA, Murphy B, Song AJ, Saifuddin H, Degnim A, Harmsen WS, Martinez-Jorge J, Jakub JW, Vijayasekaran A. Patient Experience and Clinical Outcomes after Same-day Outpatient Mastectomy and Immediate Breast Reconstruction Protocol during the Global Pandemic. Plast Reconstr Surg Glob Open 2023; 11:e5183. [PMID: 37492279 PMCID: PMC10365192 DOI: 10.1097/gox.0000000000005183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/27/2023] [Indexed: 07/27/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic provoked rapid changes in clinical practice to accommodate mandated restrictions within healthcare delivery. This study reviewed patient-reported experiences and clinical outcomes after implementation of a same-day discharge protocol after mastectomy with immediate alloplastic breast reconstruction compared with our historical overnight stay protocol. Methods This is a retrospective single-institution study of consecutive patients who underwent mastectomy and immediate alloplastic reconstruction between July 2019 and November 2020. A postoperative survey was completed by patients to evaluate satisfaction with perioperative communications, recovery, and their overall experience. Results A total of 302 patients (100% women) underwent mastectomy and immediate alloplastic reconstruction (174 pre-COVID-19, 128 during COVID-19). During COVID-19, 71% of patients were scheduled for a same-day discharge, among which 89% were successfully discharged the same day. Compared with pre-COVID-19, there were no differences in type of surgery, operative times, pain scores, 30-day readmission, or unplanned visits (all P > 0.05) during the COVID-19 pandemic. Compared with pre-COVID-19, patients during the pandemic reported comparable satisfaction with their care experience and postoperative recovery (56% survey response rate). Patient satisfaction was also similar between those discharged the same day (n = 81) versus the next day (n = 47) during COVID-19. Conclusions Same-day discharge is feasible, safe, and can provide similar patient-reported satisfaction and outcomes compared with traditional overnight stay. These data highlight the ability to deliver adaptable, high-quality breast cancer care, within the constraints of a global pandemic.
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Affiliation(s)
- Anita T. Mohan
- From the Division of Plastic Surgery, Mayo Clinic, Rochester, Minn
| | | | - Brenna Murphy
- Mayo Clinic Alix School of Medicine, Rochester, Minn
| | | | | | - Amy Degnim
- Department of Surgery, Mayo Clinic, Rochester, Minn
| | | | | | - James W. Jakub
- Division of Surgical Oncology, Mayo Clinic, Jacksonville, Fla
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Szabo Yamashita T, Lund S, Yeh VJH, Rivera M, McKenzie TJ, Stulak JM, Harmsen WS, Abraha F, Heller SF, Jakub JW. Resident evaluations: what are the predictors of future negative outcomes in surgical education? Eur Surg 2023. [DOI: 10.1007/s10353-023-00797-9] [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: 03/08/2023]
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Nash AL, Thomas SM, Nimbkar SN, Hieken TJ, Ludwig KK, Jacobs LK, Miller ME, Gallagher KK, Wong J, Neuman HB, Tseng J, Hassinger TE, King TA, Hwang ES, Jakub JW, Rosenberger LH. Racial-ethnic variations in phyllodes tumors among a multicenter United States cohort. J Surg Oncol 2023; 127:369-373. [PMID: 36206024 PMCID: PMC9892174 DOI: 10.1002/jso.27117] [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: 07/29/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Previous studies have identified racial-ethnic differences in the diagnostic patterns and recurrence outcomes of women with phyllodes tumors (PT). However, these studies are generally limited in size and generalizability. We therefore sought to explore racial-ethnic differences in age, tumor size, subtype, and recurrence in a large US cohort of women with PT. METHODS We performed an 11-institution retrospective review of women with PT from 2007 to 2017. Differences in age at diagnosis, tumor size and subtype, and recurrence-free survival according to race-ethnicity. RESULTS Women of non-White race or Hispanic ethnicity were younger at the time of diagnosis with phyllodes tumor. Non-Hispanic Other women had a larger proportion of malignant PT. There were no differences in recurrence-free survival in our cohort. CONCLUSIONS Differences in age, tumor size, and subtype were small. Therefore, the workup of young women with breast masses and the treatment of women with PT should not differ according to race-ethnicity. These conclusions are supported by our finding that there were no differences in recurrence-free survival.
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Affiliation(s)
- Amanda L. Nash
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Samantha M. Thomas
- Duke Cancer Institute, Duke University, Durham, North Carolina
- Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Suniti N. Nimbkar
- Brigham & Women’s Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Tina J. Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kandice K. Ludwig
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lisa K. Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Megan E. Miller
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Jasmine Wong
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | | | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Taryn E. Hassinger
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Tari A. King
- Brigham & Women’s Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - E. Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
| | - James W. Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, Florida
| | - Laura H. Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
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15
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Jakub JW, Zhang W, Solanki M, Yonkus J, Boughey JC, Harmsen S, Giridhar KV. Response Rates of Invasive Lobular Cancer in Patients Undergoing Neoadjuvant Endocrine or Chemotherapy. Am Surg 2023; 89:230-237. [PMID: 36305029 DOI: 10.1177/00031348221135778] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND A gap remains in the role of neoadjuvant therapy for patients with ILC. METHOD Single-institution retrospective review of patients with ILC who received neoadjuvant therapy between 2008 and 2019. RESULTS 141 patients met inclusion criteria: 71 neoadjuvant chemotherapy (NACT) and 70 neoadjuvant endocrine therapy (NET). 7/71 (9.9%) patients had a pCR following NACT compared to 1/70 (1.4%) with NET (P = .063). pCR was observed in 5/18 (27.8%) patients with Her2Neu-positive disease following NACT, compared to 2/53 (3.8%) with Her2Neu-negative disease (P = .01).For luminal B tumors, median Ki-67 decrease was similar following NACT and NET (18.3 vs 16.3, P = .26).T category decreased in 59 (42.1%) patients following neoadjuvant therapy, increased in 9 (6.4%), and was unchanged in 72 (51.4%). More patients had an increase (28.6%) than decrease (12.1%) in their N category, including 13/60 (21.7%) who were clinically node-negative at diagnosis and identified to have node-positive disease following neoadjuvant therapy, at definitive surgery. CONCLUSION In Her2Neu-negative ILC, the potential of a pCR with NACT or NET is low. Most patients' nodal status and tumor size remain unchanged. There is a potential for pathologic stage to be higher at surgery compared to the clinical stage prior to neoadjuvant therapy.
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Affiliation(s)
- James W Jakub
- Division of Surgical Oncology, 156400Mayo Clinic, Jacksonville, FL, USA
| | - Wenexia Zhang
- Department of Breast Surgery, Shenzhen Maternity & Child Healthcare Hospital, 248258Nanfang Medical University, Shen Zhen Shi, Guangdong, China
| | - Malvika Solanki
- Department of Laboratory Medicine and Pathology, 4352Mayo Clinic, Rochester, MN, USA
| | | | - Judy C Boughey
- Division of Breast & Melanoma Surgical Oncology, 4352Mayo Clinic, Rochester, MN, USA
| | - Scott Harmsen
- Department of Biostatistics, 4352Mayo Clinic, Rochester, MN, USA
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16
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Bangalore Kumar A, Peters MS, Jakub JW, Harmsen W, Baum CL. Primary cutaneous melanoma features predict development of in-transit metastases/satellite lesions: Mayo Clinic experience, 2010 to 2014. J Am Acad Dermatol 2023; 88:455-457. [PMID: 35709979 DOI: 10.1016/j.jaad.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 01/17/2023]
Affiliation(s)
| | - Margot S Peters
- Department of Dermatology, Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, Florida
| | - William Harmsen
- Department of Biostatistics, Mayo Clinic, Rochester, Minnesota
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17
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Adams AM, Carpenter EL, Clifton GT, Vreeland TJ, Chick RC, O’Shea AE, McCarthy PM, Kemp Bohan PM, Hickerson AT, Valdera FA, Tiwari A, Hale DF, Hyngstrom JR, Berger AC, Jakub JW, Sussman JJ, Shaheen MF, Yu X, Wagner TE, Faries MB, Peoples GE. Divergent clinical outcomes in a phase 2B trial of the TLPLDC vaccine in preventing melanoma recurrence and the impact of dendritic cell collection methodology: a randomized clinical trial. Cancer Immunol Immunother 2023; 72:697-705. [PMID: 36045304 PMCID: PMC9433518 DOI: 10.1007/s00262-022-03272-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/01/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND A randomized, double-blind, placebo-controlled phase 2b trial of the tumor lysate, particle-loaded, dendritic cell (TLPLDC) vaccine was conducted in patients with resected stage III/IV melanoma. Dendritic cells (DCs) were harvested with and without granulocyte-colony stimulating factor (G-CSF). This analysis investigates differences in clinical outcomes and RNA gene expression between DC harvest methods. METHODS The TLPLDC vaccine is created by loading autologous tumor lysate into yeast cell wall particles (YCWPs) and exposing them to phagocytosis by DCs. For DC harvest, patients had a direct blood draw or were pretreated with G-CSF before blood draw. Patients were randomized 2:1 to receive TLPLDC or placebo. Differences in disease-free survival (DFS) and overall survival (OS) were evaluated. RNA-seq analysis was performed on the total RNA of TLPLDC + G and TLPLDC vaccines to compare gene expression between groups. RESULTS 144 patients were randomized: 103 TLPLDC (47 TLPLDC/56 TLPLDC + G) and 41 placebo (19 placebo/22 placebo + G). Median follow-up was 27.0 months. Both 36-month DFS (55.8% vs. 24.4% vs. 30.0%, p = 0.010) and OS (94.2% vs. 69.8% vs. 70.9%, p = 0.024) were improved in TLPLDC compared to TLPLDC + G or placebo, respectively. When compared to TLPLDC + G vaccine, RNA-seq from TLPLDC vaccine showed upregulation of genes associated with DC maturation and downregulation of genes associated with DC suppression or immaturity. CONCLUSIONS Patients receiving TLPLDC vaccine without G-CSF had improved OS and DFS. Outcomes remained similar between patients receiving TLPLDC + G and placebo. Direct DC harvest without G-CSF had higher expression of genes linked to DC maturation, likely improving clinical efficacy.
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Affiliation(s)
- Alexandra M. Adams
- grid.416653.30000 0004 0450 5663Department of Surgery, Brooke Army Medical Center, San Antonio, TX USA
| | - Elizabeth L. Carpenter
- grid.416653.30000 0004 0450 5663Department of Surgery, Brooke Army Medical Center, San Antonio, TX USA
| | - Guy T. Clifton
- grid.416653.30000 0004 0450 5663Department of Surgery, Brooke Army Medical Center, San Antonio, TX USA
| | - Timothy J. Vreeland
- grid.416653.30000 0004 0450 5663Department of Surgery, Brooke Army Medical Center, San Antonio, TX USA
| | - Robert C. Chick
- grid.416653.30000 0004 0450 5663Department of Surgery, Brooke Army Medical Center, San Antonio, TX USA
| | - Anne E. O’Shea
- grid.416653.30000 0004 0450 5663Department of Surgery, Brooke Army Medical Center, San Antonio, TX USA
| | - Patrick M. McCarthy
- grid.416653.30000 0004 0450 5663Department of Surgery, Brooke Army Medical Center, San Antonio, TX USA
| | - Phillip M. Kemp Bohan
- grid.416653.30000 0004 0450 5663Department of Surgery, Brooke Army Medical Center, San Antonio, TX USA
| | - Annelies T. Hickerson
- grid.416653.30000 0004 0450 5663Department of Surgery, Brooke Army Medical Center, San Antonio, TX USA
| | - Franklin A. Valdera
- grid.416653.30000 0004 0450 5663Department of Surgery, Brooke Army Medical Center, San Antonio, TX USA
| | - Ankur Tiwari
- grid.267309.90000 0001 0629 5880Department of Surgery, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Diane F. Hale
- grid.416653.30000 0004 0450 5663Department of Surgery, Brooke Army Medical Center, San Antonio, TX USA
| | - John R. Hyngstrom
- grid.479969.c0000 0004 0422 3447Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
| | - Adam C. Berger
- grid.516084.e0000 0004 0405 0718Department of Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ USA
| | - James W. Jakub
- grid.417467.70000 0004 0443 9942Department of Surgery, Mayo Clinic, Jacksonville, FL USA
| | - Jeffrey J. Sussman
- grid.24827.3b0000 0001 2179 9593Department of Surgery, University of Cincinnati, Cincinnati, OH USA
| | - Montaser F. Shaheen
- grid.134563.60000 0001 2168 186XDepartment of Medicine, University of Arizona, Tucson, AZ USA
| | - Xianzhong Yu
- grid.26090.3d0000 0001 0665 0280Department of Biological Sciences, Clemson University, Clemson, SC USA
| | | | - Mark B. Faries
- Department of Surgery, The Angeles Clinic, Santa Monica, CA USA
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18
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Robbins T, Hoskin TL, Day CN, Mrdutt MM, Hieken TJ, Jakub JW, Glazebrook K, Boughey JC, Degnim AC. ASO Visual Abstract: Node Positivity Among Sonographically Suspicious but FNA-Negative Axillary Nodes. Ann Surg Oncol 2022; 29:622-623. [PMID: 36109410 DOI: 10.1245/s10434-022-12474-4] [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: 09/22/2023]
Affiliation(s)
- Thomas Robbins
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Tanya L Hoskin
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Courtney N Day
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Mary M Mrdutt
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Tina J Hieken
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Amy C Degnim
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA.
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19
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Jakub JW, Hesley GK, Larson NB, Yaszemski MJ, Lee Miller A, Greenleaf JF, Urban MW, Lee CU. Ultrasonographic Detection and Surgical Retrieval of a Nonmetallic Twinkle Marker in Breast Cancer: Pilot Study. Radiol Imaging Cancer 2022; 4:e220053. [PMID: 36367449 PMCID: PMC9713596 DOI: 10.1148/rycan.220053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/29/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
Purpose To evaluate the short-term safety of a nonmetallic twinkle marker and compare its conspicuity at color Doppler US with that of standard breast biopsy clips and radioactive seeds by using B-mode US in axillary lymph nodes. Materials and Methods This prospective study (November 2020-July 2021) of participants with node-positive breast cancer who completed chemotherapy involved placing a twinkle marker at the time of preoperative radioactive seed localization. A five-point scoring system (1 = easiest, 5 = most difficult) was used to rate the ease of identifying the clip, seed, and twinkle marker on postlocalization sonograms, mammograms, specimen radiographs, and gross pathologic specimens. Descriptive statistics were used. Results Eight women (mean age, 57 years ± 16 [SD]) were enrolled. The median scores for US conspicuity of each device were 3.9 (range, 3.7-5.0) for the radioactive seed, 2.4 (range, 1.0-5.0) for the clip, and 2.0 (range, 1.0-4.3) for the twinkle marker. In six of eight participants, the twinkle marker was the most identifiable at US. The seeds, clips, and twinkle markers were scored "very easy" to identify on seven of eight postlocalization mammograms. The surgeon retrieved all eight twinkle markers 1-3 days after localization. In all 16 interpretations, the seeds, clips, and twinkle markers were rated as very easy to identify on specimen radiographs. The clip was the most difficult device to identify at pathologic examination in all participants, and the twinkle marker was the easiest to identify in seven of eight participants. Conclusion This pilot study demonstrates that the safety and ease of US detection of a twinkling tissue marker may be comparable to a biopsy clip. Keywords: Ultrasonography, US-Doppler, Breast, Localization, Surgery Clinical trial registration no. NCT04674852 © RSNA, 2022.
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20
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Manrique OJ, Bustos SS, Ciudad P, Adabi K, Chen WF, Forte AJ, Cheville AL, Jakub JW, McLaughlin SA, Chen HC. Overview of Lymphedema for Physicians and Other Clinicians: A Review of Fundamental Concepts. Mayo Clin Proc 2022; 97:1920-1935. [PMID: 32829905 DOI: 10.1016/j.mayocp.2020.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/17/2019] [Accepted: 01/06/2020] [Indexed: 12/16/2022]
Abstract
Lymphedema has historically been underrated in clinical practice, education, and scholarship to the detriment of many patients with this chronic, debilitating condition. The mechanical insufficiency of the lymphatic system causes the abnormal accumulation of protein-rich fluid in the interstitium, which triggers a cascade of adverse consequences such as fat deposition and fibrosis. As the condition progresses, patients present with extremity heaviness, itchiness, skin infections, and, in later stages, dermal fibrosis, skin papillomas, acanthosis, and other trophic skin changes. Correspondingly, lymphedema results in psychological morbidity, including anxiety, depression, social avoidance, and a decreased quality of life, encompassing emotional, functional, physical, and social domains. For this review, we conducted a literature search using PubMed and EMBASE and herein summarize the evidence related to the fundamental concepts of lymphedema. This article aims to raise awareness of this serious condition and outline and review the fundamental concepts of lymphedema.
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Affiliation(s)
- Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN.
| | - Samyd S Bustos
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN
| | - Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
| | - Kian Adabi
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN
| | - Wei F Chen
- Division of Plastic and Reconstructive Surgery, University of Iowa, Iowa City
| | | | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | | | | | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
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21
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Jakub JW, Weaver AL, Meves A. Association of tumor molecular factors with in-transit metastasis in primary cutaneous melanoma. Int J Dermatol 2022; 61:1117-1123. [PMID: 35246838 PMCID: PMC9391269 DOI: 10.1111/ijd.16141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/19/2021] [Accepted: 02/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In-transit metastases (ITM) are a form of locoregional relapse representing intralymphatic metastatic spread and occur in approximately 4-9% of patients with melanoma >1 mm Breslow thickness. Our objective was to evaluate a combination of clinicopathologic risk factors and gene expression biomarkers predictive of ITM risk. METHODS We used PCR to quantify gene expression in diagnostic biopsy tissue across a prospectively designed archival cohort of 854 consecutive thin and intermediate thickness primary cutaneous melanomas. The outcome of interest was ITM >90 days after a melanoma diagnosis. Cox proportional hazard models were fit to estimate each clinicopathologic and molecular characteristic's association with the risk of ITM. RESULTS The 5-year cumulative incidence of ITM was 3.2%. Clinical factors univariately associated with an increased risk of ITM were older age, greater Breslow thickness, greater mitotic rate, lower extremity location, ulceration, and a positive SLN biopsy. Of 108 genes tested, five were significantly upregulated and five significantly downregulated when evaluated in Cox models adjusted for age, Breslow thickness, mitotic rate, and lower extremity location. Among the upregulated genes, the strongest association was observed for interleukin-8 (IL8). CONCLUSION A subset of gene expression biomarkers was identified as independently associated with the risk of ITM after adjusting for key covariates. Once sufficiently validated, our results may lead the way to regional therapy trials for a small, selected group of high-risk patients.
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Affiliation(s)
- James W. Jakub
- Department of Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Amy L. Weaver
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Alexander Meves
- Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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22
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Robbins T, Hoskin TL, Day CN, Mrdutt MM, Hieken TJ, Jakub JW, Glazebrook K, Boughey JC, Degnim AC. Node Positivity Among Sonographically Suspicious but FNA-Negative Axillary Nodes. Ann Surg Oncol 2022; 29:6276-6287. [PMID: 35854027 DOI: 10.1245/s10434-022-12131-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/17/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Fine needle aspiration (FNA) of sonographically suspicious axillary lymph nodes is helpful to clinically stage patients and guide consideration of neoadjuvant therapy in breast cancer. However, data are limited for suspicious nodes that are FNA negative. Our goal is to compare the frequency of node positivity between patients with negative axillary ultrasound (AUSneg) versus suspicious AUS with negative FNA (FNAneg). METHODS With IRB approval, we identified all clinically node-negative (cN0) patients with invasive breast cancer treated with upfront surgery at our tertiary care center between 2016 and 2021. AUS is routinely performed with FNA of suspicious lymph node(s). We compared clinicopathologic characteristics and nodal positivity rates between AUSneg and FNAneg groups. RESULTS A total of 1580 cN0 patients with invasive breast cancer were analyzed, including 1240 AUSneg and 340 FNAneg patients. The FNAneg group was younger (median age 59.7 years versus 63.5 years, p < 0.001) and had higher clinical T (cT) category (29.1% versus 21.7% with cT2-cT4 disease, p = 0.005). Final axillary pathologic node positivity did not differ significantly between the AUSneg and FNAneg groups (16.5% versus 19.1%, p = 0.25). Among FNAneg patients, 58/340 (17.1%) had a clip placed, with retrieval confirmed in 28/58 (48.3%). Of the 28 retrieved clipped nodes, 27 were sentinel nodes. Final pathologic nodal status (pN+%) did not differ between patients in whom retrieval of the clipped node was confirmed versus not confirmed (28.6% versus 16.7%, p = 0.28). CONCLUSIONS Both patients with sonographically suspicious node(s) and negative FNA and patients with negative AUS have a similarly low chance of positive nodes. Additionally, routine targeted excision of FNA-negative clipped nodes is not warranted.
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Affiliation(s)
- Thomas Robbins
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Tanya L Hoskin
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA.,Division of Clinical Trials and Biostatistics, Mayo Clinic Rochester, Rochester, MN, USA
| | - Courtney N Day
- Division of Clinical Trials and Biostatistics, Mayo Clinic Rochester, Rochester, MN, USA
| | - Mary M Mrdutt
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Tina J Hieken
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Amy C Degnim
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA.
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23
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Durgan DM, De La Cruz Ku G, Thomas M, Pockaj BA, McLaughlin SA, Casey WJ, Vijayasekaran A, Wigle D, Cheville JC, Tonneson J, Hoskin TL, Jakub JW. Chest wall resection for breast cancer: 21st century Mayo clinic experience. J Surg Oncol 2022; 126:962-969. [PMID: 35830290 DOI: 10.1002/jso.27014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND We hypothesized full-thickness chest wall resection (FTCWR) with advanced surgical techniques and modern systemic therapy is safe, provides local control, and good overall survival. METHODS Retrospective review of FTCWR (including rib or part of sternum) for breast cancer between 2000 and 2020. Primary endpoints included 90-day morbidities and all-cause mortality. Secondary endpoints were loco-regional and distant recurrence, DFS and overall survival (OS). RESULTS A total of 35 patients met the criteria. 34 FTCWR were for recurrence and the median time to chest wall recurrence was 6 years. Tumor subtype was triple-negative in 51% and the remainder HR+ Her2-. 58% were palliative resections. FTCWR included rib(s) in 89% and portion of sternum in 57%; 94% required reconstruction and 80% were R0 resections. There were no 90-day mortalities. Overall morbidity was 10/35(28%). 17(49%) patients received neoadjuvant systemic therapy for their recurrence and three received neoadjuvant radiation. Adjuvant treatment included chemotherapy (8), endocrine therapy (3), and both (8). Ten patients (28%) received adjuvant radiation. The Median follow-up was 31 months and there were 6 (17%) loco-regional and 7 (20%) distant recurrences. OS was 86% and 67% at 1 and 3 years, respectively. CONCLUSION FTCWR was associated with low morbidity, mortality, recurrence rates, and good OS. Selective FTCWR is safe and has acceptable short-term survival rates.
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Affiliation(s)
- Diane M Durgan
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabriel De La Cruz Ku
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Universidad Cientifica del Sur, Lima, Perú
| | - Mathew Thomas
- Division of Thoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Barbara A Pockaj
- Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | - William J Casey
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Aparna Vijayasekaran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dennis Wigle
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John C Cheville
- Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Tanya L Hoskin
- Department of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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24
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Broida SE, Chen XT, Baum CL, Brewer JD, Block MS, Jakub JW, Pockaj BA, Foote RL, Markovic SN, Hieken TJ, Houdek MT. Merkel cell carcinoma of unknown primary: Clinical presentation and outcomes. J Surg Oncol 2022; 126:1080-1086. [PMID: 35809230 DOI: 10.1002/jso.27010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/03/2022] [Accepted: 06/30/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy that usually occurs in the head/neck or extremities. However, there are reports of MCC developing in the lymph nodes or parotid gland without evidence of a primary cutaneous lesion. METHODS We reviewed 415 patients with biopsy-proven MCC. Patients with MCC of unknown primary (n = 37, 9%, MCCUP) made up the study cohort. The primary endpoints of the study were rate of recurrence, disease-free survival, and overall survival. RESULTS Patients with MCCUP presented with tumors in lymph nodes (n = 34) or parotid gland (n = 3). Nodal disease was most commonly detected in the inguinal/external iliac (n = 15) or axillary (n = 14) regions. The mean age at diagnosis was 70 years and 24% were female. Patients presented with distant metastases in 24.3% of cases. Patients with stage IIIA disease treated with regional lymph node dissection (RLND) had a lower risk of disease recurrence (hazard ratio 0.26, p = 0.046). Recurrence-free survival was 59.3% at 5 years. Disease-specific survival was 63.3% at 5 years. CONCLUSION Patients with MCCUP have a high risk of recurrence and mortality. The optimal treatment for MCCUP has yet to be elucidated, although therapeutic RLND appears beneficial for these patients.
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Affiliation(s)
- Samuel E Broida
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Xiao T Chen
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christian L Baum
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew S Block
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew T Houdek
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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25
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Lee CU, Urban MW, Lee Miller A, Uthamaraj S, Jakub JW, Hesley GK, Wood BG, Brinkman NJ, Herrick JL, Larson NB, Yaszemski MJ, Greenleaf JF. Twinkling-guided ultrasound detection of polymethyl methacrylate as a potential breast biopsy marker: a comparative investigation. Eur Radiol Exp 2022; 6:26. [PMID: 35711010 PMCID: PMC9203632 DOI: 10.1186/s41747-022-00283-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
Since its first description 25 years ago, color Doppler twinkling has been a compelling ultrasound feature in diagnosing urinary stones. While the fundamental cause of twinkling remains elusive, the distinctive twinkling signature is diagnostically valuable in clinical practice. It can be inferred that if an entity twinkles, it empirically has certain physical features. This work investigates a manipulable polymeric material, polymethyl methacrylate (PMMA), which twinkles and has measurable surface roughness and porosity that likely contribute to twinkling. Comparative investigation of these structural properties and of the twinkling signatures of breast biopsy markers made from PMMA and selected commercially available markers showed how twinkling can improve ultrasound detection of devices intentionally designed to twinkle. While this specific application of detecting breast biopsy markers by twinkling may provide a way to approach an unmet need in the care of patients with breast cancer, this work ultimately provides a platform from which the keys to unlocking the fundamental physics of twinkling can be rigorously explored.
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Affiliation(s)
- Christine U Lee
- Department of Radiology, Division of Breast Imaging and Intervention, Mayo Clinic, 200 First St, SW, Rochester, MN, 55905, USA.
| | - Matthew W Urban
- Department of Radiology, Division of Radiology Research, Mayo Clinic, 200 First St, SW, Rochester, MN, 55905, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First St, SW, Rochester, MN, 55905, USA
| | - A Lee Miller
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St, SW, Rochester, MN, 55905, USA
| | - Susheil Uthamaraj
- Division of Engineering, Mayo Clinic, 200 First St, SW, Rochester, MN, 55905, USA
| | - James W Jakub
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Gina K Hesley
- Department of Radiology, Division of Breast Imaging and Intervention, Mayo Clinic, 200 First St, SW, Rochester, MN, 55905, USA
| | - Benjamin G Wood
- Mayo Graduate School of Biomedical Sciences, Mayo Clinic, 200 First St, SW, Rochester, MN, 55905, USA
| | - Nathan J Brinkman
- Department of Pharmacy, Mayo Clinic, 200 First St, SW, Rochester, MN, 55905, USA
| | - James L Herrick
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St, SW, Rochester, MN, 55905, USA
| | - Nicholas B Larson
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, 200 First St, SW, Rochester, MN, 55905, USA
| | - Michael J Yaszemski
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St, SW, Rochester, MN, 55905, USA
| | - James F Greenleaf
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First St, SW, Rochester, MN, 55905, USA
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Shukla SS, Bhatt AA, Jakub JW, Solanki MH, Kaur AS, Liu MC, Corbin KS, Axmacher JA. Local Recurrence of Invasive Secretory Breast Carcinoma in a Gravid Patient Post-Mastectomy. Radiol Case Rep 2022; 17:1901-1904. [PMID: 35401896 PMCID: PMC8990053 DOI: 10.1016/j.radcr.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 10/30/2022] Open
Abstract
This is a case of locally recurrent invasive secretory carcinoma of the breast during pregnancy, detected as a palpable mass in the reconstructed right breast of a 32-year-old female at 24 weeks gestation. The patient was initially diagnosed with secretory carcinoma 8 years prior, for which she underwent nipple sparing mastectomy followed by adjuvant chemotherapy and endocrine therapy. Due to pregnancy, the recurrence was treated initially with conservative excision alone, followed by definitive management postpartum which included wide local excision, sentinel lymph node biopsy and adjuvant chest wall radiation. Secretory carcinoma of the breast is a rare cancer with a predilection for young age and indolent course. This case report describes an unusual case of recurrent secretory carcinoma, of interest due to both its diagnosis during pregnancy, and its recurrence after nipple sparing mastectomy.
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Jakub JW, Lowe M, Harrison Howard J, Farma JM, Sarnaik A, Tuttle T, Neuman HB, Ariyan CE, Uppal A, Trocha S, Beasley GM, Wasif N, Bilimoria KY, Thomay AA, Allred JB, Chen L, Terando AM, Wayne JD, Thompson JF, Cochran AJ, Sim MS, Elashoff DE, Delman KA, Faries MB. ASO Visual Abstract: Oncologic Outcomes of Multi-Institutional Minimally Invasive Inguinal Lymph Node Dissection for Melanoma Compared with Open Inguinal Dissection in MSLT-II. Ann Surg Oncol 2022. [PMID: 35552927 DOI: 10.1245/s10434-022-11856-y] [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: 11/18/2022]
Affiliation(s)
- James W Jakub
- Department of Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
| | - Michael Lowe
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - J Harrison Howard
- Department of Surgery, University of South Alabama Health, Mobile, AL, USA
| | - Jeffrey M Farma
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Amod Sarnaik
- Department of Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Todd Tuttle
- Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Heather B Neuman
- Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Abhineet Uppal
- Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Steve Trocha
- Department of Surgery, Greenville Health System, Greenville, SC, USA
| | - Georgia M Beasley
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Nabil Wasif
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Karl Y Bilimoria
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alan A Thomay
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Jacob B Allred
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Lucia Chen
- Department of Medicine Statistics Core, UCLA Medical Center, Los Angeles, CA, USA
| | - Alicia M Terando
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Jeffrey D Wayne
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Alistair J Cochran
- Department of Anatomic Pathology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Myunlg-Shin Sim
- Department of Medicine Statistics Core, UCLA Medical Center, Los Angeles, CA, USA
| | - David E Elashoff
- Department of Medicine Statistics Core, UCLA Medical Center, Los Angeles, CA, USA
| | - Keith A Delman
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Mark B Faries
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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28
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Jakub JW, Lowe M, Howard JH, Farma JM, Sarnaik A, Tuttle T, Neuman HB, Ariyan CE, Uppal A, Trocha S, Beasley GM, Wasif N, Bilimoria KY, Thomay AA, Allred JB, Chen L, Terando AM, Wayne JD, Thompson JF, Cochran AJ, Sim MS, Elashoff DE, Delman KA, Faries MB. Oncologic Outcomes of Multi-Institutional Minimally Invasive Inguinal Lymph Node Dissection for Melanoma Compared with Open Inguinal Dissection in the Second Multicenter Selective Lymphadenectomy Trial (MSLT-II). Ann Surg Oncol 2022; 29:5910-5920. [PMID: 35499783 DOI: 10.1245/s10434-022-11758-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/28/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Minimally invasive inguinal lymphadenectomy (MILND) is safe and feasible, but limited data exist regarding oncologic outcomes. METHODS This study performed a multi-institutional retrospective cohort analysis of consecutive MILND performed for melanoma between January 2009 and June 2016. The open ILND (OILND) comparative cohort comprised patients enrolled in the second Multicenter Selective Lymphadenectomy Trial (MSLT-II) between December 2004 and March 2014.The pre-defined primary end point was the same-basin regional nodal recurrence, calculated using properties of binomial distribution. Time to events was calculated using the Kaplan-Meier method. The secondary end points were overall survival, progression-free survival, melanoma-specific survival (MSS), and distant metastasis-free survival (DMFS). RESULTS For all the patients undergoing MILND, the same-basin regional recurrence rate was 4.4 % (10/228; 95 % confidence interval [CI], 2.1-7.9 %): 8.2 % (4/49) for clinical nodal disease and 3.4 % (6/179) for patients with a positive sentinel lymph node (SLN) as the indication. For the 288 patients enrolled in MSLT-II who underwent OILND for a positive SLN, 17 (5.9 %) had regional node recurrence as their first event. After controlling for ulceration, positive LN count and positive non-SLNs at the time of lymphadenectomy, no difference in OS, PFS, MSS or DMFS was observed for patients with a positive SLN who underwent MILND versus OILND. CONCLUSION This large multi-institutional experience supports the oncologic safety of MILND for melanoma. The outcomes in this large multi-institutional experience of MILND compared favorably with those for an OILND population during similar periods, supporting the oncologic safety of MILND for melanoma.
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Affiliation(s)
- James W Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Michael Lowe
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - J Harrison Howard
- Department of Surgery, University of South Alabama Health, Mobile, AL, USA
| | - Jeffrey M Farma
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Amod Sarnaik
- Department of Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Todd Tuttle
- Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Heather B Neuman
- Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Abhineet Uppal
- Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Steve Trocha
- Department of Surgery, Greenville Health System, Greenville, SC, USA
| | - Georgia M Beasley
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Nabil Wasif
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Karl Y Bilimoria
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alan A Thomay
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Jacob B Allred
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Lucia Chen
- Department of Medicine Statistics Core, UCLA Medical Center, Los Angeles, CA, USA
| | - Alicia M Terando
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Jeffrey D Wayne
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Alistair J Cochran
- Department of Anatomic Pathology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Myung-Shin Sim
- Department of Medicine Statistics Core, UCLA Medical Center, Los Angeles, CA, USA
| | - David E Elashoff
- Department of Medicine Statistics Core, UCLA Medical Center, Los Angeles, CA, USA
| | - Keith A Delman
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Mark B Faries
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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29
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Jakub JW, Faries MB. ASO Author Reflections: Minimally Invasive Inguinal Lymphadenectomy, an Incremental Step in the Evolution of the Management of Advanced Melanoma. Ann Surg Oncol 2022; 29:5921-5922. [PMID: 35501584 DOI: 10.1245/s10434-022-11847-z] [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] [Received: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022]
Affiliation(s)
- James W Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Mark B Faries
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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30
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Abd El Aziz MA, McKenna NP, Jakub JW, Hallemeier CL, Kelley SR, Jin Z, Mathis KL. Rectal cancer with synchronous inguinal lymph node metastasis without distant metastasis. A call for further oncological evaluation. Eur J Surg Oncol 2021; 48:1100-1103. [PMID: 34953643 DOI: 10.1016/j.ejso.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 09/01/2021] [Revised: 11/21/2021] [Accepted: 12/17/2021] [Indexed: 02/07/2023] Open
Abstract
This study aimed to compare the survival of patients with isolated inguinal lymph node metastases from rectal cancer to patients with inguinal and additional synchronous distant metastases from rectal cancer who treated with curative intent. A retrospective review of all consecutive adult patients with rectal adenocarcinoma and inguinal lymph node involvement who underwent curative therapy at our institution from 2002 to 2020 was conducted. Patients were classified as having synchronous inguinal lymph node metastasis (SILNM), or synchronous inguinal lymph node and distant organ metastasis (SILNDOM). Patients in the SILNM group had a median overall survival of 75 months compared to 17.6 months in the SILNDOM group;p-value = 0.09. The recurrence-free survival for patients with SILNM was 19.6 months compared to 2.4 months in the SILNDOM group;p-value = 0.053. In conclusion, SILNM appears to represent a distinct subgroup of patients with metastatic rectal cancer. These patients warrant consideration of treatment with curative intent. Further studies are needed.
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Affiliation(s)
- Mohamed A Abd El Aziz
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA; Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA
| | | | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Scott R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Zhaohui Jin
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
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31
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Durgan DM, De la Cruz Ku GA, Thomas M, Pockaj BA, McLaughlin SA, Casey WJ, Vijayasekaran A, Wigle DA, Tonneson JE, Jakub JW. Chest Wall Resection for Breast Cancer: 21st Century Experience. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.029] [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]
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32
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Asaad M, Yonkus JA, Hoskin TL, Hieken TJ, Jakub JW, Boughey JC, Degnim AC. Primary tumor resection in patients with stage IV breast cancer: 10-year experience. Breast J 2021; 27:863-871. [PMID: 34651376 DOI: 10.1111/tbj.14294] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
The role of surgery in the management of stage IV breast cancer is controversial. Existing studies in Stage IV breast cancer have not closely evaluated the role of patient response to induction systemic therapy (IST) in its relationship to survival outcomes. We identified all patients with a diagnosis of de novo stage IV breast cancer who underwent surgery of their primary tumor from January 2008 to December 2018. Patients were grouped according to their response in the primary disease site into progression (progressive primary disease) or no progression (nonprogressive primary; comprising complete, partial and stable response). We identified a total of 45 stage IV breast cancer patients who underwent operative intervention of their primary breast tumor. Prior to surgical intervention, progression in the primary site during IST was identified in 13/42 patients (31%), of whom four patients also had progression in the distant disease. The 5-year survival was higher in the nonprogressive primary (74%) than the progressive primary disease group (52%) which did not reach statistical significance (p = 0.08). Age, pathologic tumor size, clinical nodal status, number of positive lymph nodes, and distant disease response to systemic therapy were significantly associated with survival. In this single institution experience, select patients with stage IV breast cancer at initial diagnosis who underwent resection of the primary tumor following systemic therapy achieved favorable overall and distant progression-free survival. Surgery is reasonable to consider for local palliation or in selected patients who have excellent response to systemic therapy and good performance status.
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Affiliation(s)
- Malke Asaad
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Tanya L Hoskin
- Department of Health Sciences Research, Rochester, Minnesota, USA
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Judy C Boughey
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy C Degnim
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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33
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Adams AM, Chick RC, Vreeland TJ, Clifton GT, Hale DF, McCarthy PM, O'Shea AE, Bohan PMK, Hickerson AT, Park H, Sloan AJ, Hyngstrom J, Berger AC, Jakub JW, Sussman JJ, Shaheen M, Wagner T, Faries MB, Peoples GE. Safety and efficacy of autologous tumor lysate particle-loaded dendritic cell vaccination in combination with systemic therapies in patients with recurrent and metastatic melanoma. Melanoma Res 2021; 31:378-388. [PMID: 34193804 DOI: 10.1097/cmr.0000000000000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Immunotherapy has revolutionized the treatment of melanoma, yet survival remains poor for patients with metastatic disease. The autologous tumor lysate, particle-loaded, dendritic cell (TLPLDC) vaccine has been shown to be safe adjuvant therapy for patients with resected stage III/IV melanoma who complete the primary vaccine series. Here, we describe an open-label trial of patients with metastatic melanoma treated with TLPLDC vaccine in addition to standard of care (SoC) therapies. The TLPLDC vaccine is created by loading autologous tumor lysate into yeast cell wall particles, which are phagocytosed by autologous dendritic cells ex vivo. Patients who recurred while enrolled in a phase IIb trial of adjuvant TLPLDC vaccine (crossover cohort) and patients with measurable metastatic melanoma cohort were offered TLPLDC vaccine along with SoC therapies. Tumor response was measured by RECIST 1.1 criteria. Overall survival (OS) and progression-free survival (PFS) were estimated by intention-to-treat analysis. Fifty-four patients were enrolled (28 in crossover cohort; 26 in metastatic melanoma cohort). The vaccine was well-tolerated with no grade ≥3 adverse events when given with SoC therapies to include checkpoint inhibitors, BRAF/MEK inhibitors, tyrosine kinase inhibitors, intralesional therapy and/or radiation. In the crossover arm, OS was 76.5% and PFS was 57.1% (median follow-up of 13.9 months). In the metastatic melanoma arm, OS was 85.7% and PFS was 52.2% (median follow-up 8.5 months). The TLPLDC vaccine is well-tolerated and safe in combination with SoC therapies. Future trials will determine the efficacy of TLPLDC in combination with SoC therapies in metastatic melanoma.
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Affiliation(s)
- Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Robert C Chick
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Timothy J Vreeland
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Guy T Clifton
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Diane F Hale
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Patrick M McCarthy
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Anne E O'Shea
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas
| | | | | | - Hyohyun Park
- Orbis Health Solutions, Greenville, South Carolina
| | | | - John Hyngstrom
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Adam C Berger
- Department of Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Mark B Faries
- Department of Surgery, The Angeles Clinic, Santa Monica, California
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34
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Gorman BG, Jakub JW, Hobday TJ, Brewer JD. Intratumoral Interleukin-2 Injections Without Systemic Therapy for Isolated Cutaneous Metastatic Breast Cancer. Dermatol Surg 2021; 47:1119-1121. [PMID: 33899801 DOI: 10.1097/dss.0000000000003050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Benjamin G Gorman
- Mayo Clinic Alix School of Medicine, Minnesota Campus, Rochester, Minnesota
| | - James W Jakub
- Divisions of Breast, Endocrine, Metabolic, and Gastrointestinal Surgery
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35
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Rosenberger LH, Quintana LM, Thomas SM, Nimbkar SN, Hieken TJ, Ludwig KK, Jacobs LK, Miller ME, Gallagher KK, Wong J, Neuman HB, Tseng J, Hassinger TE, King TA, Jakub JW, Bentley RC, Schnitt SJ. ASO Visual Abstract: Limited Reporting of Histopathologic Details in a Multi-Institutional Academic Cohort of Phyllodes Tumors: Time for Standardization. Ann Surg Oncol 2021. [PMID: 34061280 DOI: 10.1245/s10434-021-10159-y] [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: 11/18/2022]
Affiliation(s)
- Laura H Rosenberger
- Department of Surgery, Duke University, DUMC 3513, Durham, NC, 27710, USA. .,Duke Cancer Institute, Duke University, Durham, NC, USA.
| | - Liza M Quintana
- Department of Pathology, Dana-Farber Cancer Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA.,Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Suniti N Nimbkar
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kandice K Ludwig
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lisa K Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Megan E Miller
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Jasmine Wong
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Taryn E Hassinger
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Tari A King
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rex C Bentley
- Department of Pathology, Duke University, Durham, NC, USA
| | - Stuart J Schnitt
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA
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36
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MacArthur TA, Fahy AS, Jakub JW. Surgical Resection After Talimogene Laherparepvec for Melanoma: Persistent Fuorodeoxyglucose Avidity on Positron Emission Tomography Despite No Viable Disease. Am Surg 2021; 87:849-854. [PMID: 34060947 DOI: 10.1177/00031348211023434] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Talimogene laherparepvec (TVEC) is an injectable attenuated oncolytic herpes simplex virus (HSV-1) used in the treatment of loco regionally metastatic melanoma. Lesions managed by TVEC are generally considered unresectable at time of initiation of intralesional therapy; however, a subset of patients go on to have surgical resection of loco regionally controlled disease. We sought to review our experience with surgical excision of treated lesions to offer an insight into the radiologic correlate, treatment effect, and pathological findings of intralesional TVEC therapy. METHODS This is a retrospective descriptive case series of patients who underwent TVEC injection at Mayo Clinic, Rochester, MN, between October 2016 and July 2020. Institutional Institutional Review Board approval was obtained. RESULTS Twenty-one patients underwent intralesional TVEC, met inclusion criteria, and were included in this series. Seven went on to surgical excision of the injected lesions after an initial course of TVEC. Of those 7 patients, 4 had residual melanoma in the specimen on final pathology, while 3 had a complete pathologic response. All 3 patients who had no residual disease on pathology continued to have fluorodeoxyglucose (FDG) avidity on preoperative positron emission tomography scan of the excised lesions. DISCUSSION Despite ongoing FDG avidity on PET scan, patients who have well-controlled disease and stability over time of the injected lesions may benefit from surgical excision following a course of TVEC. This may render the patient clinically disease free and/or allow them a reprieve from TVEC treatment.
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Affiliation(s)
| | | | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
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37
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Naranjo J, Portner ER, Jakub JW, Cheville AL, Nuttall GA. Ipsilateral Intravenous Catheter Placement in Breast Cancer Surgery Patients. Anesth Analg 2021; 133:707-712. [PMID: 34043309 DOI: 10.1213/ane.0000000000005597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is a continued perception that intravenous line (IV) placement is contraindicated in the arm ipsilateral to prior breast cancer surgery to avoid breast cancer-related lymphedema (BCRL). The aim of this retrospective study was to determine the risk for development of BCRL in ipsilateral arm IV placement compared to contralateral arm IV placement to prior breast cancer surgery. METHODS We performed a retrospective review, via our Integrated Clinical Systems and Epic Electronic Heath Record of IV placement for anesthesia and surgery in patients with a prior history of breast cancer surgery with or without axillary lymph node dissection. Complication rates were compared for IVs placed in the ipsilateral and contralateral arms. We identified 3724 patients undergoing 7896 IV placements between January 1, 2015, and May 5, 2018, with a prior history of breast cancer surgery via their index anesthesia and surgical procedures. RESULTS The median time from breast cancer surgery to IV placement was 1.5 years (range, 1 day to 17.8 years). Of 2743 IVs placed in the arm contralateral to prior breast cancer surgery, 2 had a complication, corresponding to an incidence of 7.3 per 10,000 (95% confidence interval [CI], 0.9-26.3 per 10,000). Of 5153 IVs placed in the arm ipsilateral to prior breast cancer surgery, 2 IVs had a complication, for an incidence of 3.9 per 10,000 (95% CI, 0.5-14.0 per 10,000). The frequency of complications was not found to differ significantly between the groups (P = .91), and the 95% CI for the risk difference (ipsilateral minus contralateral) was -23 to +8 complications per 10,000. The complication rate is similar when only the first IV placed following breast cancer surgery is considered (overall 5.4 per 10,000 [95% CI, 0.7-19.4] per 10,000; contralateral 7.0 [95% CI, 0.2-39.0] per 10,000, ipsilateral 4.4 [95% CI, 0.1-24.2] per 10,000; P = 1.00; 95% CI for risk difference [ipsilateral minus contralateral], -41 to +22 per 10,000). CONCLUSIONS We found very few complications in patients who had an IV placed for surgery following a previous breast cancer surgery and no complications in those patients with IV placement ipsilateral with axillary node dissection. Avoidance of IV placement in the arm ipsilateral to breast cancer surgery is not necessary.
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Affiliation(s)
- Julian Naranjo
- From the Department of Anesthesiology and Perioperative Medicine
| | - Erica R Portner
- From the Department of Anesthesiology and Perioperative Medicine
| | | | | | - Gregory A Nuttall
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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Adams A, Clifton GT, Vreeland TJ, O'Shea AE, McCarthy PM, Chick RC, Kemp Bohan PM, Hickerson A, Hale DF, Hyngstrom JR, Berger AC, Jakub JW, Sussman JJ, Shaheen MF, Wagner T, Faries MB, Peoples GE. The influence of harvest method on dendritic cell function and clinical outcomes in a randomized trial of a dendritic cell vaccine to prevent recurrences in high-risk melanoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9548] [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: 11/20/2022] Open
Abstract
9548 Background: A randomized, double-blind, placebo-controlled phase IIb trial of the tumor lysate, particle loaded, dendritic cell (TLPLDC) vaccine was conducted to prevent recurrence in patients (pts) with resected stage III/IV melanoma. Two methods for dendritic cell (DC) harvest were used for vaccine production, including no pretreatment or pretreatment with granulocyte-colony stimulating factor (G-CSF) in an attempt to reduce blood draw volumes. This analysis investigates differences in clinical outcomes and RNA gene expression between these DC harvest methods for TLPLDC vaccine creation. Methods: The TLPLDC vaccine is created by loading autologous tumor lysate into yeast cell wall particles (YCWPs) and exposing them to phagocytosis by DCs. By investigator/pt choice, pts had 120mL of blood drawn for DC harvest, or pts received 300μg of G-CSF for pre-DC mobilization and a 50-70 mL blood draw 24-48 hours later. Total vaccine production time was 72 hrs. Pts were randomized 2:1 to receive TLPLDC or placebo (DCs exposed to empty YCWPs). 1-1.5 x10^6 cells/dose were injected intradermally at 0, 1, 2, 6, 12, and 18 months. Differences in disease free survival (DFS) and overall survival (OS) were evaluated by Kaplan Meier analysis between pts who did not receive pretreatment (TLPLDC), pts who did receive pretreatment with G-CSF (TLPLDC+G), and pts receiving placebo. RNA-seq analysis was performed on the total RNA of pts’ prepared TLPLDC vaccines to assess gene expression. Relative RNA expression (RRE) was compared between TLPLDC and TLPLDC+G. Results: As previously reported, 144 pts were randomized: 103 received TLPLDC (46 TLPLDC, 57 TLPLDC+G) and 41 received placebo. There were no significant clinicopathologic or treatment differences between the three treatment arms. Survival was significantly improved in TLPLDC compared to TLPLDC+G or placebo, including 36-month OS (92.9% vs 62.8% vs 72.3% respectively, p = 0.022) and DFS (51.8% vs 23.4% vs 27.1%, p = 0.027). When compared to TLPLDC+G (n = 3) vaccine, RNA-seq from TLPLDC vaccine (n = 3) showed upregulation of genes associated with DC maturation, including HLA-DMB (RRE: 3.60), IFIT1 (3.38), CD27 (3.26), IFI44L (3.24), MX1 (2.96), HLA-DQA1 (2.67), HLA-DRA (2.40), CD49D (2.34) and CD74 (2.09), while downregulated genes were associated with DC suppression or immaturity including SERPINA1 (RRE:7.8), TLR2 (6.65), CCR1 (5.11), IL10 (4.19), CD93 (3.84) and CD14 (3.25). Conclusions: Pts receiving TLPLDC vaccine had significantly improved OS and DFS, while outcomes remained similar between those who received TLPLDC+G vs placebo. Pts who did not receive G-CSF had higher expression of genes linked to DC maturation and antigen processing and presentation, likely explaining the improvement in clinical efficacy. A phase III trial to further assess the TLPLDC vaccine to prevent recurrence is planned. Clinical trial information: NCT02301611.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Adam C. Berger
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
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Rosenberger LH, Quintana LM, Thomas SM, Nimbkar SN, Hieken TJ, Ludwig KK, Jacobs LK, Miller ME, Gallagher KK, Wong J, Neuman HB, Tseng J, Hassinger TE, King TA, Jakub JW, Bentley RC, Schnitt SJ. Limited Reporting of Histopathologic Details in a Multi-Institutional Academic Cohort of Phyllodes Tumors: Time for Standardization. Ann Surg Oncol 2021; 28:7404-7409. [PMID: 33990927 DOI: 10.1245/s10434-021-10118-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Phyllodes tumors are rare fibroepithelial neoplasms that are classified by tiered histopathologic features. While there are protocols for the reporting of cancer specimens, no standardized reporting protocol exists for phyllodes. METHODS We performed an 11-institution contemporary review of phyllodes tumors. Granular histopathologic details were recorded, including the features specifically considered for phyllodes grade classification. RESULTS Of 550 patients, median tumor size was 3.0 cm, 68.9% (n = 379) of tumors were benign, 19.6% (n = 108) were borderline, and 10.5% (n = 58) were malignant. All cases reported the final tumor size and grade classification. Complete pathologic reporting of all histopathologic features was present in 15.3% (n = 84) of cases, while an additional 35.6% (n = 196) were missing only one or two features in the report. Individual details regarding the degree of stromal cellularity was not reported in 53.5% (n = 294) of cases, degree of stromal atypia in 58.0% (n = 319) of cases, presence of stromal overgrowth in 56.2% (n = 309) of cases, stromal cell mitoses in 37.5% (n = 206) of cases, and tumor border in 54.2% (n = 298) of cases. The final margin status (negative vs. positive) was omitted in only 0.9% of cases, and the final negative margin width was specifically reported in 73.8% of cases. Reporting of details was similar across all sites. CONCLUSION In this academic cohort of phyllodes tumors, one or more histopathologic features were frequently omitted from the pathology report. While all features were considered by the pathologist for grading, this limited reporting reflects a lack of reporting consensus. We recommend that standardized reporting in the form of a synoptic-style cancer protocol be implemented for phyllodes tumors, similar to other rare tumors.
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Affiliation(s)
- Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA. .,Duke Cancer Institute, Duke University, Durham, NC, USA.
| | - Liza M Quintana
- Department of Pathology, Beth Israel Deaconess Medical Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA.,Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Suniti N Nimbkar
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kandice K Ludwig
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lisa K Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Megan E Miller
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Jasmine Wong
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Taryn E Hassinger
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Tari A King
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rex C Bentley
- Department of Pathology, Duke University, Durham, NC, USA
| | - Stuart J Schnitt
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA
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40
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Chick RC, Faries MB, Hale DF, Kemp Bohan PM, Hickerson AT, Vreeland TJ, Myers JW, Cindass JL, Brown TA, Hyngstrom J, Berger AC, Jakub JW, Sussman JJ, Shaheen M, Clifton GT, Park H, Sloan AJ, Wagner T, Peoples GE. Multi-institutional, prospective, randomized, double-blind, placebo-controlled phase IIb trial of the tumor lysate, particle-loaded, dendritic cell (TLPLDC) vaccine to prevent recurrence in high-risk melanoma patients: A subgroup analysis. Cancer Med 2021; 10:4302-4311. [PMID: 33982452 PMCID: PMC8267143 DOI: 10.1002/cam4.3969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/22/2021] [Accepted: 04/28/2021] [Indexed: 12/31/2022] Open
Abstract
Background Checkpoint inhibitors (CPI) in combination with cell‐based vaccines may produce synergistic antitumor immunity. The primary analysis of the randomized and blinded phase IIb trial in resected stage III/IV melanoma demonstrated TLPLDC is safe and improved 24‐month disease‐free survival (DFS) in the per treatment (PT) analysis. Here, we examine efficacy within pre‐specified and exploratory subgroups. Methods Stage III/IV patients rendered disease‐free by surgery were randomized 2:1 to TLPLDC vaccine versus placebo. The pre‐specified PT analysis included only patients completing the primary vaccine/placebo series at 6 months. Kaplan–Meier analysis was used to compare 24‐month DFS among subgroups. Results There were no clinicopathologic differences between subgroups except stage IV patients were more likely to receive CPI. In stage IV patients, 24‐month DFS was 43% for vaccine versus 0% for placebo (p = 0.098) in the ITT analysis and 73% versus 0% (p = 0.002) in the PT analysis. There was no significant difference in 24‐month DFS when stratified by use of immunotherapy or CPI. For patients with resected recurrent disease, 24‐month DFS was 88.9% versus 33.3% (p = 0.013) in the PT analysis. All benefit from vaccination was in the PT analysis; no benefit was found in patients receiving up to three doses. Conclusion The TLPLDC vaccine improved DFS in patients completing the primary vaccine series, particularly in the resected stage IV patients. The efficacy of the TLPLDC vaccine will be confirmed in a phase III study evaluating adjuvant TLPLDC + CPI versus Placebo + CPI in resected stage IV melanoma patients.
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Affiliation(s)
| | | | - Diane F Hale
- Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | | | | | | | - John W Myers
- Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | | | - Tommy A Brown
- Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - John Hyngstrom
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Adam C Berger
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | | | | | - Guy T Clifton
- Brooke Army Medical Center, Fort Sam Houston, TX, USA
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41
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Vreeland TJ, Clifton GT, Hale DF, Chick RC, Hickerson AT, Cindass JL, Adams AM, Bohan PMK, Andtbacka RHI, Berger AC, Jakub JW, Sussman JJ, Terando AM, Wagner T, Peoples GE, Faries MB. A Phase IIb Randomized Controlled Trial of the TLPLDC Vaccine as Adjuvant Therapy After Surgical Resection of Stage III/IV Melanoma: A Primary Analysis. Ann Surg Oncol 2021; 28:6126-6137. [PMID: 33641012 PMCID: PMC7914039 DOI: 10.1245/s10434-021-09709-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022]
Abstract
Background Melanoma therapy has changed dramatically over the last decade with improvements in immunotherapy, yet many patients do not respond to current therapies. This novel vaccine strategy may prime a patient’s immune system against their tumor and work synergistically with immunotherapy against advanced-stage melanoma. Methods This was a prospective, randomized, double-blind, placebo-controlled, phase IIb trial of the tumor lysate, particle-loaded, dendritic cell (TLPLDC) vaccine administered to prevent recurrence in patients with resected stage III/IV melanoma. Patients were enrolled and randomized 2:1 to the TLPLDC vaccine or placebo (empty yeast cell wall particles and autologous dendritic cells). Both intention-to-treat (ITT) and per treatment (PT) analyses were predefined, with PT analysis including patients who remained disease-free through the primary vaccine/placebo series (6 months). Results A total of 144 patients were randomized (103 vaccine, 41 control). Therapy was well-tolerated with similar toxicity between treatment arms; one patient in each group experienced related serious adverse events. While disease-free survival (DFS) was not different between groups in ITT analysis, in PT analysis the vaccine group showed improved 24-month DFS (62.9% vs. 34.8%, p = 0.041). Conclusions This phase IIb trial of TLPLDC vaccine administered to patients with resected stage III/IV melanoma shows TLPLDC is well-tolerated and improves DFS in patients who complete the primary vaccine series. This suggests patients who do not recur early benefit from TLPLDC in preventing future recurrence from melanoma. A phase III trial of TLPLDC + checkpoint inhibitor versus checkpoint inhibitor alone in patients with advanced, surgically resected melanoma is under development. Trial Registration NCT02301611. Supplementary information The online version contains supplementary material available at (10.1245/s10434-021-09709-1).
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Affiliation(s)
- Timothy J Vreeland
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, USA. .,Department of Surgical Oncology, Brooke Army Medical Center, San Antonio, TX, USA. .,Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Guy T Clifton
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, USA.,Department of Surgical Oncology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Diane F Hale
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, USA.,Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA
| | - Robert C Chick
- Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA
| | | | - Jessica L Cindass
- Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA
| | | | | | - Adam C Berger
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Guru SD, Hoskin TL, Whaley DH, Nathan MA, Jakub JW. Repeat Sentinel Lymph Node Surgery in Recurrent Breast Cancer: Peritumoral vs. Periareolar Injections. Clin Breast Cancer 2021; 21:466-476. [PMID: 33736936 DOI: 10.1016/j.clbc.2021.02.004] [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] [Received: 11/24/2020] [Revised: 02/05/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the setting of recurrent cancer, there is no standard methodology regarding the technical aspects of repeat sentinel lymph node (rSLN) surgery. We analyzed our institutional experience with attempted rSLN surgery to determine the optimal injection technique. MATERIALS AND METHODS Single site, retrospective review of patients with prior lumpectomy for breast cancer who presented with recurrent or new ipsilateral breast cancer and underwent attempt at rSLN surgery from 2008 to 2017. Patients with prior mastectomy or no prior ipsilateral axillary operation were excluded. RESULTS A total of 141 patients were included; 103 (73%) underwent successful rSLN biopsy procedure. Lymphoscintigraphy showed aberrant drainage in 32 (26%). Periareolar (PA) injection resulted in failed mapping in 23/99 (23%) and aberrant drainage in 25/85 (29%). By comparison, peritumoral (PT) injection had a 14/38 (37%) incidence of failed mapping and 7/37 (19%) aberrant drainage (P = .11 and .23, respectively). Of the patients with successful sentinel lymph node (SLN) biopsy procedure via PA injection, 11/76 (14%) were positive for metastatic disease as compared with 2/24 (8%) in PT injection. Sixteen patients had lymph node metastases; 13 (81%) were SLNs, including 3 positive aberrant SLNs. Five-year regional recurrence rates were 11.4% (95% confidence interval, 0%-21.5%) and 0% for PA and PT injection techniques, respectively. CONCLUSION PA and PT injections had a similar incidence of SLN identification and aberrant drainage. Preoperative lymphoscintigraphy is beneficial in patients with recurrent breast cancer given the higher incidence of aberrant drainage in this population. Patients who underwent PA injections had a higher incidence of regional recurrences but this difference was not statistically significant.
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Affiliation(s)
| | - Tanya L Hoskin
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | - Dana H Whaley
- Department of Diagnostic Radiology-Breast Imaging, Mayo Clinic, Rochester, MN
| | - Mark A Nathan
- Department of Diagnostic Radiology-Nuclear Medicine, Mayo Clinic, Rochester, MN
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Rosenberger LH, Thomas SM, Nimbkar SN, Hieken TJ, Ludwig KK, Jacobs LK, Miller ME, Gallagher KK, Wong J, Neuman HB, Tseng J, Hassinger TE, King TA, Jakub JW. Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines. J Clin Oncol 2020; 39:178-189. [PMID: 33301374 DOI: 10.1200/jco.20.02647] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Phyllodes tumors (PTs) are rare breast neoplasms, which have little granular data on margins. Current guidelines recommend ≥ 1 cm margins; however, recent data suggest narrower margins are sufficient, and for benign PT, a negative margin may not be necessary. METHODS We performed an 11-institution contemporary (2007-2017) review of PT practices. Demographics, surgical, and histopathologic data were captured. Logistic regression was used to estimate the association of select covariates with local recurrence (LR). RESULTS Of 550 PT patients, the majority underwent excisional biopsy (55.3%, n = 302/546) or lumpectomy (wide excision) (38.5%, n = 210/546). Median tumor size was 30 mm, 68.9% (n = 379) were benign, 19.6% (n = 108) borderline, and 10.5% (n = 58) malignant. Surgical margins were positive in 42% (n = 231) and negative in 57.3% (n = 311). A second operation was performed in 38.0% (n = 209) of the total cohort, including 51 patients with an initial negative margin (82.4% with < 2 mm), and 157 with an initial positive margin, with residual disease only found in six (2.9%). Notably, 32.0% (n = 74) of those with an initial positive margin did not undergo a second operation, among whom only 2.7% (n = 2) recurred. Recurrence occurred in 3.3% (n = 18) of the total cohort (n = 15 LR, n = 3 distant), at median follow-up of 36.7 months. LR (all PT grades) was not reduced with wider negative margin width (≥ 2 mm v < 2 mm: odds ratio [OR] = 0.39; 95% CI, 0.07 to 2.10; P = .27) or final margin status (positive v negative: OR = 0.96; 95% CI, 0.26 to 3.52; P = .96). CONCLUSION In current practice, many patients are managed outside of current guidelines. For the entire cohort, a wider margin width was not associated with a reduced risk of LR. We do not recommend re-excision of a negative margin for benign PT, regardless of margin width, as a progressively wider surgical margin is unlikely to reduce LR.
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Affiliation(s)
- Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC.,Duke Cancer Institute, Duke University, Durham, NC
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC.,Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Suniti N Nimbkar
- Brigham & Women's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | | | - Kandice K Ludwig
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Lisa K Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Megan E Miller
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Jasmine Wong
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | | | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Taryn E Hassinger
- Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Tari A King
- Brigham & Women's Hospital, Dana-Farber Cancer Institute, Boston, MA
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Yonkus JA, Jakub JW. Anterior Axillary Arch: An Anatomic Variant Every Surgeon Operating in the Axilla Should Be Aware of. J Surg Res 2020; 259:170-174. [PMID: 33285431 DOI: 10.1016/j.jss.2020.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/20/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anterior axillary arch (AAA) is a slip of latissimus dorsi muscle, of variable thickness, which crosses anterior to the axillary vessels and brachial plexus. It is the most common anatomic variant in the axilla and surgeons operating in this area should be familiar with this finding to prevent confusion and complications. The aim of this study is to enhance surgeon's awareness of AAA, report the prevalence, and to describe our experience with this anomaly. METHODS An institutionally maintained database was used to identify patients with AAA in a single surgeon's experience, from 2008 to 2019. Patient characteristics, including tumor type, laterality, and pathologic node counts were determined and compared with patients undergoing axillary lymph node dissection (ALND) without this anatomic anomaly. RESULTS Nineteen patients with AAA were identified (13 on ALND and 6 during sentinel lymph node biopsy). Indications for ALND included breast cancer (12), melanoma (5), and Merkel cell carcinoma (2). In patients with AAA undergoing an ALND, the median number of lymph nodes pathologically identified was 23 and similar to those without AAA (27, P = 0.14). The prevalence of AAA in patients who underwent ALND was 3.1% (13/422). CONCLUSIONS Surgeons who operate in the axilla are likely to encounter an AAA. Knowledge of this variant should improve operative efficiency and may prevent technical errors during an ALND or sentinel lymph node biopsy.
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Affiliation(s)
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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45
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Eggermont AMM, Bellomo D, Arias-Mejias SM, Quattrocchi E, Sominidi-Damodaran S, Bridges AG, Lehman JS, Hieken TJ, Jakub JW, Murphree DH, Pittelkow MR, Sluzevich JC, Cappel MA, Bagaria SP, Perniciaro C, Tjien-Fooh FJ, Rentroia-Pacheco B, Wever R, van Vliet MH, Dwarkasing J, Meves A. Identification of stage I/IIA melanoma patients at high risk for disease relapse using a clinicopathologic and gene expression model. Eur J Cancer 2020; 140:11-18. [PMID: 33032086 PMCID: PMC7655519 DOI: 10.1016/j.ejca.2020.08.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 04/16/2020] [Revised: 07/09/2020] [Accepted: 08/16/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Patients with stage I/IIA cutaneous melanoma (CM) are currently not eligible for adjuvant therapies despite uncertainty in relapse risk. Here, we studied the ability of a recently developed model which combines clinicopathologic and gene expression variables (CP-GEP) to identify stage I/IIA melanoma patients who have a high risk for disease relapse. PATIENTS AND METHODS Archival specimens from a cohort of 837 consecutive primary CMs were used for assessing the prognostic performance of CP-GEP. The CP-GEP model combines Breslow thickness and patient age, with the expression of eight genes in the primary tumour. Our specific patient group, represented by 580 stage I/IIA patients, was stratified based on their risk of relapse: CP-GEP High Risk and CP-GEP Low Risk. The main clinical end-point of this study was five-year relapse-free survival (RFS). RESULTS Within the stage I/IIA melanoma group, CP-GEP identified a high-risk patient group (47% of total stage I/IIA patients) which had a considerably worse five-year RFS than the low-risk patient group; 74% (95% confidence interval [CI]: 67%-80%) versus 89% (95% CI: 84%-93%); hazard ratio [HR] = 2.98 (95% CI: 1.78-4.98); P < 0.0001. Of patients in the high-risk group, those who relapsed were most likely to do so within the first 3 years. CONCLUSION The CP-GEP model can be used to identify stage I/IIA patients who have a high risk for disease relapse. These patients may benefit from adjuvant therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Mark A Cappel
- Mayo Clinic, Jacksonville, FL, USA; Gulf Coast Dermatopathology Laboratory, Tampa, FL, USA
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Rosenberger LH, Thomas SM, Nimbkar SN, Hieken TJ, Ludwig KK, Jacobs LK, Miller ME, Gallagher KK, Wong J, Neuman HB, Tseng J, Hassinger TE, Jakub JW. Germline Genetic Mutations in a Multi-center Contemporary Cohort of 550 Phyllodes Tumors: An Opportunity for Expanded Multi-gene Panel Testing. Ann Surg Oncol 2020; 27:3633-3640. [PMID: 32504368 PMCID: PMC9945652 DOI: 10.1245/s10434-020-08480-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND A paucity of data exists regarding inherited mutations associated with phyllodes tumors (PT); however, some are reported (TP53, BRCA1, and RB1). A PT diagnosis does not meet NCCN criteria for testing, including within Li-Fraumeni Syndrome (TP53). We sought to determine the prevalence of mutations associated with PT. METHODS We performed an 11-institution review of contemporary (2007-2017) PT practice. We recorded multigenerational family history and personal history of genetic testing. We identified patients meeting NCCN criteria for genetic evaluation. Logistic regression estimated the association of select covariates with likelihood of undergoing genetic testing. RESULTS Of 550 PT patients, 59.8% (n = 329) had a close family history of cancer, and 34.0% (n = 112) had ≥ 3 family members affected. Only 6.2% (n = 34) underwent genetic testing, 38.2% (n = 13) of whom had only BRCA1/BRCA2 tested. Of 34 patients tested, 8.8% had a deleterious mutation (1 BRCA1, 2 TP53), and 5.9% had a BRCA2 VUS. Of women who had TP53 testing (N = 21), 9.5% had a mutation. Selection for testing was not associated with age (odds ratio [OR] 1.01, p = 0.55) or PT size (p = 0.12) but was associated with grade (malignant vs. benign: OR 9.17, 95% CI 3.97-21.18) and meeting NCCN criteria (OR 3.43, 95% confidence interval 1.70-6.94). Notably, an additional 86 (15.6%) patients met NCCN criteria but had no genetic testing. CONCLUSIONS Very few women with PT undergo germline testing; however, in those selected for testing, a deleterious mutation was identified in ~ 10%. Multigene testing of a PT cohort would present an opportunity to discover the true incidence of germline mutations in PT patients.
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Affiliation(s)
- Laura H. Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, North Carolina,Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Samantha M. Thomas
- Duke Cancer Institute, Duke University, Durham, North Carolina,Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Suniti N. Nimbkar
- Brigham & Women’s Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Tina J. Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kandice K. Ludwig
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lisa K. Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Megan E. Miller
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Jasmine Wong
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | | | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Taryn E. Hassinger
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - James W. Jakub
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Murphy BL, Jakub JW, Asaad M, Day CN, Hoskin TL, Habermann EB, Boughey JC. Sentinel Lymph Node Removal After Neoadjuvant Chemotherapy in Clinically Node-Negative Patients: When to Stop? Ann Surg Oncol 2020; 28:888-893. [PMID: 32816252 DOI: 10.1245/s10434-020-08816-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 06/22/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The maximum number of sentinel lymph nodes (SLN) to be resected to accurately stage the axilla in patients undergoing neoadjuvant chemotherapy (NAC) for the treatment of clinically node-negative (cN0) breast cancer has not been determined. We sought to determine the sequence of removal of the positive SLNs in this patient population. METHODS All patients aged ≥ 18 years diagnosed with cN0 invasive breast cancer who received NAC and underwent SLN surgery at Mayo Clinic Rochester between September 2008 and September 2018 were identified. Univariate analysis was performed to compare factors associated with positive nodes and where the first positive node was in the sequence of removal of the SLNs. RESULTS We identified 446 cancers among 440 patients with a median age of 51 (IQR: 43, 61) years. At surgery, 381 (85.4%) cancers were pathologically node (ypN) negative and 65 (14.6%) were pN + . The number of nodes removed was similar for both patients with ypN0 and ypN + disease, with a median number of SLNs removed of 2.0 (IQR: 2.0, 3.0). Of all patients with a positive node, the first positive node was most commonly the 1st node removed (75.4%), and was identified by the 3rd SLN removed in all cases. CONCLUSIONS Among cN0 patients treated with NAC, if a positive SLN is present, it is most commonly identified as the 1st sentinel node removed by the surgeon, and was identified by the 3rd sentinel node in our series. This suggests that once 3 SLNs have been resected, removal of additional sentinel lymph nodes does not add diagnostic value.
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Affiliation(s)
- Brittany L Murphy
- Department of Surgery, Mayo Clinic Rochester, Rochester, MN, USA.,The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, MN, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Malke Asaad
- Department of Surgery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Courtney N Day
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, MN, USA.,Department of Health Science Research, Mayo Clinic Rochester, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Tanya L Hoskin
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, MN, USA.,Department of Health Science Research, Mayo Clinic Rochester, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Elizabeth B Habermann
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Judy C Boughey
- Department of Surgery, Mayo Clinic Rochester, Rochester, MN, USA.
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48
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Yamashita TS, Pockaj BA, Bagaria SP, Flotte TJ, Fahy AS, de Azevedo RU, Harmsen WS, Block MS, Jakub JW. Clinical significance of SLN benign capsular nevi in patients with melanoma. J Surg Oncol 2020; 122:1043-1049. [PMID: 33616952 DOI: 10.1002/jso.26135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Benign capsular nevi (BCN) are not infrequent in sentinel lymph nodes (SLN) of patients with melanoma. Their prognostic significance is unknown and the literature is limited. This study evaluated the clinical significance of incidentally found BCN in these patients. METHODS A multi-institutional retrospective review of patients undergoing SLN biopsy for cutaneous melanoma between 2000 and 2016. Patients were divided into the following groups: (a) negative SLN and no BCN, (b) negative SLN and presence of BCN, (c) positive SLN seen only on immunohistochemistry (IHC), and (d) positive SLN via hematoxylin and eosin (H&E). Outcomes measured were overall survival and any recurrence. RESULTS A total of 1253 patients were identified (group 1 = 978, group 2 = 56, group 3 = 32, and group 4 = 187). Fifty-seven percent were male and the mean age was 59.3 years. BCN was identified in 77 patients (6.2%), of which the majority was in the node-negative group (72%). Multivariable analysis showed that BCN was associated with lower recurrence rates, though not statistically significant (hazard ratio [HR] = 0.5; P = .06). IHC- and H&E-positive SLNs were associated with a higher risk of recurrence (HR = 2.4; P = .02 and 2.0, P < .0001, respectively). CONCLUSION Patients with BCN and negative SLN had lower recurrence rates than patients with negative SLN and no BCN. Our data suggest a possible protective effect against recurrence.
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Affiliation(s)
| | | | | | - Thomas J Flotte
- Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | | | | | - William S Harmsen
- Department of Clinical Statistics, Mayo Clinic, Rochester, Minnesota
| | - Matthew S Block
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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49
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Racz JM, Glasgow AE, Keeney GL, Degnim AC, Hieken TJ, Jakub JW, Cheville JC, Habermann EB, Boughey JC. Intraoperative Pathologic Margin Analysis and Re-Excision to Minimize Reoperation for Patients Undergoing Breast-Conserving Surgery. Ann Surg Oncol 2020; 27:5303-5311. [PMID: 32623609 DOI: 10.1245/s10434-020-08785-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Reoperation rates following breast-conserving surgery (BCS) range from 10 to 40%, with marked surgeon and institutional variation. OBJECTIVE The aim of this study was to identify factors associated with intraoperative margin re-excision, evaluate for any differences in local recurrence based on margin re-excision and determine reoperation rates with use of intraoperative margin analysis. PATIENTS AND METHODS We analyzed consecutive patients with ductal carcinoma in situ (DCIS) or invasive breast cancer who underwent BCS at our institution between 1 January 2005 and 31 December 2016. Routine intraoperative frozen section margin analysis was performed and positive or close margins were re-excised intraoperatively. Univariate analysis was used to compare margin status and the Kaplan-Meier method was used to compare recurrence. Multivariable logistic regression was utilized to analyze factors associated with re-excision. RESULTS We identified 3201 patients who underwent BCS-688 for DCIS and 2513 for invasive carcinoma. Overall, 1513 (60.2%) patients with invasive cancer and 434 (63.1%) patients with DCIS had close or positive margins that underwent intraoperative re-excision. Margin re-excision was associated with larger tumor size in both groups. The permanent pathology positive margin rate among all patients was 1.2%, and the 30-day reoperation rate for positive margins was 1.1%. Five-year local recurrence rates were 0.6% and 1.2% for patients with DCIS and invasive cancer, respectively. There was no difference in recurrence between patients with and without intraoperative margin re-excision (p = 0.92). CONCLUSION Both DCIS and invasive carcinoma had similar rates of intraoperative margin re-excision. Although intraoperative margin re-excision was common, the reoperation rate was extremely low and there was no difference in recurrence between those with or without intraoperative re-excision.
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Affiliation(s)
| | - Amy E Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Mayo Clinic, Rochester, MN, USA
| | - Gary L Keeney
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Amy C Degnim
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - John C Cheville
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Mayo Clinic, Rochester, MN, USA
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50
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Abstract
Contralateral axillary metastasis (CAM) in breast cancer is presently treated as a stage IV disease. We hypothesized that this disease pattern is a manifestation of direct aberrant lymphatic drainage and would behave more similar to advanced locoregional disease. This is a single-site, retrospective review of patients with biopsy-proven CAM from 2008–2017. Descriptive analysis was performed. Twenty-three patients met the inclusion criteria. The median disease-free interval from primary tumor treatment to diagnosis of CAM was 68 months (range, 36–155 months). This population had aggressive disease (74% local recurrences and 61% clinical evidence of cutaneous or underlying muscular invasion) and extensive locoregional therapy (70% radiated, 57% mastectomy, and 65% axillary lymph node dissection) before their presentation with CAM. Fifteen (65.2%) patients recurred after treatment of CAM; the median recurrence-free interval was 11 months (range, 5–23 months), and 12 (52.2%) patients developed distant metastases. The median distant metastasis-free survival was 14 months (range, 11–23 months), and the median overall survival was 31 months (range, 22–67.5 months). Development of CAM is associated with aggressive disease and extensive prior locoregional surgery and/or radiation. The short recurrence-free interval and high progression to additional stage IV disease suggest these patients behave similar to traditional stage IV patients with resected oligometastatic disease.
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Affiliation(s)
| | | | - Elizabeth Yan
- Radiation Oncology, Mayo Clinic, Rochester, Minnesota; and
| | - Tanya L. Hoskin
- Division of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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